Association between erectile dysfunction and the severity of obstruction to airflow in patients with chronic obstructive pulmonary disease / Asociación entre disfunción eréctil y la severidad de la obstrucción al flujo aéreo en pacientes con enfermedad pulmonar obstructiva crónica

Objectives: The objective of this study was to explore a possible association between ED and the severity of airflow obstruction in patients with COPD. Materials and methods: A cross-sectional study was conducted using the International Index Erectile Function (IIEF), a scale validated and translated to Spanish. Bivariate analyses between subgroups were made for quantitative variables using a t-test for means and Mann­Whitney U for medians; qualitative variables were compared using the χ2 test or Fisher's test, depending on distribution. Confusion bias in the association between ED and airflow obstruction was controlled using a logistic regression model. Results: The Spanish version of the IIEF-15 scale was valid and applicable to the Colombian population. The prevalence of ED in COPD patients living at high altitudes was similar to that found at sea level. Such prevalence is higher than in general population. Beta-blockers increased 7 times the risk of ED, but we found no association between the degree of airflow obstruction and ED. Conclusion: Although the severity of COPD is not associated with ED, the prevalence of ED in COPD is higher than in general population. Therefore, ED screening in COPD patients using the IIEF could be justified. The strong association between beta-blockers and ED had not been previously described in patients with COPD but must be considered in their clinical management.

Objetivos: Explorar una posible asociación entre DE y severidad de la obstrucción al flujo aéreo en pacientes con EPOC. Materiales y métodos: Estudio de corte transversal aplicando el Índice Internacional de Función Eréctil (IIFE), validado y traducido al español. Se realizó análisis bivariado para variables cuantitativas usando prueba-t para medias y U de Mann Whitney para medianas; las variables cualitativas fueron comparadas usando prueba de Chi2 o test de Fisher, según distribución. Los sesgos de confusión en la asociación entre DE y obstrucción al flujo aéreo fueron controlados usando un modelo de regresión logística. Resultados: La versión en español de la escala IIFE-15 fue aplicable en población colombiana. La prevalencia de DE en pacientes con EPOC viviendo a gran altura fue similar a lo encontrado a nivel del mar. Esta prevalencia es mayor que en población general. El uso de beta-bloqueadores aumentó hasta siete veces el riesgo de DE, pero no se encontró asociación entre el grado de obstrucción y la DE. Conclusiones: Aunque la severidad de la EPOC no está asociada con DE, la prevalencia de DE en EPOC es mayor que en población general. Está justificada la realización de tamizaje usando el IIFE. La asociación fuerte entre beta-bloqueadores y DE no se ha descrito previamente en pacientes con EPOC, pero debe considerarse en su manejo.

Management of congenital lobar overinflation in an adult.

Congenital lobar overinflation is characterized by disruption of bronchopulmonary development which produces lobar or segmental bronchial abnormalities and overinflation of normal lung tissue. This is a 44-year old man, never smoker, who presents dyspnea every time he arrived in highlands, marked decreased breathing sounds and hyperresonance in the left hemithorax. Imaging studies suggested left upper lobe overinflation. The affected area was resected resulting in symptoms improvement. Accepted treatment is resection, however conservative management has been proposed for asymptomatic patients because cases of spontaneous improvement have been described. We recommend close monitoring and resection if symptoms or overinflation progress.

Severe Neurologic Disorders in 2 Fetuses with Zika Virus Infection, Colombia.

We report the results of pathologic examinations of 2 fetuses from women in Colombia with Zika virus infection during pregnancy that revealed severe central nervous system defects and potential associated abnormalities of the eye, spleen, and placenta. Amniotic fluid and tissues from multiple fetal organs tested positive for Zika virus.

Eimeria bovis-triggered neutrophil extracellular trap formation is CD11b-, ERK 1/2-, p38 MAP kinase- and SOCE-dependent.

Eimeria bovis is an important coccidian parasite that causes high economic losses in the cattle industry. We recently showed that polymorphonuclear neutrophils (PMN) react upon E. bovis sporozoite exposure by neutrophil extracellular trap (NET) formation. We focused here on the molecular mechanisms that are involved in this process. The sporozoite encounter led to an enhanced surface expression of neutrophil CD11b suggesting a potential role of this receptor in E. bovis-mediated NETosis. Antibody-mediated blockage of CD11b confirmed this assumption and led to a significantly decreased sporozoite-triggered NET. In addition, E. bovis-induced NETosis was found to be Ca(2+)-dependent since the inhibition of store-operated calcium entry (SOCE) significantly diminished NET. Furthermore, NADPH oxidase, neutrophil elastase (NE) and myeloperoxidase (MPO) were confirmed as key molecules in sporozoite-triggered NETosis, as inhibition thereof blocked parasite-triggered NET. PMN degranulation analyses revealed a significant release of matrix metalloprotease-9 containing granules upon sporozoite exposure. We further show a significantly enhanced phosphorylation of ERK1/2 and p38 MAPK in sporozoite-exposed PMN indicating a key role of this signaling pathway in E. bovis-mediated NETosis. Accordingly, ERK 1/2 and p38 MAPK inhibition led to a significant decrease in NET formation. Finally, we demonstrate that sporozoite-induced NETosis is neither a stage-, species-, nor host-specific process.

Panorama general de la relación enfermera-paciente en algunas unidades de cuidado intensivo en Bogotá / Overview of the nurse-patient relationship in some intensive care units in Bogotá / Panorama geral da relação enfermeiro-paciente em algumas unidades de tratamento intensivo em Bogotá

Introducción: La unidad de cuidados intensivos (UCI) es un servicio de alta complejidad, cuyo objetivo es brindar un cuidado integral a aquellas personas en condiciones críticas de salud; por tal motivo, es importante contar con el recurso humano de enfermería suficiente, según la complejidad del paciente y la carga de trabajo. Una relación enfermera-paciente puede ser uno de los elementos responsables en la aparición de incidentes y eventos adversos, por lo cual es necesario conocer la situación actual de algunas UCI. Objetivo: Describir la relación enfermera-paciente en algunas UCI de Bogotá. Materiales y métodos: Para determinar la relación enfermera-paciente se aplicó una encuesta en 49 UCI de diferentes especialidades. Resultados y conclusiones: El promedio general de la relación enfermera-paciente, teniendo en cuenta todas las UCI e instituciones reportadas, corresponde a una enfermera por cada 5,98 (6) pacientes y a una auxiliar de enfermería por cada 4,59 (5) pacientes. Dadas las condiciones y el tipo de cuidado que ellos requieren, no es una relación adecuada si se compara con estándares internacionales; sin embargo, es imposible confrontarlo con estándares nacionales, porque Colombia no cuenta con lineamientos cuantitativos, aunque sí posee parámetros cualitativos respaldados por las leyes 911 y 266, así como algunos estudios que demuestran la necesidad de aplicar e interpretar adecuadamente herramientas de medición de carga de trabajo, de tal manera que se pueda establecer y sustentar, de la manera más objetiva posible, el número de pacientes por enfermera.

Introduction: The intensive care unit (ICU) is a high-complexity service, which aims to provide comprehensive care to people in critical health conditions; for this reason, it is important to have sufficient nursing human resources according to the patient complexity and the workload. A nurse-patient relationship can be one of the responsible elements for the occurrence of incidents and adverse events, which means it is necessary to know the current status of some ICU. Objective: To describe the nurse-patient relationship in some ICU of Bogota. Materials and Methods: To determine the nursepatient relation a survey was applied in 49 different ICU specialties. Results and Conclusions: The overall average of nurse-patient relationship, taking into account all ICU and reported institutions corresponds to one nurse per every 5.98 (6) patients and a nurse's aide per every 4.59 (5) patients. Given the conditions and the type of care they require it is not a suitable ratio when compared with international standards; however, it is impossible to compare this with national standards, because Colombia does not have quantitative guidelines, although it has qualitative parameters backed by laws 911 and 266, as well as some studies that demonstrate the need for application and proper interpretation of measurement tools of the workload, so the number of patients per nurse can be established and sustained, as objectively as possible

Introdução: A unidade de tratamento intensivo (UTI) é um serviço de alta complexidade que visa brindar atendimento integral para pessoas em condições críticas de saúde; por tal razão, é importante contar com suficiente recurso humano de enfermagem, de acordo à acuidade do paciente e a carga de trabalho. A relação enfermeiro-paciente pode ser um elemento responsável pela ocorrência de incidentes e eventos adversos, pelo qual é preciso conhecer a situação atual de algumas UTI. Objetivo: Descrever a relação enfermeiro-paciente em algumas UTI de Bogotá. Materiais e métodos: Para determinar a relação enfermeiro-paciente foi aplicado um inquérito a 49 UTI de diferentes especialidades. Resultados e conclusões: A média geral da relação enfermeiro-paciente, considerando todas as UTI e instituições reportadas, corresponde a um enfermeiro por cada 5,98 (6) pacientes e um auxiliar de enfermagem por cada 4,59 (5) pacientes. Dadas as condições e tipo de cuidado que eles requerem, não é uma relação adequada se comparado com padrões internacionais; no entanto, é impossível confrontá-lo com padrões nacionais porque Colômbia não tem diretrizes quantitativas, embora tenha parâmetros qualitativos respaldados pelas leis 911 e 266, assim como alguns estudos que demostram a necessidade de aplicar e interpretar adequadamente ferramentas de aferição de carga de trabalho, de maneira tal de puder estabelecer e sustentar, do jeito mais objetivo possível, o número de pacientes por enfermeiro.

Correlación de los hallazgos endoscópicos e histológicos en el diagnóstico de metaplasia intestinal gástrica en pacientes referidos para endoscopia digestiva alta en la Clínica Colombia / Correlation of endoscopic and histological findings in diagnosis of gastrointestinal metaplasia in patients referred to the Clinica Colombia for upper endoscopies

Introducción: La metaplasia intestinal es un paso más hacia el proceso final conocido del cáncer gástrico. Su correcta identificación endoscópica con toma de biopsia es vital para su confirmación histológica. No conocemos en nuestro medio la relación entre los hallazgos endoscópicos sospechosos de metaplasia intestinal y su confirmación histológica. El presento estudio busca determinar la verdadera correlación entre los hallazgos endoscópicos sugestivos de metaplasia y su contraparte histológica. Métodos: Estudio observacional analítico, realizado en la Clínica Colombia donde se incluyeron pacientes con sospecha endoscópica de metaplasia intestinal, excluyendo pacientes con antecedente previo de metaplasia y con cáncer gástrico previo. La evaluación estadística se realizó con el software estadístico STATA 11. Resultados: Se identificaron un total de 766 pacientes con sospecha endoscópica de metaplasia intestinal. En 543 de ellos se encontró confirmación histológica equivalente a un 70% del total de la muestra. Los hallazgos histológicos más frecuentes en el grupo en el que no se encontró correlación fueron gastritis crónica, gastropatía reactiva e hiperplasia foveolar entre otros. El valor predictivo positivo de los hallazgos endoscópicos fue cercano al 71%. Conclusiones: Aunque la correlación fue cercana al 70%, se requieren de estudios prospectivos, multicéntricos y con cromoendoscopia, con el fin de evaluar la concordancia respectiva entre los dos métodos y determinar variables endoscópicas predictoras de severidad, y tipo de metaplasia para determinar protocolos de seguimiento para este tipo de pacientes.

Introduction: Intestinal metaplasia is one step towards the final process known as gastric cancer. Correct identification through a biopsy taken endoscopically is vital for histological confirmation. In our surroundings the relationship between endoscopic findings when intestinal metaplasia is suspected and histological confirmation are not understood. This study aims to determine the true correlation between endoscopic findings suggestive of metaplasia and their histological counterparts. Methods: This was an observational and analytical study undertaken at the Clinica Colombia. Patients who were suspected of having intestinal metaplasia following endoscopic examinations were included. Patients with prior histories of metaplasia and gastric cancer were excluded. Statistical evaluation was performed using STATA 11. Results: A total of 766 patients suspected of having intestinal metaplasias following endoscopic examination were included. 543 (70%) were confirmed histologically. Patients who most frequently had no correlation between suspicion following endoscopy and histological findings included those with chronic gastritis, foveolar hyperplasia, and reactive gastropathy. The positive predictive value of endoscopic findings was close to 71%. Conclusions: Although the correlation was close to 70%, prospective and multicenter studies, as well as studies using chromoendoscopy, are needed in order to evaluate agreement between the two methods, to determine predictive endoscopic variables for severity and for types of metaplasia, and to determine protocols for monitoring these patients.

Information and assistance bubbles to help elderly people in public environments.

Ambient Assisted Living (AAL) is an emerging bundle of technologies and services that has been specially conceived to support disabled and elderly people to be more autonomous in their daily life. Support for mobility is a key aspect in AAL, and makes elderly people feel very independent and socially integrated. This paper describes an AAL solution to support elderly people outside home: provides information and assistance at the street near public buildings, and inside public buildings. The concept of bubble is proposed in this paper as a physical space where it is possible to consume to a number of local services. Presented mobility-based AAL Services are integrated with an ambient assisted home, so users perceive mobility service as an extension of the care chain beyond the boundaries of their homes.

Palidez palmo-plantar como método diagnóstico de anemia leve-moderada / Palm-plantar pallor as a diagnostic method of mild-moderate anemia

Objetivo: determinar las características operativas de la palidez palmo-plantar en una población rural infantil colombiana como método diagnóstico de anemia, estableciendo la correlación con los valores de microhematocrito. Metodología: a través de un estudio de corte transversal para análisis de método diagnóstico, se evaluaron ciento sesenta y nueve niños y niñas entre los dos meses y los doce años de edad del área rural de influencia del municipio San Vicente del Caguán que ingresaron a una brigada de salud y aceptaron participar en el estudio, previo consentimiento informado. Se excluyeron aquellos con patologías agudas o crónicas que pudieran influenciar los resultados. Se determinó la presencia de palidez palmo-plantar por observadores entrenados en la estrategia de atención integrada a las enfermedades prevalentes en la infancia (AIEPI) y se midió el hematocrito por técnica manual microcapilar. Previo al análisis general, se realizó un estudio de concordancia entre los observadores; posteriormente se determinaron la sensibilidad, la especificidad y los valores predictivos positivo y negativo usando el hematocrito como estándar. Resultados: de la muestra evaluada, noventa y tres fueron varones y setenta y siete niñas; 45% tenía palidez palmar. Al medir el microhematocrito, 34,1% presentaba anemia. El análisis de prueba diagnóstica mostró una sensibilidad de 67,2%, una especificidad de 66,6%, un valor predictivo positivo de 51,3% y un valor predictivo negativo de 79,5%. En la mayoría de muestras del frotis de sangre periférica de niños anémicos se encontró hipocromía y eosinofilia. Conclusiones: aunque esta herramienta presenta una baja sensibilidad y especificidad cuando se trata de anemia leve-moderada, puede ser útil para excluir anemia en los niños ante la ausencia de palidez palmar.

Objective: to determine the palm-plant paleness’ characteristics in Colombian infant rural population, as a diagnostic method of anemia, and to establish a correlation between the finding of palm-plant paleness and the Hematocrit values. Methodology: a cross sectional study was used to evaluate 169 boys and girls, between 2 months and 12 years old, of the rural area of San Vicente del Caguan, who entered into a Health Campaign. Following the signature of an informed consent, parents accept their children to participate in the study. Those with acute or chronic pathologies were excluded. The presence of palm-plant paleness was determined by observers trained in the Integrated Management of Childhood Illness (IMCI) Strategy. Hematocrit was measured to all children, as well as a peripheral blood smear. Interrater concordance evaluation (Kappa index) was determined through a pilot test and a validation (sensitivity, specificity) was performed, using Hematocrit as the standard. Results: 93 of the participants were male and 77 were female. 45% of them had palm paleness. The Hematocrit showed anemia in 34.1% of the children. The validation analysis demonstrated a 67.2% of sensibility, a 66.6% of specificity, a 51.3% of positive predictive values and a 79.5% of negative predictive values. Hypochromic and Eosinophilia were found in most of the peripheral blood smears’ children with anemia. Conclusions: although this tool presents a low sensibility and specificity for low/moderated anemia, it is useful for excluding it in infants without palm paleness.

Implementación y evaluación de dos métodos de conservación y generación de la base de datos del banco de cepas y genes del Instituto de Biotecnología de la Universidad Nacional de Colombia (IBUN) / Implementation and evaluation of two conservation and generation methods of the data base of the vine-stocks and genes bank of the Institute of Biotechnology of the National University of Colombia (IBUN)

76 cepas de las familias Enterobacteriaceae y Pseudomonadaceae fueron conservadas por el métodosemistock en papel filtro y 68 de las mismas por el método stock de criopreservación, en el banco de cepas ygenes del Instituto de Biotecnología de la Universidad Nacional de Colombia (IBUN). La eficacia de losmétodos de preservación se realizó mediante la evaluación de la viabilidad a las 24 horas de conservación yfue calculado el porcentaje de recuperación. En conclusión, la preservación en papel filtro y criopreservación son adecuados métodos semistock y stock, respectivamente; ya que el 73.7/100 de los microorganismos de la familia Enterobacteriaceae y el 82.3/100 de los microorganismos de la familia Pseudomonadaceae, presentaron un porcentaje de recuperación mayor al 50/100. Por otra parte, se implementó una base de datos elaborada en el software Access ®, la cual se implemento con éxito en el IBUN y en la página Web de la Universidad Nacional de Colombia en la dirección electrónica que esta disponible al público en general.