Lung ultrasound as a screening tool for SARS-CoV-2 infection in surgical patients.

PURPOSE: To evaluate the diagnostic performance of lung ultrasound (LUS) in screening for SARS-CoV-2 infection in patients requiring surgery. METHODS: Patients underwent a LUS protocol that included a scoring system for screening COVID-19 pneumonia as well as RT-PCR test for SARS-CoV-2. The receiver operator characteristic (ROC) curve was determined for the relationship between LUS score and PCR test results for COVID-19. The optimal threshold for the best discrimination between non-COVID-19 patients and COVID-19 patients was calculated. RESULTS: Among 203 patients enrolled (mean age 48 years; 82 males), 8.3% were COVID-19-positive; 4.9% were diagnosed via the initial RT-PCR test. Of the patients diagnosed with SARS-CoV-2, 64.7% required in-hospital management and 17.6% died. The most common ultrasound findings were B lines (19.7%) and a thickened pleura (19.2%). The AUC of the ROC curve of the relationship of LUS score with a cutoff value >8 versus RT-PCR test for the assessment of SARS-CoV-2 pneumonia was 0.75 (95% CI 0.61-0.89; sensitivity 52.9%; specificity 91%; LR (+) 6.15, LR (-) 0.51). CONCLUSION: The LUS score in surgical patients is not a useful tool for screening patients with potential COVID-19 infection. LUS score shows a high specificity with a cut-off value of 8.

Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate.

BACKGROUND: Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented. RESULTS: No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01). CONCLUSION: Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.

Rifabutina: terapia de rescate eficaz para la infección por Helicobacter pylori, revisión de la literatura actual / Rifabutin: therapeutic alternative for Helicobacter pylori infection, actual literature review

Resumen La infección por Helicobacter pylori se asocia con enfermedades gastroduodenales como gastritis crónica, úlcera péptica y adenocarcinoma gástrico. Actualmente se dispone de diferentes esquemas terapéuticos, sin embargo, el uso indiscriminado de antibióticos generó resistencia en este agente, razón para estudiar alternativas y reevaluar los criterios que determinan la selección de un esquema en específico. El objetivo de esta revisión fue describir los principios generales de tratamiento de acuerdo a guías de referencia y recomendaciones de autores independientes, y exponer el uso de la rifabutina como alternativa terapéutica. En la búsqueda bibliográfica se usaron los términos "Helicobacter pylori" AND "rifabutin", en las bases de datos PubMed, SciELO y el motor de búsqueda Google Scholar®. La evidencia actual sugiere que el uso de rifabutina como terapia de rescate es apropiado y seguro, y sería la alternativa ideal en casos de multirresistencia o difícil acceso a pruebas de susceptibilidad antibiótica. MÉD.UIS.2022;35(1): 31-42.

Abstract Helicobacter pylori infection is associated with gastroduodenal diseases such as chronic gastritis, peptic ulcer, and gastric adenocarcinoma. Nowadays, there are different therapeutic regimens, however, the indiscriminate use of antibiotics generated resistance in this agent, reason to study alternatives and reevaluate the criteria that determines the selection of a specific regimen. The aim of this review was to describe the general principles of treatment according to reference guidelines and recommendations of independent authors, and to present the use of rifabutin as a therapeutic alternative. The bibliographic search was performed using the terms "Helicobacter pylori" AND "rifabutin" in the databases PubMed, SciELO and the search engine Google Scholar®. Current evidence suggests that the use of rifabutin as rescue therapy is appropriate and safe, and would be an ideal alternative in cases of multidrug resistance or difficult access to antibiotic susceptibility tests. MÉD.UIS.2022;35(1): 31-42.

Incidencia de luxación primaria de patela en Colombia / IncidenceofprimarypatellardislocationinColombia

Introducciónyobjetivos:Laluxaciónagudaprimariadepatelarepresentael3%delaslesionestraumáticasdelarodilla.Diferentesestudioshanestimadolaincidenciadeluxacióndepatelaentre2y77.4por100,000personasa ̃no.HaypocosestudiosenLatinoamérica.ElobjetivodeesteestudioescalcularlaincidenciadeluxaciónpatelofemoralenuncentrodereferenciaenelsuroccidentedeColombia,evaluarlatendenciaenlosúltimosa ̃nosydescribirlatasademanejoquirúrgico.Materialesymétodos:Estudioobservacionalanalíticotipocortetransversalqueincluyótodoslospacientesmayoresde9a ̃nosconluxaciónprimarialateraldepatelaentreenerode2011yjuniode2018,enunhospitaldeatenciónavanzadaenColombia.Resultados:Enestapoblación,laincidenciadeluxaciónlateralpatelofemoralfuede32.38por100,000personas-a ̃no.Elgrupodeedadentre14-18a ̃nostuvolamayorincidencia(187.74por100.000).Soloenelgrupoentre10-13a ̃nos,elsexofemeninotuvounaincidenciasignificati-vamentemayorqueloshombres(179.05vs59.85por100,000,p<0.001).Conclusiones:Conincidenciade32.38por100,000personas-a ̃no,laluxaciónpatelofemoralesunapatologíaortopédicafrecuenteennuestrapoblación.Elpicodeincidenciaesentre14-18a ̃nos

Introductionandobjectives:Primaryacutepatellardislocations(PAPD)accountfor3%ofalltraumatickneelesions,andseveralstudieshaveestimatedthegeneralincidenceofpatellardislocationtobebetween2and77.4per100,000person-years.FewstudieshaveevaluatedtheincidenceofprimarylateralpatellardislocationinLatinAmerica.TheaimofthestudywastoevaluatetheincidenceofpatellardislocationinpatientsfromareferencecenterintheColombiansouthwest,reporttrendsintheincidenceofdislocation,anddescribetherateofsurgicaltreatment.Materialsandmethods:Weperformedanobservational,analytical,cross-sectionalstudyincludingallpatientsolderthan9yearsoldwithprimarylateralpatellardislocation(PLPD),betweenJanuary2011andJune2018,inatertiarycarecenterinLatinAmerica.Results:Inourpopulation,theincidenceofprimarylateralpatellardislocation(PLPD)was32.38per100,000person-years.Theagegroupbetween14and18yearsoldhadthehighestincidence(187.74per100.000).Inthe10to13-year-oldgroup,femaleshadasignificantlyhigherincidence(179.05vs59.85/100,000,p-value<0.001).Conclusions:Withanincidenceof32.38per100,000person-years,primarypatellardislocationisafrequentorthopaedicinjuryinourpopulation.Thepeakincidencebyagegroupwasinadolescentsbetween14to18yearsold

Hydromediastinum and hydrothorax as delayed complications of peripherally inserted central catheter used for total parenteral nutrition: A case report.

INTRODUCTION: Central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) may cause delayed complications, such as venous erosion, hydrothorax, or hydromediastinum. Vascular erosion is most frequently associated with left-sided CVC insertions. We report a case of hydropneumomediastinum and hydropneumothorax as a delayed complication of right-sided PICC used for total parenteral nutrition. PRESENTATION OF CASE: A 77-year-old man with muscle-invasive urothelial bladder cancer underwent pelvic lymphadenectomy and radical cystectomy with uretero-ileostomy reconstruction (Bricker). The patient developed postoperative ileus, and thus, a right PICC was inserted for total parenteral nutrition. On postoperative day 8, he developed bilateral hydromediastinum, and bilateral thoracentesis was performed. After the procedure, he presented with respiratory and hemodynamic deterioration and was transferred to the intensive care unit for 12 days. The patient was eventually discharged and followed-up at the outpatient department. DISCUSSION: Ruptured SVC has been predominantly described in left-sided CVCs at the right angle of the junction of the left brachiocephalic vein and SVC. However, our patient is the second documented case of bilateral hydropneumothorax and hydropneumomediastinum as a delayed complication of a PICC used to administer total parenteral nutrition. Catheters may migrate from their initial position due to breathing, bloodstream flow dynamics, postural rotation, and neck movements. Chemical irritation of the vessel wall may be caused by hyperosmolar hyperalimentation fluid. CONCLUSION: A right-sided vascular approach is preferred to avoid friction complications, and the tip should be placed at the lower third of the vena cava to prevent vascular erosion.

Mortality from anti-personnel mines before and during the Colombian peace process / Mortalidad secundaria a minas antipersona antes y durante el proceso de paz colombiano

Abstract Introduction: Although the peace process in Colombia resulted in a significant reduction in the number of anti-personnel mines across the country, there are no reliable data on the effects of this phenomenon on outcomes for patients who were victims of these devices. Objective: The objective of this study was to assess mortality from landmine injuries before and during the Colombian peace process. Furthermore possible associations between peace negotiations and mortality were explored. Methods: For this study, we used the "Colombian Victims of Antipersonnel Mines Injuries registry" (MAP/MUSE database) data from 2002 to 2018. This registry was launched in 2001 by the government of Colombia with the aim of prospectively and systematically collect information on all the cases of anti-personnel mine injuries in the country. The period between 2002-2012 was classified as the pre-negotiation period (período de guerra), and 2014-2018 as the peace negotiations period, with 2013 classified as a washout year. Multivariate logistic regression was used to explore the association between peace negotiations and mortality among anti-personnel landmine injured individuals. Results: A total of 10306 landmine injury cases were registered. Of these, 1180 (11.4%) occurred in the peace-negotiation period. Mortality was significantly lower during the period of peace negotiations. After adjusting for sex, age group, race, active duty soldier status, rural area, and geographic Departamentos case volumes, the peace negotiation period was found to be associated with lower risk-adjusted odds of mortality after suffering a landmine injury (OR= 0.6, 95% CI, 0.5-0.7; p<0.001). Conclusions: Our findings suggest an association between the period of peace negotiation and a lower likelihood of mortality among victims of anti-personnel landmines.

Resumen Introducción: Aunque el proceso de paz colombiano produjo una reducción en la cantidad de minas antipersona en el país, no hay estimativos sobre el efecto de este fenómeno en los desenlaces de los pacientes víctimas de estos artefactos. Objetivo: Nuestro objetivo fue evaluar la mortalidad por minas antipersona antes y durante la negociación del proceso de paz en Colombia. Además, exploramos posibles asociaciones entre las negociaciones de paz y la mortalidad. Métodos: Para este estudio utilizamos los datos del "Registro de víctimas colombianas de lesiones de minas antipersona" (base de datos MAP / MUSE) de 2002 a 2018. Este registro fue lanzado en 2001 por el gobierno de Colombia con el objetivo de recolectar información de manera prospectiva y sistemática de los casos de trauma por minas antipersona en el país. Clasificamos el período comprendido entre 2002 y 2012 como el período previo a la negociación (período de guerra), el comprendido entre 2014 y 2018 como el período de negociaciones de paz y el año 2013 como período de "depuración". Se utilizaron modelos de regresión logística multivariados para explorar las asociaciones entre las negociaciones de paz y la mortalidad. Resultados: Se registraron un total de 10306 casos de lesiones por minas antipersona. De estos, 1180 (11.4%) ocurrieron en el período de negociación de paz. La mortalidad fue significativamente menor durante el período de negociaciones de paz. El análisis de regresión logística multivariado determinó que el período de negociación de paz se asoció con una menor probabilidad de mortalidad después de sufrir una lesión por minas antipersona (OR = 0,6, IC 95%, 0,5-0,7; p <0,001). Conclusiones: Nuestros hallazgos sugieren una asociación entre el período de negociación de paz y una menor probabilidad de mortalidad entre las víctimas de las minas antipersona.

Cross-cultural translation and validation of the Spanish version of the patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF).

OBJECTIVE: The aim of this study was to translate to Spanish the patellofemoral pain and osteoarthritis subscale of the knee injury and osteoarthritis outcome score (KOOS-PF) and validate this Spanish version of a disease-specific patient-reported outcome measure (PROM) for patellofemoral pain. RESULTS: The KOOS-PF was translated to Spanish and sixty patients with patellofemoral pain and/or osteoarthritis accepted to complete the questionnaire. 1-week later 58 patients answered the questions again for the test-retest reliability validation and finally 55 patients completed 1-month later for the responsiveness assessment. The Spanish version showed very good internal consistency (Cronbach's alpha: 0.93) and test-retest reliability (intraclass correlation coefficient: 0.82). Responsiveness was confirmed, showing a strong correlation with the global rating of change (GROC) score (r 0.64). The minimal detectable change was 11.1 points, the minimal important change was 17.2 points, and there were no floor or ceiling effects for the score.

Patellofemoral Dislocation Recurrence After a First Episode: A Case-Control Study.

BACKGROUND: Lateral patellar dislocation can become a recurrent problem after the first episode. Identifying those patients who are at increased risk of redislocation is important for the treatment decision-making process. PURPOSE: To identify clinical and radiologic risk factors for recurrence of patellar dislocation after a first episode. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The study included patients with lateral patellar dislocation and a 1-year minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to 65 years were included. Patient characteristics, physical examination (patellar apprehension, J sign), and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and D. RESULTS: A total of 130 patients (139 knees) with primary lateral patellar dislocation were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15 (OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years (OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P < .001) were significantly associated with patellar redislocation. Based on the presence of these factors, the probability of dislocation after a first lateral patellar dislocation was 31.2% with no factors present, 36.6% with any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3 conditions were present. CONCLUSION: The results of this study indicated that patella alta, high-grade trochlear dysplasia, and age <21 years were independent risk factors for patellar redislocation after a first episode, with an additive effect when they were present together. This may help to guide the type of treatment for these patients.

The tenets of intrathoracic packing during damage control thoracic surgery for trauma patients: a systematic review.

PURPOSE: Although Damage Control Thoracic Surgery (DCTS) has become a provocative alternative to treat patients with chest injuries who are critically ill and physiologically depleted, the management approaches of chest-packing and the measurement of clinically relevant outcomes are not well established. In this paper, we systematically reviewed the available knowledge and evidence about intra-thoracic packing during DCTS for trauma patients. We furthermore inform on the management approaches, surgical strategies, and mortality associated with this intervention. METHODS: We identified articles in MEDLINE and SCOPUS. We reviewed all studies that included trauma patients with chest injuries and managed with intrathoracic packing during DCTS. Studies were eligible if the use of intrathoracic packing in trauma populations was reported. RESULTS: We identified 14 studies with a total of 211 patients. Overall, intrathoracic packing was used in 131 trauma patients. Packing was most commonly used to arrest persistent coagulopathic bleeding or oozing either from raw surfaces or repaired structures and in conjunction with other operative techniques. Pneumonectomy was a deadly intervention; however, one study reported survivors when pneumonectomy was deferred. CONCLUSION: Packing is a feasible, reliable and potentially effective complementary method for hemorrhage control. Therefore, we recommend that packing can be used liberally as a complement to rapid lung-sparing techniques.

Detección y genotipificación del virus del papiloma humano de alto riesgo mediante PCR multiplex en tiempo real (RT-PCR VPH AR) / High risk human papillomavirus detection and genotyping by multiplex real time PCR (RT-PCR HR HPV)

Utilidad clínica de la prueba La relación causal entre el desarrollo de cáncer de cérvix y la infección con genotipos de alto riesgo (AR) del virus del papiloma humano (VPH), ha llevado al desarrollo de estrategias para su detección y caracterización genotípica, como una medida de prevención de este tipo de cáncer. Dado que la presencia del VPH no puede ser determinada mediante los hallazgos clínicos de la paciente, como tampoco en los hallazgos morfológicos en la citología ni en la detección de anticuerpos específicos contra el VPH (pruebas serológicas), su detección y genotipificación recaen en el uso de pruebas moleculares, las cuales en su mayoría están dirigidas a la detección del ADN de los genotipos de alto riesgo, usando la técnica de reacción en cadena de la polimerasa (PCR) convencional y en tiempo real (RT-PCR) [1]. La técnica de PCR permite la amplificación de regiones específicas del ADN del VPH en los genes L1, E6 y E7, los cuales, por sus variaciones en la secuencia, permiten la genotipificación del virus [2,3]. Las pruebas de detección de ADN y/o genotipificación del VPH son consideradas herramientas de tamización en cáncer de cérvix, que detectan la infección causada por VPH. Su aplicación está enfocada en la clasificación de anormalidades citológicas, monitoreo de infecciones persistentes, seguimiento postratamiento de lesiones intraepiteliales de alto grado y vigilancia epidemiológica en salud pública [4-6]. La utilización de la citología y las pruebas de detección de ADN del VPH, aumenta la sensibilidad de la tamización para la detección de cáncer de cérvix y reduce de manera significativa el riesgo de sufrir lesiones cervicales premalignas por un periodo de 5 años [2,7]

Body mass index and knee arthroplasty.

OBJECTIVE: this study aims to evaluate the relationship between body mass index (BMI), age at which knee joint arthroplasty is performed and complications. The hypothesis is that the higher the BMI, the greater likelihood that the patient will require surgery at an earlier age.Methods: this is a cohort study with all patients who underwent a primary knee arthroplasty, between August 2013 and February 2019, in a tertiary level university hospital. Association between BMI, age and complications were analyzed. Quality of life of patients was also evaluated with the Oxford Knee Score (OKS). RESULTS: 565 primary total knee replacements (TKR) were performed. A cut-off point was found in BMI of 30; 348 patients had a BMI ≤30 and 173 patients had a BMI >30. When comparing the two groups, a statistically significant difference (p = 0.0186) was found in the age at which the TKR was performed. There was a significant improvement for both groups in functional score (Oxford knee score). Additionally, intra and post-operative complications showed no statistically significant difference. CONCLUSION: patients with BMI greater than 30 required primary knee arthroplasty at a younger age (average: 3.5 years), compared to patients with a lower BMI. Obesity does not appear to confer and independent risk for surgery in the short and mid-term. Knee arthroplasty improves significantly quality of life in the short and mid-term, regardless of their BMI, as measured with the OKS.

Trauma team conformation in a war-influenced middle-income country in South America: is it possible?

INTRODUCTION: Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country. OBJECTIVE: To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle-income country war-influenced country. MATERIAL AND METHODS: Retrospective analytical study. Patients older than 17 years admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. Four hundred sixty-four patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, and continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using χ2 or Fisher's test and continuous variables using Student's T test or Wilcoxon-Mann-Whitney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission. RESULTS: The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p < 0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p < 0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215-0.789) p = 0.006 CONCLUSIONS: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in trauma patients.

Could resuscitative endovascular balloon occlusion of the aorta improve survival among severely injured patients with post-intubation hypotension?

Current literature shows the association of post-intubation hypotension and increased odds of mortality in critically ill non-trauma and trauma populations. However, there is a lack of research on potential interventions that can prevent or ameliorate the consequences of endotracheal intubation and thus improve the prognosis of trauma patients with post-intubation hypotension. This review paper hypothesizes that the deployment of REBOA among trauma patients with PIH, by its physiologic effects, will reduce the odds of mortality in this population. The objective of this paper is to review the current literature on REBOA and post-intubation hypotension, and, furthermore, to provide a rational hypothesis on the potential role of REBOA in severely injured patients with post-intubation hypotension.

Control prehospitalario de la hemorragia en pacientes de trauma: una estrategia de prevención secundaria factible para países de bajos y medianos ingresos / Prehospital control of hemorrhage in trauma patients: a feasible secondary prevention strategy in countries of low and median income

Introducción. La hemorragia no controlada es la principal causa prevenible de muerte en trauma. No hay precedentes locales que estimen el efecto de estrategias de prevención que involucren al público en la atención inicial de las víctimas. Objetivo. Evaluar si es factible implementar programas de entrenamiento para el control prehospitalario básico del sangrado en pacientes de trauma, en un país de bajos a medianos ingresos. Métodos. Cirujanos y estudiantes de medicina se encargaron de desplegar el curso "Stop the bleed" en estudiantes universitarios del suroccidente colombiano. Se hizo una evaluación antes y después de hacer el entrenamiento. Se usó la prueba t de Student y un análisis de regresión logística ordinal, para determinar los factores que estuvieron asociados a obtener mejores puntajes en la evaluación del curso. Resultados. Se entrenaron 265 estudiantes, con una edad media de 21,4 ± 4 años, de los cuales 136 (51,5 %) eran mujeres. Después de recibir el entrenamiento un participante tuvo 15,6 veces la oportunidad de obtener mayor puntaje de calificación con respecto al periodo preentrenamiento [IC95%: 15,1-16,2 (p<0,001)], 99,4 y 95,2 %, respectivamente, estarían dispuestos a tomar medidas y colocar un torniquete a una víctima de sangrado (p<0,001). Conclusión. Es factible para los países con recursos limitados hacer el entrenamiento en control básico del sangrado. Este se puede llevar a cabo de manera eficaz, tanto por instructores con un bagaje amplio en técnicas de control del sangrado como por instructores con menor nivel de formación, pero con un entrenamiento adecuado

Background: uncontrolled hemorrhage is the leading cause of preventable death in trauma. There are no local precedents that estimate the effect of prevention strategies that involve the public in the initial care of victims. Our objective was to evaluate if it is feasible to implement training programs for the basic control of prehospital bleeding in trauma patients, in a low to a middle-income country. Methods: Surgeons and medical students deploying the Stop the bleed course in a Colombian southwestern university, evaluation was performed before and after the training. A T-test and an ordinal logistic regression analysis were used to determine the factors associated with better scores in the course evaluation. Results: of the 265 students, were women 136 (51.5%), age was 21.4± 4. After receiving the training, a participant had 15.6 times the chance of obtaining a higher score than the pre-training period [95% CI: 15.1-16.2 (p <0.001)]. 99.4% and 95.2% respectively, would be willing to take actions and place a tourniquet on a bleeding victim (p <0.001). Conclusion: in a low to a middle-income country is feasible to perform the Bleeding Control Basic training. This can be done effectively by instructors with a broad background in bleeding control techniques as well as by instructors with less experience, but with adequate training

Mortalidad precoz en trasplante cardíaco / Early mortality in heart transplant

Resumen Objetivo: describir las principales causas de mortalidad en los 30 primeros días postrasplante cardíaco. Métodos: cohorte retrospectiva de pacientes con trasplante cardiaco realizado de 2008 a 2015, que murieron en los primeros 30 días luego del procedimiento. La información se recolectó del registro institucional de trasplante cardíaco. Se describieron variables sociodemográficas, clínicas, características del receptor, causas de muerte, complicaciones y características del pre- intra- y postoperatorio. Resultados: desde enero de 2008 hasta agosto de 2015 se realizaron 74 trasplantes cardíacos. De estos, 10 pacientes murieron en los primeros 30 días postrasplante (mortalidad de 13,51%).La mediana de edad fue 55 años (rango intercuartil [RIQ] 26-62 años) y 50% de ellos fueron de sexo masculino. La mediana de fracción de eyección pretrasplante fue 24% (RIQ 18-47) y el tiempo en lista de espera 81 días (RIQ 12-157 días). Cuatro pacientes se encontraban en estadio 0 A y los seis restantes en estadio 1. La mediana de tiempo entre el trasplante y la muerte fue un día (RIQ 0-3 día) y la mortalidad más tardía se presentó a los 18 días. Las principales causas de muerte fueron: falla multiorgánica (5 casos), falla aguda del injerto (3 casos) y coagulopatía perioperatoria (2 casos). Conclusiones: en una institución de referencia para trasplante cardíaco del suroccidente colombiano, la mortalidad precoz postrasplante cardíaco fue del 13,51%, similar a la reportada por registros internacionales. La principal causa de muerte fue la falla multiorgánica, que ocurrió principalmente en las primeras 24 horas después del trasplante cardíaco.

Abstract Objective: To describe the main causes of mortality in the first 30 days post-heart transplant. Methods: A study was conducted on a representative patient cohort with a heart transplant performed between 2008 and 2015, and who died in the first 30 days after the procedure. The information was collected from an institutional heart transplant register. A description is presented of the sociodemographic and clinical variables, the receiver characteristics, causes of death, as well as pre-, intra-, and post-operative characteristics and complications. Results: A total of 74 heart transplants were performed between January 2008 and August 2015. Of these, 10 patients died in the first 30 days post-transplant (a mortality rate of 13.51%). The median age was 55 years (Inter-quartile range (IQR) 26-62 years) and 50% of them were male. The median ejection fraction pre-transplant was 24% (IQR 18-47) and time on the waiting list of 81 days (IQR 12-157 days). Four of the patients were in Stage 0 A, and the remaining 6 were in Stage 1. The median time between the transplant and death was 1 day (IQR 0-3 days, and the later mortality rate was at 18 days. The main causes of death were: multi-organ failure (5 cases), acute graft failure (3 cases), and peri-operative coagulopathy (2 cases). Conclusions: In an institution of reference for heart transplantation in South-West Colombia, the early post-transplant mortality rate was 13.51%, similar to that reported in international registers. The main cause of death was multi-organ failure, which occurred mainly in the first 24 hours after the heart transplant.

Molecular identification and genotyping of Streptococcus mutans from saliva samples of children in Medellin, Colombia / Identificación molecular y genotipificación de Streptococcus mutansde muestras de saliva de niños de Medellín, Colombia

Abstract Introduction and objective: Tooth decay is one of the most prevalent infectious diseases of the oral cavity. The aim of this study was to determine the prevalence of Streptoccocus mutans and its genotypes in saliva samples from 6 and 7 year old children with and without dental caries. Materials and methods: Forty seven saliva samples were obtained from 6-7 year-old children, randomly selected from a Public School in Medellin, Colombia. Oral examinations in order to determine the DMF-T Index (Decay, Missing and Filling Teeth) were carried out. Isolates were identified by the Streptoccocus sobrinus and Streptococcus mutans PCR, API 20STREP and 16S rRNA sequence analysis. Genotypes c, e, f and k were detected by PCR. Results: Prevalence of S. mutanswas 14.9%. Of the 47 saliva samples, 57.4% (27) corresponded to children with dental caries, and 8.5% (4) were positive for S. mutans genotype c, 2.1% (1 each) genotype f genotype k, and genotype cand k, respectively. Conclusion: Prevalence of S. mutanswas lower than in previous studies of Colombian children with similar demographic characteristics. Streptoccocusmutans'genotype c, fand kwere found in children with caries but not in the group without caries. This is the first report of S. mutans genotype kin Colombia; this genotype requires further study to clarify its relation with dental caries and cardiovascular disease in Colombia.

Resumen Introducción y objetivo: La caries dental es una de las enfermedades infecciosas de la cavidad oral más comunes en el mundo. El objetivo de este estudio fue determinar la prevalencia de Streptococcus mutansy sus genotipos en muestras de saliva de niños de 6 y 7 años, con y sin caries dental. Materiales y métodos: Cuarenta y siete (47) muestras de saliva fueron obtenidas de niños de 6-7 años, seleccionados aleatoriamente de una escuela pública en Medellín, Colombia. Se realizaron evaluaciones orales para determinar el índice COP-D (número de dientes permanentes cariados, obturados y perdidos). Los aislamientos fueron identificados mediante PCR para diferenciación de S. sobrinusy S. mutans, API-20STREP y análisis de ARNr 16S. Se determinaron mediante PCR los genotipos c e, fy ken las cepas identificadas como S. mutans. Resultados: La prevalencia de S. mutansfue 14,9%. De las 47 muestras de saliva, 57,4% (27) correspondieron a niños con caries dental, y 8,5 % (4), fueron positivas para S. mutans genotipo c, 2,1 % (1 cada una) genotipo f genotipo ky genotipo cy k, respectivamente. Conclusión: La prevalencia de S. mutansfue menor que la reportada en estudios previos de niños colombianos con características demográficas similares. Se encontró presencia de genotipos c, fy kde S. mutansen niños con caries dental, pero no en el grupo de niños sin caries dental. Este es el primer estudio en reportar la presencia del genotipo ken Colombia. Es necesario realizar más investigaciones en nuestro país para aclarar la relación de S. mutans genotipo k con caries dental y enfermedad cardiovascular.