Knowledge and attitudes of health professionals in Chile towards people living with human immunodeficiency virus: A cross-national survey.

Introduction: People living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) often experience discrimination from both other individuals and the health personnel who care for them. Chile has experienced a marked increase in the number of new HIV cases.Methods: Prospective cross-sectional study. The HIV/AIDS questionnaire for providers and health personnel was obtained from the International Planned Parenthood Federation, initially carrying out a pilot test and evaluating its validity.Results: A total of 784 health professionals answered the questionnaire correctly. Among them, 68.4% (n = 536) were women, and 36.2% (n = 284) were physicians. The study revealed that more than 90% of respondents had a positive attitude towards caring for people living with HIV, and more than 75% did not mind buying food from them or sharing services with them. Furthermore, more than 99% rejected the religiously endorsed labeling of people living with HIV/AIDS as immoral. Additionally, 95.5% (n = 749) mentioned that they did not feel anxious about knowing whether the next patient on their care list was living with HIV, and 76.9% (n = 603) of the respondents felt safe taking blood samples.Conclusions: Chilean health professionals have good knowledge about HIV infection and its mode transmission. Their attitudes towards people living with HIV are also generally positive.

Relationship between Duffy Genotype/Phenotype and Prevalence of Plasmodium vivax Infection: A Systematic Review.

The Duffy protein, a transmembrane molecule, functions as a receptor for various chemokines and facilitates attachment between the reticulocyte and the Plasmodium Duffy antigen-binding protein. Duffy expression correlates with the Duffy receptor gene for the chemokine, located on chromosome 1, and exhibits geographical variability worldwide. Traditionally, researchers have described the Duffy negative genotype as a protective factor against Plasmodium vivax infection. However, recent studies suggest that this microorganism's evolution could potentially diminish this protective effect. Nevertheless, there is currently insufficient global data to demonstrate this phenomenon. This study aimed to evaluate the relationship between the Duffy genotype/phenotype and the prevalence of P. vivax infection. The protocol for the systematic review was registered in PROSPERO as CRD42022353427 and involved reviewing published studies from 2012 to 2022. The Medline/PubMed, Web of Science, Scopus, and SciELO databases were consulted. Assessments of study quality were conducted using the STROBE and GRADE tools. A total of 34 studies were included, with Africa accounting for the majority of recorded studies. The results varied significantly regarding the relationship between the Duffy genotype/phenotype and P. vivax invasion. Some studies predominantly featured the negative Duffy genotype yet reported no malaria cases. Other studies identified minor percentages of infections. Conversely, certain studies observed a higher prevalence (99%) of Duffy-negative individuals infected with P. vivax. In conclusion, this systematic review found that the homozygous Duffy genotype positive for the A allele (FY*A/*A) is associated with a higher incidence of P. vivax infection. Furthermore, the negative Duffy genotype does not confer protection against vivax malaria.

Knowledge, attitudes and experience of physicians working in Chile toward the prescription of pre-exposure prophylaxis (PrEP): A cross-national survey.

BACKGROUND: Pre-exposure prophylaxis (PrEP) involves administering antiretroviral drugs to prevent human immunodeficiency virus (HIV) infection in at-risk subjects. Chile is considered one of the countries with the highest number of new cases per year of HIV infections. METHODS: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes toward the prescription of PrEP was used. RESULTS: 632 doctors responded correctly the survey. 58.5% (n = 370) were women, and median age was 34 years (IQR 25-43). 55.4% (n = 350) responded that they have never prescribed antiretrovirals for HIV-negative individuals to prevent HIV infection, and only 10.1% have prescribed PrEP. 60.8% (n = 384) mentioned having informed about the possibility of using antiretroviral post-exposure prophylaxis in case of risky sexual activity. 76.3% (n = 482) believed each institution should formulate internal protocols for administering these drugs, and 98.4% (n = 622) stated that with the currently available evidence, PrEP should be suggested to cope with the HIV pandemic. CONCLUSION: It was concluded that knowledge, attitudes and experience toward PrEP prescribing are variable and related to patient care. However, Chile has a marked tendency in favor of this therapy, which is similar to that reported in studies worldwide.

Perception of Physicians Working in Chile Toward Assisted Suicide and Euthanasia: A Nationwide Cross-Sectional Study.

INTRODUCTION: Assisted suicide and euthanasia are controversial issues today and have been throughout the history of humanity, mainly because there are individuals for and against them. Currently, the legalization of these practices is being discussed in Chile, and the perception of physicians regarding this issue is unknown. Therefore, this study aimed to assess physicians' perception of Chile's euthanasia and assisted suicide. METHODS: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes and opinions on assisted suicide and euthanasia was used. The population was the doctors who work in Chile, and the sample was convenient with a sample calculation of 384 physicians. About 20 variables were considered and included in a form created through the Google forms option, which was distributed through social networks: LinkedIn, Facebook, Twitter, and WhatsApp. To guarantee the anonymity of the participants, the option to request and remember the participant's email was deactivated. A generated database allowed the quantitative analysis of the variables and their expression through frequencies, percentages, and graphs. The European University of the Atlantic's research ethics committee approved this study as stated in the document CE-55 of March 2021. RESULTS: A total of 410 physicians were surveyed. 50.7% (n = 208) of the participants identified themselves as men, and 69.8% (n = 286) were Chilean. The city of Santiago was the area of residence of 72.9% (n = 299) of the participants. About 34.6% (n = 142) of participants were general practitioners, and 39.3% (n = 161) of the physicians had more than 20 years of experience. About 68.7% had favorable attitudes toward euthanasia and 54.4% toward assisted suicide; However, although the majority favored legalizing euthanasia and assisted suicide, approximately 48.8% stated that they would not participate in an assisted suicide procedure. CONCLUSIONS: There was evidence of support for the implementation and legalization of euthanasia and assisted suicide by physicians in Chile. However, there are still professionals who have not yet decided on a definitive position on these practices.

[Pituitary apoplexy in pediatric patients: systematic review]. / Apoplejía hipofisaria en pacientes pediátricos: revisión sistemática.

Introduction: Necrosis or hemorrhage associated with pituitary tumors is an infrequent complication. The term pituitary apoplexy is related to the development of an inflammatory process that leads to irritation of the meningeal and periselar areas. Regardless of the mechanism (hemorrhage or infarction), the extent of the hemorrhage and necrosis will produce an increase in intraselar pressure which, in turn, will lead to a more or less pronounced compression of neighboring structures, thus explaining the broad spectrum clinical. Methods: We carried out a systematic review of cases published internationally. The analysis of 8 cases published in the literature was carried out, 5 cases in the male pediatric population (62.5%), and 3 cases of the female gender (37.5%). Results: The mean age was 12.8 years (SD ± 2.5). The clinical manifestations included: headache, impaired vision, nausea and vomiting, fever, cranial nerve involvement, and, to a lesser extent, compromise of consciousness. Seventy-five percent (n = 6) of the patients had a headache, 16.6% had a frontal location, 16.6% accompanied by retroorbital pain, and 66.6% did not specify the location. On the other hand, only 37.5% of the patients had nausea and/or vomiting. While 25% were admitted with fever and 12.5% (n = 1) had changes in the state of consciousness. Conclusion: Pituitary apoplexy is a pathology that requires a multidisciplinary approach at the pediatric level. Management directed by pediatric neurosurgery and endocrinology will allow us to offer our patients the best, evidence-based treatment available.

Introducción: Introducción: La necrosis o hemorragia asociada a tumores hipofisiarios es una complicación infrecuente. El termino apoplejía pituitaria está relacionado con el desarrollo de un proceso inflamatorio que conduce a irritación meníngea y de las zonas periselares. A nivel pediátrico, la apoplejía pituitaria es una patología muy rara y poco analizada en la literatura. Métodos: Realizamos una revisión sistemática de casos publicados a nivel internacional. Se realizo el análisis de 8 casos publicados en la literatura, 5 casos en población pediátrica masculina (62.5%), y 3 casos del género femenino (37.5%). Resultados: La media de edad fue de 12,8 años (DE ±2.5). Las manifestaciones clínicas abarcaron: cefalea, alteración en la visión, náuseas y vómitos, fiebre, compromiso de pares craneales y en menor medida compromiso del estado de conciencia. El 75% (n=6) de los pacientes cursó con cefalea, el 16.6% de localización frontal, 16.6% acompañado de dolor retroorbitario, y un 66.6% no especificaron la localización. Por otro lado, solo el 37.5% de los pacientes presentaron nauseas y/o vómitos. Mientras que un 25% ingresaron con fiebre y un 12.5% (n=1) tuvieron cambios en el estado de conciencia. Conclusión: La apoplejía pituitaria es una patología que requiere un abordaje multidisciplinario a nivel pediátrico, el manejo dirigido por neurocirugía y endocrinología pediátrica permitirá ofrecer a nuestros pacientes el mejor, tratamiento disponible basado en la evidencia.

Eutanasia y suicidio asistido: revisión y análisis de marcos legales internacionales comparados con Colombia

El avance en materia de derechos humanos es indispensable durante el desarrollo de políticas públicas en salud y marcos legales que garanticen el cuidado integro de la salud; la eutanasia y suicidio asistido siguen siendo conceptos ampliamente discutidos desde la medicina, y especialmente en la bioética por el peso que poseen en la toma de decisiones del paciente terminal y cuidados paliativos. Estos términos, su uso, aprobación y regulación legal dependen de la influencia de diversos determinantes como la investigación biomédica, las creencias religiosas, los aspectos socioculturales, entre otros. Sin embargo, lo que permite la interpretación y observación de resultados son las practicas soportadas por las legislaciones de cada país; Colombia es el único país que ha despenalizado la eutanasia en la región y que progresa activamente en temas relacionados. En este orden de ideas, el objetivo de esta revisión consiste en analizar los marcos legales internacionales sobre la definición y uso de la eutanasia y el suicidio asistido, que permitan comprender la evolución de la normatividad sobre el cuidado al final de la vida.

Advances in human rights are indispensable during the development of public policies in health and legal frameworks that guarantee integral health care; euthanasia and assisted suicide continue to be concepts widely discussed in medicine, and especially in bioethics due to the weight they have in the decision-making process of the terminal patient and palliative care. These terms, their use, approval, and legal regulation depend on the influence of various determinants such as biomedical research, religious beliefs, and sociocultural aspects. However, what allows the interpretation and observation of results are the practices supported by the legislation of each country; Colombia is the only country that has decriminalized euthanasia in the region and is actively progressing in related issues. In this order of ideas, the objective of this review is to analyze the international legal frameworks on the definition and use of euthanasia and assisted suicide to understand the evolution of regulations on end-of-life care.

Os avanços nos direitos humanos são indispensáveis para o desenvolvimento de políticas públicas de saúde e marcos legais que garantam a atenção integral à saúde. A eutanásia e o suicídio assistido continuam sendo conceitos amplamente discutidos na medicina e, principalmente, na bioética, devido ao peso que têm no processo de tomada de decisão de pacientes terminais e nos cuidados paliativos. Esses termos, seu uso, aprovação e regulamentação legal dependem da influência de vários determinantes, como pesquisas biomédicas, crenças religiosas, aspectos socioculturais, entre outros. No entanto, o que permite a interpretação e a observação dos resultados são as práticas apoiadas pela legislação de cada país; a Colômbia é o único país que descriminalizou a eutanásia na região e está avançando ativamente em questões relacionadas. O objetivo desta revisão é analisar as estruturas jurídicas internacionais sobre a definição e o uso da eutanásia e do suicídio assistido a fim de compreender a evolução das regulamentações de cuidados no fim da vida.

Euthanasia and assisted suicide: An in-depth review of relevant historical aspects.

End-of-life care is an increasingly relevant topic due to advances in biomedical research and the establishment of new disciplines in evidence-based medicine and bioethics. Euthanasia and assisted suicide are two terms widely discussed in medicine, which cause displeasure on many occasions and cause relief on others. The evolution of these terms and the events associated with their study have allowed the evaluation of cases that have established useful definitions for the legal regulation of palliative care and public policies in the different health systems. However, there are still many aspects to be elucidated and defined. Based on the above, this review aimed to compile relevant historical aspects on the evolution of euthanasia and assisted suicide, which will allow understanding the use and research of these terms.

Unusual presentation Achenbach syndrome.

Achenbach syndrome is a condition of unknown etiology, characterized by changes in the coloration of the skin of the fingers and associated with acute pain. There are few epidemiological data, but it is estimated that it is a rare condition, which exceptionally appears under 40 years of age. We present the case of a young woman who has been diagnosed with Achenbach syndrome thanks to her history and after ruling out rheumatic, vascular, and metabolic pathology. We finalize by discussing data on the pathology and the differences found with the case we describe here.

El síndrome de Achenbach es una condición de etiología desconocida, caracterizado por cambios en la coloración de la piel de los dedos y asociado a dolor agudo. Existen pocos datos epidemiológicos, pero se estima que es una condición rara, que excepcionalmente aparece por debajo de los 40 años de edad. Presentamos el caso de una mujer joven a quien se dio el diagnóstico de síndrome de Achenbach por sus antecedentes y después de descartar patología reumática, vascular y metabólica. Comentamos datos sobre la patología y las diferencias que se encuentran con el caso que describimos.

Implementación de telerradiología en neurotrauma en áreas de difícil acceso-revisión sistemática / Implementation of teleradiology in neurotrauma in areas of difficult access - systematic review

ABSTRACT: Introduction: According to the world health organization, injuries represent more than 20% of health problems in the world. Head trauma and the absence of neurosurgery and radiology services in less populated areas make it difficult to assess and manage patients with brain injury. Objective: To describe the clinical findings and benefits derived from the implementation of teleradiology in neurotrauma in areas of difficult geographic access. Materials and methods: A systematic search was carried out in Pubmed, Scopus, Ebsco host, Sciencedirect, and Embase, with the thesauri "Teleradiology" and "Craniocerebral Trauma". Results: The decision to intervene in a patient with brain trauma and the period of time until surgery are essential for the clinical outcome. Those centers that use teleradiology require transfers to specialized hospitals, for which portable technological devices contribute to the response time of neurosurgery care. Conclusion: Teleradiology has a positive impact on patients with traumatic brain injury in geographical areas of difficult access, facilitating communication with specialists; providing timely care and optimizing transfers to high complexity centers.

RESUMEN: Introducción: Según la organización mundial de la saludlos traumatismos representan más del 20% de los pro-blemas en salud en el mundo. El trauma craneoencefálico y la ausencia de servicios de neurocirugía y radiología en zonas menos pobladas dificultan la valoración y manejo de pacientes con lesión cerebral. Objetivo: Describir los hallazgos clínicos y beneficios derivados de la implementación de la telerradiología en neurotrauma en áreas de difícil acceso geográfico. Materiales y métodos: Se realizó una búsqueda sistemática en Pubmed, Scopus, Ebsco host, Sciencedirect, y Embase, con los tesauros "Teleradiology" y "Craniocerebral Trauma". Resultados: La decisi-ón de intervenir a un paciente con traumatismo cerebral y el periodo de tiempo hasta la cirugía son fundamentales para el desenlace clínico. Aquellos centros que usan la telerradiología, precisan los traslados a los hospitales espe-cializados, por lo cual los dispositivos tecnológicos portátiles contribuyen en el tiempo de respuesta de la atención en neurocirugía. Conclusión: La telerradiología impacta positivamente en pacientes con trauma craneoencefálico en zonas geográficas de difícil acceso, facilitando la comunicación con especialistas; brindando atención oportuna y optimizando los traslados a centros de alta complejidad. (AU)

Achenbach's syndrome: a rare condition.

Achenbach's syndrome corresponds to a pathology characterized by the appearance of ecchymoses and bruises on the fingers of the hands and eventually on the feet. It is a benign and self-limited disease, which is accompanied by pain. It generates great concern because its sudden appearance leads women who are the most affected to consult the emergency services. At present, its pathophysiology is unknown and requires knowledge of the disease to diagnose it. It is a must for poorly trained professionals.

[May-Thurner syndrome as a cause of abdominal pain: Case report]. / Síndrome de May-Thurner como causa de dolor abdominal: caso clínico.

BACKGROUND: The May-Thurner syndrome consists of an anatomical anomaly of the iliac veins that predisposes the person presenting it to the appearance of venous insufficiency and recurrent thrombotic episodes of the lower limbs. The aim of this article was to present a case of this pathology, highlighting a rare symptom that led to its diagnosis. CASE REPORT: 46-year-old woman with severe abdominal pain in the right iliac fossa not associated with other gastrointestinal symptoms or fever. Contrast tomography of the abdomen and pelvis reported bilateral common iliac vein thrombosis. After ruling out acute surgical abdomen or immunological pathologies, an abdominal-pelvic angiography was performed, which led to the diagnosis of May-Thurner syndrome. It was performed endovascularly, pharmaco-mechanical thrombolysis, balloon plasty, and stent installation. CONCLUSIONS: This type of abdominal vascular compression syndromes are rare and require a high index of suspicion to be diagnosed, which is why publications of this type of pathology take on relevance since they teach readers about the pathology.

INTRODUCCIÓN: el síndrome de May-Thurner consiste en una anomalía anatómica de las venas ilíacas que predispone a quien la presenta a la aparición de insuficiencia venosa y episodios trombóticos recurrentes de los miembros inferiores. El objetivo de este trabajo fue presentar un caso de esta patología, destacando un síntoma poco frecuente que motivó su diagnóstico. CASO CLÍNICO: mujer de 46 años con dolor abdominal severo en fosa ilíaca derecha, no asociado a otros síntomas gastrointestinales ni fiebre. La tomografía con contraste de abdomen y pelvis ayudó a diagnosticar trombosis de las venas ilíacas comunes bilaterales. Tras descartar abdomen agudo quirúrgico o patologías inmunológicas, se realizó una angiotomografía abdómino-pélvica que condujo al diagnóstico de síndrome de May-Thurner. Se realizó endovascularmente, trombólisis fármaco-mecánica, angioplastia con balón e instalación de stent. CONCLUSIONES: este tipo de síndromes de compresión vascular abdominal son poco comunes y requieren de un alto índice de sospecha para ser diagnosticados, es por ello que publicaciones de este tipo de patología adquieren relevancia, dado que ilustran a los lectores sobre la patología en cuestión.

Enfermedad, eutanasia y aborto: una reflexión desde la bioética / Disease, euthanasia and abortion: a reflection from bioethics

Resumen El objetivo de este manuscrito es reflexionar sobre la enfermedad, la eutanasia y el aborto desde la bioética, considerando las implicaciones legales en Colombia y la visión al respecto de profesionales dedicados a las ciencias de la salud en diferentes lugares del mundo. Las enfermedades crónicas son causa importante de limitación funcional, sufrimiento y mortalidad; algunas patologías comprometen tanto el estado de conciencia en las personas que afectan la capacidad de decidir, por lo cual, es importante buscar alternativas para garantizar la autonomía de los pacientes. La eutanasia es aceptada solo en algunos países, pero cuenta con dificultades para el acceso, debido a trámites burocráticos o falta de reglamentación. Finalmente, el aborto es un procedimiento altamente cuestionado por colectivos sociales y religiosos, lo cual ha llevado a la estigmatización de las mujeres que desean acceder a él.

Abstract This manuscript aims to reflect on the disease, euthanasia, and abortion from bioethics, reviewing the legal implications in Colombia and comparing with the vision of health sciences professionals in different parts of the world. Chronic diseases are a major cause of functional limitation, suffering, and mortality. Some pathologies compromise the state of consciousness in people, which affects the ability to decide, so it is important to look for alternatives to guarantee the autonomy of patients. Euthanasia is accepted in only a few countries, but it has difficulties with access due to red tape or lack of regulation. Finally, abortion is judged by religious and social groups, which has led to the stigmatization of women who wish to access it.

Usefulness of 24-hour ambulatory blood pressure monitoring in a population with high cardiovascular risk.

BACKGROUND: High blood pressure is considered a disease and at the same time a cardiovascular risk factor, mainly involved in ischemic heart disease, cerebrovascular disease and kidney failure, causing high mortality worldwide. OBJECTIVE: The objective was to follow up with 24-hour ambulatory blood pressure monitoring in patients with high blood pressure belonging to a population with high cardiovascular risk. METHOD: Descriptive, observational, retrospective study, which analyzes 24-hour outpatient pressure controls of 1858 patients, in Cartagena, Colombia. RESULTS: 1173 exams were validated and included in the study. The median age was 66 years. 66.8% (783) were women and 33.2% (390) were men. The main changes occurred during the night, when 79.1% of the patients had high systolic pressure loads, 65.6% recorded diastolic pressure averages and 83.7% had abnormal circadian patterns. Only 11% of the studies were normal in all parameters. CONCLUSIONS: 24-hour ambulatory blood pressure monitoring proved to be a useful tool to identify uncontrolled hypertensive patients, detect nocturnal hypertension and abnormal circadian patterns, which are risk markers for cardiovascular morbidity and mortality.

ANTECEDENTES: La hipertensión arterial es considerada una enfermedad y al mismo tiempo un factor de riesgo cardiovascular, involucrada principalmente en la cardiopatía isquémica, la enfermedad cerebrovascular y la insuficiencia renal, causando una elevada mortalidad. OBJETIVO: Realizar seguimiento con monitoreo ambulatorio de la presión arterial de 24 horas en pacientes con hipertensión arterial pertenecientes a una población con alto riesgo cardiovascular. MÉTODO: Estudio descriptivo, observacional, retrospectivo, en el que se analizaron los monitoreos ambulatorios de presión de 24 horas de 1858 pacientes, en Cartagena, Colombia. RESULTADOS: Se incluyeron 1173 registros. La mediana de edad fue de 66 años. El 66.8% (783) fueron mujeres y el 33.2% (390) fueron hombres. Las principales alteraciones ocurrieron durante la noche, cuando el 79.1% de los pacientes tuvieron cargas elevadas de presión sistólica, el 65.6% registraron promedios elevados de presión diastólica y el 83.7% tuvieron patrones circadianos anormales. Solo el 11% de los estudios fueron normales en todos los parámetros. CONCLUSIONES: El monitoreo ambulatorio de la presión arterial de 24 horas demostró ser una herramienta útil para identificar a los pacientes hipertensos no controlados, detectando hipertensión nocturna y patrones circadianos anormales, los cuales son marcadores de riesgo para morbilidad y mortalidad cardiovascular.

Primary undifferentiated sarcoma of left atrium.

El objetivo es ilustrar al lector sobre un tumor infrecuente en la literatura médica y resumir los conocimientos actuales que se tienen sobre esta patología. Caso clínico: Reportamos el caso de un varón en la quinta década de la vida, a quien se realizó ecocardiograma transtorácico por deterioro de la clase funcional. La ultrasonografía evidenció un tumor que ocupaba el 95% de la aurícula izquierda, con compromiso hemodinámico e hipertensión pulmonar grave. Luego de estudios de extensión, fue llevado a cirugía para extracción de la masa por esternotomía media. La patología reveló sarcoma de alto grado indiferenciado sin compromiso linfovascular.This text aimed to illustrate the reader about one of the most infrequent tumors in the medical literature and discuss based on current literature what is known to date of this pathology. Case report: We report the case of a male in the fifth decade of life, who underwent transthoracic echocardiography due to impairment of the functional class. Ultrasound showed tumor lesion that occupied 95% of the left atrium, with hemodynamic compromise and severe pulmonary hypertension. After extension studies, he was taken to surgery with total mass extraction by middle stereotomy. The pathology revealed undifferentiated high-grade sarcoma without lymphovascular involvement.

Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche) / CT angiography for suspected aortoiliac occlusive disease (or Leriche syndrome) / Angiotomografia por suspeita de doença oclusiva aorto-ilíaca (ou síndrome de Leriche)

Introducción. El síndrome de Leriche fue definido en 1940 por René Leriche como una enfermedad oclusiva aorto-ilíaca. Su importancia radica en que ocupa el segundo lugar en incidencia dentro de las enfermedades oclusivas arteriales, después de la enfermedad de la arteria femoral superficial. Objetivo. Presentar el caso clínico de un paciente con Síndrome de Leriche cuyo diagnóstico trombótico fue confirmado por una angiotomografía computarizada con su respectiva reestructuración en 3D. Adicionalmente, se informa al lector sobre los datos propios de la patología a través de una breve revisión de la literatura. Caso clínico. Paciente masculino con síntomas clínicos agudos de enfermedad oclusiva aorto-ilíaca o síndrome de Leriche en una extremidad. Se realiza el respectivo procesamiento de imagen asistida por computador (reconstrucción tridimensional) que evidencia la patología a pesar de que la ecografía Doppler no determinó trombosis inicial. Discusión. En procesos oclusivos arteriales se emplean técnicas no invasivas como la ecografía y la angiotomografía. Sin embargo, esta última es la técnica por excelencia, sobre todo para procesos trombóticos, pues agiliza la anticoagulación, así como el abordaje terapéutico. Conclusiones. La angiotomografía es una técnica no invasiva con alta sensibilidad y especificidad para detectar estenosis aorto-ilíaca. Se ha convertido en una gran herramienta diagnostica por sus alcances imagenológicos, como la obtención de imágenes iso volumétricas, que permiten evaluar todo el trayecto arterial en los diferentes planos, por medio del uso de medios de contraste, superando en resultados a la ecografía. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.

Introduction. Leriche syndrome was defined in 1940 by René Leriche as an aortoiliac occlusive disease. Its importance lies in it occupying second place in the incidence of occlusive arterial diseases, after superficial femoral artery disease. Objective. Present the clinical case of a patient with Leriche syndrome whose diagnosis of thrombosis was confirmed by a computed tomography angiography with its respective 3D reconstruction. Additionally, the reader is given information about the pathology through a brief summary of the literature. Clinical case. Male patient with acute clinical symptoms of aortoiliac occlusive disease or Leriche syndrome in one limb. The respective computer-assisted image processing (three-dimensional reconstruction) is carried out, which shows the pathology, despite the Doppler ultrasound not initially establishing thrombosis. Discussion. Non-invasive techniques are used in procedures for occlusive arteries, such as ultrasound and CT angiography. However, the latter is a technique par excellence, above all for thrombosis procedures, as well as the therapeutic approach. Conclusions. CT angiography is a non-invasive technique with high sensitivity and specificity in the detection of aortoiliac stenosis. It has become a great diagnostic tool because of its imagery scope, such as obtaining isovolumic images, which enable the assessment of the entire arterial route in different planes, through the use of contrast media, producing more results than the ultrasound. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.

Introdução. A síndrome de Leriche foi definida em 1940 por René Leriche como uma doença oclusiva aorto-ilíaca. Sua importância reside no fato de ocupar o segundo lugar em incidência dentro das doenças arteriais obstrutivas, após a doença na artéria femoral superficial. Objetivo. Apresentar o caso clínico de um paciente com síndrome de Leriche cujo diagnóstico trombótico foi confirmado por uma angiotomografia computadorizada (angio-TC) com reestruturação em 3D. Adicionalmente, o leitor é informado sobre os dados próprios da patologia através de uma breve revisão de literatura. Caso clínico. Paciente de sexo masculino com sintomas clínicos agudos da doença oclusiva aorto-ilíaca ou síndrome de Leriche em uma extremidade. Foi realizado o processamento da imagem assistida por computador (reconstrução tridimensional), evidenciando a patologia, ainda que a ultrassonografia Doppler não determinou trombose inicial. Discussão. Em processos oclusivos arteriais são utilizadas técnicas não invasivas como a ultrassonografia e a angiotomografia. No entanto, a angiotomografia é a técnica padrão ouro, principalmente para processos trombóticos, pois acelera a anticoagulação e a abordagem terapêutica. Conclusão. A angiotomografia é uma técnica não invasiva com alta sensibilidade e especificidade para detectar estenose aorto-ilíaca. Tornou-se uma ótima ferramenta de diagnóstico por suas características imagenológicas, como a obtenção de imagens isovolumétricas que permitem avaliar todo o trajeto arterial nos diferentes planos, através do uso de meios de contraste, superando os resultados da ultrassonografia. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.

Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia / Central control of body temperature and its alterations: fever, hyperthermia and hypothermia / Controle central da temperatura corporal e suas alterações: febre, hipertermia e hipotermia

Introducción. En mamíferos, el control de la temperatura corporal es vital. El estado de consciencia y control motor en humanos, ocurren a una temperatura de 37°C y las desviaciones pueden alterar las propiedades celulares, generando disfunciones fisiológicas. En especies como los roedores (su relación área de superficie/volumen facilita la pérdida de calor) mantienen temperaturas basales cercanas a los 30°C. Distinto es con animales como los paquidermos, cuya temperatura es menor comparada con los humanos. El objetivo es identificar los aspectos fisiológicos de la termorregulación. Descripción de temas tratados. Revisión descriptiva de la literatura de artículos publicados en diferentes bases de datos. La termorregulación es la capacidad del cuerpo para establecer y mantener su temperatura, regulando producción y pérdida de calor para optimizar la eficiencia de procesos metabólicos. El protagonismo lo tiene el sistema nervioso central y su control neurohormonal en múltiples niveles. El centro regulador térmico está en el hipotálamo anterior. Este recibe información de los receptores de grandes vasos, vísceras abdominales, médula espinal y de la sangre que perfunde el hipotálamo. Cuando aumenta la temperatura central, el termorregulador activa fibras eferentes del sistema nervioso autónomo, provocando pérdida de calor por convección y evaporación. Ante el descenso de temperatura, la respuesta es disminuir la pérdida de calor (vasoconstricción y menor sudoración); además, incrementar la producción de calor, intensificando la actividad muscular. Conclusión. La termorregulación es liderada por el hipotálamo, quien regula aumento y disminución de la temperatura respondiendo a las necesidades del organismo para llegar a la homeostasis y compensación, enfrentando las alteraciones de la temperatura ambiental. Cómo citar: Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MedUNAB. 2020;23(1):118-130. doi:10.29375/01237047.3714

Introduction. In mammals, controlling body temperature is vital. Consciousness and motor control in humans occur at a temperature of 37°C and any deviation can alter the cellular properties, generating physiological dysfunctions. In species such as rodents (their surface area/volume ratio facilitates heat loss) they maintain basal temperatures close to 30°C. This is different with animals such as pachyderms, whose temperature is lower compared to humans. This article aims to Identify the physiological aspects of thermoregulation. Topics. Descriptive literature review of articles published in different databases. Thermoregulation is the body's ability to establish and maintain its temperature, regulating heat production and loss to optimize the efficiency of metabolic processes. The main actor in this process is the central nervous system and its neuro-hormonal control on multiple levels. The thermal regulating center is located in the anterior hypothalamus. It receives information from the receptors of large vessels, abdominal viscera, spinal cord and the blood that perfuses the hypothalamus. When the core temperature increases, the thermoregulator activates efferent fibers of the autonomic nervous system, causing heat loss by convection and evaporation. When the temperature drops, the response is to decrease heat loss (vasoconstriction and less sweating); in addition, increase heat production by intensifying muscle activity. Conclusion. Thermoregulation is led by the hypothalamus, which regulates temperature increase and decrease by responding to the organism's need to reach homeostasis and compensation, facing the alterations of the ambient temperature. Cómo citar: Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MedUNAB. 2020;23(1):118-130. doi:10.29375/01237047.3714

Introdução. Nos mamíferos, o controle da temperatura corporal é vital. O estado de consciencia e controle motor em humanos ocorre a uma temperatura de 37 °C e os desvios podem alterar as propriedades celulares, gerando disfunções fisiológicas. Espécies como os roedores (a sua relação superfície/volume, facilita a perda de calor), mantêm a temperatura basal próxima de 30 °C. É diferente em animais como paquidermes, cuja temperatura é mais baixa em comparação aos humanos. Objetivo. Identificar os aspectos fisiológicos da termorregulação. Desenvolvimento. Revisão descritiva da literatura de artigos publicados em diferentes bases de dados. A termorregulação é a capacidade do corpo de estabelecer e manter sua temperatura, regulando a produção e a perda de calor para otimizar a eficiência dos processos metabólicos. O sistema nervoso central tem o papel principal, assim como seu controle neuro-hormonal em múltiplos níveis. O centro de regulação térmica está no hipotálamo anterior, que recebe informações dos receptores de grandes vasos, vísceras abdominais, medula espinhal e do sangue distribuído pelo hipotálamo. Quando a temperatura central aumenta, o termorregulador ativa fibras eferentes do sistema nervoso autônomo, causando perda de calor por convecção e evaporação. Dada a diminuição da temperatura, a resposta é reduzir a perda de calor (vasoconstrição e menos transpiração), além de aumentar a produção de calor, intensificando a atividade muscular. Conclusão. A termorregulação é liderada pelo hipotálamo, que regula o aumento e a diminuição da temperatura, respondendo às necessidades do organismo de atingir a homeostase e a compensação, enfrentando mudanças na temperatura ambiente. Cómo citar: Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MedUNAB. 2020;23(1):118-130. doi:10.29375/01237047.3714

Sarcoma cardíaco metastático a miembros inferiores / Cardiac sarcoma with metastasis to the lower limbs / Sarcoma cardíaco metastático dos membros inferiores

Introducción. Las neoplasias de corazón son patologías infrecuentes con tasas de incidencias en reportes de autopsias menores al 0.02 %. El 75 % de esos tumores son de comportamiento benigno y solo el 25 % restante se considera cáncer. Aunque se presentan en ambos sexos, la relación hombres mujeres es de 2.5:1 respectivamente. Presentación del caso. Reportamos el caso de un paciente de 41 años a quien se diagnosticó con un sarcoma primario de corazón, en atrio izquierdo, con inmunohistoquímica compatible con sarcoma indiferenciado con metástasis a miembros inferiores, que debutó con deterioro de la clase funcional y pérdida de peso involuntaria, lo cual lo llevó a consultar al médico. Discusión. Los sarcomas indiferenciados constituyen una patología poco frecuente en la literatura médica, encontrando solo unos pocos reportes de casos que comparten datos relacionados con el sitio de localización de la lesión y los síntomas clínicos de los pacientes. Sin embargo, aquí se pone de manifiesto un extraño caso de metástasis a miembros inferiores, el cual fue considerado luego de descartar la presencia de un foramen oval permeable o lesiones pulmonares que hicieran pensar en una secuencia de migración tumoral diferente. Conclusiones. Se trata de una patología compleja con pobre pronóstico a largo plazo, la cual requiere mayor investigación y tratamiento multifactorial con equipos multidisciplinarios para mejorar la calidad de vida de los pacientes.

Introduction. Neoplasms of the heart are infrequent pathologies with incidence rates in autopsy reports less than 0.02%. 75 % of these tumors are benign and only the remaining 25 % are considered cancerous. Although they occur in both sexes, the male to female ratio is 2.5: 1 respectively. Case report. We report the case of a 41-year-old patient who was diagnosed with a primary heart sarcoma, in the left atrium, with immunohistochemistry compatible with undifferentiated sarcoma with metastases to the lower limbs, who debuted with impairment of functional class and loss of involuntary weight which led him to consult the doctor. Discussion. Undifferentiated sarcomas constitute a rare pathology in the medical literature, finding only a few cases reports that share data, such as the location of the lesion and the clinical symptoms of the patients. However, this case reveals a strange case of metastasis to lower limbs, which was considered, after ruling out the presence of a patent foramen ovale or lung lesions that suggested a different tumor migration sequence. Conclusions. This is a complex pathology with a poor long-term prognosis that requires more re- search and multifactorial treatment with multidisciplinary teams to improve the quality of life of patients

Introdução. As neoplasias do coração são patologias pouco frequentes, com taxas de incidência em relatórios de autópsia inferiores a 0,02%. 75% desses tumores são benignos e apenas 25% restantes são considerados câncer. Embora ocorram em ambos os sexos, a proporção entre homens e mulheres é de 2,5: 1 respectivamente. Apresentação do caso. Relatamos o caso de um paciente de 41 anos de idade com diagnóstico de sarcoma primário do coração, no átrio esquerdo, com imuno-histoquímica compatível com sarcoma indiferenciado com metástase nos membros inferiores, que começou com deterioração da classe funcional e perda involuntária de peso, o que o levou a consultar o médico. Discussão. Os sarcomas indiferenciados constituem uma patologia rara na literatura médica, encontrando apenas alguns relatos de casos que compartilham dados relacionados ao local da localização da lesão e aos sintomas clínicos dos pacientes. No entanto, aqui é revelado um caso estranho de metástase nos membros inferiores, que foi considerado após descartar a presença de forame oval permeável ou lesões pulmonares que sugerem uma sequência de migração tumoral diferente. Conclusões. É uma patologia complexa, com mau prognóstico a longo prazo, que requer mais investigação e tratamento multifatorial com equipes multidisciplinares para melhorar a qualidade de vida dos pacientes.

[Spontaneous digital hematoma, Achenbach Sindrome.] / Hematoma digital espontaneo, síndrome de Achenbach.

INTRODUCTION: The Achenbach syndrome was described in the '50s by the German physician Walter Achenbach and corresponds to an entity characterized by the appearance of ecchymosis or purpura and even bruises on the fingers and sometimes on the feet. It courses benignly and is self-limited. METHODS: We present the case of a 60-year-old woman who was diagnosed with this syndrome after performing laboratory tests, antibodies and images without finding alterations in them, with improvement after receiving analgesia and physical means. RESULTS: The Achenbach syndrome continues to be an unknown entity, with few reports in the literature. Up to the year 2 016, 12 case reports had been identified worldwide, concluding that it is a pathology that mainly affects women between the fifth and sixth decade of life. CONCLUSION: Although this nosological entity is benign and its pathophysiology is not entirely clear, it is important that during the initial approach it is consulted for similar episodes in the past and if it is an acute event, look for other alterations such as delay in capillary refill, coldness distal, absence of pulses and thus discarding acute ischemic pathology with diagnostic exams.

Introducción: El síndrome de Achenbach fue descrito en los años 50' por el médico alemán Walter Achenbach y corresponde a una entidad caracterizada por la aparición de equimosis o purpuras e incluso hematomas en los dedos de las manos y en algunas ocasiones de los pies. Cursa de forma benigna y es autolimitada. Métodos: Presentamos el caso de una mujer de 60 años a quien se diagnosticó este síndrome luego de realizar exámenes de laboratorio, anticuerpos e imágenes sin encontrar alteraciones en ellos, con mejoría luego de recibir analgesia y medios físicos. Resultados: El síndrome de Achenbach continúa siendo una entidad desconocida, con pocos reportes en la literatura. Hasta el año 2 016 se habían identificado 12 reportes de caso a nivel mundial concluyendo que es una patología que afecta principalmente a mujeres entre la quinta y sexta década de vida. . Conclusión: Aunque esta entidad nosológica es benigna y su fisiopatología no está del todo clara, es importante que durante el abordaje inicial se consulte por episodios similares en el pasado y en caso de ser un evento agudo, buscar otras alteraciones como retardo en el llenado capilar, frialdad distal, ausencia de pulsos y de ese modo se descarte patología isquémica aguda con ayudas diagnosticas