Neumomediastino espontáneo: una serie de casos / Spontaneous Pneumomediastinum: Case Series

El neumomediastino espontáneo es una condición clínica de baja incidencia. Se caracteriza por tener aire libre en el mediastino sin trauma asociado, y se considera un trastorno benigno y autolimitado. El diagnóstico se realiza por sospecha clínica y se confirma con imágenes diagnósticas. Esta entidad ha sido poco informada en la literatura nacional, y se considera que el probable subdiagnóstico se debe al poco conocimiento de sus características clínicas y epidemiológicas en nuestro medio. Se presenta una serie de 11 casos de neumomediastino espontáneo estudiados en dos instituciones de alta complejidad de Medellín, Colombia.

Spontaneous pneumomediastinum, a clinical condition with low incidence, is characterized by the presence of free air in the mediastinum without associated trauma, and it is considered a benign and self-limiting disorder. The diagnosis is made by clinical suspicion and is confirmed with diagnostic images. This entity has been little reported in the national literature, considering that the probable underdiagnosis is due to lack of knowledge of its clinical and epidemiological characteristics in our environment. A series of 11 cases of spontaneous pneumomediastinum in patients admitted to two institutions of high complexity in Medellin-Colombia are presented.

Descripción de la biopsia de tiroides con aguja fina guiada con ecografía / Description of the Thyroid Biopsy with Fine Needle Guided with Ecography

Introducción: La biopsia con aguja fina guiada con ecografía (BCAF-E) de nódulos tiroideos es frecuente en nuestro Hospital y no conocemos su desempeño. Objetivo: Conocer el desempeño global y según el método empleado (capilaridad o capilaridad combinada con aspiración) de la BCAF-E de tiroides. Métodos: Estudio de corte transversal retrospectivo. Se recolectaron del archivo digital todas las BCAF-E de tiroides realizadas entre enero de 2010 y junio de 2016. Se obtuvieron 873 biopsias realizadas en 774 pacientes. Se clasificaron según el operador, un total de 11 radiólogos con diferentes años de experiencia. Las biopsias de cada operador se clasificaron según la categoría Bethesda encontrada en el reporte de patología. Los resultados de la biopsia quirúrgica fueron la prueba de oro para el desempeño del método en este subgrupo de pacientes. Resultados: La distribución de suficiencia de la citología fue: 65 (7,4 %) Bethesda 1, 694 (79,5 %) Bethesda 2, 7 (0,8 %) Bethesda 3, 11 (1,3 %) Bethesda 4, 47 (5,4 %) Bethesda 5, 49 (5,6 %) Bethesda 6. A 97 pacientes se les realizó cirugía. Tomando como benignas las categorías Bethesda 1 a 4 y malignas las categorías 5 y 6 resulta para la BCAF-E: sensibilidad 86,75 %, especificidad 85,71 %, VPP 97,29 % y VPN 52,17 %. Conclusión: El desempeño de la BCAF-E de tiroides está influenciado por el número de biopsias realizadas. Hacerla con técnica de capilaridad o combinar la técnica de capilaridad con la de aspiración no tiene diferencia significativa. El desempeño de la citología con respecto a la biopsia quirúrgica es bueno. El procedimiento en el Hospital está dentro de los estándares.

Introduction: Ultrasound-guided fine needle biopsy of the thyroid nodules (US-FNB) is frequent in our hospital and we do not know its performance. Objective: To know the overall performance and according to the method used (capillarity or capillarity combined with aspiration) of the US-FNB of the thyroid nodules. Methods: Retrospective cross-sectional study. All US-FNB of the thyroid nodules performed between January 2010 and June 2016 were collected from the digital archive. A total of 873 biopsies were obtained from 774 patients. A total of 11 radiologists with different years of experience were classified according to the operator. The biopsies of each operator were classified according to the Bethesda category found in the pathology report. 97 patients were taken to surgery. The results of the surgical biopsy were the gold standard for the performance of the method in this subgroup of patients. Results: The distribution of cytological adequacy was: 65 (7.4%) Bethesda 1, 694 (79.5%) Bethesda 2, 7 (0.8%) Bethesda 3, 11 (1.3%) Bethesda 4, 47 (5.4%) Bethesda 5.49 (5.6%) Bethesda 6. 97 patients were operated on at the institution. Taking Bethesda categories 1 to 4 as benign and categories 5 and 6 as malignant, results for the US-FNB of the thyroid nodules are: sensitivity 86,75% ; Specificity 85,71% ; PPV 97,29% ; NPV 52,17%. Conclusion: The number of biopsies performed influences the performance of US-FNB of the thyroid nodules. To do it with capillary technique or to combine the technique of capillarity with that of aspiration has no significant difference. The performance of cytology with respect to histopathology is good. The procedure at the hospital is within standards.

Inhibición parcial de dos genes que codifican para proteínas del empalmosoma en Giardia intestinalis / Partial inhibition of two genes that encode spliceosomal proteins in Giardia intestinalis

Introducción. Giardia intestinalis es un organismo tempranamente divergente en el que recientemente se demostró la presencia de intrones. La maquinaria responsable de la remoción de intrones en organismos eucariotas superiores es el empalmosoma, el cual está conformado por cinco ribonucleoproteínas, cada una de las cuales tiene un ARN pequeño nuclear, un set de siete proteínas Sm (B, D1, D2, D3, E, F y G) y varias proteínas específicas. En G. intestinalis se han identificado los genes de algunas proteínas del empalmosoma por bioinformática. Aunque se asume que este es el responsable del empalme en el parásito, su caracterización bioquímica no se ha hecho. Objetivo. Inhibir dos genes que codifican para proteínas del empalmosoma de G. intestinalis con el fin de determinar si esta inhibición afecta el crecimiento o el enquistamiento del parásito. Materiales y métodos. En un vector específico para G. intestinalis se clonaron secuencias antisentido de los genes que codifican para las proteínas SmB y SmD3 del empalmosoma del parásito. Posteriormente, se transfectó G. intestinalis con los vectores recombinantes y se seleccionaron aquellos parásitos que lo incorporaron. Se confirmó la disminución del mensajero mediante reacción en cadena de la polimerasa (PCR) en tiempo real, y se evaluaron el crecimiento y el enquistamiento en parásitos silvestres y transfectados. Resultados. Se observó una disminución de 40 y 70 % en el ARNm de SmB y SmD3, respectivamente. El crecimiento y el enquistamiento no se vieron afectados en estos parásitos. Conclusión. La disminución de SmB y SmD3 no afectó al parásito, lo que indica que el empalmosoma sigue siendo funcional, o que el empalme no es una función vital del parásito.

Introduction. Giardia intestinalis is an early divergent organism that was recently shown to have introns. The machinery responsible for the removal of introns in higher eukaryotes is the spliceosome, which consists of five ribonucleoproteins. Each of these ribonucleoproteins has a small nuclear RNA, a set of seven Sm proteins (B, D1, D2, D3, E, F and G) and several specific proteins. Some genes that encode spliceosome proteins have been bioinformatically identified in the parasite genome. Although it is assumed that the spliceosome is responsible for splicing in this parasite, biochemical characterization is lacking. Objective. To inhibit two G. intestinalis spliceosome protein genes in order to determine whether this inhibition affects parasite growth or encystation. Materials and methods. Antisense sequences of the genes encoding the spliceosomal parasite proteins SmB and SmD3 were cloned into a specific G. intestinalis vector. G. intestinalis individuals were subsequently transfected with the recombinant vectors and those parasites that incorporated the vector were selected. A decrease in mRNA levels by real-time PCR was confirmed and the growth and encystation in wild and transfected parasites was assessed. Results. A decrease of 40% and 70% of SmB and SmD3 mRNA levels, respectively, was observed. Growth and encystation in these parasites were not affected. Conclusion. Decrease of SmB and SmD3 mRNA levels does not affect the parasite, indicating that the spliceosome remains functional or that splicing is not essential for parasite viability.

Heridas neoplásicas: aspectos básicos del cuidado de enfermería / Neoplastic wounds: basic aspects of nursing care

Las heridas neoplásicas están relacionadas con el tumor y requieren un abordaje especial y más cuidadoso por los diferentes factores asociados con el cáncer. Se pueden encontrar problemas de difícil manejo como mal olor, exudado, sangrado, dolor, infección, apariencia visual que causa baja autoestima y aislamiento social que conlleva a un marcado deterioro de la calidad de vida de los pacientes y sus familias. Objetivo: determinar cuáles son los aspectos básicos del cuidado de enfermería en heridas neoplásicas. Materiales y métodos: esta revisión documental analiza la epidemiología, clasificación, instrumentos de valoración y las intervenciones de cuidado actual que el profesional de enfermería debe tener al brindar el cuidado a estos pacientes. Conclusión: se requiere un equipo multidisciplinario para el manejo de las heridas neoplásicas. Se deben identificar los problemas o necesidades, acorde con esto se diseñará un plan de manejo personalizado y se evaluarán las intervenciones generando un impacto positivo en el estilo de vida actual y futuro del paciente...

Neoplastic wounds are related to an underlying tumor and require specific and more careful care compared with other patients, due to the various factors associated with cancer. They are characterized by distressing issues such as fetid odor, exudate, bleeding, pain, infection, and bodily disfigurement which cause impaired self-esteem, social isolation and significantly impaired quality of life of patients and their family. Objective: to determine the basic aspects of neoplastic wounds nursing care. Materials and Methods: the documental review conducted in this study entails the epidemiology, classification and evaluating instruments, and the interventions that nurses must currently provide to these patients. Conclusion: a multidisciplinary team is essential to manage neoplastic wounds. Issues and needs must be identified to design a personalized management plan and interventions must be evaluated aiming to generate a positive impact on the life style of the patient...

Association between child maltreatment indicators and developmental problems in early childhood education

INTRODUCTION: Short and long-term exposure to maltreatment can increase the risk of developmental problems. OBJECTIVE: To characterize a sample of children in early education with regard to the presence of indicators of child abuse and emotional and behavioural problems and to determine the association between these variables. METHODS: The sample consisted of 40 elementary school children whose parents or guardians and teachers (n = 6) gave permission for their participation in this study. Data were obtained using the Phrase Inventory of Intra-family Child Abuse (PIICA) and the Teacher's Report Form (TRF). Descriptive and inferential statistical analyses were made. RESULTS: The average score in IFVD was 17.82, which is out of range of risk, according to the instrument instructions. However, 30% of the sample with suspicions of maltreatment obtained a score higher than 23. The sample was divided into two groups for comparison according to the TRF (victimized and non-victimized). Significant differences were found in Total Problems and in Internalizing Problems, although the averages of the item responses from both groups were considered normal at all levels and in all sub-items. CONCLUSION: Children that present indicators of abuse are also likely to present indicators of depression and anxiety at non-clinical levels, corroborating other studies. However, the convenience sample in this study may have introduced a bias in terms of maltreatment severity. Further studies with larger and more diverse samples are necessary...

INTRODUÇÃO: a experiência de maus tratos constitui-se em um importante fator de risco ao desenvolvimento humano, a curto e longo prazo. OBJETIVO: caracterizar uma amostra de crianças em início de escolarização quanto à presença de indicadores de maus tratos infantis e à de problemas emocionais e comportamentais e verificar a associação entre essas variáveis. MÉTODOS: a amostra (n = 40) foi composta por todas as crianças do 1º ano de uma escola municipal cujos pais/responsáveis autorizaram, e seus respectivos professores (n = 6). Para a coleta de dados empregou-se o Inventário de Frases no Diagnóstico de Violência Doméstica contra Crianças e Adolescentes (IFVD) e o Teacher's Report Form (TRF). Procedeu-se a análises descritivas e inferenciais. RESULTADOS: a pontuação média no IFVD foi de 17,82, fora da faixa de risco, segundo as normas do instrumento. Porém, 30% da amostra obtiveram escore superior a 23, o preconizado para suspeitar de maus tratos. Com isso, estabeleceu-se 2 grupos para a comparação no TRF (crianças suspeitas de serem maltratadas/crianças sem suspeita). Verificou-se diferenças significativas em Total de Problemas e em Problemas Internalizantes, ainda que em termos médios os dois grupos tenham apresentado performances em níveis normais, em todos os subitens. CONCLUSÃO: crianças apresentando indicadores de maus tratos apresentaram também indicadores de depressão e ansiedade, ainda que em níveis não clínicos, corroborando outros estudos. Deve-se, entretanto, considerar que a amostra formada por conveniência pode ter introduzido um viés no tocante à severidade/gravidade dos maus tratos abarcados no estudo. Outros estudos, com amostras maiores e mais diversificadas, devem ser realizados...

Treinta años de homicidios en Medellín, Colombia, 1979-2008 / Thirty years of homicides in Medellín, Colombia, 1979-2008

El homicidio en Medellín, Colombia, se convirtió en la primera causa de muerte desde 1986 y su participación del total de muertes pasó de 3,5% en 1976 a 42% en 1991 y 7% en 2006. Entre 1979 y 2008 hubo 81.166 homicidios (2.706 promedio/año). La tasa de homicidios por 100.000 habitantes fue 44 en 1979 y 47 en 2008, con un máximo de 388 en 1991. Se describen características de los homicidios en 30 años, entre 1979 y 2008, por quinquenios, mediante una muestra aleatoria de 3.414 necropsias médico-legales. Los muertos fueron hombres 92.8% (IC95%: 91,8; 93,6), jóvenes con promedios de edad entre 27 y 33 años, residentes en estratos socio-económicos bajos, con predominó de los móviles ajustes de cuentas, riñas y atracos. Se evidenciaron tres periodos diferentes de la epidemia de homicidios: el primero de incremento acelerado 15 años, el segundo de descenso sostenido hasta 1998 y el tercero ondulante y descenso abrupto en los 10 últimos años. Estos resultados de larga duración de la violencia en la ciudad abren posibilidades analíticas para encontrar políticas más consistentes de intervención.

In Medellín, Colombia, homicides have been the leading cause of death since 1986. Their proportion among total deaths increased from 3.5% in 1976 to 42% in 1991 and subsequently decreased to 7% in 2006. From 1979 to 2008, there were 81,166 homicides (annual mean, 2,706). The homicide rates per 100,000 inhabitants were 44 in 1979 and 47 in 2008, with a peak of 388 in 1991. The current article analyzes homicides in 30 years (1979-2008) using a random sample of 3,414 forensic autopsy reports. The vast majority of victims were males, 92.8% (95%CI: 91.8%; 93.6%), mostly low-income young people from 27 to 33 years of age. Most homicides involved revenge, fights, or armed robberies. The study showed different periods in the homicide epidemic: the first 15 years, with a rapid increase, the second, with a steady decline until 1998, and the third, with a fluctuating but overall steep decline in the last 10 years. This long-term study on violence in Medellin opens possibilities for analyzing and identifying more consistent policies for intervention.

Urticaria pigmentosa en el adulto / Urticaria pigmentosa in adult

La urticaria pigmentosa es una de las formas más comunes de las mastocitosis, las cuales corresponden a una serie de procesos caracterizados por un aumento anormal de los mastocitos en diversos órganos y tejidos corporales. En la urticaria pigmentosa la manifestación es exclusiva de la piel, caracterizada por la presencia de lesiones maculopapulares de 2.5 a 5 mm de diámetro, de un color que puede oscilar entre rojo y café, distribuyéndose generalmente en tronco y extremidades respetando palmas y plantas. Cerca de la mitad de los lesiones presenta rubor localizado, prurito y ampollas. Su incidencia y prevalencia son desconocidas; sin embargo, su aparición es más común en niños que en adultos. El diagnóstico depende en gran manera de un adecuado examen físico complementado con estudios de laboratorio e histopatología. El tratamiento de elección constituye la administración de antihistamínicos orales. [Ávila JA, Cala JC, Gelvis JA, Torres V, Mosquera H. Urticaria pigmentosa en el adulto. MedUNAB 2012; 15:63-67].

Urticaria pigmentosa is one of the most common forms of mastocytosis, which correspond to a series of processes characterized by an abnormal increase of mast cells in different organs and tissues. Urticaria pigmentosa has an unique manifestation in the skin, characterized by maculopapular lesions 2.5 to 5 mm in diameter, of a color that can range from red and brown, usually distributed on the trunk and limbs respecting the palms and soles. Half of the lesions presented blush on a specific site, pruritus and blisters. The incidence and prevalence are unknown but their appearance is more common in children than in adults. Diagnosis depends on an properly physical examination with laboratory test and histopathological analysis. The treatment of choice is the administration of oral antihistamines. [Ávila JA, Cala JC, Gelvis JA, Torres V, Mosquera H. Urticaria pigmentosa in adult. MedUNAB 2012; 15:63-67].

Transcription of meiotic-like-pathway genes in Giardia intestinalis

The reproductive mechanism of Giardia intestinalis, considered one of the earliest divergent eukaryotes, has not been fully defined yet. Some evidence supports the hypothesis that Giardia is an exclusively asexual organism with a clonal population structure. However, the high genetic variability, the variation in ploidy during its life cycle, the low heterozygosity and the existence of genes involved in the meiotic-like recombination pathway in the parasite's genome cast doubt on exclusively asexual nature of Giardia. In this work, semiquantitative RT-PCR analysis was used to assess the transcription pattern of three meiosis-like-specific genes involved in homologues recombination: dmc1, hop1 and spo11. The mRNAs were amplified during the parasite's differentiation processes, encystation and excystation, and expression was found at each stage of its life cycle. A semiquantitative assessment also suggests that expression of some of the genes is regulated during encystation process.