Association between anthropometric indices and cardiometabolic risk factors in pre-school children.

BACKGROUND: The world health organization (WHO) and the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants- study (IDEFICS), released anthropometric reference values obtained from normal body weight children. This study examined the relationship between WHO [body mass index (BMI) and triceps- and subscapular-skinfolds], and IDEFICS (waist circumference, waist to height ratio and fat mass index) anthropometric indices with cardiometabolic risk factors in pre-school children ranging from normal body weight to obesity. METHODS: A cross-sectional study with 232 children (aged 4.1 ± 0.05 years) was performed. Anthropometric measurements were collected and BMI, waist circumference, waist to height ratio, triceps- and subscapular-skinfolds sum and fat mass index were calculated. Fasting glucose, fasting insulin, homeostasis model analysis insulin resistance (HOMA-IR), blood lipids and apolipoprotein (Apo) B-100 (Apo B) and Apo A-I were determined. Pearson's correlation coefficient, multiple regression analysis and the receiver-operating characteristic (ROC) curve analysis were run. RESULTS: 51% (n = 73) of the boys and 52% (n = 47) of the girls were of normal body weight, 49% (n = 69) of the boys and 48% (n = 43) of the girls were overweight or obese. Anthropometric indices correlated (p < 0.001) with insulin: [BMI (r = 0.514), waist circumference (r = 0.524), waist to height ratio (r = 0.304), triceps- and subscapular-skinfolds sum (r = 0.514) and fat mass index (r = 0.500)], and HOMA-IR: [BMI (r = 0.509), waist circumference (r = 0.521), waist to height ratio (r = 0.296), triceps- and subscapular-skinfolds sum (r = 0.483) and fat mass index (r = 0.492)]. Similar results were obtained after adjusting by age and sex. The areas under the curve (AUC) to identify children with insulin resistance were significant (p < 0.001) and similar among anthropometric indices (AUC > 0.68 to AUC < 0.76). CONCLUSIONS: WHO and IDEFICS anthropometric indices correlated similarly with fasting insulin and HOMA-IR. The diagnostic accuracy of the anthropometric indices as a proxy to identify children with insulin resistance was similar. These data do not support the use of waist circumference, waist to height ratio, triceps- and subscapular- skinfolds sum or fat mass index, instead of the BMI as a proxy to identify pre-school children with insulin resistance, the most frequent alteration found in children ranging from normal body weight to obesity.

Neurocognitive subtypes of schizophrenia.

OBJECTIVE: To empirically identify schizophrenia neurocognitive subtypes and establish their association with clinical characteristics. METHODS: Sustained attention, executive function, facial emotion recognition, verbal learning, and working memory tests were applied to 253 subjects with schizophrenia. We identified neurocognitive subtypes by a latent class analysis of the tests results. After, we made a search for the association of these subtypes with clinic characteristics. RESULTS: We identified four neurocognitive subtypes: 1) “Global cognitive deficit”, 2) “Memory and executive function deficit”, 3) “Memory and facial emotion recognition deficit,” and 4) “Without cognitive deficit.” In comparison with the subtype “without cognitive deficit,” we found that the “memory and executive function deficit subtype” and the “global cognitive deficit subtype” had a higher frequency of male, unemployed, severe impairment, and adherence to treatment participants. However, in the “global cognitive deficit subtype” the differences were higher and there was also a lower frequency of past major depressive episodes (OR 0.39; 95%CI: 0.16 to 0.97). The “memory and facial recognition deficit subtype” had a higher probability of severe impairment (OR 5.52; 95%CI: 1.89 to 16.14) and unemployed (OR 2.43; 95%CI: 1.06 to 5.55) participants, but also a lower probability of past depressive episodes (OR 0.21; 95%CI: 0.07 to 0.66). CONCLUSION: Our results suggest the existence of four neurocognitive subtypes in schizophrenia with a spectrum of dysfunction and severity. We found higher dysfunction in those with worse cognitive dysfunction, and higher affective psychopathology and less treatment adherence in those with less cognitive dysfunction.

Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms.

OBJECTIVE: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. METHODS: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for "negative symptoms" and "disorganization" was performed afterwards. RESULTS: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. CONCLUSION: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia.

Antarctic Lichens under Long-Term Passive Warming: Species-Specific Photochemical Responses to Desiccation and Heat Shock Treatments.

Climate warming in the Antarctic tundra will affect locally dominant cryptogams. Being adapted to low temperatures and freezing, little is known about the response of the polar lichens' primary photochemistry to warming and desiccation. Since 2008, we have monitored the ecophysiological responses of lichens to the future warming scenario during a long-term warming experiment through open top chambers (OTCs) on Fildes Peninsula. We studied the primary photochemical response (potential Fv/Fm and effective efficiency of photosystem II YPSII) of different lichen taxa and morphotypes under desiccation kinetics and heat shock experiments. As lichens grow slowly, to observe changes during warming we methodologically focused on carbon and nitrogen content as well as on the stable isotope ratios. Endemic Himantormia lugubris showed the strongest effect of long-term warming on primary photochemistry, where PSII activity occurred at a lower %RWC inside the OTCs, in addition to higher Fv/Fm values at 30 °C in the heat shock kinetic treatment. In contrast, Usnea aurantiaco-atra did not show any effect of long-term warming but was active at a thallus RWC lower than 10%. Both Cladonia species were most affected by water stress, with Cladonia aff. gracilis showing no significant differences in primary photochemical responses between the warming and the control but a high sensibility to water deficiency, where, at 60% thallus RWC, the photochemical parameters began to decrease. We detected species-specific responses not only to long-term warming, but also to desiccation. On the other hand, the carbon content did not vary significantly among the species or because of the passive warming treatment. Similarly, the nitrogen content showed non-significant variation; however, the C/N ratio was affected, with the strongest C/N decrease in Cladonia borealis. Our results suggest that Antarctic lichens can tolerate warming and high temperature better than desiccation and that climate change may affect these species if it is associated with a decrease in water availability.

Inhibition of Primary Photosynthesis in Desiccating Antarctic Lichens Differing in Their Photobionts, Thallus Morphology, and Spectral Properties.

Five macrolichens of different thallus morphology from Antarctica (King George Island) were used for this ecophysiological study. The effect of thallus desiccation on primary photosynthetic processes was examined. We investigated the lichens' responses to the relative water content (RWC) in their thalli during the transition from a wet (RWC of 100%) to a dry state (RWC of 0%). The slow Kautsky kinetics of chlorophyll fluorescence (ChlF) that was recorded during controlled dehydration (RWC decreased from 100 to 0%) and supplemented with a quenching analysis revealed a polyphasic species-specific response of variable fluorescence. The changes in ChlF at a steady state (Fs), potential and effective quantum yields of photosystem II (FV/FM, ΦPSII), and nonphotochemical quenching (NPQ) reflected a desiccation-induced inhibition of the photosynthetic processes. The dehydration-dependent fall in FV/FM and ΦPSII was species-specific, starting at an RWC range of 22-32%. The critical RWC for ΦPSII was below 5%. The changes indicated the involvement of protective mechanisms in the chloroplastic apparatus of lichen photobionts at RWCs of below 20%. In both the wet and dry states, the spectral reflectance curves (SRC) (wavelength 400-800 nm) and indices (NDVI, PRI) of the studied lichen species were measured. Black Himantormia lugubris showed no difference in the SRCs between wet and dry state. Other lichens showed a higher reflectance in the dry state compared to the wet state. The lichen morphology and anatomy data, together with the ChlF and spectral reflectance data, are discussed in relation to its potential for ecophysiological studies in Antarctic lichens.

Peripheral adenopathies in children - an attempt of clinical morphological profile.

AIM: The authors have proposed to assess peripheral adenopathies in a series of hospitalized children in order to identify and define clinical and morphological profiles of different types of lymph node (LN) diseases. MATERIALS AND METHODS: The studied group consisted of 58 patients less than 18 years of age. The investigation algorithm included: gender, age, site, involvement, side, extension and histopathological (HP) type of LN lesions. Tissue fragments were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE). In some cases (tuberculous lesions and lymphomas), special stainings (Ziehl-Neelsen) and immunohistochemistry were used. Stratification scales of cases were defined according to each parameter in order to compare the data. All obtained data were assessed individually, compared to each other and with similar data from the literature with the help of a statistical apparatus [χ² (chi-squared) test and analysis of variance (ANOVA) test] in some cases. RESULTS: The young patients were slightly more frequently boys, of all ages but with a mean age of 10 and half years. The affected LNs belonged most often to neck region, either on the left or on the right side but sometimes bilateral or even on the midline; usually, more than one LN was involved in the area. In most of the cases, the lesions were localized in only one LN area. HP picture was dominated by the inflammatory processes, firstly the nonspecific ones, followed by tuberculosis. DISCUSSIONS: Our observations fitted, for each parameter, with the wide ranges found in the literature. Comparisons between parameters' variations revealed differences, sometimes significant that we tried to organize in clinical and morphological profiles. CONCLUSIONS: The assessment of our data allowed us to define some clinical and morphological profiles of different types of adenopathy that, by improvement on studies including larger series, could be of real use in daily pediatric practice.

Characteristics of hypoparathyroidism in Colombia: data from a single center in the city of Medellín.

OBJECTIVE: Hypoparathyroidism is a rare condition, whose most common etiology is complications of neck surgery. The aim of the study was to identify the clinical and biochemical profile of the patients with diagnosis of hypoparathyroidism, including the frequency of symptoms, clinical signs, long-term complications and disease control. Additionally, the study sought to know what the medication profile was, and the doses required by the patients. SUBJECTS AND METHOD: A retrospective cohort study was conducted wherein all patients with ICD-10 codes associated with hypoparathyroidism between 2011 and 2018 at the Hospital Universitario San Vicente Fundación were included. We investigated the etiology of the disease; biochemical profile including lowest serum calcium, highest serum phosphorus, 25OHD levels, calciuria and calcium/phosphorus product; medication doses, disease control, and presence of complications, especially renal and neurologic complications were also evaluated. RESULTS: The cohort included 108 patients (99 women/9 men) with a mean age of 51.6 ± 15.6 years. The main etiology was postoperative (93.5%), the dose of elemental calcium received was relatively low (mean 1,164 mg/day), and in only 9.2% of cases more than 2,500 mg/day of elemental calcium was necessary. We were able to evaluate the follow-up in 89 patients, and found that only 57.3% met the criteria for controlled disease. CONCLUSION: The clinical profile of patients with hypoparathyroidism in our cohort is similar to that described in other international studies, with predominantly postoperative etiology. With standard therapy, only adequate control is achieved in a little more than half of patients. Arch Endocrinol Metab. 2020;64(3):282-9.

Manifestaciones mucocutáneas y su relación con el recuento de linfocitos T CD4 en pacientes infectados con el virus de inmunodeficiencia humana hospitalizados en Medellín, Colombia / Mucocutaneous manifestations and their relationship with CD4 T-lymphocyte count in hospitalized patients infected with the human immunodeficiency virus (HIV) in Medellín, Colombia

Introducción. Entre el 80 y el 95 % de los pacientes infectados por el virus de inmunodeficiencia humana (HIV) desarrollan manifestaciones en la piel que sirven como marcadores de su estado inmunológico. Objetivos. Describir las manifestaciones dermatológicas y los factores clínicos y sociodemográficos de los pacientes hospitalizados con diagnóstico de HIV y su correlación con el recuento de linfocitos T CD4. Materiales y métodos. Se hizo un estudio observacional de corte transversal y retrospectivo a partir del registro de las historias clínicas de 227 pacientes mayores de edad con diagnóstico de HIV, evaluados por dermatología en un hospital de Medellín, Colombia. Resultados. Los 227 registros daban cuenta de 433 manifestaciones dermatológicas, el 64,4 % de ellas infecciosas. Las tres manifestaciones más frecuentes fueron candidiasis oral, condilomas acuminados y reacciones a medicamentos. Se encontró una relación estadísticamente significativa entre el virus del herpes zóster (HZ) diseminado y la sífilis secundaria, con un recuento de CD4 entre 200 y 499 células/mm3 (p=0,04 y 0,028, respectivamente), y entre la candidiasis oral y un recuento de CD4 menor de 100 células/ mm3 (p=0,008). Conclusiones. La relación entre el herpes zóster diseminado y un recuento de CD4 entre 200 y 499 células/mm3 sugiere que, a pesar de los recuentos altos, se pueden presentar formas graves de la enfermedad debido a una posible disfunción de las células T y el agotamiento del sistema inmunológico. La relación entre la candidiasis oral y un recuento de CD4 menor de 100 células/mm3 plantea la posibilidad de considerar esta infección micótica como un marcador importante de debilitamiento inmunológico de los pacientes con HIV.

Introduction. About 80-95% of patients infected with the human immunodeficiency virus (HIV) develop skin manifestations, which are markers of the patients' immune status. Objective. To describe the dermatologic manifestations and the clinical and sociodemographic factors of hospitalized patients diagnosed with HIV and their correlation with CD4 T-lymphocyte count. Materials and methods. We conducted an observational, cross-sectional, and retrospective study of the medical records of 227 adult patients with HIV diagnosis evaluated by dermatology in a hospital in Medellín, Colombia. Results. We included 227 patient records with 433 dermatologic manifestations, 64.4% of them infectious. The most frequent manifestations were oral candidiasis, condylomata acuminata, and drug reactions. Moreover, a statistically significant relationship was found between disseminated herpes zoster virus and secondary syphilis with a CD4 count between 200-499 cells/mm3 (p=0.04 and 0.028, respectively). There was also a statistically significant relationship between oral candidiasis and a CD4 count of less than 100 cells/ mm3 (p=0.008). Conclusions. The relationship between disseminated herpes zoster with CD4 between 200-499 cells/mm3 suggests that, despite having high CD4 counts, severe forms of the disease may occur due to possible T-cell dysfunction and depletion of the immune system. Additionally, the relationship between oral candidiasis and CD4 less than 100 cells/mm3 indicates the potential role of oral candidiasis as an essential marker of weakened immune status in HIV patients.

Síndrome de Brooke-Spiegler asociado a carcinoma basocelular: reporte de caso / Brooke-Spiegler syndrome associated with basal cell carcinoma: case report

El síndrome de Brooke-Spiegler (SBS) es una entidad rara, autosómica dominante, que ocurre por mutaciones del gen CYLD, el cual funciona como supresor de tumores. Se presenta el caso de una mujer de 50 años de edad, con historia de aparición de lesiones características de tricoepiteliomas que predominaban en nariz, región interciliar y mentón, que iniciaron desde los 14 años de edad. Desde hace 5 años refiere aumento del tamaño de lesiones en alas nasales, y una lesión en punta nasal de 2 años de evolución. Al realizarse una correlación clínica e histológica, asociada a los antecedentes familiares de la madre y hermano de la paciente, se concluyó que el cuadro clínico era compatible con tricoepitelioma múltiple familiar, una variante especial del SBS, en este caso asociado a carcinoma basocelular, que aunque no es un hallazgo común, se ha visto que se puede presentar en esta enfermedad. El diagnóstico preciso de SBS requiere de una correlación clínico-histológica, y se debe hacer un seguimiento clínico cercano para detectar cambios en las lesiones en piel, que puedan indicar una transformación maligna

Brooke-Spiegler syndrome (BSS) is a rare autosomal dominant condition that occurs due to mutations in the CYLD gene, which functions as a tumor suppressor gene. The case of a 50-year-old woman with a history of characteristic trichoepitheliomas predominantly in the nose, glabella and chin that began at 14 years of age is presented. She reports an increase in the size of the nasal ala lesions for the past 5 years, and the appearance of a new lesion in the nasal tip 2 years ago. When performing a clinical and histological correlation, associated with family history in both the mother and brother, it was concluded that the diagnosis was compatible with multiple familial trichoepithelioma, a special variant of BSS, associated in this case with basal cell carcinoma, that although not a common finding, has been seen to coexist in this disease. The diagnosis of BSS requires a clinical and histological correlation, and a close clinical follow-up must be performed to detect changes in the skin lesions that may indicate malignant transformation

Squamous esophageal carcinoma and mucinous adenocarcinoma of the colon - an unusual association.

The existence of a simultaneous cancer of the esophagus and colon is a rare situation that recognizes an increased incidence in recent years in the world, probably as a result of the improved measures of diagnosis and treatment, as well as the development of screening programs. The aim of this work is to present a case of synchronous esophageal squamous carcinoma with mucinous adenocarcinoma of the hepatic angle of the colon. The patient was hospitalized to our Surgical Clinic with the thoracic squamous esophageal carcinoma diagnosis. On admission, symptoms were dominated by overall dysphagia, patient showing a weight loss of 10 kg for the last 30 days. Preoperative imaging tests did not revealed regional or distant metastatic disease. Preoperative colonoscopy was incomplete (only until the splenic angle of the left colon) due to the insufficient mechanical preparation. On laparotomy, a carcinoma of the hepatic angle of the colon, partially stenosing was discovered. An upper pole esogastrectomy with intrathoracic esogastrostomy and a right colectomy with ileotransversostomy were practiced, at the same operative session. Postoperative evolution was poor and the patient died on the ninth day from the surgery during an alcohol withdrawal crisis.

Characteristics of hypoparathyroidism in Colombia: data from a single center in the city of Medellín

ABSTRACT Objective Hypoparathyroidism is a rare condition, whose most common etiology is complications of neck surgery. The aim of the study was to identify the clinical and biochemical profile of the patients with diagnosis of hypoparathyroidism, including the frequency of symptoms, clinical signs, long-term complications and disease control. Additionally, the study sought to know what the medication profile was, and the doses required by the patients. Subjects and method A retrospective cohort study was conducted wherein all patients with ICD-10 codes associated with hypoparathyroidism between 2011 and 2018 at the Hospital Universitario San Vicente Fundación were included. We investigated the etiology of the disease; biochemical profile including lowest serum calcium, highest serum phosphorus, 25OHD levels, calciuria and calcium/phosphorus product; medication doses, disease control, and presence of complications, especially renal and neurologic complications were also evaluated. Results The cohort included 108 patients (99 women/9 men) with a mean age of 51.6 ± 15.6 years. The main etiology was postoperative (93.5%), the dose of elemental calcium received was relatively low (mean 1,164 mg/day), and in only 9.2% of cases more than 2,500 mg/day of elemental calcium was necessary. We were able to evaluate the follow-up in 89 patients, and found that only 57.3% met the criteria for controlled disease. Conclusion The clinical profile of patients with hypoparathyroidism in our cohort is similar to that described in other international studies, with predominantly postoperative etiology. With standard therapy, only adequate control is achieved in a little more than half of patients. Arch Endocrinol Metab. 2020;64(3):282-9

Comparative genomics of the protocatechuate branch of the ß-ketoadipate pathway in the Roseobacter lineage.

The protocatechuate branch of the ß-ketoadipate pathway is the most common pathway for degradation of monoaromatic compounds in the Roseobacter lineage. We analyzed 43 Roseobacter genomes in order to determine if they possessed all genetic elements for this pathway and if there were common patterns in gene organization. The eight genes of the pathway (pcaG, -H, -B, -C, -D, -I, -J, and -F), possible regulators, and genes encoding for proteins with related function (i.e. catabolism of 4-hydroxybenzoate, catechol, and meta-cleavage of protocatechuate) were predicted by sequence homology analysis. Most of the Roseobacters studied had putatively a complete protocatechuate branch of the ß-ketoadipate pathway while 11 of them would probably have an incomplete pathway. Thirty-one Roseobacters would be potentially able of transforming 4-hydroxybenzoate to protocatechuate, and 13 of them might transform catechol via ortho-cleavage, the starting reaction of the catechol branch of the ß-ketoadipate pathway. We observed variability in gene organization, with no clear relationship between gene order and Roseobacter taxonomy. Genes were usually organized in several gene clusters. One of the clusters (pcaRIJF) was not reported previously in Roseobacters. The presence of the putative regulator pcaR in these bacteria was also a novel finding. The conserved ORF (chp), encoding for a protein of family DUF849 whose functional role has been proven recently, was detected in 34 genomes. Sequence homology confirmed that proteins encoded by chp corresponded to putative BKACE G4 proteins, which are able to transform ß-ketoadipate. Therefore, most Roseobacters seemed to possess two different enzymes for transforming ß-ketoadipate. We also report two possible regulation mechanisms of gene pobA (encoding for the enzyme transforming 4-hydroxybenzoate to protocatechuate): via PcaQ, the regulator commonly found with pca genes, and via an independent regulator (PobR). The results of this study evidence the relevance of 4-hydroxybenzoate, protocatechuate and ß-ketoadipate degradation pathways in Roseobacters and provide a more complex view of possible regulation mechanisms.

Analysis of aortic size in subjects died due to cardiovascular and non-cardiovascular events: a necropsy study.

Aortic size is known to be a predictor for cardiovascular deaths. The purpose of this study was to investigate whether aortic diameters measured on tissue samples obtained during autopsy from subjects that died of cardiovascular disease were bigger when compared to those from subjects deceased from other cause than cardiovascular disease. The study included 91 deceased subjects (average age 56 ± 18.1 years), which underwent autopsy to determine cause of death. Morphological measurements were completed on 364 aortic specimens obtained from four different sites, namely ascending aorta, aortic arch, distal thoracic aorta and abdominal aorta. Aorta showed the tendency to decrease in diameter from ascending aorta to abdominal aorta, the latter presenting with the smallest diameter. All studied aortic diameters were found to be larger in the cardiovascular population (p<0.01).

Hiponatremia luego de uso de cisplatino: a propósito de un caso / Hyponatraemia after cisplatin use: a case report

Paciente de 26 años con diagnóstico de teratoma inmaduro de ovario derecho. Se le realizó resección del tumor más salpingooforectomía en junio de 2014. Recibió manejo adyuvante con carboplatino y ciclofosfamida por un ciclo en enero de 2015, pero sin respuesta. Se realizó laparotomía exploradora por obstrucción intestinal evidenciándose masa pélvica e implantes peritoneales a nivel hepático. Valoró oncología clínica del INC en febrero del 2015, se inicia manejo con esquema PEB; recibió el primer ciclo sin complicaciones. El segundo ciclo fue retrasado por infección en la pared abdominal. Empezó tratamiento con sodio sérico normal, con posterior descenso sin alteración en el resto de electrolitos, función renal, ni estado ácido base. La paciente no presentó síntomas neurológicos y estuvo euvolémica. Se inició estudio de hiponatremia haciéndose diagnóstico de SIADH. Se indicó manejo con restricción hídrica y dieta hipersódica, con posterior ascenso gradual de niveles séricos de Na, considerándose SIADH secundario a uso de cisplatino.

The case is presented of a 26 year-old patient diagnosed with an immature teratoma of the right ovary. Tumour resection plus salpingo-oophorectomy was performed in June 2014. She received one cycle of adjuvant treatment with carboplatin and cyclophosphamide, but with no response. An exploratory laparotomy was performed due to an intestinal obstruction, which showed a pelvic mass and peritoneal implants at hepatic level. She was assessed in the oncology clinic of the Colombian National Institute (INC) in February 2015, and treatment with a platinol (cisplatin), etoposide, and bleomycin (PEB) scheme was started. She received the first cycle without complications, but the second cycle was delayed due to an infection in the abdominal wall. She started the treatment with a normal serum sodium, with a subsequent decrease with no changes in the rest of the electrolytes, kidney function, or acid-base status. The patient showed no neurological signs and was euvolaemic. A hyponatraemia study was performed, ending up making the diagnosis of inappropriate antidiuretic hormone secretion (IADHS). A water restriction and high sodium diet was indicated, with the subsequent gradual increase in the serum Na levels. The IADHS was considered secondary to the use of cisplatin.

Hallazgos electrocardiográficos en pacientes hipertensos del programa de vigilancia y control de la hipertensión arterial de ASSBASALUD ESE, Manizales, Colombia / Electrocardiographic findings in hypertensive patients of the hypertension surveillance and control program at ASSBASALUD ESE, Manizales, Colombia

Antecedentes. La hipertensión arterial sistémica es una enfermedad multifactorial que incluye la elevación de las cifras de tensión arterial, factores de riesgo cardiovascular e hipertrofia ventricular izquierda. Objetivo. Analizar los cambios electrocardiográficos en pacientes hipertensos inscritos en el programa de hipertensión arterial en ASSBASALUD Empresa Social del Estado, Manizales, Colombia, 2012. Materiales y métodos. Estudio poblacional de corte transversal. 102 pacientes. Variables electrocardiográficas analizadas: índices de Cornell, Sokolow Lyon y Macruz; cambios en la onda P y cambios en el eje. Se tomó electrocardiograma. Resultados. Edad promedio de 62 años. El 58,5% de los pacientes estudiados se clasificaron como pre-hipertensos, el 18,6% tenían frecuencia cardíaca superior a 100 latidos por minuto. Se encontraron cambios en la onda P en el 26,3%. En el 34% el eje estaba desviado. 64,6% tenían índice de Macruz anormal. 10,8% mostraron aumento en el voltaje del índice Sokolow-Lyon. En un 10,8% el voltaje de Cornell estaba elevado. En un 5,1% la fuerza terminal de onda P fue mayor a 40. Un 7,8% tenían bloqueos de rama derecha. En los pacientes con niveles altos de la presión arterial se encontró relación significativa con la elevación en los índices de Cornell (p=0,000) y de Sokolow-Lyon (p=0,016). Se encontró relación significativa entre los valores elevados de la presión arterial sistólica y los cambios en los índices de Cornell (p=0,010) y Sokolow-Lyon (p=0.001), los valores de la presión arterial diastólica se asociaron más a cambios en el Sokolow-Lyon (p=0,001). Conclusiones. Se confirma en esta población de hipertensos la asociación entre hipertensión arterial y cambios electrocardiográficos, especialmente en los índices de Cornell y de Sokolow-Lyon.

Background. Systemic blood pressure (HBP) is a multifactorial disease that includes elevated blood pressure levels, cardiovascular risk factors and left ventricular hypertrophy. Objective. To analyze the electrocardiographic changes in hypertensive patients enrolled in the hypertension surveillance and control program at ASSBASALUD ESE, Manizales, Colombia in 2012. Materials and methods. Cross-sectional study that involved 102 patients. The variables used were electrocardiogram indexes as Cornell, Sokolow Lyon, Macruz and P wave duration. It took a 12-lead electrocardiogram for each patient executed at ASBASALUD ESE, La Asunción. Results. The average age was 62 years, 58.5% were in the prehypertension range, also 18.6% had abnormal heart rate, 26.3% abnormal P wave duration, 34% abnormal cardiac axis, 64.6% abnormal Macruz index, 10.8% abnormal Sokolow-Lyon index, 10.8% abnormal Cornell index, 5.1% positive P-wave terminal force, 7.8% had right bundle branch block. The rank of hypertension showed significant relationship with the level of Cornell (p=0.000) and Sokolow-Lyon (p=0.016) indexes. A significant relationship between systolic blood pressure value and Cornell (p=0.010) and Sokolow-Lyon indexes were found (p=0.001), likewise diastolic blood pressure value and Sokolow-Lyon index value showed relationship (p=0.001). Conclusions. It is confirmed, in this population of hypertensive patients, that the indexes show variation according to level of hypertension, as well with the values of systolic and diastolic blood pressure are Cornell and Sokolow-Lyon indexes.

Diagnóstico de acromegalia / Acromegaly diagnosis

Resumen: La acromegalia como entidad clínica se ha reconocidodesde la antigüedad, es considerada una enfermedad de bajaincidencia pero con grandes repercusiones en cuanto a morbilidad,mortalidad y enfermedades asociadas. En la actualidad siguesiendo un reto su diagnóstico debido a que los síntomas y signosconsiderados como patognomónicos son de aparición lenta y sutil,por lo que se requiere de una alta sospecha y experticia clínica enel personal de salud que se enfrenta al paciente con acromegalia,particularmente en una fase temprana de la enfermedad. Enel presente artículo se hace un recorrido por los pasos que sedeben seguir para establecer el diagnóstico de acromegalia en unpaciente sospechoso, haciendo especial énfasis en las mediciones hormonales requeridas.

Abstract: Acromegaly as a clinical entity has been recognized sinceancient times, it is considered a disease of low incidence but withgreat impact in terms of morbidity, mortality and associated diseases.Today its diagnosis remains a challenge because pathognomonicsymptoms and signs are of slow onset and subtle, so it requiresa high index of suspicion and clinical expertise from the healthpersonnel who faces the patient with acromegaly, particularly atan early stage of the disease. This article will go through the stepsto establish the diagnosis of acromegaly in a suspect patient, withspecial emphasis on the required hormonal measurements.

Risk score for pediatric intensive care unit admission in children undergoing hematopoietic stem cell transplantation and analysis of predictive factors for survival.

The authors retrospectively analyzed postransplantation events in 198 children who underwent hematopoietic stem cell transplantation (HSCT) between 1998 and 2002 to obtain a risk score for pediatric intensive care unit (PICU) admission and to ascertain variables predicting a poor outcome. Thirty-six patients (18%) were admitted to the PICU. Median age was 9 years (range 1-18). On univariate analysis, variables significantly associated with PICU admission were male gender (P = 0.01), more than first complete remission (P = 0.003), allogeneic transplantation (P = 0.001), engraftment syndrome (P = 0.03), and acute graft-versus-host disease grade of at least two (P = 0.05). According to this, patients were divided in two levels of risk (low and high), with a respective probability of PICU admission of 8.8 +/- 2.2% and 63.8 +/- 8.8% (P < 0.0001). Seventeen (47%) patients were discharged from the PICU. The probability of event-free survival after PICU admission at 3 years was 24.2 +/- 7%. On univariate analysis, variables with a negative impact on event-free survival were type of transplantation, inotropic support, a C-reactive protein level of at least 10 mg/dL, and a high O-PRISM score. On multivariate analysis, the only variable that influenced event-free survival was the O-PRISM score (< or =10 points, 54.6 +/- 15.3%; >10 points, 8.6 +/- 5.8%; P = 0.007). In conclusion, the risk of PICU admission may be easily estimated using simple variables. A high O-PRISM score at the time of PICU admission predicts a dismal outcome.

Predicting factors for admission to an intensive care unit and clinical outcome in pediatric patients receiving hematopoietic stem cell transplantation.

BACKGROUND AND OBJECTIVES: In children, hematopoietic stem cell transplantation (HSCT) implies life-threatening complications and some patients need admission to a pediatric intensive care unit (PICU). Few studies have been reported analyzing this issue in a pediatric population and most focused on risk factors predicting survival following PICU admission. DESIGN AND METHODS: We examined data of 240 pediatric patients who received HSCT (100 allogeneic and 140 autologous) in order to ascertain the incidence of life-threatening complications requiring PICU admission, the contributing risk factors and the patients' long-term survival. RESULTS: Forty-two (17.5%) (25 males and 17 females) of the transplanted children were admitted to the PICU. Twenty-nine of them (69%) had received an allogeneic transplant and thirteen (31%) an autologous transplant. Their median age was 7 years (range; 1-18). The most frequent reason for admission was respiratory failure (37 cases, 88%). The overall probability of developing complications requiring PICU admission was 21.2% (33.5% for allogeneic transplantation and 10.1% for patients receiving autologous grafts, p=0.0002). On univariate analysis, only the type of transplantation was significantly associated with PICU admission (allogeneic vs autologous RR 1.92, 95% CI: 1.46-2.53)(p = 0.0001). In allogeneic transplants, only the underlying disease (non-malignant) and the status of disease at transplantation within malignant diseases (advanced phase) were pretransplant variables associated with PICU admission. Post-transplantation risk factors were presence of graft-versus-host disease (GvHD) (p = 0.046) and its grade (II-IV) (p = 0.002), as well as the presence of multiorgan dysfunction during the early post-infusion phase especially when the lung was the first failing organ (p = 0.0001). However, on multivariate analysis, only severe GvHD was statistically significant. In the autologous transplantation group, the underlying disease (solid tumor, p = 0.07) and status at transplantation (advanced phase, p = 0.0029) were the only risk factors. In the post-transplant phase, patients who develop multiorgan dysfunction during the neutropenic period and those with engraftment syndrome had an increased risk of requiring critical care. The overall event-free survival (EFS) at 3 years was 15.3%, (18.4% for autologous transplant recipients and 13.7% for those receiving an allogeneic graft, p = 0.4). Using a Cox regression model, multiorgan failure (MOF) present at admission was the only variable that had a negative impact on EFS (4.28% vs 35.71% for patients with no MOF, p = 0.016). INTERPRETATION AND CONCLUSIONS: Despite high mortality, intensive care support can be beneficial for pediatric patients with life-threatening complications following HSCT. However, for patients with multiorgan failure involving the lungs, admission to the PICU should be avoided.

Traqueomegalia y artririts reumatoide / Traqueomegalia and rheumatoid arthritis

La traqueo-broncomegalia es una rara condición de etiología desconocida que ha sido descrita en asociación con enfermedades del tejido conectivo ocasionalmente. Presentamos un caso de traqueomegalia en una paciente con artritis reumatoide de larga evolución. Este es el segundo caso reportado en la literatura médica hasta ahora. La asociación entre estas patologías es incierta y no se puede establecer una clara relación fisiopatológica debido a la rareza de su ocurrencia y el inicio tardío de los síntomas.

Tracheobronchomegaly is a rare condition of unknown etiology that has been described in association with connective tissue diseases. We present a case of tracheomegaly in a patient with a long evolution rheumatoid arthritis. This is the second case reported in the medical literature until now. Association between these pathologies is uncertain and we can not establish a clear pathophysiological link due to the rarity of its occurrence and the late onset of symptoms.