Bilateral Congenital Knee Dislocation in Colombia: Case Report and Literature Review.

Congenital knee dislocation (CKD) is a rare disease with an estimated incidence of 1 per 100,000 live births, characterized by a rare musculoskeletal malformation in genu recurvatum deformity present at birth, affecting one or both lower limbs. The diagnosis may be suspected during ultrasound when observing that the situation of the extremities is not correct, and is confirmed by physical examination at birth, with plain radiography being helpful to establish the degree of severity. At present there are controversies regarding treatment and there is no definitive protocol. We present a new case of CKD, observed in the city of Manizales, diagnosed immediately after birth.

Diagnosis and management of delirium in hospital oncology services.

The diagnosis of delirium in oncologic services is a challenge; nowadays, there is very little evidence-based information available to guide the medical personnel in the diagnosis and decision taking regarding delirium in the oncologic patient. This article provides an updated review of the literature with extensive information on delirium in patients with cancer; the subject includes its definition, clinical features, precipitating and triggering factors, the frequency of delirium in oncological patients, its consequences, its treatment, and prognosis.

El ejercicio médico en el siglo XXI. Retos y rescate del método clínico / Medical practice in the twenty-first century. Challenges and rescue of the clinical method

Resumen El método clínico, desde su creación en la Grecia antigua, no ha tenido mayores cambios en sus componentes y aplicación. Sin embargo, desde hace un tiempo se ha venido vulnerando debido al gran impacto que ha tenido la tecnología en las ciencias de la salud, y los nuevos paradigmas impuestos a la práctica clínica y la educación médica. El presente artículo describe los datos históricos más relevantes del método clínico, sus componentes científicos y su aplicación en la medicina, se resalta su importancia en todos los aspectos médicos, y se plasma una reflexión acerca de las causas de esta crisis y cómo involucra al profesional de medicina general en Colombia. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1997).

Abstract Since its inception in ancient Greece, the clinical method has experienced no major changes in its components and application. However, for some time now, it has been infringed upon by the high impact of technology on the healthcare sciences, and the new paradigms imposed on clinical practice and medical education. This article describes the most relevant historical data on the clinical method, its scientific components and its application in medicine, highlighting its importance in all medical aspects; and provides some thoughts on the reasons for this crisis and how it involves general medical practitioners in Colombia. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1997).

Bone bridges in the groove for middle meningeal artery / Puentes óseos en el surco para la arteria meníngea media

SUMMARY: The middle meningeal artery is an important vessel that is distributed in the endocranium region, between greater wing of sphenoid by the homonymous groove. There are few references on the formation of bone bridges in their trajectory, an aspect of relevance in morphology. The present study included 100 skulls -dried and whole heads- of adults, removing the calvaria, and identifying the spinous foramen, through which the middle meningeal artery courses to determine the existence or not of bone bridges -unilateral, bilateral or absence- for the passage of this artery. Of 100 adult skulls analyzed, it was found at the level of the medial aspect of the greater wing of the sphenoid bone and in its internal table, 73 % presented it and in 27 % there was absence. Of the specimens with bone bridges, 39 % were bilateral and of the latter, 34 % was unilateral and 16 % was on the right and 18 % on the left. The bony bridge for the middle meningeal artery is an anatomical constant that must be evaluated in anatomical, clinical and surgical considerations.

RESUMEN: La arteria meníngea media se distribuye en la región del endocráneo entre el ala mayor del esfenoides por el surco para dicha arteria. Existen pocas referencias sobre la formación de puentes óseos en su trayectoria, aspecto de relevancia en el campo morfológico. El presente estudio incluyó 100 cráneos -secos y cabezas enteras- de adultos, a los que se les extirpó la calvaria e identificó el foramen espinoso, por donde discurre la arteria meníngea media, para determinar la existencia o no de puentes óseos -unilaterales, bilaterales o ausenciaen su interior. De 100 cráneos adultos analizados, se encontró puentes óseos a nivel de la lámina medial del ala mayor del hueso esfenoides y en su tabla interna en un 73 % y en el 27 % no hubo. De las piezas con puentes óseos, el 39 % eran bilaterales y el 34 % eran unilaterales; el 16 % a la derecha y el 18 % a la izquierda. El puente óseo de la arteria meníngea media es una constante anatómica que debe ser evaluada en consideraciones anatómicas, clínicas y quirúrgicas.

Presentación atípica de síndrome de CamuratiEngelmann en una paciente femenina colombiana. Reporte de caso / Atypical presentation of Camurati-Engelmann syndrome in a colombian female patient. Case report

Resumen El síndrome de Camurati-Engelmann, también conocido como displasia diafisaria progresiva, es una enfermedad rara, autosómica dominante y con una prevalencia de uno por cada millón de habitantes. Genera mutaciones del factor de crecimiento transformante beta, que participa en la proliferación ósea. Son frecuentes las manifestaciones osteomusculares y neurológicas, con escasas expresiones de laboratorio. El diagnóstico se basa en la clínica, los hallazgos radiológicos y la confirmación genética; el tratamiento se dirige al control sintomático y el pronóstico es incierto. La presente publicación tiene como objetivo compartir con la comunidad médica el tercer caso de síndrome de Camurati-Engelmann conocido en Colombia. Se trata de una paciente femenina de 33 años con cuadro clínico de distonías intensas y signos y síntomas característicos de este síndrome, cuyo diagnóstico fue confirmado por prueba molecular, encontrando la presencia de la variante patogénica p.Arg156Cys en el gen TGF-β1, con presentación de novo. MÉD.UIS.2021;34(1): 119-27.

Abstract Camurati-Engelmann syndrome, also known as progressive diaphyseal dysplasia, is a rare, autosomal dominant disease with a prevalence of one per million inhabitants. It generates mutations of the transforming growth factor beta, which participates in bone proliferation. Osteomuscular and neurological manifestations are frequent, with few laboratory expressions. The diagnosis is based on the clinic, radiological findings, and genetic confirmation, treatment is aimed at symptom control and prognosis is uncertain. The objective of this publication is to share with the medical community the third case of Camurati-Engelmann syndrome known in Colombia. This is a 33-year- old female patient with a clinical picture of intense dystonia and characteristic signs and symptoms of this syndrome, whose diagnosis was confirmed by molecular testing, finding the presence of the pathogenic variant p.Arg156Cys in the TGF-β1 gene, with de novo presentation. MÉD.UIS.2021;34(1): 119-27.