Characterization of cornea donors at a tissue center in the city of Medellin, Colombia.

The cornea transplant is considered the most frequently performed type of transplant in the world, with a demand that has been increasing in recent years. An observational descriptive study was conducted, focusing on the ocular tissue extracted from cadaveric donors from January 2019 to December 2021 at the Red Cross Eye Bank in Medellin, Colombia. This is the first epidemiological characterization of corneal donor tissues within the eye banks of our city, where high rates of violence-related deaths explain that tissue donors are mostly young individuals. This, in turn, results in excellent counts of endothelial cells and tissue viability in their microscopic studies. Additionally, there are lower rates of discarded tissues compared to similar studies.

Characterization of patients with autoimmune hepatitis at an university hospital in Medellín-Colombia: cohort study. / Caracterización de los pacientes con hepatitis autoinmune de un hospital universitario, Medellín-Colombia: estudio de cohorte.

INTRODUCTION: Autoimmune hepatitis is a chronic liver disease that impacts on morbidity and mortality of patients. Few epidemiological data exist of this in Latin America and Colombia. OBJECTIVES: The aim of this study is to describe the demographic, clinical and laboratory characteristics of the patients; the treatment and the response to it, the evolution and course of the disease, requirement of liver transplantation and mortality. METHODS: Historical cohort study that include patients attended at an University Hospital in Medellin, Colombia between January 2010 and December 2016 with ≥16 years age at the time of diagnosis of autoimmune hepatitis. Data collection was done from the review of medical records. Statistical analysis was performed using SPSS version 20. RESULTS: The study included 278 patients, 90% of the patients were women, the median age at diagnosis was 50 years. 37.8% were cirrhotic at the time of diagnosis. The biochemical remission was 85%. In patients who developed cirrhosis it was found a higher proportion of men (21.2 vs. 7.8%, p=.027), a greater frequency of overlap autoimmune-primary sclerosant cholangitis (6.0 vs. 0% p=.006) and a greater frequency of non-response to treatment (12.1 vs. 1.6%, p=.004). CONCLUSION: Autoimmune hepatitis is not a rare disease in Colombian population; it predominates in women but has a less favourable course in men. An important number of patients are cirrhotic at the time of diagnosis, the response to treatment and complications in our population are similar to those described worldwide.

Autoimmune hepatitis - primary biliary cholangitis overlap syndrome. Long-term outcomes of a retrospective cohort in a university hospital. / Síndrome de superposición: hepatitis autoinmune y colangitis biliar primaria. Resultados a largo plazo de una cohorte retrospectiva en un hospital universitario.

BACKGROUND: Autoimmune hepatitis (AIH) with characteristics of primary biliary cholangitis (PBC) is known as overlap syndrome. Its prevalence and prognosis have not yet been determined comparatively with AIH. METHODS: A retrospective cohort study was conducted comparing patients diagnosed with AIH and AIH-PBC overlap syndrome, followed-up for seven years in a university hospital in Colombia, until 31 December 2016. RESULTS: A total of 210 patients were included (195 women, mean age 48.5years). Of these, 32 (15.2%) had AIH-PBC overlap syndrome. At diagnosis, no significant differences were found by demographic profile, positive autoantibodies (ANA, ASMA), except AMA (81.2% vs 3.9%, P<.001), and histological grade of fibrosis. The most frequent clinical presentations were nonspecific symptoms in AIH-PBC and acute hepatitis in AIH. Although there were no significant differences, AIH showed a greater biochemical response to immunosuppressive management (87.3% vs 74.2%, P=.061) and a greater number of relapses in those who achieved partial or complete remission during treatment (12.4% vs 7.63%; P=.727). Patients with AIH-PBC had greater progression to cirrhosis (22.2% vs 13.1%, P=.038), even in those who achieved partial or complete biochemical remission without relapse, with greater indication of orthotopic liver transplantation (P=.009), but not retransplantation (P=.183); there were no differences in mortality. CONCLUSIONS: AIH-PBC overlap syndrome accounts for a significant proportion of patients with AIH, with greater progression to cirrhosis, indication of liver transplantation and possibly retransplantation. This higher risk of adverse outcomes suggests closer monitoring, probably with follow-up until confirmed histopathological remission.

Immediate Impact on Tear Osmolarity Following the Application of Different Ocular Lubricants in Patients Experiencing Moderate Dry Eye Symptoms.

PURPOSE: This study addresses the growing concern of Dry Eye Disease (DED), which has become increasingly prevalent due to modern lifestyles characterized by prolonged screen usage, global warming, polypharmacy, and extended life expectancy. METHODS: Grounded in the Dry Eye Workshop II (DEWSII) diagnosis framework, the study focuses on DED as a multifactorial condition affecting the ocular surface's tear film homeostasis. The study evaluates the short-term impact of 5 commercially available ocular lubricants on disrupting the hyperosmolar environment and determine whether these lubricants can offer potential treatment benefits for DED. RESULTS: Conducted on 300 eyes (from 150 patients) with 5 preservative-free lubricants compared to a control group, the study reveals that all lubricants effectively reduced tear film osmolarity within 15 minutes of application. Notably, the control group exhibited an increase in average osmolarity (+0.98 mOsm/L) without lubricant use. Siccafluid demonstrated the most substantial osmolarity reduction after 15 minutes, with an average decrease of 11.54 mOsm/L. Statistical significance was observed for Siccafluid, Optive Fusion unique dose (UD), and Systane Ultra UD, while Hyabak and Freegen preservative free (PF) showed lower significance. CONCLUSIONS: Emphasizing the importance of disrupting the hyperosmolar environment to break the cycle of inflammation, the study concludes that ocular lubricants, at least as an immediate post-application effect, can interrupt this cycle and improve the hyperosmolar environment of the ocular surface.

Risk factors for ophthalmologic involvement and ocular findings in patients diagnosed with fungemia in a high-complexity hospital in the city of Medellín, Colombia.

PURPOSE: To describe the demographic clinical characteristics and to identify the risk factors of patients diagnosed with fungemia and secondary intraocular involvement. METHODS: Retrospective cohort of 97 patients diagnosed with fungemia and with or without involvement of the posterior segment. Demographic, clinical and ophthalmological variables were identified to establish the risk of retinal seeding. RESULTS: An incidence of ocular involvement of 22.68% was obtained and no clear risk factor was found for subsequent showings in patients with fungemia. A risk trend was only found in patients with diabetes with an OR: 2.85; CI 95%: (0.80-10.12) and history of HIV with an OR: 2.29 CI95%: (0.85-6.12). CONCLUSIONS: In this first cohort carried out in Colombia according to our search, findings were obtained that agree with those of other authors worldwide, where there is no evidence of a decrease in incidence compared with older studies and the absence of risk factors for the compromise of the posterior pole in patients with fungemia.KEY MESSAGESSystematic fundus evaluation by an ophthalmologist in patients with candidaemia is a recommended practice based on low-quality evidence.The identification of real risk factors for retinal compromise in fungemia would allow us to be more selective with the population to be evaluated.Fungemia generally occurs in critically ill patients, where access and availability of ophthalmology evaluation are a resource that is not always available.

Caracterización de pacientes con trombosis portal sobre hígado no cirrótico en un hospital universitario de Medellín, Colombia / Characterization of patients with portal vein thrombosis on non-cirrhotic liver at a university hospital in Medellín, Colombia

Introducción. La trombosis de la vena porta es la oclusión parcial o completa de la luz de la vena porta o sus afluentes por la formación de trombos. Se asocia a desenlaces adversos y a un peor pronóstico. La frecuencia de aparición viene en aumento, a menudo de manera incidental, debido al uso cada vez mayor de imágenes diagnósticas. Metodología. Estudio observacional de una serie de casos de pacientes mayores de 18 años a quienes se les documentó trombosis venosa portal en hígado no cirrótico en el periodo comprendido entre enero de 2012 y diciembre de 2019 en un hospital de cuarto nivel de la ciudad de Medellín, Colombia. Resultados. Se documentaron 94 trombosis portales, la media de edad fue 44 ± 15 años, el 56 % eran mujeres. El promedio de aparición de síntomas fue de 14 días. La presentación de la trombosis fue aguda en un 41 %, crónica en 44 % y de instauración aguda sobre una trombosis crónica en un 15 %. La presentación clínica fue asintomática en el 33 %, el dolor abdominal fue la presentación más común con el 62 %. La trombofilia adquirida de mayor ocurrencia fueron las neoplasias mieloproliferativas crónicas en un 18 %, seguida del síndrome antifosfolípido en un 6 %. El método diagnóstico más usado fue la TAC trifásica en un 58 % seguido de la ultrasonografía en un 35 %. El 66 % de los pacientes fueron anticoagulados, siendo la warfarina el principal anticoagulante usado en un 56 %. El 16 % presento algún tipo de sangrado, aunque ninguno fue sangrado mayor. Conclusiones. La trombosis portal sigue siendo en muchos casos un hallazgo incidental. Se encontró un número inusual de neoplasias mieloproliferativas crónicas. La anticoagulación es segura y eficaz, aunque los anticoagulantes orales directos aún tienen un uso restringido.

Introduction. Portal vein thrombosis is the partial or complete occlusion of the lumen of the portal vein or its tributaries by thrombus formation. It is associated with adverse outcomes and a poorer prognosis. Its frequency is increasing, often incidentally, due to the growing use of diagnostic imaging. Methodology. This is an observational study of a case series of patients over 18 years old who were documented with portal vein thrombosis in a non-cirrhotic liver between January 2012 and December 2019 in a fourth-level hospital in the city of Medellín, Colombia. Results. Ninety-four cases of portal vein thrombosis were documented. The mean age was 44 ± 15 years, and 56 % were women. The average onset of symptoms was 14 days. Thrombosis presentation was acute in 41 %, chronic in 44 %, and acute on chronic in 15 %. Clinically, 33 % were asymptomatic, and abdominal pain was the most common presentation at 62 %. The most common acquired thrombophilia was chronic myeloproliferative neoplasms at 18 %, followed by antiphospholipid syndrome at 6 %. The most used diagnostic method was triphasic CT at 58 %, followed by ultrasonography at 35 %. Sixty-six percent of the patients received anticoagulation, with warfarin being the main anticoagulant used at 56 %. Sixteen percent experienced some type of bleeding, although none were major. Conclusions. Portal vein thrombosis remains, in many cases, an incidental finding. An unusual number of chronic myeloproliferative neoplasms were found. Anticoagulation is safe and effective, although the use of direct oral anticoagulants remains restricted.

Caracterización clínico-epidemiológica de los pacientes sometidos a trasplante hepático por cirrosis alcohólica en el Hospital Pablo Tobón Uribe de Medellín entre 2004 y 2015 / Clinical-epidemiological characterization of patients undergoing liver transplantation for alcoholic cirrhosis at the Pablo Tobón Uribe Hospital in Medellín between 2004 and 2015

Introducción. El alcohol ha sido asociado con más de 60 enfermedades diferentes y es el tercer factor de riesgo más común relacionado con muerte y discapacidad en el mundo. La enfermedad alcohólica hepática (EAH) es la causa más común de enfermedad hepática terminal (EHT) en los países occidentales. El objetivo de este estudio fue caracterizar la población adulta sometida a trasplante ortotópico hepático (TOH) indicado por EHT secundaria a EAH, en el Hospital Pablo Tobón Uribe (HPTU) de Medellín entre 2004 y 2015. Metodología. Estudio observacional retrospectivo. Se revisaron las historias clínicas electrónicas de todos los pacientes trasplantados en el HPTU entre los años 2004 y 2015, sometidos a TOH indicado por EHT secundaria a EAH. Se registraron las características demográficas, comorbilidades médicas y psiquiátricas, complicaciones tempranas y tardías, recaída en el consumo de alcohol posterior al TOH, supervivencia y causa de la muerte. Resultados. Se encontraron 59 pacientes trasplantados por cirrosis de origen alcohólico. El 91,5 % fueron de sexo masculino, el 82,6 % (38/46) tuvo un período abstinencia previo al TOH mayor o igual a 6 meses, y solamente el 10,2 % (6/59) de los pacientes estuvieron vinculados a un programa de adicciones. Se encontró comorbilidad psiquiátrica en el 30 % (18/59) con predomino de depresión. Se identificó recaída pesada en el consumo de alcohol postrasplante en 6 pacientes, este subgrupo se caracterizó por una alta mortalidad (66 %), pobre adherencia a la terapia inmunosupresora y alta frecuencia de depresión (83 %). En general, la cohorte tuvo una supervivencia a 5 y 10 años de 60,8 % y 28,1 %, respectivamente. Conclusiones. Las características epidemiológicas de la población son compartidas con reportes previos en relación al predominio de sexo masculino y adultos en la sexta década de la vida. La recaída en el consumo pesado de alcohol no es la regla, sin embargo, se encuentra asociada con abandono del tratamiento inmunosupresor y muerte. En comparación con reportes de otros países, nuestras tasas de complicaciones y mortalidad a 5 años son superiores.

Introduction. Alcohol has been associated with more than 60 different diseases and is the third most common risk factor related to death and disability throughout the world. Alcoholic liver disease is the most common cause of end-stage liver disease in Western countries. The main objective of this study was to characterize adult patients with orthotopic liver transplant due to alcoholic cirrhosis at the Pablo Tobón Uribe Hospital in Medellín between 2004 to 2015. Methodology. Observational retrospective study. We reviewed clinical records of all patients with orthotopic liver transplant due to alcoholic cirrhosis at the HPTU between 2004 and 2015, and retrieved demographic data, comorbidities, complications, consumption relapse and survival. Results. We analyzed 59 patients, 91.5% were male, 82.6% had an abstinence period previous to liver transplant equal or greater to six months, 10.2% were part of an addiction program, and 30% had psychiatric morbidities, mainly depression. We identified 6 patients with heavy alcoholic relapse after transplantation, this subgroup was characterized by a high mortality (66%), poor adherence to immunosuppressive therapy and high rates of depression (83%). In general, this cohort had a 5- and 10-year survival of 60.8% and 20.1%, respectively. Conclusions. The epidemiological characteristics of the population are shared with previous reports regarding the predominance of males and adults in the sixth decade of life. Relapse into heavy alcohol consumption is not the rule, however, it is associated with discontinuation of immunosuppressive treatment and death. In comparison with other reports, we have higher complications and mortality rates at 5 five years.

Characteristics of hyperglycemic crises in an adult population in a teaching hospital in Colombia.

BACKGROUND: Hyperglycemic crisis are the most serious forms of acute decompensation of diabetes mellitus and require urgent medical attention. The epidemiological data of these conditions in Latin America are scarce and in Colombia unknown, that is why we decided to describe the clinical characteristics and factors associated with the mortality of adults who presented with hyperglycemic crises in a teaching hospital in Colombia. MATERIALS AND METHODS: Retrospective cohort study of all episodes of hyperglycemic crisis treated in Pablo Tobón Uribe Hospital in a three-year period. RESULTS: The records of 2233 hospitalization episodes related to diabetes mellitus were review, the prevalence of hyperglycemic crises was 2%, half of the events were diabetic ketoacidosis and 57% of the events occurred in people with type 2 diabetes mellitus, 32% of the events were precipitated by an infection and 27% by and inadequate therapy. The average hospital length of stay was 14 ± 3 days and the mortality rate 2.27%. CONCLUSIONS: In a teaching hospital in Latin America hyperglycemic crises are common, with diabetic ketoacidosis being the most frequent, and in a significant number of cases may be preventable. The hospital length of stay in our population is longer than reported in the literature.

Differential characteristics in drug-induced autoimmune hepatitis.

BACKGROUND AND AIM: Drug-induced autoimmune hepatitis (DIAIH) is an adverse effect associated with several drugs that usually occurs acutely, with variable latency, and it may potentially be mortal. There are a few reports and studies about DIAIH. METHODS: This was an analytical study of a retrospective cohort of patients, discriminated according to idiopathic or drug-induced etiology, followed up for a 7-year period until 31 December 2016. RESULTS: A total of 190 patients were selected for the analysis, 12 (6.3%) with DIAIH. The two main drugs related to DIAIH were nitrofurantoin, n = 8 (67%), and NSAID, n = 2 (17%), constituting 84% of the cases. There were no significant differences in seropositivity between AIH with DIAIH in antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) antibodies, with 82.6% versus 82.6% and 34% versus 16%, respectively. The fibrosis stages were similar, except for the F4 stage, in a greater proportion in AIH. None of the patients with DIAIH had cirrhosis or developed it during follow-up, but it was present in 42.1% of the AIH cases at diagnosis (P = 0.003). Biochemical remission with management was higher in DIAIH but not significant (91.7% vs 80.9%, P = 0.35). The definitive interruption of immunosuppression was successfully performed in 25% of those with DIAIH without relapses but was only possible in 2.8% in AIH (P < 0.001) with 32 cases of relapses. CONCLUSION: DIAIH constitutes a minor proportion of AIH. The clinical and histological characteristics may be similar; DIAIH patients have a greater chance of having treatment suspended with a low risk of relapse, progression to cirrhosis, or need for liver transplant.

Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

Experiencia de downstaging versus criterios de Milán para trasplante hepático por carcinoma hepatocelular en una cohorte prospectiva / Experience with downstaging versus Milan criteria for liver transplantation in patients with hepatocellular carcinoma in a prospective cohort

Introducción. El acceso al trasplante hepático (TH) en pacientes con carcinoma hepatocelular (CHC) se basa en la aplicación de criterios morfológicos rigurosos estipulados desde 1996, co-nocidos como criterios de Milán. Una de las estrategias descritas para expandir estos criterios se conoce como downstaging (reducción del estadiaje tumoral mediante terapias locorregionales). El objetivo de este estudio fue describir el comportamiento postrasplante de pacientes con CHC que ingresaron dentro de los parámetros de Milán, comparado con el de aquellos pacientes llevados a terapia de downstaging en un centro colombiano. Metodología. Se incluyeron pacientes adultos con cirrosis hepática (CH) y CHC que fueron llevados a TH en el Hospital Pablo Tobón Uribe, entre julio de 2012 a septiembre de 2021. Como desenlace principal se definió recurrencia y tiempo de recurrencia de la enfermedad tumoral, muerte por todas las causas y tiempo al fallecimiento. Se evaluaron las características sociodemográficas y clínicas de cada grupo. Se incluyeron scores pronósticos de recurrencia de la enfermedad tumoral. Resultados. Se trasplantaron 68 pacientes con CH y CHC, 50 (73,5 %) eran hombres y la edad promedio fue 59 años; 51 pacientes (75 %) cumplían con los criterios de Milán y 17 (25 %) fueron llevados a terapia de downstaging previo al TH. No hubo diferencias significativas en la supervivencia global y supervivencia libre de trasplante entre los dos grupos evaluados, p=0,479 y p=0,385, respectivamente. Tampoco hubo diferencia significativa en la recurrencia de la enfermedad tumoral entre ambos grupos (p=0,81). En total hubo 7 casos de recurrencia tumoral (10,2 %) y 11 casos de muerte (16,2 %). Conclusiones. No se encontraron diferencias significativas en recurrencia y mortalidad entre los pacientes que cumplían los criterios de Milán y los trasplantados luego de la terapia de downstaging, en un tiempo de se-guimiento de 53 meses hasta el último control posterior al trasplante hepático. Esta sería la primera evaluación prospectiva de un protocolo de downstaging para CHC en Colombia.

Introduction. Access to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is based on the application of rigorous morphological criteria stipulated since 1996, known as the Milan criteria. One of the strategies described to expand these criteria is known as downstaging (tu-mor staging reduction through locoregional therapies). The objective of this study was to describe the post-transplant performance of patients with HCC who were admitted within the Milan parameters, compared with those of patients taken to downstaging therapy, in a Colombian center. Methodolo-gy. Adult patients with cirrhosis and HCC that received LT between July 2012 and September 2021 at the Pablo Tobón Uribe Hospital were included. The main outcome was defined as recurrence and time to recurrence of the tumor disease, death from all causes, and time to death. The socio-demographic and clinical characteristics of each group were evaluated. Tumor disease recurrence prognostic scores were included. Results. Sixty-eight patients with cirrhosis and HCC received LT in the time frame, 50 (73.5%) were men and the mean age was 59 years. Fifty-one patients were trans-planted (75%) fulfilling Milan criteria, and 17 (25%) patients received downstaging therapies before LT. There were no significant differences in overall survival and transplant-free survival between the two groups, p=0.479 and p=0.385, respectively. There was also no significant difference in the recurrence of the tumor disease between both groups (p=0.81). In total there were 7 tumoral recurrences (10.2%) and 11 deaths (16.2%). Conclusions. There were no differences in recurrence and survival between patients transplanted fulfilling Milan criteria and those receiving downstaging therapies, following a mean time of 53 months after LT. This is the first prospective evaluation of the downstaging protocol in Colombia.

Planteamiento del problema de un proyecto de investigación: escritura y formulación en ciencias de la salud

El planteamiento del problema de investigación es el punto de partida de toda investigación científica y es de suma importancia que se realice adecuadamente. Por esta razón, es fundamental tener claro que el desarrollo de un adecuado problema de investigación es un proceso complejo y está compuesto por cinco partes. En primer lugar, se debe definir la condición clínica de interés y tener total claridad sobre ella; se recomienda escribir una pequeña descripción de la enfermedad que sirva como marco de referencia para el problema. Posteriormente, se debe expresar el problema en términos de una situación adversa o negativa (morbilidad, mortalidad, costos, entre otros), bien sea para el paciente, su familia, el sistema de salud o la sociedad. En tercer lugar, el problema de investigación implica que haya un vacío o discrepancia en el conocimiento sobre dicha situación negativa; para identificarlo es necesario llevar a cabo una revisión completa y precisa de la literatura, idealmente una revisión sistemática, con el fin de tener presente las respuestas encontradas en investigaciones previas. Luego, se deben estimar las implicaciones o beneficios prácticos que pueda traer el resolver dicho problema. Finalmente, el problema de investigación se debe concretar de forma justificada y estructurada, dando lugar a la pregunta de investigación. Además, el investigador debe determinar si su pregunta de investigación cumple con los elementos necesarios para ser adecuada, los cuales se resumen en la mnemotecnia FINER (factible, interesante, novedosa, ética y relevante).

The research problem statement is the starting point of all scientific research, and it is crucially important that this step is carried out correctly. For this reason, it is essential to be aware that the development of a suitable research problem is a complex process that has five parts. First, the clinical condition of interest must be defined, and it is essential to have total clarity about it; it is recommended to write a short description of the disease that serves as a frame of reference for the problem. Subsequently, the problem must be expressed regarding an adverse situation (morbidity, mortality, costs, among others), either for the patient, family, the health system, or society. Third, the research problem implies that there's a gap or discrepancy in current knowledge about said negative situation; to identify it, it is necessary to carry out a comprehensive review of the literature to consider the answers found in previous research. Then, the practical implications or benefits of solving said problem must be estimated. Finally, the research problem must be specified in a justified and structured manner giving place to the research question. In addition, the researcher must be able to determine if his research question meets the necessary elements to be adequate, which are summarized in the mnemonic FINER (feasible, interesting, novel, ethical and relevant).

Eritrosedimentación extremadamente elevada en pacientes adultos hospitalizados en una institución de alta complejidad en la ciudad de medellín, colombia entre 2016 y 2018 / Extremely elevated erythrosedimentation in adult patients hospitalized in a high complexity institution in the city of medellín, colombia between 2016 and 2018

Resumen Introducción: La eritrosedimentación es una medida indirecta de inflamación, se eleva ante un aumento de proteínas (reactantes de fase aguda) durante trastornos inflamatorios, un valor extremadamente elevado ≥100mm/hora) tiene una alta especificidad para el diagnóstico de enfermedades infecciosas, neoplásicas y autoinmunes. Objetivo: Caracterizar a los pacientes hospitalizados con una elevación extrema de la eritrosedimentación, y explorar su asociación con otros factores determinantes. Métodos: Estudio descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años, con eritrosedimentación extrema, internados en el Hospital Pablo Tobón Uribe de la ciudad de Medellín, desde Noviembre de 2016 hasta Junio de 2018. Resultados: Se seleccionaron 1007 pacientes de la base de datos del hospital, las infecciones, con 743 (73,8%) afectados, fueron el principal diagnóstico relacionado. Se evidenció una correlación negativa de la eritrosedimentación con la hemoglobina -0.092(-0.155 a -0.029) P <0.01 y con el hematocrito -0.087(-0.150 a -0.024) P 0.01, y una positiva significativa débil con la PCR 0.080 (0.014 a 0.146) p 0.02. Discusión: Acorde a otros estudios, las infecciones representaron el primer grupo de elevación extrema, contrario a otro estudio se evidenció una correlación directa, débil y estadísticamente significativa entre la Proteina C reactiva y la eritrosedimentación extremadamente elevada. Conclusión: Las infecciones fueron el principal grupo de enfermedades con eritrosedimentación extrema, se evidenció una correlación inversa entre la eritrosedimentación con la hemoglobina y el hematocrito, y una correlación positiva débil con la proteína C reactiva. MÉD.UIS.2021;34(3): 39-45.

Abstract Sedimentation rate is an indirect inflammation measure, it rises when increase proteins (acute phase reactants) during inflammatory disorders, extreme high value (≥100mm / hour) has a high specificity for the diagnosis of infectious, neoplastic, and autoimmune diseases. Objective: To characterize inpatients with an extreme elevation of the sedimentation rate, and to establish the correlation between determinant factors and extreme sedimentation. Methods: Observational and cross-sectional study, including patients older than 18 years, with an extremely sedimentation rate, hospitalized in Hospital Pablo Tobon Uribe in Medellin city, during November of 2016 to June of 2018. Results: We selected 1007 patients from the data base, Infections were the most common diagnosis (743, 73.8%), and the main type were urinary tract infections (133, 13%). We evidence a negative correlation with the hemoglobin -0.092(0.155 a -0.029) and with the hematocrit -0.087(0.150 a -0.024), and a positive and weak significant correlation with the C-reactive protein 0.080 (0.014 a 0.146) p 0.02. Discussion: The infections, as in other studies, represent the main etiology associated with an extreme sedimentation. Different to other analyzed investigations, we observed a direct, weak and statistically significant correlation between the PCR and the extreme VSG. Conclusions: Infections were the main cause of extreme sedimentation rate. We evidence an inverse correlation between the blood sedimentation and the hemoglobin and the hematocrit, and a weak correlation with the C-reactive protein. MÉD.UIS.2021;34(3): 39-45.

Types of randomized clinical trials published in PubMed over 40 years / Tipos de ensayos clínicos con asignación aleatoria publicados en PubMed durante 40 años

Abstract Introduction: there are several variations of randomized clinical trials. Trials can be classi fied by design as parallel, cross-over, factorial, assignment by group, n-of-1, paired, withdrawal, adaptive and pragmatic; and by purpose as superiority, non-inferiority and equivalence. Given this heterogeneity, the Consolidated Standards of Reporting Trials (CONSORT) were introduced in 1996 to provide a guideline for reporting randomized clinical trials. Objective: to describe the publication tendency of the various types of randomized clinical trials over 40 years, with reference to the publication of CONSORT and its extensions. Methods: the PubMed tool was used to search for randomized clinical trials published between 1979 and 2018, classifying them according to the varieties described. Results: a total of 472,114 published articles were found; 90.2% did not report the type of design and 98.2% did not report the purpose. Among the articles that reported the variety of randomized clinical trial, the predominant design was cross-over (5.9%), followed by parallel groups (2.34%); while the most common purpose was superiority (0.84%). After the launch of CONSORT, there was an increased proportion of articles published with the following designs: parallel groups; difference in proportions 1.89 95% CI (1.1-2.7); paired 1.07 95% CI (0.2-1.9); and pragmatic 4.73 95% CI (4.4-5.1); and for the purpose of non-inferiority 5.97 95% CI (5.6-6.3). Discussion: most articles on randomized clinical trials do not mention their type in the title and abstract. The proportion of articles that did, increased slightly after CONSORT was published. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1884).

Resumen Introducción: existen múltiples variantes del ensayo clínico aleatorizado; según diseño: grupos paralelos, cruzado, factorial, asignación por grupos, N de 1, pareado, retiro, adaptativo y pragmático; y por propósito: superioridad, no inferioridad y equivalencia. Debido a esta heterogeneidad, en 1996 se introdujo el CONSORT (Consolidated Standards of Reporting Trials) para suministrar una guía para el reporte de los ensayos clínicos aleatorizados. Objetivo: describir la tendencia de publicación de los tipos de ensayos clínicos aleatorizados durante 40 años, en relación con la publicación del CONSORT y sus extensiones. Métodos: se utilizó la herramienta PubMed para realizar una búsqueda de ensayos clínicos aleatorizados publicados entre 1979 y 2018, discriminándolos según las variantes descritas. Resultados: se encontraron 472 114 artículos publicados, el 90.2% no reportó tipo de diseño y 98.2% no reportó propósito. Entre los artículos que reportaron la variante de ensayos clínicos aleatorizados, el diseño predominante fue el cruzado (5.9%), seguido por grupos paralelos (2.34%); mientras que el propósito más frecuente fue el de superioridad (0.84%). Hubo un aumento en la proporción de artículos por variante publicados después del lanzamiento del CONSORT para los diseños de: grupos paralelos; diferencia de proporciones 1.89 IC 95% (1.1-2.7); pareado 1.07 IC 95% (0.2-1.9); pragmático 4.73 IC 95% (4.4-5.1); y para el propósito de no inferioridad 5.97 IC 95% (5.6-6.3). Discusión: la mayoría de los artículos sobre ensayos clínicos aleatorizados no mencionan en su título y resumen la variante de estos. La proporción de artículos que sí lo hicieron, aumentó discre tamente después de la publicación del CONSORT. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1884).

Characterization of ocular biometric parameters in Colombian candidates for cataract surgery / Caracterización de los parámetros biométricos oculares de pacientes colombianos candidatos a cirugía de catarata

Abstract Introduction: Intraocular lens (IOL) power calculation, based on ocular biometry, is a determinant for the success of cataract surgery. Objectives: To characterize the ocular biometric parameters of Colombian patients over 40 years of age who are candidates for cataract surgery and to determine the prevalence of the 9 clinical conditions proposed by Holladay according to the interaction between axial length (AL) and anterior chamber depth (ACD). Materials and methods: Analytical cross-sectional study. The ocular biometry results of 781 patients (831 eyes) who were going to be taken to cataract surgery between January 2014 and January 2015 in Medellín, Colombia, were reviewed. After applying exclusion criteria, 716 eyes were included for analysis. Data on age, sex, AL, keratometry (flat keratometry (K1) and steep keratometry (K2)), ACD and white-to-white distance were collected. Results are presented using descriptive statistics. Results: Most eyes were from women (62.3%). The mean values of AL, K1 and ACD were 23.37±1.51mm, 43.52±2.06 and 3.03mm±0.41, respectively. Mean AL in men was 23.62±1.37mm, and in women, 23.21±1.67mm. The highest mean AL was observed in patients <50 years old (23.84±2.41) and the lowest in patients ≥80 years old (22.96±1.03 mm). Regarding eye size according to their AL, 90.5% were normal, 4.89% long, and 4.61% short. Conclusions: 85% of the participants had normal biometric parameters. For the remaining 15%, it is necessary to take some precautions when calculating IOL power, such as using fourth-generation formulas like Holladay 2 in long eyes, because the same refractive behavior will not be obtained using traditional prediction formulas in these patients. Furthermore, according to the Holladay classification, excluding normal eyes, the most frequent eyes were those with myopia and axial hyperopia.

Resumen Introducción. El cálculo del poder del lente intraocular (LIO), basado en la biometría ocular, es un factor determinante del éxito en la cirugía de catarata. Objetivos. Caracterizar los parámetros biométricos oculares de pacientes colombianos mayores de 40 años candidatos a cirugía de catarata y determinar la prevalencia de las 9 condiciones clínicas propuestas por Holladay según la interacción entre longitud axial (LA) y profundidad de la cámara anterior (ACD). Materiales y métodos. Estudio transversal analítico. Se revisaron los resultados de biometría ocular de 781 pacientes (831 ojos) que iban a ser sometidos a cirugía de cataratas entre enero de 2014 y enero de 2015 en Medellín, Colombia. Luego de aplicar los criterios de exclusión, se incluyeron 716 ojos para análisis. Se recolectaron datos sobre edad, sexo, LA, queratometría (queratometría más plana (K1), queratometría más curva (K2)), ACD y distancia blanco-blanco. Los resultados se presentan mediante estadística descriptiva. Resultados. La mayoría de ojos eran de mujeres (62.3%). Las medias de LA, K1 y ACD fueron 23.37±1.51mm, 43.52±2.06 y 3.03±0.41mm, respectivamente. La media de LA en hombres fue 23.62±1.37mm, y en mujeres, 23.21±1.67mm. La media más alta de LA se observó en pacientes <50 años (23.84±2.41mm) y la más baja en aquellos ≥80 años (22.96±1.03mm). Respecto al tamaño de los ojos según su LA, 90.5% fueron normales; 4.89%, largos, y 4.61%, cortos. Conclusiones. 85% de los participantes tuvo parámetros biométricos normales. Para el 15% restante es necesario tomar precauciones al calcular el poder del LIO, tales como el uso de fórmulas de cuarta generación como la Holladay 2 en ojos largos, pues en estos pacientes no se obtendrá el mismo comportamiento refractivo con las fórmulas de predicción tradicionales. Además, según la clasificación de Holladay, excluyendo a los ojos normales, los ojos más frecuentes fueron aquellos con miopía e hipermetropía axial.

Comparación entre dos esquemas de inmunosupresión en pacientes con trasplante hepático en un hospital universitario en Medellín, Colombia / Comparison of two immunosuppressive regimens for liver transplant patients in a university hospital in Medellín, Colombia

Introducción. El desarrollo de terapias inmunosupresoras en trasplante hepático ha sido uno de los aspectos fundamentales que ha permitido disminuir la presencia de rechazos y mejorar la supervivencia del injerto y de los pacientes. El presente estudio se hizo para conocer la efectividad de dos esquemas de tratamiento inmunosupresor en una cohorte de pacientes con trasplante hepático, entre 2006 y 2017, en un hospital universitario en Medellín, Colombia. Metodología. Se realizó un estudio observacional retrospectivo donde se compararon dos esquemas de tratamiento inmunosupresor con ciclosporina (CsA) y azatioprina (AZA) versus tacrolimus (TAC) y micofenolato (MMF). Resultados. Se incluyeron 147 pacientes al estudio, 79 mujeres y 68 hombres, con una mediana de edad de 55 años. La tasa de incidencia de rechazo agudo en el grupo CsA/AZA fue de 7,3 y para el grupo TAC/MMF fue de 13,8, con una razón de tasas de 0,53 (IC95%=0,31-0,89) por cada 100 personas/año, siendo esta diferencia estadísticamente significativa (p=0,02). No hubo diferencias significativas entre los grupos con respecto a la presencia de rechazo crónico, supervivencia del injerto o de los pacientes. Con respecto a los efectos adversos asociados al tratamiento, solo hubo diferencia significativa en una mayor presencia de diarrea en el grupo TAC/MMF. Conclusión. Solo se encontró diferencia significativa en cuanto a un número mayor de rechazos agudos en el grupo tratado con TAC/MMF. Estos hallazgos están en concordancia con la experiencia local, en la que en pacientes seleccionados se puede utilizar este esquema, con buenos resultados clínicos y menores costos para el sistema de salud. Hasta el momento, esta es la primera cohorte retrospectiva de Colombia y Latinoamérica que realiza una comparación, como la expuesta.

Introduction. The development of immunosuppressive therapies in liver transplantation has been one of the major contributing factors that have reduced the presence of rejections and improved graft and patient survival. The present study was conducted to determine the effectiveness of two immunosuppressive schemes in a cohort of liver transplant patients, between 2006 and 2017, at a university hospital in Medellin, Colombia. Methodology. A retrospective observational study was performed to compare two immunosuppressive treatment schemes with cyclosporine (CsA) and azathioprine (AZA) versus tacrolimus (TAC) and mycophenolate (MMF). Results. A total of 147 patients were included in the study, 79 women and 68 men, with a median age of 55 years. The incidence rate of acute rejection in the CsA/AZA group was 7.3 while in the TAC/MMF group was 13.8, with a rate ratio of 0.53 (95%CI=0.31-0.89) for every 100 person-year, this difference being statistically significant (p=0.02). There were no significant differences between the groups regarding the presence of chronic rejection, graft or patient survival. With respect to adverse effects associated with the treatment, there was only a significant difference in the presence of diarrhea in the TAC/MMF group. Conclusion. A significant difference was only found in terms of a higher number of acute rejections in the group treated with TAC/MMF. These findings are in agreement with local experience, in which this scheme can be used in selected patients, with good clinical results and lower costs for the health system. So far, this is the first retrospective study in Colombia and Latin America to make a comparison such as the one presented.

Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy : a systematic review and meta-analysis.

INTRODUCTION: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution. OBJECTIVE: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury. METHODS: A systematic review of studies registered in the COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO and EMBASE databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included. RESULTS: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I(2)= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I(2)= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I(2)= 0%; p= 0.51). CONCLUSIONS: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

INTRODUCCIÓN: La nefropatía inducida por medio de contraste es una de las causas principales de lesión renal aguda, lo cual incrementa la morbilidad y mortalidad intrahospitalaria. La nefroprotección con bicarbonato de sodio ha surgido como una estrategia preventiva, sin embargo su eficacia es controversial cuando se compara con estrategias como la hidratación con solución salina al 0.9%. OBJETIVO: Comparar la efectividad del bicarbonato de sodio versus la hidratación con solución salina al 0.9% en la prevención de la lesión renal aguda inducida por contraste. MÉTODOS: Se realizó una revisión sistemática de los estudios registrados en COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO y EMBASE. Se incluyeron estudios aleatorizados, controlados donde se evaluó el uso de solución salina al 0.9% versus bicarbonato de sodio para prevenir la nefropatía por medio de contraste. RESULTADOS: Se incluyeron 22 estudios (5,686 pacientes). El bicarbonato de sodio no disminuyó el riesgo de nefropatía inducida por contraste (DR= 0.00 IC95%= -0.02 -0.03; p= 0.83, I2= 0%). Tampoco se encontró diferencia significativa en la necesidad de terapia de reemplazo renal (DR= 0.00 IC 95%= -0.01-0.01, I2= 0%, p= 0.99); ni en la mortalidad (DR= -0.00, IC 95%= -0.001-0.001, I2= 0%, p= 0.51). CONCLUSIONES: La administración de bicarbonato de sodio no es superior al suministro de solución salina al 0.9% en la prevención de nefropatía inducida por medio de contraste en pacientes con factores de riesgo. Su uso tampoco es superior en la reducción de mortalidad y el requerimiento de terapia de reemplazo renal.

Descripción de la experiencia en pacientes diagnosticados con insulinoma. Estudio multicéntrico en Medellín, Colombia / Description of the experience with patients with insulinoma diagnosis. Multicentric study in Medellín, Colombia

RESUMEN Objetivo: describir la experiencia de los pacientes con insulinoma, diagnosticados y tratados entre los años 2002 y 2017 en tres hospitales de la ciudad de Medellín, Colombia. Métodos: estudio descriptivo y retrospectivo de pacientes con criterios bioquímicos para hipoglucemia hiperinsulínica y confirmación histopatológica de insulinoma. Resultados: se estudiaron 19 casos, 10 eran mujeres (52,6 %), la edad media al diagnóstico fue 43 años (D.E 15,5). Hubo cuatro casos de insulinoma multifocal (21,1 %), tres asociados con NEM-1 (15,8 %) y dos malignos (10,6 %). Todos presentaron hipoglucemia en ayunas y 63,2 % posprandial. En la prueba de ayuno, el nadir de glucemia sucedió antes de 48 horas en todos los casos, en promedio 9 horas (D.E 8,0). El diagnóstico bioquímico fue realizado con hipoglucemia e insulina elevada en todos los casos, aunque el péptido C fue reportado en nueve pacientes (47,3 %) y las sulfonilureas en dos (11,1 %). La localización preoperatoria se hizo por imágenes en 12 individuos (68,5 %) y las pruebas invasivas fueron necesarias en seis (31,5 %). Las pruebas diagnósticas fueron positivas en un 83 % para resonancia, 50 % para ecografía endoscópica y prueba de estímulo intraarterial con calcio y 100 % para ecografía intraoperatoria. La cirugía se realizó en 18 casos (94,7 %). La mortalidad (15,8 %) fue derivada de complicaciones en el posoperatorio temprano; la curación se logró en todos los casos. Conclusiones: el insulinoma en nuestro medio tiene características demográficas y clínicas similares a otras series. Existen limitaciones locales para el acceso a los estudios bioquímicos y en el rendimiento diagnóstico de las pruebas de localización.

SUMMARY Objective: The objective of the study was to describe the characteristics of patients with insulinoma in three hospitals in Medellín, Colombia, between 2002 and 2017. Methods: A retrospective analysis of patients with hyperinsulinemic hypoglycemia and histologic confirmation of insulinoma was conducted. Results: A total of 19 cases were identified. Ten women (52.6 %) and 9 males (47.4 %). The mean age at diagnosis was 43 years (S.D: 15.5). Four cases had multifocal insulinoma (21.1%), 3 cases were secondary to multiple endocrine neoplasia type 1 (15.8 %), and 2 of them were malignant (10.6 %). All patients presented fasting hypo-glycemia, and 63.2% presented post-prandial hypoglycemia. Glucose nadir in the fasting test occurred in the first 48 hours in all cases, with a mean time to hypoglycemia of 9 hours (S.D 8.0). The biochemical diagnosis was done with increased insulin in the presence of hypoglycemia. C-peptide was done in 9 patients (47.3 %), and sulfonylureas in 2 cases (11.1 %). Preoperative localization was done by imaging in 12 cases (68.5 %), and invasive tests were required in 6 cases (31.5 %). Localization tests were positive as follows: magnetic resonance imaging in 83%, endoscopic ultrasound in 50%, selective intra-arterial calcium injection in 50 %, and intraoperative ultrasound in 100%. Eighteen patients (94. 7%) underwent surgery. Mortality (15.8 %) was secondary to early post-operative complications. Conclusions: The characteristics of patients with insulinoma in Medellín are similar to other series. However, there are important local limitations for proper biochemical testing and imaging localization. This is the largest study in our country.

Caracterización de pacientes con cirrosis hepática y bacteriemia de un hospital universitario en Medellín, Colombia / Characterization of patients with liver cirrhosis and bacteremia treated at a university hospital in Medellín-Colombia

Resumen Introducción: la bacteriemia en pacientes cirróticos es frecuente y se asocia con una alta mortalidad y hospitalización prolongada. Este estudio describe las características demográficas, clínicas y de laboratorio en pacientes con cirrosis hepática y bacteriemia en un hospital de cuarto nivel. Métodos: estudio observacional de cohorte retrospectiva. Incluyó pacientes con cirrosis hepática y bacteriemia entre el 1 de enero de 2010 y el 31 de diciembre de 2017 en el Hospital Pablo Tobón Uribe de Medellín, Colombia. Se recogieron variables demográficas, clínicas y de laboratorio. Se estimó la supervivencia durante el tiempo de hospitalización y hasta 30 días desde el diagnóstico de bacteriemia. Resultados: se hallaron 78 pacientes con cirrosis y bacteriemia. La media de edad fue de 65 años, 66,7 % fueron mujeres. Las principales etiologías de la cirrosis fueron: criptogénica (30,8 %) y esteatohepatitis no alcohólica (EHNA; 19,3 %). La principal fuente de infección fue la vía urinaria (24 %), seguida de colangitis (23 %) y la bacteriemia espontánea (19 %). Los bacilos gramnegativos (BGN) representaron la mayoría de los aislamientos (67,9 %). La prevalencia de multidrogorresistentes (MDR) fue de 25,6 % y el uso adecuado de antibiótico empírico fue de 80,8 %. La mortalidad a 30 días fue de 11,5 %. Como mejores predictores de mortalidad se encontraron la puntuación Child-Pugh y Model for End-stage Liver Disease (MELD) al ingreso con área bajo la curva ROC (AUROC) de 0,79 (p = 0,008) y 0.72 (p = 0,042), respectivamente. Conclusiones: los hallazgos permiten conocer las principales características de los pacientes con cirrosis que desarrollan bacteriemia en nuestro medio. Se encontró un número considerable de infecciones MDR. Los pacientes con un grado avanzado de la cirrosis son los que presentan un mayor riesgo de mortalidad.

Abstract Introduction: Bacteremia in cirrhotic patients is frequent and associated with high mortality and prolonged hospital stays. This study describes the demographic, clinical, and laboratory characteristics of patients with liver cirrhosis and bacteremia treated at a quaternary care hospital. Methodology: Observational, retrospective cohort study. The sample consisted of patients with liver cirrhosis and bacteremia treated between January 1, 2010, and December 31, 2017, at the Hospital Pablo Tobon Uribe of Medellín, Colombia. Demographic, clinical, and laboratory variables were collected. Survival was estimated during the time of hospitalization and up to 30 days following the diagnosis of bacteremia. Results: 78 patients had cirrhosis and bacteremia. The average age was 65 years; 66.7% were women. Cirrhosis was labeled cryptogenic in 30.8% of the cases and NASH in 19.3%. The main source of infection was the urinary tract (24%), followed by cholangitis (23%) and spontaneous bacteremia (19%). Gram-negative bacteria were observed in most of the isolates (67.9%). The prevalence of MDR was 25.6%, and the adequate use of empirical antibiotics was 80.8%. The 30-day mortality rate was 11.5%. The best mortality predictors were the Child-Pugh and MELD scores on admission with AUROC of 0.79 (P=0.008) and 0.72 (P=0.042), respectively. Conclusions: The findings allow describing the main characteristics of patients with cirrhosis who develop bacteremia in our environment. A considerable number of MDR infections were found. Patients with an advanced degree of cirrhosis are at the highest risk of mortality.

Perfil cardiovascular en pacientes con disfunción eréctil tratados en un centro de alta complejidad en la ciudad de Medellín, Colombia / Cardiovascular Profile in Patients with Erectile Dysfunction Treated in a High Complexity Center in Medellín City, Colombia

Objetivo Determinar el perfil cardiovascular de los pacientes con disfunción eréctil en un centro de alta complejidad de Medellín. Métodos Estudio descriptivo, retrospectivo, en el que se incluyeron pacientes con diagnóstico de disfunción eréctil confirmado por el departamento de Urología, tratados en un centro de alta complejidad de Medellín entre 2010 y 2017; excluyendo aquellos con historia clínica con información incompleta o con desenlace cardiovascular previo al diagnóstico de disfunción eréctil. Los datos se obtuvieron de fuentes secundarias y se realizó su registro en una base de datos para su análisis mediante paquete estadístico (SPSS 24 Inc, Chicago, IL). Resultados Se captaron, durante el periodo de estudio, 67 pacientes con disfunción eréctil que cumplieron los criterios de elegibilidad. Con una media de edad de 47,5 años. El 82% presentó disfunción eréctil severa, que estuvo asociada con el antecedente de angina, enfermedad coronaria y síndrome coronario agudo. Así mismo, más del 80% de los pacientes con diabetes, hipertensión, dislipidemia, tabaquismo, enfermedad renal crónica, obesidad y alcoholismo considerados como marcadores importantes de riesgo cardiovascular, presentaron disfunción eréctil severa. Conclusión La comorbilidad cardiovascular en pacientes con DE es alta, existiendo una relación al compartir factores de riesgo y vías fisiopatológicas. Los pacientes con DE severa presentan mayor número de patologías asociadas, volviéndolos más propensos a desenlaces cardio-cerebrovasculares.

Objective To determine the cardiovascular profile of patients with erectile dysfunction in a high complexity center in Medellín. Methods Descriptive, retrospective study, in patients diagnosed with erectile dysfunction confirmed by the Department of Urology, treated in a high complexity center of Medellín between 2010 and 2017; excluding those with a clinical history with incomplete information or with a cardiovascular outcome prior to the diagnosis of erectile dysfunction. The data were obtained from secondary sources and their registration was made in a database for analysis by statistical package (SPSS 24 Inc, Chicago, IL). Results 67 patients with erectile dysfunction were selected during the study period, who met the eligibility criteria. With an average age of 47.5 years. 82% had severe erectile dysfunction, and it was associated with a history of angina, coronary disease and acute coronary syndrome. Likewise, more than 80% of patients with diabetes, hypertension, dyslipidemia, smoking, chronic kidney disease, obesity and alcoholism, considered important markers of cardiovascular risk, presented severe erectile dysfunction. Conclusion Cardiovascular comorbidity in patients with ED is high, there is a relationship, sharing risk factors and pathophysiological pathways. Patients with severe ED have a greater number of associated pathologies, making them more prone to cardio-cerebrovascular outcomes.