Diabetes mellitus y covid-19: epidemiología, fisiopatología, manejo ambulatorio e intrahospitalario: revisión / Diabetes mellitus and covid-19: epidemiology, pathophysiology, outpatient and inpatient management: review

La diabetes mellitus ha sido asociado a una mayor probabilidad de enfermedad más grave por Covid-19. Los estudios epidemiológicos evidencian que los pacientes diabéticos tienen un riesgo mayor de un cuadro grave que requiera UCI, ventilación mecánica y probabilidad de morir. Un buen control metabólico parece fundamental para disminuir este riesgo. En el caso del manejo ambulatorio es importante asegurar la continuidad de los tratamientos crónicos, medir los niveles de glicemia capilar y minimizar la posibilidad de infección. En caso de infección por SARS-Cov2 el paciente diabético deberá hacer los ajustes necesarios en su tratamiento tanto para lograr un control glicémico adecuado como para disminuir los riesgos de algunos fármacos antidiabéticos. El uso de telemedicina constituye una excelente herramienta para facilitar el logro de los objetivos terapéuticos. En caso de requerir hospitalización, se ha evidenciado que los pacientes diabéticos tienen altos requerimientos de insulina y rápida tendencia a producir cetosis. Considerando la situación actual de pandemia las metas intrahospitalarias pueden ser más laxas y seguras, en especial en pacientes no críticos. En caso de pacientes críticos idealmente se debe mantener las metas glicémicas entre 140-180 mg/dL.

Diabetes mellitus has been associated with a higher probability of severe disease due to Covid-19. Epidemiological studies show that diabetic patients have an increased risk of a serious condition requiring ICU, mechanical ventilation and of course the probability of dying. Good metabolic control seems essential to reduce this risk. In the case of outpatient management, it is very important to ensure the continuity of chronic treatments, measure capillary blood glucose levels and minimize the possibility of infection. In case of SARS-Cov2 infection, the diabetic patient should make the necessary adjustments in their treatment, both to achieve adequate glycemic control and to reduce the risks of some antidiabetic drugs. Telemedicine is an excellent tool to facilitate the achievement to therapeutic goals. In case of requiring hospitalization, it has been shown that diabetic patients have high insulin requirements and rapid tendency to produce ketosis. Considering the current situation of a pandemic, intrahospital goals may be laxer and safer, especially in non-critically ill patients. In the case of critically ill patients, the glycemic goals should ideally be maintained between 140-180 mg/dL.

Síndrome de Sweet asociado a infección por el Virus de la Inmunodeficiencia Humana / Sweet's syndrome associated to human immunodeficiency virus infection

El síndrome de Sweet es una dermatosis neutrofílica aguda y febril que puede ser desencadenada por diferentes noxas. El diagnóstico es clínico a partir de una dermatosis aguda, con fiebre, leucocitosis y lesiones cutáneas localizadas en cara, cuello y extremidades. La histopatología muestra un denso infiltrado inflamatorio de la dermis a predominio neutrofílico, sin signos de vasculitis. Se presenta un paciente con síndrome de Sweet asociado a infección por el virus de la inmunodeficiencia humana

Sweet's syndrome associated with human immunodeficiency virus infection Sweet's syndrome is a neutrophilic and acute febrile dermatosis that can be triggered by different noxas. Diagnosis should be suspected in a patient with fever, leukocytosis and cutaneous lesions located on the face, the neck and the extremities. Cutaneous biopsy confirms the diagnosis of Sweet syndrome, with typical features of a neutrophilic dermatosis in the absence of vasculitis. Here we present a case of Sweet syndrome associated with human immunodeficiency virus infection

Cinética de muerte de linfocitos en diabetes mellitus tipo 1 y su posible asociación con miR-146a y miR-155 / Kinetics of cell death in type 1 diabetes mellitus and their possible association with miR-146a and miR-155

Aim: Analyze mi-146a and miR-155 expression and its correlation with the apoptosis of lymphocytes T in T1D and control patient. Patients and Methodology: 17 T1D patients (5 children between 8-14 yr and 12 adults between 19-29 yr). Activated and not activated peripheral mononuclear cells were studied were studied. Cellular activation with anti-CD3 and primary culture with interleukyne-2 by 5 days. Apoptosis assays through flow cytometry. miRNA through Taqman probes. Statistical analysis through Kruskal-Wallis and post-hoc Dunn's test. Results: Composition of virgin and memory T CD4 cells showed significant differences for stimulus response in control group (p = 0,0004). Increased memory cells count in control group activated by 7 days than basal (p = 0,0047). For early apoptosis differences were observed in days 3 and 7 with and without activation (p = 0,001). AICD apoptosis showed increases in control group after re-stimulation through TCR (p= 0,03). miR-146a expression was lower in recent-onset T1D children vs recent-onset DM1 adults (p = 0,0167). Conclusion: This study shows a differential miR-146a expression in T1D children with respect to T1D adult patients, diminished AICD mechanism in T1D and altered CD4+CD45RA-CD45R0+ memory cells generation in T1D adult patients.

Tabaquismo y Diabetes / Smoking and Diabetes

Resumen El tabaco ejerce daño en los pacientes con diabetes mellitus acelerando las complicaciones crónicas, incremento en el riesgo de mortalidad global y cardiovascular. Dejar de fumar produce una reducción del riesgo. Además, el tabaquismo tanto activo como pasivo incrementa la incidencia de diabetes tipo 2. La exposición al tabaco durante el embarazo también puede predisponer al desarrollo de diabetes de las hijas y diabetes gestacional en las madres. Un estudio en diabetes mellitus 1 comparó una cohorte de EE. UU. con una europea, demostró que los fumadores tienen niveles de HbA1c significativamente mayores y un perfil lipídico con mayor nivel de triglicéridos y colesterol LDL. Por todas estas razones es urgente realizar consejería breve o ABC-D, según las Primeras Guías de Práctica Clínica de Tratamiento del Tabaquismo, Chile, 2017 a todo paciente diabético ya sea en atención ambulatoria como hospitalaria.

Tobacco exerts damage in patients with diabetes mellitus by accelerating chronic complications, increasing the risk of global and cardiovascular mortality. Quitting smoking produces risk reduction. In addition, both active and passive smoking increases the incidence of type 2 diabetes. Exposure to tobacco during pregnancy can also predispose to the development of diabetes of daughters and gestational diabetes in mothers. A study in diabetes mellitus 1 compared a US cohort with a European cohort, showed that smokers have significantly higher levels of HbAlc and a lipid profile with a higher level of triglycerides and LDL cholesterol. For all these reasons it is urgent to brief counsel or provide ABC-D, according to the First Clinical Practice Guidelines of Tobacco Treatment, Chile, 2017 for all diabetic patients, whether in outpatient or hospital care.

Fractura luxación axial del carpo. Reporte de tres casos y revisión de la literatura / Axial-fracture dislocation of the carpal bone, report of three cases and literature review

Reportamos tres casos de fractura de luxación axial del carpo tratados en nuestro servicio. Los tres, hombres entre la tercera y cuarta décadas de la vida, que sufrieron accidentes laborales por aplastamiento. En todos los casos se realizó reducción abierta y estabilización con clavillos, posteriormente fueron enviados a medicina física y rehabilitación. Se valoró la función de la muñeca a los diez meses con la escala de la Clínica Mayo para la muñeca (Mayo Wrist Score) y se tomaron estudios radiográficos para evaluar sus resultados postoperatorios. En este escrito se exponen tres ejemplos de pacientes que sufrieron estas lesiones con desenlaces "bueno", "satisfactorio" y "pobre".

We report three cases of axial-fracture dislocation of the carpal bone treated in our department. The three men were between thirty and forty years old who had a work related crushing fracture. We performed an open reduction and stabilization with pins in all cases; patients were then referred to physical medicine and rehabilitation. We assessed the wrist function at ten months using the Mayo Wrist Score and with X-rays to evaluate postoperative results. In this summary we present three examples of patients who suffered these injuries with "good", "satisfactory" and "poor" outcomes.

Síndrome de Cushing por ACTH ectópica: revisión a propósito de dos casos clínicos / Cushing syndrome caused by ectopic ACTH secretion: report of two cases

Twelve percent of Cushing syndromes (CS) are caused by ectopic ACTH secretion. We report two cases of the condition. A 57 years old woman with an ectopic CS caused by a bronchial carcinoid tumor. After the tumor excision, the patient had a favorable evolution. A 63 years old woman consulting for cough, dyspnea and weight loss causes by a small cell lung cancer. The patient presented hyperglycemia, hypokalemia and metabolic alcalosis. The laboratory showed a severe hypercortisolism with elevated ACTH levels. The metabolic condition did not subside after the first course of chemotherapy and the patient died due to an infectious complication...

Caso clí­nico: reactivación de psoriasis posterior a adrenalectomía por sí­ndrome de Cushing / Case report: psoriasis relapse following adrenalectomy for cushing syndrome

The relapse of autoimmune diseases following resolution of Cushing syndrome (CS) has been established with frequency, especially for thyroid disease. We present the case of a 39-year-old woman with a history of psoriasis vulgaris, with no other comorbidities. She presented a one-year of weight gain, high blood pressure, hypermenorrhea, pre-diabetes and dyslipidemia. During this period of time, the complete remission of psoriatic lesions was confirmed. The laboratory analysis demonstrated elevated free urinary cortisol in two opportunities, and a confirmatory low-dose dexamethasone test. Low ACTH levels were established (12,3pg/ml), and the abdominal images where compatible with a right adrenal adenoma of 3,0 x 2,3 cm, sothe patient underwent a laparoscopic right adrenalectomy with no complications. Her blood pressure, glucose and cholesterol levels improved following surgery. One month after surgery the patient developed new, generalized psoriatic plaques. The excess of glucocorticoids produced by the adrenal tumor could have controlled the immunopathogeny of psoriasis. By removing the tumor, with the consequent reduction of cortisol levels, a more severe relapse of her cutaneous disease occurred.

Osteomalacia hipofosfatémica secundaria a sarcoma de muslo: caso clínico / Hypophosphatemic osteomalacia secondary to a sarcoma: report of one case

Tumor induced osteomalacia is uncommon and is characterized by an isolated and not PTH dependent reduction in tubular phosphate reabsorption. This alteration is produced by phosphaturic factors, such as fibroblast growth factor-23 (FGF-23) that are secreted by tumors. We report a 41 years old female presenting with joint pain and progressive loss of muscle strength in the lower limbs. Initial laboratory assessment showed hypophosphatemia, elevated alkaline phosphatases, normal intact parathormone levels, low levels of 25 hydroxy vitamin D and an elevated 24 h phosphaturia. Bone mineral density showed spine and femoral neck osteopenia. A positron emission tomography (PET) revealed a right thigh tumor with lung metastases. Its biopsy disclosed a fibrosarcoma. FGF-23 levels, measured by ELISA were markedly elevated. The patient was discharged with palliative measures.

Compromiso endocrinológico en el síndrome de POEMS: revisión a propósito de un caso / Secondary amenorrhea and hypothyroidism in a women with POEMS syndrome: report of one case

POEMS is an acronym for a syndrome characterized by osteosclerotic myeloma: polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes. Hypothyroidism, hypogonadism, diabetes mellitus and adrenal failure can be associated to POEMS syndrome. We report a 39 years old women with monoclonal gammopathy and paraparesis caused by a polyneuropathy, in whom a POEMS syndrome was diagnosed and treated with dexamethasone. The patient had a secondary amenorrhea and a clinical hypothyroidism with negative antithyroidal antibodies. Substitutionwith levothyroxine was started.

Compromiso genital en un paciente con lepra lepromatosa / Involvement of genitals in e patient with lepromatous leprosy

El compromiso de los órganos genitales masculinos en la lepra, se observa con mayor frecuencia en el transcurso de los cuadros reaccionales. Sin embargo, fuera de estos episodios agudos, la piel y mucosa de los genitales externos pueden estar comprometidas por lesiones específicas. Se comunica el caso de un paciente hanseniano que recidivó, lepromatoso con lesiones infiltradas y nodulares en prepucio y lóbulo auricular, como únicas manifestaciones de la enfermedad.

The involvement of male genitals in leprosy appears more frecuently in the immunologic reactions. Although, the genital skin and mucous can be affected, by specific lesions too. We report a case of relapsed lepromatous leprosy with infiltrated lesions and nodules in prepuce and earlobe as the only disease manifestation.

Vasculitis ANCA-positivo en pacientes hipertiroideos usuarios de propiltiouracilo: Report of four cases / Antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis associated to the use of propylthiouracil

Antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis is an uncommon complication of the use of propylthiouracil. When it occurs, it affects multiple organs as any systemic vasculitis. We report three females and one male, aged 30, 40, 43 and 41 years respectively, that after a lapse of 12 to 28 months of propylthiouracil use, presented clinical signs of vasculitis. All had high titers of ANCA against myeloperoxidase. In three patients, a skin biopsy confirmed the diagnosis. The condition subsided when propylthiouracil was discontinued, but one female patient required the use of prednisone.

Efectos de la exposición al humo de tabaco ambiental en no fumadores / Effects in passive smokers of environmental tobacco smoke exposure

National and international environmental tobacco smoke studies were reviewed regarding its effects on passive smokers' health. Environmental tobacco smoke is composed by more than 4,000 known substances, which are different if they are in the mainstream or sidestream. Studies with biomarkers like cotinine have concluded that exposed nonsmokers have an increased cardiovascular morbi-mortality. Passive smokers also have an increased risk of lung, nasal sinus and breast cancer. Children have more acute and chronic respiratory symptoms, low respiratory infections, otitis and sudden infant death syndrome. Environmental tobacco smoke induces asthma and causes exacerbations in both children and adults. In reproductive health, it decreases the age of menopause and produces menstrual disorders. Newborn infants of passive smoking mothers have a higher probability of low birth weight and to be small for gestational age. This international scientific evidence should lead countries to take measures in order to protect nonsmokers' health.

Se realizó una revisión de los estudios nacionales e internacionales sobre los efectos del humo de tabaco ambiental en la salud de los fumadores pasivos. El humo de tabaco ambiental está conformado por más de 4.000 sustancias químicas, las que difieren cuali y cuantitativamente al estar presentes en la corriente principal o en la lateral. Los no fumadores expuestos presentan un aumento de morbi-mortalidad por enfermedad cardiovascular, incluso con estudios con biomarcadores como cotinina. Además los fumadores pasivos tienen un riesgo aumentado de presentar cáncer de pulmón, de senos paranasales y mama. En niños existe un mayor número de síntomas respiratorios agudos y crónicos, infecciones respiratorias bajas, otitis media y síndrome de muerte súbita infantil. El humo de tabaco ambiental favorece la inducción y exacerbación de asma bronquial en niños y adultos. En la salud reproductiva, disminuye la edad de aparición de la menopausia y produce desórdenes menstruales. Los recién nacidos hijos de madres fumadoras pasivas tienen mayor probabilidad de nacer con bajo peso o de ser pequeños para la edad gestacional. La evidencia científica internacional debe contribuir a que los países tomen medidas para proteger la salud de los no fumadores.

Tratamiento de los estados reaccionales de la lepra / Treatment of leprosy reactions

Los estados reaccionales de la lepra son episodios agudos o que se producen en el transcurso de la evolución crónica de la enfermedad, como resultado de la activación brusca de la inmunidad celular (reacción tipo 1), o de una inapropiada estimulación de la inmunidad humoral (reacción tipo 2). Su tratamiento integral comprende, además de la terapia medicamentosa, medidas fisioterápicas adecuadas para evitar futuras secuelas discapacitantes: técnicas sencillas de inmovilización con férulas, ejercicios terapéuticos, parafinoterapia, electroestimulación. En la reacción tipo 1, muy frecuentemente acompañada de neuritis aguda, es de elección la corticoterapia junto al manejo del daño neural. En las reacciones tipo 2, que comprenden una amplia gama de manifestaciones clínicas de distinta severidad tanto en piel como en otros órganos y sistemas, las drogas más eficaces siguen siendo la talidomida, los corticoides y la clofazimina. Recientes publicaciones proponen la utilización de otras drogas como la pentoxifilina, zafirlukaste y tenidap, con escasa experiencia en lepra, en nuestro medio. En los episodios reaccionales crónicos de ambos tipos, y con el objetivo de disminuir la dosis y depèndencia a los corticoides, utilizamos habitualmente la clofazimina. En caso de falta de respuesta se recomiendan los inmunosupresores azatioprina y ciclosporina, con resultados variables

Restricción del crecimiento fetal e insulinorresistencia: Nuevos hallazgos y revisión de la literatura / Fetal growth restriction and insulin resistance: New findings and review of the literature

There is a strong association between low birth weight and insulin resistance. The thrifty phenotype hypothesis, which postulates fetal programming for adaptation to an adverse intrauterine environment, resulting in a lower insulin sensitivity in utero, is one of the hypothesis to explain this association. Later in life, syndrome X may develop, featuring hypertension, dyslipidemia, central obesity and type 2 diabetes, associated to an excessive food intake. Our investigation during the first three years of life in a prospective cohort of small (SGA) or appropriate for gestational age newborns, demonstrated that a significant increase of insulin levels is detected in SGA, as early as during the first year of life, but only when catch up growth (CUG) occurs. Orexigenic peptides such as Ghrelin appear to participate in this CUG phenomenon. We also sought to determine whether these associations were observed in individuals born with very low birth weight. We found that in utero as well as postnatal growth rates were independent determinants of insulin sensitivity and secretion. Education about feeding practices and physical activity in SGA children, is a future challenge to prevent the onset of syndrome X in this predisposed population.

Tabaquismo en funcionarios de educación / Smoking mong schhool teachers and other schoolworkers

A descriptive and transversal survey was carried out to know the prevalence of smoking and the attitudes of school teachers and other school workers. An anonymous self administered questionnaire was distributed in 235 educational establishments (132 basic schools, 14 high schools and 87 kindergartens) across the country. The analysis of 3,270 completed questionnaires showed a prevalence of smoking of 36.7%, women smoking more than men (37.3% versus 34.6%). The greatest prevalence was found between 20 and 44 years of age. Teacher auxiliaries and administrative staff showed the highest prevalece (57,6 and 48,6% respectively) while directive staff and teachers showed the lowest (22.2 and 32.6% respectively). Two thirds were daily smokers with an average consumption of 5.7 ± 4.3 (SD) cigarettes per day. Only 0.3% smoked more than 20 cigarettes per per day and 13.5% smoked one cigarette in the first 30 minutes after waking up in the morning. Seventy four percent do not allow smoking in their homes and 92.3% agree to limit smoking in their workplaces. The data from this survey suggest that school workers smoke less than the general population and than health workers. This may favour the development of smoke free environments in schools.

Se realizó un estudio descriptivo y transversal para conocer la prevalencia de tabaquismo y actitudes en funcionarios del sector educación. Para esto se distribuyó una encuesta autoaplicada y anónima en 235 establecimientos educacionales del país (132 escuelas, 14 liceos y 87 jardines infantiles). El análisis de 3.270 encuestas mostró una prevalencia de tabaquismo de 36,7%, siendo las mujeres más fumadoras que los hombres (37,3% vs 34,6%). La prevalencia de tabaquismo es mayor entre los 20 y 44 años. Los más fumadores son los paradocentes (57,6%) y administrativos (48,8%); mientras que los menos fumadores son los directivos (22,2%) y profesores (32,6%). Dos tercios de los fumadores son consumidores diarios, con un consumo promedio (± DE) 5,7 ± 4,3 cigarrillos/día. Sólo 0,3% fuma más de 20 cigarrillos/día y 13,5% consume el primer cigarrillo en los primeros 30 minutos luego de despertar. El 74,1% de los funcionarios no permite que se fume en su hogar y el 92,3% está de acuerdo en que se restringa fumar en sus lugares de trabajo. Los datos de esta encuesta sugieren que los funcionarios de educación son menos fumadores que la población general y que los funcionarios de salud, lo que favorece el desarrollo de políticas de ambientes libres del humo de tabaco.

Encuesta nacional de de tabaquismo en funcionarios de salud / A national survey on smoking habit among health care workers in Chile

Background: Worldwide, smoking is the main avoidable cause of death among adults. Aim: To study smoking habits among health care workers in Chile. Material and methods: A national survey about smoking among subjects working in the Chilean Ministry of Health. An anonymous and self administered enquiry was used. Results: The enquiry was answered by 20,848 employees, corresponding to 58 percent of the total universe of workers. There was an overall prevalence of smoking of 40.7 percent. Sixty four percent of smokers did it daily and their mean consumption was 7 cigarettes per day. Smoking was more common among men than women (43 and 39.6 percent, respectively). Also, nicotine addiction was also more common among men (16.5 and 11.7 percent, respectively). The prevalence of smoking decreased along with age. Journalists, guards, students and paramedics had the higher prevalence of smoking. Physicians, teachers and nutritionists had the lower prevalence. Although physicians had the lower frequency of smoking, they had the higher prevalence of nicotine addiction. Forty five percent of smokers were interested in therapies to quit, 69 percent did not allow smoking at home and 89 percent agreed with smoking restrictions in work places. Conclusions: The prevalence of smoking among health care workers is similar to that of the general population in Chile.

Test de estimulación intraarterial selectiva con calcio en el diagnóstico de localización de insulinomas: Casos clínicos / Selective intra arterial calcium stimulation for the localization of insulinomas: Report of two cases

Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonography did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done (Rev Méd Chile 2004; 132: 71-5).

Linfoma primario de esofago en una paciente con SIDA / Primary esophageal lymphoma in a patient with AIDS

Primary esophageal lymphomas are extremely rare. We report a primary esophageal T cell lymphoma of a diffuse large cell phenotype B in a patient with AIDS. Also we reviewed other published cases. The diagnosis of this complication should be considered in HIV seropositive patients with progressive displagia and endoscopic findings of masses, polyps or ulcerations and, specially in those unresponsive to antifungal or antiviral therapy. Biopsy and histopathologic studies are needed to confirm the diagnosis.

Criptococosis diseminada en pacientes con SIDA. Análisis clÝnico, microbiológico e inmunológico de 51 pacientes / Disseminated cryptococcosis in patients with AIDS. Clinical, microbiological, and immunological analysis of 51 patients

In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patient's life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6) and in 16 as relapse (31.3). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7, slightly superior among patients in relapse (40) compared to those who presented a first episode of the mycosis (35.2). In those individuals for whom data were available, 65.2 of blood cultures, 94.1 of CSF cultures and 79.06 of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1 and > or = 1/1000 in 73.6 of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.

Loci geneticos asociados al trastorno bipolar: estudios en poblacion colombiana / Genetic loci associated to bipolar disorder: studies in colombian population

Objetivos: Caracterizar una muestra de familias y tríos de una población colombiana aislada para mapear loci involucrados en la vulnerabilidad al Trastorno Afectivo Bipolar tipo I (TAB- I). Métodos: Se recolectan tríos y genealogías utilizando las entrevistas FIGS-DIGS en miembros de las familias y posibles afectados. El poder para detectar ligamiento (PDL) se estima por simulación. El modelo utilizado asume una frecuencia para el alelo afectado de 0.003, penetrancias de 0.01,0.81 y 0.9 y un marcador de cuatro alelos a 5cM del locus. Resultados: Se identificaron 28 familias con TAB-I, con 3.603 individuos y 160 afectados, y 246 tríos. Asumiendo homogeneidad genética y teniendo en cuenta la evidencia genética del mestizaje, las simulaciones mostraron PDL significativos de 100 por ciento para un LOD-score>3. Estamos examinando el desequilibrio promedio en tríos y tamizando en familias los cromosomas 12,18 y 21. Conclusión: Tenemos un grupo significativo de familias y trios pertenecientes a una población aislada con un poder para detectar ligamiento al Trastorno Afectivo Bipolar. Esto permite realizar estudios de ligamiento buscando genes involucrados en la vulnerabilidad al TAB-I en población Colombiana