[Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document]. / Abordaje integral del vértigo: algoritmo diagnóstico, causas, tratamientos y criterios de derivación desde la perspectiva de atención primaria. Documento de consenso SEMERGEN.

Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.

Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population.

OBJECTIVE: To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS: Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS: Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS: This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Prevalence of traffic rule infractions in Cali, Colombia, at sites where injury crashes occurred.

This study aim to determine the proportion of traffic rule infractions in Cali, Colombia, in places where a road traffic injury (RTI) occurred. Description of videotaping of sites where a person was injured in an RTI in 2009. Counts of road users and infractions were established for each road user group and were compared using a Z-test. They were found 13,491 users, distributed as follow: 8.9% were pedestrians, 4.6% cyclists, 24.6% motorcyclists, and 61.8% were automobile drivers. The most frequent traffic violation among motorcyclists was transiting on lines designated for other vehicles (55.2%). Among cyclists, the most frequent violations were transiting without a helmet (99.2%) and not wearing the designated vest (100%). Among pedestrians, crossing streets at prohibited places (77.3%), even at sites where a pedestrian bridge was present (72.7%), represented two common violations. Vulnerable road users committed more traffic infractions than automobile drivers (p < 0.001). High rates of traffic rule infractions among vulnerable road users were observed. Studies to better understand the occurrence of these behaviours and the promotion of effective interventions are warranted.

Evaluation of the lytic response of prostaglandin F2 alpha in Zebu cattle based on serum progesterone.

To evaluate by means of blood progesterone levels and estrous expression the effect of the injection of 25 mg of PGF2alpha in Zebu cows, 17 Indobrazil cows with a palpable corpus luteum (CL) were injected with PGF2alpha and blood samples taken every 6 h in Experiment I. In Experiment II, 15 cows from the previous experiment at the same stage of diestrus were injected with PGF2alpha and bled every 4 h for 5 d. Progesterone levels had declined by 50% 6 h after injection in all cows and dropped to below 1 ng/ml by 30 h. Estrus was observed in 47% of the animals in Experiment I and 60% in Experiment II. Ovulation was detected accurately in 29% of the animals at 33.6 +/- 11.6 h after the onset of estrus. The correlation between finding a CL by rectal palpation and levels of progesterone higher than 1 ng/ml of blood was 86 and 93% in Experiments I and II, respectively. These studies indicate that the injection of 25 mg of PGF2alpha is sufficient to produce luteolysis in Zebu cattle, although estrous expression is poor.

Oestrous cycles, oestrus and ovulation of the zebu in the Mexican tropics.

The length of the oestrous cycle, oestrus and the time of ovulation were assessed in 20 adult, non-lactating zebu cows over 53 consecutive days of observation. Oestrus was detected at 30-minute observation periods daily. Peripheral blood samples were collected twice weekly for progesterone determination. To measure the length of the synchronised oestrous period, 10 cows with a palpable corpus luteum were injected with prostaglandin F2 alpha and continuously observed for 96 hours. Two cows at a time were exposed to a bull with a deviated penis for five minutes every three hours during this period. To measure the length of the natural oestrus, eight of the 10 cows from the previous experiment were continuously observed from day 21 after prostaglandin injection. They were kept during the daytime in a field with two teaser bulls and at night in a cattle pen where they were exposed to a teaser bull every three hours. Oestrus was considered to occur when the cow stood to be mounted. Ovulation was detected by rectal palpation every three hours in five cows starting six hours after receptivity commenced until ovulation took place. The length of the oestrous cycle was 20.1 +/- 1.9 days; 20 per cent of the animals did not show oestrus although their progesterone levels demonstrated that they were cycling. Two cows showed oestrus following prostaglandin F2 alpha injection although they were cycling as revealed by serum progesterone. Five animals showed behavioural oestrus around 118 hours after injection and following their release. Oestrus duration was 15.3 +/- 6.0 hours and ovulation occurred 28.2 +/- 5.0 hours after the start of the period of sexual receptivity.

[Intrafamilial contagion with the hepatitis B virus]. / Contagio intrafamiliar del virus de la hepatitis B.

BACKGROUND: A study of the intrafamilial transmission of the hepatitis B virus (HBV) and its relationship with the viral replication and epidemiological factors. METHODS: The intrafamilial transmission of 106 chronic carriers of HBV was evaluated: 79 were asymptomatic carriers (AC) and 27 had chronic liver disease (CLD). Overall 347 relatives of the first group individuals and 112 of the second group were investigated. In the index cases, all HBV markers were investigated, and also DNA-HBV in those with CLD. In the relatives, HBsAg, HBsAc and HBcAc were investigated. Also, a survey to evaluate the influence of socioeconomic and cultural factors was also carried out. RESULTS: The prevalence of markers was significantly higher in the relatives of patients with CLD (HBcAg, HBcAc and evidence of contact) followed by AC and controls. The most infective relation in AC was that of other contacts with significant differences from the mother-child relationship (HBsAc p less than 0.003, HBcAc p less than 0.01, and evidence of contact p less than 0.001). By contrast, in CLD the most infective relation was mother-child. The mother-child relation was more infective than the father-child one (HBsAg p less than 0.05, HBcAc p less than 0.03, and evidence of contact p less than 0.02). Regarding viral replication, it was found that the HBeAg and DNA positive patients were more infective. The prevalence of HBcAc and the evidence of contact increased with the time of living together of spouses. Finally, it can be stated in a general sense that, according to the results of the survey, the socioeconomic factors have a small influence on the familial transmission. CONCLUSIONS: The relatives of HBV carriers, particularly in the case of HC with high replication, have a high risk of transmission. Thus, their investigation and subsequent vaccination is mandatory.

[Differential diagnosis of jaundice]. / Diagnóstico diferencial de las ictericias.

Jaundice a frequent diagnostic problem and in many cases difficult to resolve, despite of current advances in exploration techniques, echography specially. In this review the significance of each method is discussed. The significance of clinical data as a first diagnostic stage is analyzed. Afterwards, according to biochemical data, the different jaundice types are distinguished and the diagnostic tests are chosen. Lastly, the main diagnostic invasive and noninvasive methods are evaluated.

[Treatment of chronic non-A, non-B-C hepatitis]. / Tratamiento de la hepatitis crónica NANB-C.

Preventive measures, and particularly screening for anti-HCV donors, have diminished the incidence of HCV infections, however, a vaccine against the disease is necessary for an effective prevention. The most active treatment at this time, seems to be alpha-interferon, at the dosage of 3 MU during 6 months. Possibly larger doses during longer periods of time might improve response and recurrence indexes, but not sufficiently as to give indiscriminate treatment to all patients at great cost and with many adverse reactions. While waiting for better predictive factors, the most convenient therapy remains the indicated dosage during 6 months, followed by periodic assessment during 2-3 months of transaminase levels: if they remain normal, the patient should be reassessed later on, if there is a recurrence, another course of treatment should be tried; non-responders should not be treated again with single interferon; other combinations or different treatments should be tried.

[Alveolar hemorrhage in mixed cryoglobulinemia associated with hepatitis C virus infection]. / Hemorragia alveolar en el seno de una crioglobulinemia mixta asociada a infección por el virus de la hepatitis C.

Alveolar hemorrhage in mixed cryoglobulinemia associated with hepatitis C virus infection. A 61 year-old woman with type II mixed cryoglobulinemia associated to hepatitis C virus infection has suffered alveolar hemorrhage with multiple pulmonary infiltrates, purpura, glomerulonephritis and polyneuropathy. The respiratory and kidney findings resolved with prednisone, but glomerulonephritis reappeared when interferon-alpha treatment was started and prednisone was reduced. This is the third case of alveolar hemorrhage and glomerulonephritis associated with mixed cryoglobulinemia reported in the literature. The lung involvement in mixed cryoglobulinemia is reviewed. The clinic manifestations (asthma, pleural effusion, hemoptysis or pulmonary fibrosis) are uncommon, but the lung involvement is very frequent if roentgenographic signs and necropsy findings are assessed.

Abordaje integral del vértigo: algoritmo diagnóstico, causas, tratamientos y criterios de derivación desde la perspectiva de atención primaria. Documento de consenso SEMERGEN / Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document

El vértigo es un síntoma común que puede tener diversas causas y requerir un enfoque integral para su diagnóstico y tratamiento desde atención primaria. Se propone un algoritmo de diagnóstico basado en la clasificación propuesta por la Comisión de Otoneurología de la SEORL-PCF, que facilita la clasificación de los diferentes tipos de vértigo y proporciona criterios de derivación de pacientes desde atención primaria hacia otras especialidades. Se realiza una revisión de los tratamientos disponibles basada en la causa subyacente para un manejo terapéutico adecuado. Se espera que este documento se convierta en una herramienta valiosa para los profesionales que atienden a pacientes con vértigo. El documento se basa en evidencia científica y en la experiencia de expertos en el campo de las diferentes especialidades médicas implicadas; y busca mejorar la comprensión y el abordaje clínico del vértigo agudo desde atención primaria.(AU)

Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.(AU)

Factores asociados al desprendimiento de retina pseudofáquico: seguimiento a largo plazo en una población colombiana / Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population

Objetivo Identificar factores asociados a la aparición de desprendimiento de retina pseudofáquico en pacientes con antecedente de cirugía de catarata. Métodos Estudio retrospectivo de casos y controles de 802 ojos de 783 pacientes con antecedente de cirugía de catarata. Los casos fueron pacientes con desprendimiento de retina pseudofáquico (n=258 ojos), mientras que los controles fueron pacientes con cirugía de cataratas que no desarrollaron desprendimiento de retina durante un período de seguimiento de 10 años (n=544 ojos). Resultados La edad de la cirugía de cataratas entre los casos fue menor que en el grupo control (57±13 vs. 67±14 años, respectivamente; p<0,0001). La edad al desprendimiento de retina fue de 59±13 años (rango 6-88) y el tiempo entre la cirugía de catarata y el desprendimiento de retina tuvo una mediana de 2 años (rango intercuartílico 1-4), con un rango de un mes a 14 años. Los factores asociados para el desprendimiento de retina pseudofáquico fueron la edad más joven (<50 años: razón de probabilidad ajustada [ORa]=18,03; intervalo de confianza del 95% [IC 95%]=5,92-54,87; 50-59 años: ORa=10,09, IC 95%=3,37-30,23 y 60-69 años: ORa=5,48, IC 95%=1,88-15,93), sexo masculino (ORa=3,71, IC 95%=2,54-5,44), vitrectomía anterior (ORa=3,26, IC 95%=1,16-9,16), antecedentes de desprendimiento de retina en el ojo contralateral (ORa=6,95, IC 95%=3,15-15,31) y complicaciones intraoperatorias durante la extracción de cataratas (ORa=7,45, IC 95%=3,54-15,69). Conclusiones Este es el primer artículo de factores asociados al desprendimiento de retina pseudofáquico en población colombiana. Se encontró que las complicaciones quirúrgicas, el sexo y la edad estaban asociados con el desprendimiento de retina. Los pacientes deben ser conscientes de estos riesgos potenciales para tomar decisiones informadas sobre su salud ocular (AU)

Objective To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. Methods Retrospective case–control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n=258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n=544 eyes). Results Age at cataract surgery among cases was lower than in the control group (57±13 vs. 67±14 years old, respectively; P<.0001). Age at retinal detachment was 59±13 years old (range 6–88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1–4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR]=18.03, 95% confidence interval [95% CI]=5.92–54.87; 50–59 years: aOR=10.09, 95% CI=3.37–30.23; and 60–69 years: aOR=5.48, 95% CI=1.88–15.93), male sex (aOR=3.71, 95% CI=2.54–5.44), anterior vitrectomy (aOR=3.26, 95% CI=1.16–9.16), history of retinal detachment in the fellow eye (aOR=6.95, 95% CI=3.15–15.31), and intraoperative complications during cataract extraction (aOR=7.45, 95% CI=3.54–15.69). Conclusions This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health (AU)

[The function of polymorphonucleocytes: chemotaxis, the nitroblue tetrazolium test and myeloperoxidases in healthy children and adults]. / Estudio de la función de los polimorfonucleares: quimiotaxis, "test" del nitroazul de tetrazolio y mieloperoxidasas en niños y adultos sanos.

Polymorphonuclear leucocytes function--chemotaxis, NBT and myeloperoxidase--was studied in 31 children and 62 healthy adults. Chemotaxis was superior in adults (p less than 0.001), while the other test had a similar behaviour. Results show that there is a dissociation on the maturity of different functions of the neutrophil, and it is necessary to dispose of age-matched controls to evaluate chemotaxis in children.

[Reduction of the function of polymorphonucleocytes: chemotaxis and myeloperoxidases in viral infections in childhood]. / Depresíon de las funciones de los polimorfonucleares: quimiotaxis y mieloperoxidasas, durante las infecciones virales de la infancia.

Polymorphonuclear leucocytes function--Gey mobility, chemotaxis, NBT and myeloperoxidases--was studied in 29 patients with active viral infection and after clinic recuperation: 19 mumps meningitis, five measles, three varicella, one adenovirosis and one hepatitis A; these patients were compared with 31 age matched controls. Gey mobility and chemotaxis was markedly depressed during the acute period (p [0.05 and p less than 0.001 respectively), returning to normal values with clearing of infection. Also, myeloperoxidase decreases during acute period (p less than 0.05), but they don't return to normal values with clinic recuperation (p less than 0.05). NBT was similar in both groups. Studying mumps meningitis alone authors observed that results were similar to before: chemotaxis deficit (p less than 0.05) and myeloperoxidases (p less than 0,01). According to these results depression of polymorphonuclear function justifies only partially the higher predisposition to bacterial superinfection that some viral infections have.

[Importance of the function of polymorphonuclear neutrophils in intrinsic and extrinsic asthma. Interaction of whole serum in the control of cellular activity]. / Importancia de la función de los polimorfonucleares neutrófilos en el asma intrínseco y extrínseco. Interacción del suero total en el control de la actividad celular.

A study was made of polynuclear leucocyte function: chemotaxis, NBT reduction and the influence of total plasma on chemotaxis, was investigated in a large group of asthmatic paediatric patients, both during and between asthmatic attacks. It has been proved that polynuclear function is different in the two types of asthma. During the asthmatic's crisis and in the intrinsic patients in intercrisis periods, there is a polynuclear neutrophil hyperreaction when the chemotaxis and the NBT reduction are raised. An inhibited chemotactic activity in the plasma of these patients is noted. This activity doesn't produce irreversible effects on the cells; it acts as a regulating mechanism on the chemotactic factors found in plasmatic fractions.

[Function of neutrophilic polymorphonuclear leukocytes in pediatric patients with intrinsic and extrinsic asthma during the intercrisis period]. / Etude de la fonction des polynucléaires neutrophiles chez des patients pédiatriques atteints d'asthme intrinsèque et extrinsèque pendant l'intercrise.

Polymorphonuclear leukocyte function: chemotaxis, NBT and myeloperoxidases activity, was investigated in a group of asthmatic pediatric patients, 26 with intrinsic and 27 with extrinsic asthma, during intercrisis. There was no difference between the extrinsic asthma group and the control one while the group with intrinsic asthma showed an increase of chemotaxis activity (p less than 0.001) and NBT reduction (p less than 0.01); myeloperoxidases activity was similar to the control group. The comparative study of the two types of asthma shows a significant increase of NBT reduction (p less than 0.02) and chemotaxis activity (p less than 0.001) in the intrinsic group. These findings demonstrate that polymorphonuclear function is different in the two main types of asthma during the asymptomatic period.

[Study of viral replication in HbsAg positive chronic hepatitis]. / Estudio de la replicaciíon vírica en las hepatitis crónicas AgHBs positivo.

Viral replication seric markers (VRSM), (BeHAg, BcHAg, and DNA-VHB) and the hepatic tissue BcHAg of thirty four patients suffering from chronic hepatopathies (6 PCH, 18 ACH, and 10 cirrhosis) were investigated. The greatest incidence of RVSM was observed in PCH. The combined study using all the markers demonstrated a positive correlation: DNA-VHB and BeHAg (p less than 0,001); DNA-VHB and BcHAg (p less than 0,001); BeHAg and BcHAg (p less than 0,001). The same result was obtained when comparing BcHAg (n) with the rest of RVSM: DNA-VHB (p less than 0,001), BeHAg (p less than 0,001) and seric BcHAg (p less than 0,01). Patients with a most intense histologic activity according to the Knodell index, presented a higher ratio of positive nuclei for BcHAg. The conclusion is that there is a good correlation amongst replication markers, specially hepatic BcHAg and DNA-VHB.