Development and validation of a stressor-coping style scale for students in a public medical school

Background@#The medical curriculum is one of the most stressful academic curricula worldwide. Studies indicate that great levels of stress, that encompass academics to personal life, may be connected to a number of worrying statistics for the mental health of Philippine medical students.@*Objectives@#To develop a validated stressor-coping style scale for students in a public medical school.@*Methods@#The study employed a sequential mixed-methods design. An open-ended questionnaire was used to determine the common stressors and coping styles through convenience sampling. A scale was constructed from this data and was statistically tested for concurrent validity and reliability from a random sample.@*Results@#Following thematic analysis, an initial six stressor domains and eleven coping mechanisms were identified. However, after item analysis and principal component analysis of responses, the scale was transformed to seven stressor domains and five coping mechanism domains. All of which are deemed internally consistent (α>0.6). Scores from the scale were also convergent with the scores of Brief COPE (r=0.5 to 0.9). @*Conclusions@#The developed stressor-coping style scale for medical students is a reliable and valid tool for Filipino medical students in a public medical school.

Estructura de las comunidades de briófitos en los complejos de páramos de Boyacá-Colombia / Structure of bryophyte communities in the paramo complexes of Boyacá-Colombia

Introducción: Los páramos de Boyacá cubren el 18.3 % de la superficie de Colombia, y son diversos en flora y fauna, además, registran una alta variabilidad climática, topográfica y de hábitats, que permite que estos ecosistemas sean centros de diversidad en el Neotrópico, y por tanto albergan una alta diversidad de briófitos. Objetivo: Analizar la estructura y composición de las comunidades de briófitos de los complejos de páramos de Boyacá. Métodos: a partir de información de literatura, bases de datos y revisión de herbarios, se evaluó la composición florística y la completitud de muestreo para los complejos de páramos y sustratos. Resultados: Se encontraron 5 132 ejemplares, con 343 especies de musgos que fue el grupo más diverso, 256 hepáticas y dos antocerotes. El análisis de completitud de muestreo es representativo en un 98 %. Además, encontramos que la preferencia de sustratos es el terrícola con 409 especies y el cortícola con 341. La diversidad alfa del orden 0D mostró que Tota-Bijagual-Mamapacha (TBM) es el complejo más diverso con 368 especies, y Pisba (124) el menos diverso; el índice 1D mostró que el complejo (TBM) presentó 178 especies consideradas comunes, y la dominancia de especies (2D) fue mayor en el complejo Iguaque-Merchán con 119 taxa dominantes y en menor número Guantiva-La Rusia (105) y TBM (102). Conclusiones: El análisis de la diversidad beta mostró que el 62 % de la disimilitud en la composición de especies entre los complejos se debe al recambio de especies, igualmente sucede con la divergencia por sustratos que es del 51 %. Los briófitos en los páramos de Boyacá representan el 36.05 % de la diversidad colombiana, y el 2.96 % a nivel mundial.

Introduction: The Boyacá paramos cover 18.3 % of the Colombian surface, and are diverse in flora and fauna, moreover, have a high temperature, topography, and habitats, which allow these ecosystems to be centers of diversity in the Neotropics, and therefore they harbor a high diversity of bryophytes. Objectives: Analyze the structure and composition of the bryophyte communities of the paramos in the Boyacá complexes. Methods: Using literature, databases and herbariums records, the floristic composition, and the completeness of the sampling for the paramo and substrate complexes was evaluated. Results: We analyzed 5 132 specimens, with 343 species of mosses being the most diverse group, 256 liverworts and two hornworts. The sampling completeness analysis is 98 % representative. In addition, we found that the preference of substrates is terrestrial with 409 species and corticolous with 341. Alpha diversity of order 0D showed that Tota-Bijagual-Mamapacha (TBM) is the most diverse complex with 368 species, and Pisba (124) the least diverse; the 1D index showed that the complex (TBM) presented 178 species considered common, and the dominance of species (2D) was higher in the Iguaque-Merchán Complex with 119 dominant taxa and Guantiva-La Russia (105) and TBM (105) to a lesser number. (102). Conclusions: the analysis of beta diversity showed that 62 % of the dissimilarity in the composition of species between the complexes is due to the species turnover, the same happens with the divergence by substrates that is 51 %. Bryophytes in the Boyacá paramos represent 36.05 % of Colombian diversity, and 2.96 % worldwide.

Serie de casos de sangrado intraluminal postoperatorio en colectomía izquierda / Case series of postoperative intraluminal bleeding in left colectomy

Introducción: El sangrado digestivo intraluminal postoperatorio es una entidad poco frecuente y su manifestación clínica no difiere de la hemorragia digestiva baja de otra etiología. A pesar de que su presentación más habitual es la hematoquecia autolimitada en la primera deposición, en un discreto porcentaje puede requerir transfusiones, tratamiento endoscópico, hemodinámico, o incluso cirugía. Objetivo: Analizar los pacientes con sangrado digestivo intraluminal postoperatorio tratados en un centro de alta complejidad y realizar una revisión bibliográfica del tema. Diseño: Estudio retrospectivo, descriptivo. Material y métodos: Pacientes con sangrado anastomótico durante el post operatorio inmediato de una colectomía izquierda, operados en el Servicio de Cirugía General y Coloproctología desde enero del 2017 a diciembre del 2021. Las variables estudiadas fueron edad, sexo, anticoagulación y su causa, descenso de hemoglobina, cirugía realizada y su indicación, vía de abordaje, configuración de la anastomosis, electividad de la cirugía, complicaciones, días de internación y manejo terapéutico. Resultados: Se incluyeron 4 pacientes con una edad media de 72 (rango 54-87) años y una distribución por sexo de 1:1. En todos la colectomía izquierda fue programada y en 3 el abordaje fue laparoscópico. La anastomosis fue termino-terminal con sutura mecánica circular. Todos los pacientes presentaron sangrado en las primeras 24 horas postoperatorias. El tratamiento fue decidido de acuerdo a la condición hemodinámica: en los 2 pacientes con estabilidad hemodinámica fue suficiente el tratamiento conservador con reanimación y transfusiones. Los otros 2 que presentaron inestabilidad hemodinámica requirieron manejo intervencionista con endoscopía rígida, videocolonoscopía y cirugía. Conclusión: El sangrado intraluminal es una complicación poco frecuente de la anastomosis colorrectal que requiere manejo intervencionista solo en los pacientes que presentan inestabilidad hemodinámica. (AU)

Introduction: Postoperative intraluminal gastrointestinal bleeding is a rare entity and its clinical manifestation does not differ from lower gastro-intestinal bleeding of another etiology. Despite the fact that its most common presentation is self-limited hematochezia at the first stool, in a small percentage it may require transfusions, endoscopic or hemodynamic management, or even surgery. Aim: To analyze the patients with postoperative intraluminal gastrointestinal bleeding treated in a tertiary center and to carry out a bibliographic review of the subject. Design: Retrospective descriptive study. Material and methods: Patients with immediate postoperative anastomotic bleeding from a left colectomy, operated on at the General Surgery and Coloproctology Service from January 2017 to December 2021 were included. The variables recorded were age, sex, anticoagulation and its cause, decrease in hemoglobin, procedure performed and its indication, surgical approach, type of anastomosis, electiveness of surgery, complications, hospital stay and management. Results: Four patients with a mean age of 72 (range 54-87) years and a 1:1 gender distribution were included. All procedures were elective and 3 laparoscopic. All anastomoses were performed end-to-end with a circular stapler. All patients presented bleeding in the first 24 postoperative hours. The treatment was decided according to the hemodynamic condition; patients with hemodynamic stability (2) received medical treatment while those with hemodynamic instability (2) required interventional management with rigid endoscopy, colonoscopy and surgery. Conclusion: Intraluminal bleeding is a rare complication of colorectal anastomosis that requires interventional management only in patients with hemodynamic instability. (AU)

Differences in the distribution of hemoglobin variants according to the geographic regions in a Colombian population

ABSTRACT Introduction: Colombia has been subject to intense genetic and cultural currents due to its geographical location. Hemoglobinopathies are the most common recessive diseases found worldwide and represent an important public health problem, according to the region and ancestry of each country. Objectives: To evaluate the frequency of hemoglobin variants according to the geographical region in a population group adjusted to sex and age in Colombia. Methods: This was a descriptive retrospective study of hemoglobin variants performed by electrophoresis in patients treated at and/or referred to specialized care institutions in Bogota, Colombia between January 2009 and December 2020. Results: A total of 2,224 results were analyzed, 48.4% male and 51.5% female; 63.3% of patients were without alterations, 14.3% presented with thalassemia, 17.3%, HbS, 2.3%, HbS/C, 1.8%, HbC, 0.5%, HbE and 0.5% persistent HbF, with HbS being more prevalent in males (p = 0.005). When assessing the geographical regions of Colombia, a higher prevalence of HbS was found in the Pacific (p = 0.005) and Caribbean regions, while Thalassemia and HbS were more prevalent in the Andean and Orinoquia regions, and it was rare to find any hemoglobinopathies (p = 0.0001) in the Amazonian region. Conclusions: The main hemoglobinopathies found in Colombia are HbS, predominantly in males, and Thalassemia. The distribution of hemoglobinopathies in different geographical regions of Colombia is influenced by ancestry.

Exposición a pantallas de niñas, niños y adolescentes: recomendaciones, límites y controversias en el marco del distanciamiento social obligatorio: un estudio cualitativo / Child and Teenage Screen Exposure: Recommendations, Limits,and Controversies in the Context of Enforced Social Distancing: a Qualitative Study

Introducción: la utilización de pantallas durante la niñez y la preocupación por su potencial daño aumentaron en los últimos años. La recomendación de no superar dos horas diarias de uso resultó controvertida durante la pandemia por COVID-19. El objetivo principal de esta investigación fue explorar las opiniones y actitudes de los profesionales con respecto al uso de pantallas y comprender cómo se modificaron durante dicha pandemia. Materiales y métodos: estudio exploratorio con enfoque cualitativo y estrategia de teoría fundamentada, realizado entre 2020 y 2021.Participaron 23 profesionales (pediatras y generalistas) en cuatro grupos focales. Se realizaron lecturas del material desgrabado para interpretación del contenido. El análisis incluyó la generación de códigos que fueron agrupados en cinco ejes temáticos. Resultados: los ejes resultantes fueron: 1) temática de las pantallas en la consulta ambulatoria de niños sanos, 2) percepción sobre daños, 3) percepción sobre beneficios, 4) pantallas en épocas de ASPO (Aislamiento Social Preventivo y Obligatorio) y 5) pensamientos y acciones contradictorios sobre el uso de pantallas. Discusión: a la hora de recomendar sobre exposición a pantallas, en nuestros entrevistados predominó la intuición personal por sobre la evidencia científica disponible. Reconocieron que el contexto de ASPO visibilizó algunos beneficios asociados a la conectividad que brindan estos dispositivos. Conclusión: nuestros resultados muestran que la percepción sobre las pantallas se está volviendo cada vez más neutral en términos del balance entre sus riesgos y beneficios, conduciendo a que los profesionales sean más flexibles en sus recomendaciones al respecto. (AU)

Introduction: screen use during childhood and potential harm concerns have increased in recent years. Advice not to allow more than two hours of screen use per day was contested during the COVID-19 pandemic. The primary purpose of this research was to probe the opinions and attitudes of professionals regarding the use of screens and to understand how these changed during the pandemic. Materials and methods: this exploratory study, with a qualitative approach and theory-based strategy, was made between 2020 and 2021, and involved the participation of 23 professionals (pediatricians and general practitioners) in four focus groups. The recorded material was analyzed for content interpretation. The analysis included generating codes that were grouped into five thematic areas. Results: the resulting axes were: 1) the issue of screens in the outpatient practice of healthy children; 2) perception of harm; 3) perception of benefits; 4) screens in times of Preventive and Compulsory Social Isolation (ASPO, for its acronym in Spanish); and 5) contradictory thoughts and actions on the use of screens. Discussion: when making recommendations regarding screen exposure, the interviewees' intuition predominated over available scientific evidence. They recognized that the ASPO context highlighted some of the benefits associated with the connectivity provided by these devices. Conclusion: our results show that awareness of screen displays is becoming increasingly neutral concerning the trade-off between their risks and benefits, prompting practitioners to become more flexible in their recommendations. (AU)

Cardioverter-defibrillator reduces mortality risk in eligible ischemic and non-ischemic cardiomyopathy patients: Sub-analysis of the multi-center Improve SCA study

Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38e0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33e.0.88, p ¼ 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p 0.263). Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.

Manifestaciones orales de la infección por COVID-19

Las secuelas y consecuencias de la COVID-19 son múltiples y engloban disímiles aspectos, con gran impacto negativo para los sistemas sanitarios y la humanidad. En tal sentido, poseer información actualizada y pertinente favorece al arduo enfrentamiento a esta pandemia. Este trabajo tiene el propósito de actualizar los conocimientos sobre las manifestaciones orales de la infección por COVID-19. A propósito de este tema, se realizó una revisión bibliográfica. La búsqueda se ejecutó a través de Google Académico, SciELO y otras fuentes de información de la Biblioteca Virtual de Salud de Cuba. El impacto de la COVID-19 en la salud oral está determinado por el sistema inmunológico del paciente, la farmacoterapia que recibe y la patogenia del virus. Predominan los síntomas de sequedad de boca, hipogeusia, disgeusia y ageusia, incluso antes de los síntomas respiratorios. Entre otras manifestaciones se encuentra la candidiasis orofaríngea, presente en aproximadamente el 5 % de los pacientes en días posteriores al diagnóstico. Las principales manifestaciones orales relacionadas a la COVID-19 reportadas en la literatura son: hiposalivación, xerostomía, ageusia, hipogeusia, disgeusia, lesiones herpéticas y candidiasis.

The aftereffect and consequences of COVID-19 are multiple and include dissimilar aspects, with a great negative impact on health systems and humanity. In this sense, having updated and relevant information favors the arduous confrontation with this pandemic. The purpose of this research is updating knowledge about the oral manifestations of COVID-19 infection. A bibliographical review was carried out. The search was carried out through Google Scholar, SciELO and other information sources from the Cuba Virtual Health Library. The impact of COVID-19 on oral health is determined by the patient's immune system, the pharmacotherapy they receive, and the pathogenesis of the virus. Symptoms of dry mouth, hypogeusia, dysgeusia, and ageusia predominate, even before respiratory symptoms. Other manifestations include oropharyngeal candidiasis; appear approximately in 5% of patients, days after diagnosis. The main oral manifestations related to COVID-19 reported in the literature are: hyposalivation, xerostomia, ageusia, hypogeusia, dysgeusia, herpetic lesions, and candidiasis.

Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature / 中华创伤杂志(英文版)

PURPOSE@#Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales.@*METHODS@#The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction.@*RESULTS@#A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities.@*CONCLUSIONS@#Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.

Flow Diverter Treatment for Non-Ruptured Carotid Aneurysms: Efficacy and Safety / 신경중재치료의학

Purpose@#Internal carotid artery (ICA) aneurysm treatment with a flow diverter (FD) has shown an adequate efficacy and safety profile, presenting high complete occlusion or near occlusion rates with low complications during follow-up. The purpose of this study was to evaluate the efficacy and safety of FD treatment in non-ruptured internal carotid aneurysms. @*Materials and Methods@#This is a retrospective, single-center, observational study evaluating patients diagnosed with unruptured ICA aneurysms treated with an FD between January 1, 2014, and January 1, 2020. We analyzed an anonymized database. The primary effectiveness endpoint was complete occlusion (O’Kelly–Marotta D, OKM-D) of the target aneurysm through 1-year follow-up. The safety endpoint was the evaluation of modified Rankin Scale (mRS) 90 days after treatment, considering a favorable outcome an mRS 0-2. @*Results@#A total of 106 patients were treated with an FD, 91.5% were women; the mean follow- up was 427.2±144.8 days. Technical success was achieved in 105 cases (99.1%). All patients included had 1-year follow-up digital subtraction angiography control; 78 patients (73.6%) completed the primary efficacy endpoint by achieving total occlusion (OKM-D). Giant aneurysms had a higher risk of not achieving complete occlusion (risk ratio, 3.07; 95% confidence interval, 1.70 - 5.54]). The safety endpoint of mRS 0-2 at 90 days was accomplished in 103 patients (97.2%). @*Conclusion@#Treatment of unruptured ICA aneurysms with an FD showed high 1-year total occlusion results, with very low morbidity and mortality complications.

Guía colombiana de práctica clínica para el diagnóstico y tratamiento del incidentaloma adrenal / Colombian clinical practice guideline for diagnostic and treatment of adrenal incidentaloma

Objetivo: Brindar recomendaciones actualizadas a urólogos y profesionales de la salud involucrados en el diagnóstico y manejo del incidentaloma adrenal. Métodos: Mediante la adopción de la guía para manejo de incidentaloma adrenal de la Sociedad Europea de Endocrinología (AGREE-II y AGREE-REX) y búsqueda complementaria de literatura basada en la mejor evidencia científica disponible en definición, diagnóstico, manejo quirúrgico y seguimiento. Adicionalmente, esta guía aborda pacientes con incidentalomas bilaterales y embarazadas. Resultados: Incidentaloma adrenal se define como una lesión mayor de 1 cm localizado en la suprarrenal, detectada mediante una imagen realizada por una razón diferente a cualquier sospecha de patología adrenal. La gran mayoría son adenomas no funcionantes, que no representan riesgo y no requieren manejo adicional. Sin embargo, existen lesiones tumorales como el carcinoma adrenocortical, el feocromocitoma, adenomas productores de hormonas o metástasis. Conclusiones: Los incidentalomas adrenales son masas predominantemente benignas que no requieren adrenalectomía, no obstante se requiere estudiarlas para descartar patologías que requieran manejo específico. Enfáticamente, la intervención quirúrgica debe guiarse por la probabilidad de malignidad, grado de secreción hormonal, edad, estado de salud y preferencia del paciente.

Objective: To provide updated recommendations to urologists and health-care providers faced to diagnosis and treatment of adrenal incidentaloma. Methods: Through adoption of the adrenal incidentaloma guideline from European Endocrinology Society (AGREE-II and AGREE-REX), and complementary search of literature based on available high-quality scientific evidence for definition, diagnosis, surgical management and follow-up. Additionally, this guideline covers bilateral adrenal incidentalomas and pregnant women. Results: Adrenal incidentaloma is defined as a lesion greater than 1 cm localized in adrenal gland, detected by imaging studies which are requested for another different reason than an adrenal pathology suspicion. A great majority are non-functional adenomas, without life-threatening risk nor additional treatment necessity. However, there are tumoral lesions that demand appropriate management like adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastasis. Conclusions: Adrenal incidentalomas predominantly are benign masses that do not require adrenalectomy (specially in asymptomatic, unilateral, non-functioning adrenal mass), nevertheless, must be exclude other harmful pathologies. Emphatically, surgical treatment must be indicated by malignant probability, hormonal-secreting status, age, health condition, and patient's preference.

Guía colombiana de tuberculosis genitourinaria / Colombian clinical practice guideline for urogenital tuberculosis

Objetivo: Brindar recomendaciones actualizadas en el diagnóstico, así como en el tratamiento médico y quirúrgico, para urólogos y profesionales de la salud atendiendo pacientes con tuberculosis genitourinaria. Método: Revisión sistemática de la literatura sobre tuberculosis urogenital definiendo preguntas de trabajo con esquema PICO para temas como epidemiología, fisiopatología, diagnóstico, manejo médico y quirúrgico de la enfermedad, y secuelas. Resultados: La tuberculosis genitourinaria presenta una incidencia aproximada del 20%, aunque se estima que hay subregistro importante. En Colombia, la tuberculosis es endémica, pero no hay guías para el diagnóstico y el manejo de este compromiso urogenital, por lo que son una necesidad. La tuberculosis genitourinaria debe sospecharse en pacientes con cuadros inflamatorios o infecciosos urinarios recurrentes, con o sin alteración estructural del tracto genitourinario, sin respuesta al tratamiento farmacológico convencional, sin causa clara o con nexo y factor de riesgo epidemiológico identificado. Puede diagnosticarse por medio de pruebas bacteriológicas, serológicas, moleculares o histopatológicas. En cada caso se requiere una evaluación imagenológica adecuada para determinar el compromiso orgánico o las secuelas, así como la estrategia para el manejo quirúrgico. Conclusiones: La tuberculosis genitourinaria es una condición infectocontagiosa, problema de salud pública, que concierne con gran interés a Colombia. Puede afectar cualquier órgano del tracto genitourinario femenino y masculino. El tratamiento médico oportuno tiene los mejores resultados y las menores tasas de necesidad quirúrgica y de secuelas. El abordaje diagnóstico y terapéutico estandarizado busca mejorar los resultados clínicos, la calidad de vida y la oportunidad del paciente con sospecha de esta enfermedad.

Objective: To provide updated recommendations in diagnosis, as well as for medical and surgical treatment focused on urologists and health-care professionals participating actively in care for urogenital tuberculosis. Method: Systematic review of literature on urogenital tuberculosis, previously defining working clinical questions with PICO scheme for topics such as epidemiology, pathophysiology, diagnosis, medical and surgical therapeutics for the disease. Results: Genitourinary tuberculosis has an incidence of approximately 20%, although a significant underreporting is estimated. In Colombia, tuberculosis infection is endemic, but there are no guidelines focused on this urogenital involvement, so there is a necessity. Urogenital tuberculosis should be suspected in patients with recurrent urinary inflammatory or infectious conditions, with or without structural alterations of genitourinary tract, who do not respond to conventional pharmacological treatment, with no apparent cause or have identified epidemiological link and risk factors. Diagnosis can be made by serological, bacteriological, molecular tests or histopathology. In each case, adequate imaging evaluation is mandatory to determine organ involvement, sequelae, and as strategy for surgical treatment. Conclusions: Genitourinary tuberculosis is an infectious disease, a public health issue, which concerns Colombia. It can affects any female and male urogenital tract organic tissue. Timely pharmacological management offers and has the best clinical results and lowest rates of surgical need or sequelae. The standardized diagnostic and therapeutic approach seeks to improve clinical outcomes, quality of life and opportunity for patients with suspected disease.

Abordaje transcervical en el síndrome de Eagle. Reporte de caso clínico / Transcervical Approach in Eagle Syndrome. Clinical Case Report

Resumen El síndrome de Eagle es una enfermedad rara responsable de múltiples síntomas de cabeza y cuello, resultado de un alargamiento del proceso estiloideo u osificación del ligamento estilohioideo comprimiendo estructuras neurovasculares adyacentes, hay dos variantes, el clásico caracterizado principalmente por dolor y disfagia y la variante carotídea distinguido con dolor y en ocasiones isquemia cerebral. Describimos un reporte de caso clínico de un paciente femenino de 45 años, quien experimentaba dolor cervical de lado izquierdo, realizando el protocolo completo de dolor miofascial del Hospital Regional General Ignacio Zaragoza ISSSTE de la Ciudad de México, el estudio de tomografía computada evidenció una elongación de 50mm del proceso estiloideo, confirmando el diagnóstico, enfocando el artículo en la descripción anatómico-quirúrgica.

Abstract Eagle syndrome is a rare disease responsible for multiple head and neck symptoms, resulting from an elongation of the styloid process or ossification of the stylohyoid ligament compressing adjacent neurovascular structures. There are two variants, the classic one characterized mainly by pain and dysphagia and the carotid variant distinguished with pain and sometimes cerebral ischemia. We describe a clinical case report of a 45-year-old female patient, who experienced left cervical pain, performing the complete myofascial pain protocol of the Regional Hospital "General Ignacio Zaragoza" ISSSTE in Mexico City, resulting in a 50mm elongation of the styloid process in the CT scan, confirming the diagnosis, and focusing the article on the anatomical-surgical description.

2021 clinical practice guideline for the early detection, diagnosis, treatment, and monitoring of patients with axial spondyloarthritis. Colombian Association of Rheumatology / Guía de práctica clínica 2021 para la detección temprana, el diagnóstico, el tratamiento y el seguimiento de los pacientes con espondiloartritis axial. Asociación Colombiana de Reumatología

Abstract Introduction: Axial spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. Objective: To develop a set of recommendations based on the best available evidence for the early detection, diagnosis, treatment, and monitoring of adult patients with axial spondy-loarthritis. Methods: A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations on diagnosis (n=2), pharmacological treatment (n=6), non-pharmacological treatment (n=2) and monitoring (n=1) are presented. Results: Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A are recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. Conclusions: This set of recommendations provides an updated guideline for the diagnosis, treatment, and monitoring of patients with axial spondyloarthritis.

RESUMEN Introducción: La espondiloartritis axial es una enfermedad reumatológica que afecta a individuos jóvenes y tiene una gran repercusión sociolaboral. El retraso en el diagnóstico y el tratamiento se asocia con un mayor deterioro funcional y un impacto negativo en la calidad de vida, por lo que requiere un abordaje multidisciplinario. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para la detección temprana, el diagnóstico, el tratamiento y el seguimiento de los pacientes adultos con espondiloartritis axial. Métodos: Se configuró un grupo desarrollador, se formularon preguntas clínicas contestables, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado, minimizando el sesgo por conflictos de intereses. Se utilizó la aproximación Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la calidad de la evidencia, al igual que la dirección y la fortaleza de las recomendaciones. Se presentan 11 recomendaciones relacionadas con diagnóstico (n = 2), tratamiento farmacológico (n = 6), tratamiento no farmacológico (n = 2) y seguimiento (n = 1). Resultados: Se recomienda la radiografía de articulaciones sacroilíacas como primer método diagnóstico, y el uso de escalas de actividad para el seguimiento de los pacientes (ASDAS o BASDAI). Los antiinflamatorios no esteroideos son la primera opción de tratamiento; en caso de intolerancia o dolor residual se recomienda acetaminofén u opioides. En pacientes con compromiso axial se recomienda abstenerse de utilizar medicamentos antirreumáticos modificadores de la enfermedad convencionales ni glucocorticoides sistémicos o locales. En pacientes con falla a los antiinflamatorios no esteroideos, se recomienda un anti-TNFα o un anti-IL17A. En pacientes con falla a anti-TNFα, se recomienda iniciar un anti-IL17A. El ejercicio y la terapia física y ocupacional se recomiendan como parte del tratamiento. Se recomienda no utilizar las terapias no convencionales como única opción de tratamiento. Conclusiones: Este conjunto de recomendaciones proporciona una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis axial.

Current Evidence About the Role of Animais in the Transmission of Sars-Cov-2: Implications for Public Health / Evidencia Actual sobre el Papel de los Animales en la Transmisión del Sars-Cov-2: Implicaciones para la Salud Pública / Evidências Atuais sobre o Papel dos Animais na Transmissão do Sars-Cov-2: Implicações para a Saúde Pública

Abstract Introduction: The SARS-CoV-2 is the denomination of the new betacoronavirus, which was discovered and isolated for the first time in Wuhan, China, at the end of December 2019, and it is the causal agent of the sanitary emergency of the COVID-19 pandemic. Experimental studies have shown susceptibility to infection in pets (dogs and cats). Objective: To present the current information available on SARS-CoV-2 in animals under the care of humans that have been officially reported in the sanitary registries of the World Animal Health Information System (WAHIS) of the World Organization for Animal Health. Materials and methods: We conducted a narrative review using Medline/ PubMed, Scopus, and Web of Sciences, and official documents of the World Organisation for Animal Health. The search terms used were as follows: "coronavirus", "SARS coronavirus 2019", "SARS-CoV", "SARS-CoV-2 in dog and/or cat" "pets SARS-CoV-2". Results: The studies reviewed in this manuscript highlight those positive cases in cats and dogs for SARS-CoV-2 have been associated with an exposure to positive COVID-19 people. In the available evidence, 55.17 % of the total cases of animals that were positive for SARS-CoV-2 were associated with people with COVID-19 who had the disease at home, possibly due to maintaining a longer exposure to the humans. Conclusion: Regarding the zoonotic aspects, it is important to clarify that although several animal species have been infected by SARS-CoV-2, none of them has been scientifically proven to represent a risk of direct transmission between positive animals and other humans or to play an epidemiological role in the disease.

Resumen Introducción: El SARS-CoV-2 es el nombre para el nuevo betacoronavirus, que fue descubierto y aislado por primera vez en Wuhan, China, a fines de diciembre de 2019, y es el agente causal de la emergencia sanitaria del COVID-19. Estudios experimentales han demostrado susceptibilidad a la infección en mascotas (perros y gatos). Objetivo: Presentar la información actual sobre el SARS-CoV-2 en animales bajo el cuidado de humanos que han sido oficialmente reportados en los registros sanitarios del Sistema Mundial de Información Sanitaria Animal (WAHIS) de la Organización Mundial de Sanidad Animal. Materiales y métodos: Se realizó una revisión narrativa utilizando Medline/PubMed, Scopus y Web of Sciences, y documentos oficiales de la Organización Mundial de Sanidad Animal. Los términos de búsqueda utilizados fueron los siguientes: "coronavirus", "SARS coronavirus 2019", "SARS-CoV", "SARS-CoV-2 en perro y/o gato" "mascotas SARS-CoV-2". Resultados: Los estudios revisados en este manuscrito destacan que los casos positivos en gatos y perros para SARS-CoV-2 se han asociado con una exposición a personas positivas para COVID-19. En la evidencia disponible, el 55,17 % del total de casos de animales positivos para SARS-CoV-2 estaban asociados a personas con COVID-19 que tenían la enfermedad en casa, posiblemente por mantener una mayor exposición a los humanos. Conclusión: En cuanto a los aspectos zoonóticos, es importante aclarar que si bien varias especies animales han sido infectadas por el SARS-CoV-2, ninguna de ellas ha demostrado científicamente que represente un riesgo de transmisión directa entre animales positivos y otros humanos o que juegue un papel epidemiológico en la enfermedad.

Resumo Introdução: SARS-CoV-2 é o nome do novo betacoronavírus, que foi descoberto e isolado pela primeira vez em Wuhan, China, no final de dezembro de 2019, e é o agente causal da emergência sanitária COVID-19. Estudos experimentais mostraram suscetibilidade à infecção em animais de estimação (cães e gatos). Objetivo: Apresentar as informações atuais sobre SARS-CoV-2 em animais sob cuidados humanos que foram oficialmente notificados nos registros sanitários do World Animal Health Information System (WAHIS) da Organização Mundial de Saúde Animal. Materiais e métodos: Foi realizada uma revisão narrativa utilizando Medline/PubMed, Scopus e Web of Sciences e documentos oficiais da Organização Mundial de Saúde Animal. Os termos de pesquisa utilizados foram os seguintes: "coronavírus", "SARS coronavirus 2019", "SARS-CoV", "SARS-CoV-2 in dogs and/ or cats" "SARS-CoV-2 pets". Resultados: Os estudos revisados neste manuscrito destacam que casos positivos em gatos e cães para SARS-CoV-2 foram associados à exposição a pessoas positivas para COVID-19. Nas evidências disponíveis, 55,17 % do total de casos animais positivos para SARS-CoV-2 foram associados a pessoas com COVID-19 que tiveram a doença em casa, possivelmente devido à maior exposição a humanos. Conclusão: Em relação aos aspectos zoonóticos, é importante esclarecer que, embora várias espécies animais tenham sido infectadas pelo SARS-CoV-2, nenhuma de las foi cientificamente comprovada como representando risco de transmissão direta entre animais positivos e outros humanos ou que desempenhe um papel papel epidemiológico da doença.

Tratamiento exitoso de enfermedad de Rosai-Dorfman con inmunomoduladores y quimioterapia metronómica / Successful treatment of Rosai-Dorfman disease with immunomodulators and metronomic chemotherap

RESUMEN Introducción: La enfermedad de Rosai-Dorfman es una histiocitosis linfática masiva caracterizada por emperipolesis con inmunohistoquímica positiva para S100 y CD68. Es una entidad clínica rara y de curso benigno más comúnmente presentada en varones. Objetivo: El propósito de este caso clínico es demostrar el tratamiento exitoso de la enfermedad de Rosai-Dorfman con inmunomoduladores y quimioterapia metronómica. Presentación del caso: Paciente masculino de 57 años que acude por linfadenopatía cervical bilateral, a quien se le realiza tomografía y biopsia ganglionar con resultados positivos para S100 y CD68 con marcado fenómeno de emperipolesis. Recibió esquema inmunomodulador y quimioterapia metronómica exitosa con remisión de enfermedad. Conclusiones: Los pacientes diagnosticados con Rosai-Dorfman son muy pocos debido a lo inusual de esta entidad clínica. Es importante mencionar que esta enfermedad es una histiocitosis de células tipo No Langerhans con características de benignidad y buena respuesta al manejo con corticoides y quimioterapia metronómica, terapia instaurada en nuestro paciente con buena evolución.

ABSTRACT Introduction: Rosai-Dorfman disease is a massive lymphocytic histiocytosis characterized by emperipolesis with positive immunohistochemistry for S100 and CD68. It is a rare clinical entity of benign course most commonly presenting in males. Objective: The purpose of this clinical case is to demonstrate successful treatment of Rosai-Dorfman disease with immunomodulators and metronomic chemotherapy. Case presentation: A 57-year-old male patient presenting with bilateral cervical lymphadenopathy underwent CT scan and lymph node biopsy with positive results for S100 and CD68 with marked emperipolesis phenomenon. He received immunomodulatory scheme and successful metronomic chemotherapy with disease remission. Conclusions: Patients diagnosed with Rosai-Dorfman are very few due to the unusual nature of this clinical entity. It is important to mention that this disease is a non-Langerhans cell histiocytosis with benign characteristics and good response to management with corticosteroids and metronomic chemotherapy, therapy established in our patient with good evolution.

Prevalencia de fibrilación auricular en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of atrial fibrillation in Colombia according to information from the Comprehensive Information System of the Social Protection (SISPRO)

Resumen Introducción: La fibrilación auricular es la arritmia cardíaca más frecuente, es una de las causas más importantes de eventos cerebrovasculares de origen embólico y se asocia con el desarrollo de insuficiencia cardíaca y muerte súbita. En Colombia, constituye una enfermedad con altos costos para el sistema de salud; sin embargo, su prevalencia es desconocida. Objetivo: Describir la prevalencia de fibrilación auricular reportada a los sistemas oficiales de información en Colombia. Método: Mediante la extracción, el tabulado y el análisis de datos de la herramienta SISPRO, del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de fibrilación auricular estandarizada por edad, global y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Se identificaron 143,656 casos reportados con el código I48X, que corresponde a fibrilación auricular en la CIE-10. La prevalencia de fibrilación auricular se incrementó desde 41 hasta 87 por cada 100,000 habitantes entre 2013 y 2017 (p < 0.001). En Colombia, la fibrilación auricular es más frecuente en las mujeres, con mayor prevalencia en mayores de 60 años (606/100,000 en 2017); hay zonas con prevalencia superior a 150/100,000 en los departamentos de Antioquia, Caldas, Santander y Bogotá D.C. Conclusiones: Este estudio sugiere que la fibrilación auricular tiene una tendencia ascendente en Colombia, es más frecuente en las mujeres y más prevalente en los centros urbanos, posiblemente debido a una mayor proporción de pacientes mayores y al mejor acceso a los sistemas de salud.

Abstract Introduction: Atrial fibrillation is the most frequent cardiac arrhythmia. It is responsible for an important proportion of embolic strokes and is associated with the development of congestive heart failure and sudden cardiac death. In Colombia, atrial fibrillation is highly costly for the healthcare system; however, its true prevalence is unknown. Objective: To describe the prevalence of atrial fibrillation reported to the official information systems in Colombia. Method: We calculated the prevalence of atrial fibrillation through the extraction, tabulation and analysis of data contained in the Integral Information System for Social Protection tool, which was created by the Ministry of Health and Social Protection in Colombia. Global and age-standardized prevalence rates were obtained for the period between years 2013 and 2017. Results: A total of 143,656 cases were identified. These were reported through the ICD-10 code I48X, corresponding to atrial fibrillation. The prevalence of atrial fibrillation increased from 41 to 87 cases per 100,000 inhabitants between years 2013 and 2017 (p < 0.001). In Colombia, atrial fibrillation is more frequent among women, and individuals over the age of 60 (606/100,000 in 2017). The departments of Antioquia, Caldas, Santander and Bogotá D.C had zones with prevalence greater than 150/100,000. Conclusions: This study suggests that atrial fibrillation displays an upward trend in Colombia. Its prevalence is higher in women and urban centers. The latter may be due to the higher proportion of older patients and better access to healthcare in these subgroups.

Utilidad del monitoreo hemodinámico con espectroscopia cercana infrarroja en pediatría / Use of near infrared spectroscopy for hemodynamic monitoring in pediatrics

La espectroscopia cercana infrarroja (NIRS, por su sigla en inglés), es una técnica óptica no invasiva y no ionizante utilizada para medir la oxigenación tisular regional a través de sensores transcutáneos. En los últimos años, han aumentado de manera exponencial las publicaciones sobre este tema; esto refleja el creciente interés de investigadores y clínicos por la utilización de esta nueva tecnología y los beneficios que podría ofrecerles a los pacientes pediátricos. El objetivo de esta revisión es dar a conocer el funcionamiento y las posibles aplicaciones de la saturación regional medida por NIRS, así como los desafíos en el futuro.

Near infrared spectroscopy (NIRS) is a non-invasive optical technique for the evaluation of regional tissue oxygenation using transcutaneous detectors. In recent years, publications about this topic have increased exponentially; this reflects the growing interest among investigators and clinicians about this new technology and its potential benefits for pediatric patients. The objective of this review is to know the functioning and potential uses of regional saturation measured by NIRS and establish future challenges.

2021 clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with peripheral spondyloarthritis. Colombian Association of Rheumatology / Guía de práctica clínica 2021 para el diagnóstico, el tratamiento y el seguimiento de pacientes con espondiloartritis periférica. Asociación Colombiana de Reumatología

ABSTRACT Background: Peripheral spondylarthritis is a chronic Inflammatory disease whose clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. Objective: To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment, and monitoring of adult patients with peripheral spondyloarthritis. Methods: A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the for mal expert consensus method, the GRADE methodology "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence and generate the recommendations. The clinical practice guideline includes ten recommendations related to monitoring of disease activity (n = 1) and treatment (n = 9). Results: In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids are conditionally recommended. In patients with failure to cDMARDs, an anti TNFα or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondylarthritis associated with inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFα over an anti-IL-17 or an anti-IL-12-23 is recom mended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with a bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. Conclusions: This set of recommendations provides an updated guideline on the diagnosis and treatment of peripheral spondyloarthritis.

RESUMEN Antecedentes: La espondiloartritis periférica es una patología Inflamatoria crónica cuya presentación clínica está determinada por la presencia de artritis, entesitis y/o dactilitis. Este término se utiliza indistintamente con algunos de sus subtipos como artritis psoriásica, artritis reactiva y espondiloartritis indiferenciada. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para el diagnóstico, el tratamiento y el seguimiento de pacientes adultos con espondiloartritis periférica. Métodos: Se constituyó un grupo desarrollador, se formularon preguntas clínicas, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado. Siguiendo el método de consenso formal de expertos, se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para para evaluar la calidad de la evidencia y generar las recomendaciones. La guía de práctica clínica incluye 10 recomendaciones: una sobre seguimiento de la actividad de la enfermedad y nueve sobre tratamiento. Resultados: En pacientes con espondiloartritis periférica se sugiere usar metotrexato o sulfasalazina como primera línea de tratamiento y se recomienda en forma condicional la inyección local de glucocorticoides. En los pacientes que fallan a cDMARDs, se recomienda iniciar un anti TNFα o un anti IL17A. Ante falla terapéutica a la primera línea con bDMARDs, se sugiere usar otro bDMARD o un inhibidor JAK. En pacientes con espondiloartritis periférica y enfermedad inflamatoria intestinal asociada, se recomienda iniciar tratamiento con cDMARDs; en ausencia de respuesta, se recomienda el uso de un anti TNFα sobre un anti IL-17 o un anti IL-12-23 como segunda línea de tratamiento. En pacientes con artritis psoriásica se recomienda, de forma condicional, el uso combinado de metotrexato con bDMARD para favorecer la optimización de la dosis de estos. Para evaluar la actividad de la enfermedad en artritis psoriásica, se sugiere el uso del DAPSA o MDA para el seguimiento de los pacientes. Conclusiones: Este conjunto de recomendaciones proporcionan una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis periférica.

Prevalencia de sarcopenia en adultos mayores de dos hogares geriátricos de Pereira, Colombia Prevalence of sarcopenia in older adults in t / Prevalence of sarcopenia in older adults in two retirement homes in Pereira, Colombia

Introducción: La sarcopenia es un factor de riesgo para morbilidad, mortalidad y discapacidad en adultos mayores, por lo que su manejo es prioridad en geriatría. El objetivo de este artículo, consiste en caracterizar una población de adultos mayores de dos hogares geriátricos y establecer la prevalencia de sarcopenia y el grado de dependencia. Métodos: Estudio de corte transversal desarrollado en la ciudad de Pereira-Colombia. Se incluyó a una población de 72 adultos desde los 65 hasta los 98 años, usando muestreo probabilístico. Se determinó la sarcopenia por medio de los Criterios del Consenso Europeo sobre Definición y Diagnóstico de Sarcopenia; evaluándose la fuerza de prensión, índice de masa muscular esquelética, en caso de presentarse sarcopenia, la severidad de esta junto a la velocidad de marcha, y el grado de dependencia según la escala de Barthel. Resultados: Participaron finalmente 57 personas. El 68,4% (n=39) eran mujeres. La mediana de la edad fue de 83 años. El 2% no presentó sarcopenia, 9% presentaban sospecha de sarcopenia, 28% tenían sarcopenia confirmada y 61% sarcopenia grave. Según la escala de Barthel, el 31,5% eran independientes, 45,6% tenían dependencia leve, 15,8% moderada, 5,3% severa y 1,8% total. Conclusiones: La prevalencia de sarcopenia en los hogares geriátricos de Pereira es mayor en comparación a la reportada en la literatura. Del mismo modo, encontrarse en un hogar geriátrico privado no garantiza una mejor condición física y/o calidad de vida.

Introduction: Is a risk factor for morbidity, mortality and disability in older adults, so its management is a priority in geriatrics. The aim of this article is to characterize a population of older adults from two geriatric homes and to establish the prevalence of sarcopenia and the degree of dependence. Methods: Cross-sectional study developed in the city of Pereira-Colombia. A population of 72 adults from 65 to 98 years of age was included, using probability sampling. Sarcopenia was determined by means of the Criteria of the European Consensus on Definition and Diagnosis of Sarcopenia, evaluating grip strength, skeletal muscle mass index, in case of sarcopenia, the severity of sarcopenia together with walking speed, and the degree of dependence according to the Barthel scale. Results: 57 people participated. A total of 68.4% (n=39) were women. The median age was 83 years. Two percent had no sarcopenia, 9% had suspected sarcopenia, 28% had confirmed sarcopenia and 61% had severe sarcopenia. According to the Barthel scale, 31.5% were independent, 45.6% had mild, 15.8% moderate, 5.3% severe and 1.8% total dependence. Conclusions: The prevalence of sarcopenia in nursing homes in Pereira is higher compared to that reported in the literature. Similarly, being in a private nursing home does not guarantee a better physical condition and/or quality of life

Origen anómalo de la arteria descendente anterior / Anomalous origin of the anterior descending artery

Resumen Se considera origen anómalo de una arteria coronaria cuando esta no se origina de su seno de Valsalva respectivo. La prevalencia estimada varía entre el 0.6% y el 1.3%. Si bien la mayoría estarán asintomáticos, el 20% puede debutar con arritmias, síncope, infarto del miocardio o muerte súbita. Se expone el caso de una mujer de 42 años, con historia de hipertensión arterial, quien, durante una prueba de esfuerzo para prescripción de ejercicio, presentó bloqueo de rama izquierda. Ante la ausencia de síntomas se decidió realizar una angiografía coronaria por tomografía, la cual mostró un origen anómalo de la arteria descendente anterior desde el seno de Valsalva derecho. Se consideró realizar angiografía coronaria para evaluar la compresión dinámica durante el ciclo cardiaco; sin embargo, la paciente no aceptó intervenciones adicionales, por lo que se indicó restricción del ejercicio, metoprolol y seguimiento. A la fecha no reporta complicaciones. Las anomalías de las arterias coronarias son defectos cardiacos poco comunes, y entre estos, las anormalidades de la arteria descendente anterior son aún menos habituales. Son una causa frecuente de muerte súbita en atletas. Sus características anatómicas y la presencia de síntomas ayudarán a elegir a los pacientes que se beneficiarán del manejo quirúrgico.

Abstract An anomalous origin of a coronary artery is considered when it does not originate from its respective Valsalva sinus. The estimated prevalence varies between 0.6% to 1.3%. While the majority will be asymptomatic, 20% may debut with arrhythmias, syncope, myocardial infarction or sudden death. It is presented a case of a 42 year old woman, with a history of high blood pressure. During exercise stress test for exercise prescription she presented a left bundle branch block. In absence of symptoms, it was decided to perform a coronary angiotomography that showed an anomalous origin of the anterior descending artery from the right Valsalva sinus. It was considered to perform coronary angiography to evaluate dynamic compression during the cardiac cycle, however, the patient did not accept additional interventions, so exercise restriction was indicated, metoprolol as drug treatment and follow up, not report complications to date. Coronary artery abnormalities are rare heart defects and within these abnormalities of the anterior descending artery are even less frequent. They are a frequent cause of sudden death in athletes. Its anatomical characteristics as the presence of symptoms will help to choose the patients who will benefit from surgical management.