Retrospective analysis of 261 autopsies of penetrating cardiac injuries with emphasis on sociodemographic factors.

Penetrating cardiac injuries (PCIs) are highly lethal and several factors are related to its incidence and mortality. While most studies focus on characterizing patients who arrived at a medical facility alive and exploring the relationship between the degree of heart compromise and mortality, our study delved deeper into the topic. This study analyzed 261 autopsy reports from 2017 in Bogotá, Colombia, and characterized the factors surrounding PCI incidence and mortality while emphasizing the role of sociodemographic variables. Of these cases, 247 (94.6%) were males with a mean age of 29.19 ± 9.7 years. Weekends, holidays, and late hours had the highest incidence of PCIs. The victims' deaths occurred at the scene in 66 (25.3%) cases, and 65.1% of the victims died before receiving medical care. Upon admission, patients with vital signs were more likely to have been transported by taxi or a private vehicle. Two or more compromised cardiac chambers, increased time of transportation, trauma occurred in the city outskirts, and gunshot wounds were related to increased mortality. Our data is valuable for surgeons, health system managers, and policy analysts as we conducted a holistic assessment of the anatomical and sociodemographic factors that are closely associated with mortality following a PCI. Surgeons must recognize that PCIs can occur even when the entrance wound is outside the cardiac box. Reinforcing hospital infrastructure in the outskirts and improving the availability, accuracy, and response time of first responders may lead to improved patient mortality rates.

Succoring the challenging acute mesenteric ischemia: Feasibility of lactate dehydrogenase for evaluation of intestinal necrosis extension and mortality.

Background: Acute mesenteric ischemia is a lethal challenging pathology for surgeons in the emergency department due to its ambiguous clinical presentation and lack of early diagnostic markers. Serum lactate is considered a relevant biomarker in terms of bowel necrosis length and mortality prediction. Nevertheless, its association has been poorly studied. Hence, we evaluated the relation between serum lactate admission levels, bowel necrosis extension, and mortality in patients with acute mesenteric ischemia. Methods: A Retrospective cross-sectional study with a prospective database was conducted, including patients over 18 years old with mesenteric ischemia that required surgical management between January 2012 and December 2018. We describe the association between serum lactate admission levels with bowel necrosis length and mortality in patients with acute mesenteric ischemia. Results: 74 patients presented with acute mesenteric ischemia, 44 males and 30 females. Mean age was 73.5 ± 10.7 years old. Significant association between serum lactate admission levels and mortality was found (ROC cut-value of 3.8 mmol/l, 81.0% sensibility and 76% specificity, LR+3.41 (95%CI 1.57, 7.40), LR- 0.25 (95%CI 0.13-0.45))(P.001). Nonetheless no statistically significant association was found between serum lactate admission levels and bowel necrosis length (ρ = 0.195,95%CI -0.046, -0.436, P > .99). As post hoc analysis, a classification and regression tree on mortality was fitted. Conclusions: Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate admission levels can be considered as a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.

Cine documental y ficciones narrativas sobre justicia y trasplante de órganos / How old are you, doctor?, when we removed from the list? Movies, justice and organ transplants

Este artículo analiza, desde la perspectiva del principio de justicia distributiva, los procesos de obtención de componentes anatómicos para trasplante. Se examinan, a partir de la revisión de la literatura, la consulta de fuentes de datos estadísticos y el recurso de narrativas fílmicas, documentales y ficcionales, algunos factores que inciden en la brecha existente entre la oferta y demanda, el fenómeno del turismo de trasplantes, la obtención forzada de componentes anatómicos y algunos de los mitos divulgados por medios de comunicación que impactan negativamente la donación de órganos, tanto a nivel global como en el contexto del Sistema de Salud en Colombia. Se examinan también las nociones de justicia distributiva (equidad y utilidad) que legitiman los criterios de obtención, distribución y asignación de órganos y tejidos, partir de la categorización de estos bio-objetos como bienes sociales

This chapter analyzes, from the perspective of the principle of distributive justice, the processes of obtaining anatomical components for transplantation. Based on the review of the literature, the consultation of sources of statistical data and the use of film narratives are examined, some factors that affect the gap between supply and demand, the phenomenon of transplant tourism, forced obtaining of anatomical components and some of the myths disclosed by the media that negatively impact organ donation, both globally and in the context of the Health System in Colombia. The notions of distributive justice (equity and utility) that legitimize the criteria for obtaining, distributing and assigning organs and tissues are also examined, based on the categorization of these bio-objects as social goods

Atresia biliar por citomegalovirus: un reporte de caso / Cytomegalovirus-associated biliary atresia: Case report

Resumen La atresia biliar asociada con inmunoglobulina M (IgM) positiva para citomegalovirus (CMV) es una entidad infrecuente que se caracteriza por la obliteración inflamatoria progresiva de los conductos intra- o extrahepáticos producida por una reacción autoinmune perinatal contra el CMV. El diagnóstico se realiza con IgM positiva para CMV y biopsia hepática con evidencia de atresia de las vías biliares. El conocimiento y la identificación temprana de esta patología conduce a un manejo quirúrgico temprano, mejorando considerablemente el pronóstico de estos pacientes. Se presenta un caso clínico de una paciente de 82 días de edad con un cuadro de acolia, coluria e ictericia de inicio tardío, asociado con hiperbilirrubinemia a expensas de la directa, elevación de perfil hepático e IgM positiva para CMV. La colangiorresonancia intraoperatoria confirmó el cuadro de atresia de las vías biliares. Se realizó una derivación biliodigestiva tipo Kasai y la toma de biopsia hepática que confirmó el cuadro clínico.

Abstract Biliary atresia associated with positive cytomegalovirus IgM results is a rare condition characterized by progressive inflammatory obliteration of the intra- or extrahepatic ducts. It is caused by a perinatal autoimmune reaction against cytomegalovirus (CMV). Diagnosis is made based on positive IgM for CMV and liver biopsy with evidence of bile duct atresia. Knowledge and timely identification of this disease leads to early surgical management, considerably improving the prognosis of these patients. This is the clinical case of an 82-day-old female patient with late-onset acholia, choluria, and jaundice, associated with conjugated hyperbilirubinemia, elevated liver function tests and positive CMV IgM results. Intraoperative cholangioresonance confirmed bile duct atresia. The Kasai procedure was performed, and a liver biopsy was taken, confirming the diagnosis.