Leucemia promielocítica aguda M3. Reporte de un caso clínico / Acute promyelocytic leukemia M3. Report of a clinical case

La leucemia es una neoplásica hemática que contiene múltiples subtipos, entre ellos la leucemia promielocítica aguda, caracterizada por la multiplicación clonal del linaje mieloide y eritroide. El presente caso pertenece a un paciente masculino de 20 años, sin antecedentes de importancia y con un cuadro evolutivo de 20 días con sangrado del dedo anular de la mano derecha, y con ausencia de proceso cicatricial. A partir de los exámenes de laboratorio se identifica bicitopénia eritroide y plaquetaria, con evidencia de un 93% de promielocitos. El tratamiento con ATO, ATRA y Antraciclinas logró una leve mejoría. Durante su estadía hospitalaria desarrolló síndrome de diferenciación, lo que ocasionó su fallecimiento.

Leukemia is a hematic neoplastic that contains multiple subtypes, including acute promyelocytic leukemia, characterized by the clonal multiplication of the myeloid and erythroid lineage. The present case belongs to a 20-year-old male patient without health history of importance and with a 20-day evolutionary picture with bleeding from the ring finger of his right hand, and without scarring process. Erythroid and platelet bicytopenia is identified from laboratory tests with evidence of 93% promyelocytes. The treatment including ATO, ATRA and Anthracyclines achieved a slight improvement. He developed differentiation syndrome during hospitalization, which caused his death.

Malformación arteriovenosa cerebelosa. Caso clínico / Cerebellar arteriovenous malformation. Clinical case

Las malformaciones arteriovenosas representan un grupo extenso y heterogéneo de lesiones. Dichas anomalías se caracterizan por ser congénitas y por representar un verdadero desafío diagnóstico y terapéutico. El presente caso trata de una paciente femenina de 7 años, sin antecedentes de importancia que presentó un cuadro evolutivo de 2 meses, caracterizado por cefalea a nivel fronto-parietal derecha y debilidad de miembro superior izquierdo. Mediante exámenes complementarios de imagen se identifica una malformación arteriovenosa-cerebelosa que compromete diencéfalo y tálamo derecho. Durante su estadía hospitalaria es sometida a embolización, lo que mejoró notablemente el cuadro patológico establecido.

Arteriovenous malformations represent a large and heterogeneous group of lesions. These anomalies are characterized by being congenital and representing a true diagnostic and therapeutic challenge. The present case deals with a 7-year-old female patient without health history of importance. She presented a 2-month evolutionary picture, specified by right frontal-parietal headache and left upper limb weakness. Complementary imaging tests identify an arteriovenous-cerebellar malformation that compromises the diencephalon and right thalamus. An embolization was applied during hospitalization, which markedly improved the established pathological picture

Factores de riesgo para la enfermedad coronaria temprana en mujeres / Risk factors for premature coronary disease in women

Introducción. La enfermedad coronaria es la causa principal de muerte en las mujeres; por esta razón, es prioritario el control del riesgo cardiovascular. Los estudios recientes sugieren una relación entre las alteraciones de la gestación y la enfermedad coronaria; sin embargo, esta hipótesis no ha sido evaluada en la población de mujeres latinoamericanas.Objetivo. Identificar la asociación de riesgo que existe entre la enfermedad coronaria prematura y las alteraciones de la gestación en una población de mujeres colombianas. Materiales y métodos. Es un estudio de casos y controles. Se consideraron casos a las mujeres menores de 55 años sometidas a nueva irrigación quirúrgica o percutánea, y los controles fueron mujeres menores de 55 años con diagnóstico de coronarias sanas por angiografía. Resultados. Se incluyeron 200 pacientes, 100 con coronarias sanas y 100 con enfermedad coronaria, con edad promedio de 46,5±4,3 y 49,5±3,7 años, respectivamente. El análisis univariado mostró asociación entre la enfermedad coronaria y los antecedentes de preeclampsia, partos prematuros, recién nacidos de bajo peso, diabetes mellitus, dislipidemia y tabaquismo. El análisis multivariado mostró persistencia de la asociación con partos pretérmino (OR=6,05; IC95% 2,3-15; p=0,00), dislipidemia (OR=4,09; IC95% 2,1-7,8; p=0,00) y tabaquismo (OR=1,7; IC95% 0,93-3,2; p=0,08). La práctica de actividad física regular se encontró como factor protector (OR=0,5; IC95% 0,27-0,97; p=0,04). Conclusiones. El presente estudio sugiere asociación entre la presencia de enfermedad coronaria prematura y el antecedente de alteraciones de la gestación.

Introduction. Coronary disease is the leading cause of death in women, and consequently, identification of cardiovascular risk factors must be a priority. Recent studies have linked pregnancy disturbances and coronary disease, but this hypothesis has remained unproved in Hispanic women.Objective. The association of traditional risk factors and pregnancy disturbances with coronary heart disease was assessed in a sample of women with premature coronary disease. Materials and methods. The case control study included only women <55 years old, who had undergone a coronary angiography. Two hundred women were included, 100 without and 100 with coronary disease, and with mean ages of 46.5±4.3 and 49.5±3.7 years, respectively. Logistic regression analysis was used to assess the relationship between risk factors and coronary disease. Crude and multivariate adjusted odds ratios with 95% confidence intervals were calculated. Results. Univariate analysis showed an association between coronary disease and the past medical history of preeclampsia, premature delivery, low birth weight, diabetes, hypercholesterolemia and smoking habit. Logistic regression analysis showed an association of premature delivery (OR=6.0, 95%CI 2.3-15.0, p<0.01), hypercholesterolemia (OR=4.1, 95%CI 2.1-7.8, p<0.01) and smoking habit (OR=1.7, 95%Ci 0.9-3.2, p=0.08). The practice of regular physical activity was identified as a protection factor (OR=0.5, 95%CI 0.3-1.0, p=0.04).Conclusion. Pregnancy disturbances and traditional risk factors were related to an increased risk of coronary artery disease in a Hispanic population of women with premature coronary disease.

[Risk factors for premature coronary disease in women]. / Factores de riesgo para la enfermedad coronaria temprana en mujeres.

INTRODUCTION: Coronary disease is the leading cause of death in women, and consequently, identification of cardiovascular risk factors must be a priority. Recent studies have linked pregnancy disturbances and coronary disease, but this hypothesis has remained unproved in Hispanic women. OBJECTIVE: The association of traditional risk factors and pregnancy disturbances with coronary heart disease was assessed in a sample of women with premature coronary disease. MATERIALS AND METHODS: The case control study included only women <55 years old, who had undergone a coronary angiography. Two hundred women were included, 100 without and 100 with coronary disease, and with mean ages of 46.5±4.3 and 49.5±3.7 years, respectively. Logistic regression analysis was used to assess the relationship between risk factors and coronary disease. Crude and multivariate adjusted odds ratios with 95% confidence intervals were calculated. RESULTS: Univariate analysis showed an association between coronary disease and the past medical history of preeclampsia, premature delivery, low birth weight, diabetes, hypercholesterolemia and smoking habit. Logistic regression analysis showed an association of premature delivery (OR=6.0, 95%CI 2.3-15.0, p<0.01), hypercholesterolemia (OR=4.1, 95%CI 2.1-7.8, p<0.01) and smoking habit (OR=1.7, 95%Ci 0.9-3.2, p=0.08). The practice of regular physical activity was identified as a protection factor (OR=0.5, 95%CI 0.3-1.0, p=0.04). CONCLUSION: Pregnancy disturbances and traditional risk factors were related to an increased risk of coronary artery disease in a Hispanic population of women with premature coronary disease.

Características clínico-epidemiológicas de las infecciones por enterobacter en la clínica cardiovascular de Medellín: agosto de 2004 a agosto de 2006 / Epidemiological profile of enterobacter infections in the clinica cardiovascular Santa Maria in Medellin, August 2004 – August 2006 Colombia

Objetivo: describir las características clínico-epidemiológicas de las infecciones por Enterobacter. Metodología: se revisaron las historias clínicas de 54 pacientes hospitalizados durante agosto de 2004 a agosto de 2006, en la Clínica Cardiovascular de Medellín, con diagnóstico de infección por Enterobacter confirmado por Gram y cultivo. Resultados: 64.8 por ciento de los pacientes del estudio eran hombres con edad media de 48 años. Las especies que se aislaron con mayor frecuencia fueron E. cloacae (75 por ciento) y E. aerogenes (17 por ciento). El tiempo promedio de aislamiento fue de nueve días, luego del ingreso. Las muestras en que se que se aisló la bacteria fueron principalmente orina (42 por ciento) y hemocultivos (34 por ciento); la infección de tracto urinario y la de torrente circulatorio fueron las infecciones que más causó Enterobacter en los pacientes del estudio. La infección fue considerada nosocomial en el 75 por ciento de los casos. Los betalactámicos fueron los antibióticos que con más frecuencia se emplearon como terapia empírica, luego del diagnóstico de infección por Enterobacter y antes del antibiograma, cuyos resultados generaron un cambio en el tratamiento antibiótico en 78 por ciento de los casos. Conclusión: es importante que se tenga en cuenta un manejo empírico de acuerdo a los perfiles de resistencia que esta bacteria está mostrando en la institución.

Objective: to describe the clinical and epidemiological characteristics of infections by Enterobacter. Methods: clinical records of 54 patients who had been hospitalized and had received a confirmed diagnosis of Enterobacterinfection were reviewed. Results: 64.8% of patiens were male, with a mean age of 48. The species which were most commonly isolated included E. cloacae (75%) and E. aerogenes (17%). Mean time for isolation was 9 days after admission to the hospital ward. The samples from which the microorganisms were most commonly isolated were urine (42%) and blood (34%). Urinary tract and bloodstreaminfection were the most commonly caused by Enterobacter. The infection was considered to be hospital-acquired in 75% of cases. Betalactams antibiotics were the empirical choice at the time of treatment, after the infection diagnosis and before the results of antibiograms the treatment was adjusted in 78% of the patients.Conclusion: it is important to keep in mind the local resistance profiles when it comes to treatment of this infection in the institution.