Principales patologías diagnosticadas por el servicio de Neurología en urgencias e internación en un hospital universitario en Colombia 2020 - 2021 / Main pathologies diagnosed by the Neurology service in emergencies and hospitalization in a university hospital in Colombia 2020 - 2021

RESUMEN INTRODUCCIÓN: Las enfermedades neurológicas constituyen gran parte de las urgencias médicas (10 %-15%). Por ende, se hace necesario el reconocimiento de la distribución de las principales condiciones tanto en urgencias como en hospitalización. Se decidió caracterizar la distribución real de la enfermedad neurológica atendida en un hospital universitario de tercer nivel en Boyacá. MATERIALES Y MÉTODOS: Estudio descriptivo de corte transversal. RESULTADOS: 1203 pacientes con edad promedio de 56,2 (± 21,2) años, la mayoría de sexo masculino, casi la mitad de ellos nivel de educación básica primaria. De un total de 81 diagnósticos, se caracterizaron clínica y sociodemográficamente los 12 primeros, encontrando que en el área de urgencias prevalece la enfermedad cerebrovascular, epilepsia, cefalea, polineuropatia y vértigo. CONCLUSIONES. Los principales motivos de interconsulta del servicio son la enfermedad cerebrovascular y el delirio en urgencias e internación respectivamente, siendo generadas principalmente por medicina general, medicina interna y unidad de cuidado intensivo.

ABSTRACT INTRODUCTION: Neurological diseases constitute a large proportion of medical emergencies (10%-15%). Knowledge of the distribution of the main neurological conditions both in the emergency room and in hospitalization is necessary. The real distribution of neurological disease treated in a tertiary university hospital in Boyacá can be characterized. METHODOLOGY: Descriptive cross-sectional study. Results: 1203 patients with a mean age of 56.2 (± 21.2) years, most of them male, almost half of them with basic primary education. From a total of 81 diagnoses, the first 12 were characterized clinically and socio demographically, we found that in the emergency department, cerebrovascular disease, epilepsy, headache, polyneuropathy and vertigo prevailed. CONCLUSIONS. The main reasons for consultation were cerebrovascular disease and delirium in the emergency department and hospitalization, respectively, being mainly generated by internal medicine and the intensive care unit.

Physioprophylaxis post-stress test in soccer players: effects blood lactate concentrations

Abstract Objective: To determine the effects of physioprophylaxis (PP) on blood lactate (BL) concentrations after maximal incremental stress test, considering that this is the application of techniques in sports physiotherapy to reduce signs of muscle fatigue that can trigger injuries due to overload. Materials and Methods: Quantitative study, experimental type, longitudinal section in 12 university players. The group is divided into one control group (CG) with recovery at rest without PP and another experimental group (EG) to which PP is applied at the end of the test. Blood lactate is recorded with Accutrend Plus at the beginning of the test, (1) five minutes after finishing the test (2) and after the PP (3) at two different moments for intra-subject analysis. Results: The following data were obtained regarding blood lactate clearance, Moment 1: Without Plan (WoP) 4.86±1.4 and With Plan (WP) 8.85±1.25 (p<0.05), moment 2: (WoP) 5.6±1.76 and (WP) 7.8±1.3 (p<0.05) in mmol/L, and intra-subject: (WoP): 5.25±1.58; (WP): 8.35±1.33 (p<0.05). Conclusions: The clearance of lactate in the blood at 30 minutes post stress test in the EG is bigger than the CG, because they recovered with the physioprophylactic plan.

Resumen Objetivo: Determinar los efectos de la fisioprofilaxis (PP) sobre las concentraciones de lactato en sangre (BL) tras la prueba de esfuerzo incremental máximo, considerando que se trata de la aplicación de técnicas en fisioterapia deportiva para reducir los signos de fatiga muscular que pueden desencadenar lesiones por sobrecarga. Materiales y métodos: Estudio cuantitativo, tipo experimental, sección longitudinal en 12 jugadores universitarios. El grupo se divide en un grupo control (GC) con recuperación en reposo sin PP y otro grupo experimental (GE) al que se aplica PP al final de la prueba. El lactato sanguíneo se registra con Accutrend Plus al inicio de la prueba, (1) cinco minutos después de finalizar la prueba (2) y después de la PP (3) en dos momentos diferentes para el análisis intra-sujeto. Resultados: Se obtuvieron los siguientes datos con respecto al aclaramiento de lactato en sangre, Momento 1: Sin Plan (WoP) 4.86 ± 1.4 y Con Plan (WP) 8.85 ± 1.25 (p <0.05), Momento 2: (WoP) 5.6 ± 1.76 y (WP) ) 7,8 ± 1,3 (p <0,05) en mmol / L, e intra-sujeto: (WoP): 5,25 ± 1,58; (WP): 8,35 ± 1,33 (p <0,05). Conclusiones: El aclaramiento de lactato en sangre a los 30 minutos post prueba de esfuerzo en el GE es mayor que en el GC, debido a que se recuperaron con el plan fisioprofiláctico.

Prevalencia de no resiliencia y factores asociados en escolares de un municipio colombiano, 2019

Objetivo: Determinar la prevalencia de no resiliencia y los factores demográficos, escolares y familiares asociados, en escolares de un municipio colombiano, en el año 2019. Metodología: Estudio trasversal, con muestreo probabilístico estratificado bietápico, con una muestra de 2958 escolares, a los que se les aplicó el cuestionario JJ46. Se calculó la prevalencia de no resiliencia y se relacionó con los factores indicados, mediante intervalos de confianza del 95 %. Además, se construyó una regresión binomial para la no resiliencia, teniendo presente el control de aquellas variables independientes que podrían confundir la relación con el desenlace. Resultados: Se encontró una prevalencia de no resiliencia del 58,4 %, siendo mayor en los hombres, de la zona urbana, que cursaban grado séptimo y que habían vivido algún evento vulnerable, en el 22,0, 29,0, 73,0 y 40,0 % respectivamente, con respecto a las mujeres, de la zona rural, que estaban en grado noveno y que no habían vivido eventos vulnerables. La prevalencia de no resiliencia en los hombres excedió en un 20 % el de las mujeres; y con respecto a la persona que le daba más cariño al escolar, en el 88 % de los casos eran otros familiares distintos a ambos padres. Conclusiones: Urge la necesidad de implementar talleres en los programas educativos sobre la promoción de la resiliencia y realizar una valoración periódica de la misma.

Objective: To determine the prevalence of non-resilience and associated demographic, school, and family factors in schoolchildren in a Colombian municipality in 2019. Methodology: This is a cross-sectional study with twostage stratified probability sampling on a sample of 2,958 schoolchildren to whom the JJ46 questionnaire was administered. We calculated the prevalence of non-resilience and related it to the selected factors using 95% confidence intervals. Moreover, we constructed a binomial regression for non-resilience while controlling the independent variables that could potentially misidentify the relationship with the outcome. Results: A 58.4% prevalence of non-resilience was found, being higher in males (22.0%), from the urban area (29.0%), in the seventh grade (73.0%), and who had experienced some vulnerable event (40.0%), compared to females, from the rural area, in the ninth grade, and who had not experienced vulnerable events. The prevalence of non-resilience in males exceeded that of females by 20%. In 88% of cases, the most affectionate person to the schoolchild was another relative other than the parents. Conclusions: There is an urgent need to implement workshops in school programs for the promotion of resilience and to conduct a periodic assessment of resilience.

Objetivo: Determinar a prevalência de não resiliência e os fatores demográficos, escolares e familiares associados, em escolares de um município colombiano, no ano 2019. Metodologia: Estudo transversal, com amostragem probabilística estratificada bietápica, com uma amostra de 2958 escolares, aos que se aplicou o questionário JJ46. Foi calculada a prevalência de não resiliência e associada com os fatores indicados, por meio de intervalos de confiança do 95%. Além disso, construiu-se uma regressão binomial para a não resiliência, considerando o controle daquelas variáveis independentes que poderiam confundir a relação com o desenlace. Resultados: Achouse uma prevalência de não resiliência de 58,4%, sendo maior nos homens, da zona urbana, que cursavam sétimo grau e que tinham vivido algum evento vulnerável, de 22,0, 29,0, 73,0 e 40,0% respectivamente, em relação com as mulheres, da zona rural, que estavam em nono grau e que não tinham vivido eventos vulneráveis. A prevalência de não resiliência nos homens excedeu em um 20% à das mulheres; e no que tange à pessoa que dava mais carinho ao escolar, 88% dos casos eram outros familiares diferentes a ambos os pais. Conclusões: Urge a necessidade de implementar oficinas nos programas educativos sobre a promoção da resiliência e realizar uma valoração periódica da mesma.

Predictors of poor outcomes in young non-comorbid patients with COVID-19

ABSTRACT Background: Prognostic factors in previously healthy young patients with COVID-19 remained understudied. Objective: The objective of the study was to identify factors associated with in-hospital death or need for invasive mechanical ventilation (IMV) in young (aged ≤ 65 years) and previously healthy patients with COVID-19. Methods: We conducted a prospective cohort study that included patients admitted with COVID-19. The primary outcome was in-hospital death/need for IMV. Secondary outcomes included need for IMV during follow-up, days on IMV, length of stay (LOS), hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP), and pulmonary embolism (PE). Bivariate and multivariate analyses were performed. Results: Among 92 patients, primary outcome occurred in 16 (17%), death in 12 (13%), need for IMV in 16 (17%), HAP/VAP in 7 (8%), and PE in 2 (2%). Median LOS and IMV duration were 7 and 12 days, respectively. Independent associations were found between the primary outcome and male sex (Adjusted odds ratio [aOR] 7.1, 95%CI 1.1-46.0, p < 0.05), D-dimer levels > 1000ng/mL (aOR 9.0, 95%CI 1.6-49.1, p < 0.05), and RT-PCR Ct-value ≤ 24 on initial swab samples (aOR 14.3, 95%CI 2.0-101.5, p < 0.01). Conclusions: In young and non-comorbid COVID-19 patients, male sex, higher levels of D-dimer, and low SARS-CoV-2 RT-PCR Ct-value on an initial nasopharyngeal swab were independently associated with increased in-hospital mortality or need for IMV.

HIV-positive patients presenting with peripheral blood cytopenias: is bone marrow assessment a priority?

ABSTRACT Introduction: Hematologic abnormalities are frequent among persons living with HIV (PLWH). The bone marrow aspirate (BMA) and biopsy (BMB) are commonly performed in the diagnostic approach of patients with unexplained cytopenias. Changes in antiretrovirals, supportive therapy and increased life expectancy have modified the distribution and etiology of cytopenias, questioning their use. Our aim was to analyze the diagnostic yield of BMA, BMB and marrow cultures for the evaluation of cytopenias in PLWH. Methods: This was a retrospective cohort of ≥ 18-year-old PLWH undergoing bone marrow assessment (MA) for the evaluation of cytopenias between January 2002 and December 2015. Results: A total of 236 cytopenic events were analyzed, 47.9% being PLWH who had a longstanding diagnosis (≥ 1 year). Adherence to antiretrovirals was 63.5%. Anemia was seen in 91.9% and pancytopenia in 39%. Common presentations included fever (52.1%), weight loss (42.8%) and adenopathies (28.8%). Median days from detection to MA was 5 (0 - 63 days). Most common etiologies were non-HIV infectious diseases (31.4%) and benign/malignant hematologic diseases (26.3%). The diagnostic yield was 16.1% for BMA, 20.3% for BMB, 30.5% for both and 35.6% when cultures were added. Patients most likely to have conclusive MA were those with moderate/severe thrombocytopenia (p = 0.007). Fever, splenomegaly, and low CD4+ counts were associated with infectious etiologies, while hematologic diagnoses were related to the presence of adenopathies. Conclusion: As a minimally invasive intervention, the MA has a high yield for identifying the etiology of cytopenic events in PLWH, being conclusive in one in three patients. Early performance could lead to prompt diagnosis and timely therapy initiation.

Significant Rise in SARS-CoV-2 Reinfection Rate in Vaccinated Hospital Workers during the Omicron Wave: A Prospective Cohort Study

ABSTRACT Background: Relatively low SARS-CoV-2 reinfection rates have been reported in vaccinated individuals, but updates considering the Omicron variant are lacking. Objective: The objective of the study was to provide a current estimate of the SARS-CoV-2 reinfection rate in a highly immunized population. Methods: A prospective cohort of Mexican hospital workers was followed (March 2020-February 2022). Reinfection was defined as the occurrence of two or more episodes of COVID-19 separated by a period of ≥ 90 days without symptoms. The reinfection rate was calculated as the number of reinfection episodes per 100,000 persons per day. Results: A total of 3732 medical consultations were provided to 2700 workers, of whom 1388 (51.4%) were confirmed COVID-19 cases. A total of 73 reinfection cases were identified, of whom 71 (97.3%) had completed their primary vaccination series and 22 (30.1%) had had a booster dose before the second episode. The overall reinfection rate was 23.1 per 100,000 persons per day (as compared to a rate of 1.9 per 100,000 persons per day before the Omicron wave). Conclusions: The SARS-CoV-2 reinfection rate rose significantly during the Omicron wave despite a high primary vaccination coverage rate. Almost one-third of reinfected workers had a vaccine booster ≥ 14 days before the last COVID-19 episode.

Prevención de eventos de superpropagación de COVID-19 en autobuses que transportaron pacientes presintomáticos / Prevention of COVID-19 superspreader events in buses boarded by presymptomatic patients

Resumen Introducción: Ha ocurrido superpropagación de COVID-19 cuando individuos sintomáticos sin uso de cubrebocas abordaron autobuses. Objetivo: Reportar el riesgo de superpropagación cuando individuos presintomáticos abordaron autobuses junto con pasajeros no vacunados, pero se mantuvieron intervenciones preventivas no farmacológicas. Métodos: Estudio prospectivo de personal de salud transportado durante dos semanas en autobuses a un centro de vacunación contra COVID-19. Fue obligatorio llevar ventanas abiertas, uso correcto de cubrebocas y exclusión de personas con síntomas. La vigilancia prospectiva identificó a trabajadores con COVID-19 los 14 días siguientes a la vacunación. Cada pasajero asintomático de autobuses donde se detectaron casos fue vigilado durante un periodo similar. Los resultados de tamizaje voluntario estuvieron disponibles para los trabajadores que se realizaron prueba el mes previo o el siguiente a la vacunación. Resultados: 1879 trabajadores abordaron 65 autobuses. El tiempo a bordo varió de tres a ocho horas. Veintinueve casos de COVID-19 y cuatro casos asintomáticos fueron identificados entre 613 pasajeros de 21 autobuses. La mediana de tiempo entre la vacunación y el inicio de síntomas de COVID-19 fue de seis días. Fue identificado un caso de transmisión sospechada en autobús. Conclusiones: Las intervenciones preventivas no farmacológicas estrictas redujeron sustancialmente el riesgo de superpropagación de COVID-19 en autobuses ocupados por individuos presintomáticos.

Abstract Introduction: COVID-19 superspreader events have occurred when symptomatic individuals without wearing face masks boarded buses. Objective: To report the risk of superspreader events when presymptomatic individuals boarded buses together with unvaccinated passengers, but with non-pharmacological preventive interventions being maintained. Methods: Prospective study of health personnel transported in buses to a COVID-19 vaccination center for two weeks. Open windows, correct use of face masks and exclusion of symptomatic individuals were mandatory. Prospective surveillance identified workers with COVID-19 within 14 days after vaccination. Each asymptomatic passenger of buses where cases were identified was monitored for a similar time period. Voluntary screening results were available for workers who were tested in the month before or after vaccination. Results: 1,879 workers boarded 65 buses. On-board time ranged from three to eight hours. Twenty-nine cases of COVID-19 and four asymptomatic cases were identified among 613 passengers of 21 buses. Median time between vaccination and COVID-19 symptoms onset was six days. One case of suspected transmission on a bus was identified. Conclusions: Strict nonpharmacological preventive interventions substantially reduced the risk of COVID-19 superspreader events in buses boarded by presymptomatic individuals.

Lesión pulmonar autoinflingida por el paciente en la Unidad de Cuidados Intensivos / Patient Self-Inflicted Lung Injury (P-SILI) in the Intensive Care Unit / Lesão pulmonar auto-infligida pelo paciente na Unidade de Cuidados Intensivos

Resumen: Hasta la fecha, no se ha demostrado superioridad de algún modo de ventilación mecánica invasiva en particular, la mayoría de los autores destacan la individualización de la programación y modalidad de la ventilación mecánica, teniendo en cuenta la presencia de asincronías y buscando el mejor confort del paciente, incluso la ventilación espontánea, aunque al parecer se asemeja a la manera fisiológica de la mecánica respiratoria, no está exenta de complicaciones. Tres mecanismos potenciales se proponen para el desarrollo de lesión pulmonar por esfuerzo respiratorio espontáneo: sobredistensión global y local, aumento de la perfusión pulmonar y la presencia de asincronías paciente-ventilador, derivadas en una lesión autoinfligida por el paciente o «P-SILI¼, por sus siglas en inglés Patient Self Inflicted Lung Injury. En los últimos 20 años se han desarrollado estrategias que permiten minimizar los riesgos asociados a la ventilación mecánica, la más importante de todas es mantener soporte ventilatorio guiado por metas, identificación del posible desarrollo del paciente y extubar al paciente lo más rápido posible, siempre y cuando sus condiciones lo permitan.

Abstract: To date, the superiority of any particular mode of invasive mechanical ventilation has not been demonstrated; most authors emphasize the individualization of the programming and modality of mechanical ventilation, taking into account the presence of asynchronies and seeking the best patient comfort; even spontaneous ventilation, although it seems to resemble the physiological manner of respiratory mechanics, is not free of complications. Three potential mechanisms are proposed for the development of lung injury by spontaneous respiratory effort: global and local overdistension, increased pulmonary perfusion and the presence of patient-ventilator asynchronies, resulting in a Patient Self-Inflicted Injury or «P-SILI¼. In the last twenty years, strategies have been developed to minimize the risks associated with mechanical ventilation, the most important of which is to maintain goal-directed ventilatory support, identify the possible development of the patient and extubate the patient as quickly as possible, as long as the patient's conditions allow it.

Resumo: Até o momento, nenhum modo específico de ventilação mecânica invasiva se mostrou superior, a maioria dos autores enfatiza a individualização da programação e modalidade de ventilação mecânica, levando em consideração a presença de assincronia e buscando o melhor conforto do paciente. Mesmo a ventilação espontânea, embora pareça assemelhar-se à maneira fisiológica da mecânica respiratória, não é isenta de complicações. Três mecanismos potenciais são propostos para o desenvolvimento de lesão pulmonar por esforço respiratório espontâneo: hiperdistensão global e local, aumento da perfusão pulmonar e presença de assincronia paciente-ventilador, derivada de uma lesão autoinfligida pelo paciente ou «P-SILI¼ por suas siglas em inglês patient self inflicted lung injury. Nos últimos vinte anos, foram desenvolvidas estratégias para minimizar os riscos associados à ventilação mecânica. O mais importante de tudo é manter o suporte ventilatório guiado por metas, identificar o possível desenvolvimento do paciente e extubar o paciente o mais rápido possível, enquanto suas condições permitirem.

Transformación integral del sistema de salud de la República Democrática de Timor Leste (2013-2016) / Comprehensive transformation of the health system of the Democratic Republic of Timor Leste (2013-2016)

Resumen Objetivo: Implementar un proyecto de reformas al sistema de salud de la República Democrática de Timor Leste, en el periodo 2013-2016. Materiales y métodos: Se realizó un estudio de tipo investigación/acción desde una perspectiva gerencial. Se incluyó muestra no probabilística por conveniencia de usuarios, proveedores y funcionarios, se emplearon técnicas cualitativas como grupos focales y entrevistas abiertas, así como el uso de herramientas gerenciales. Resultados: En una primera fase se realizó el análisis situacional a escala de país. Con estos elementos se definieron sucesivamente las prioridades estratégicas, los objetivos, indicadores y metas por cada perspectiva. Finalmente, el programa de cambios se organizó, se ejecutó el proceso de transformaciones y se fueron determinando los resultados. Se diseñaron y quedaron funcionando el Programa Nacional de Cáncer y el Programa Nacional de Atención Primaria; se introdujeron especialidades médicas y servicios asistenciales con los que no se contaba; se crearon nuevos enfoques para la gestión de los recursos humanos y, se elevó el nivel del trabajo científico, entre otros beneficios. Conclusiones: Se produjeron mejoras sustanciales en el Sistema de Salud y además se dejó creada una capacidad potencial para que dichos efectos sigan creciendo en cantidad y calidad.

Abstract Objective: Implement a Project to reform the health system of the Democratic Republic of Timor Leste in the period 2013-2016. Materials and methods: A research / action type study was carried out from a managerial perspective. A non-probabilistic sample was included for the convenience of users, suppliers and officials, qualitative techniques such as focus groups and open interviews were used, as well as the use of management tools. Results: In a first phase, the situational analysis was carried out at the country level. With these elements, the strategic priorities, objectives, indicators and goals were successively defined for each perspective. Finally, the change program was organized, the transformation process was carried out and the results were determined. The National Cancer Program and the National Primary Care Program were designed and kept functioning; Missing medical specialties and care services were introduced; New approaches to human resource management were created and the level of scientific work was raised, among other benefits. Conclusions: There were substantial improvements in the health system and in addition, a potential capacity was created so that these effects continue to grow in quantity and quality.

Prevalencia de consumo de sustancias psicoactivas y su relación con características sociodemográficas, familiares y de personalidad en estudiantes en formación tecnológica / Prevalence of psychoactive substance use and its relationship with characteristics sociodemographic, family and personality in students in technology training

Resumen. El objetivo del estudio fue determinar la prevalencia del consumo de sustancias psicoactivas y los factores asociados con las caracteristicas sociodemográficas, familiares y de personalidad. El estudio se realizó en un Instituto de formación tecnológica de carácter público Medellin, 2016. La muestra estuvo conformada por 891 estudiantes a quienes se les aplicó los instrumentos ASSIT, APGAR Familiar, NEO-FFI, ERI y un cuestionario de variables sociodemográficas. Los resultados mostraron que la prevalencia de consumo de sustancias psicoactivas fue de 51,6%; con mayor consumo de alcohol (49,7%). La prueba de regresión logistica sugiere que ser hombre (OR= 2,97), con edad entre 18 y 24 años (OR= 2,72), con expresión en estado bajo en las relaciones intrafamiliares (OR= 1,63) y prestar un nivel muy bajo en amabilidad (Or=9,32) se asocia de forma negativa con el consumo de sustancias psicoactivas. Se resalta la importancia de fortalecer aspectos de la personalidad relacionados con la amabilidad (confianza, franqueza, actitud conciliadora, sensibilidad a los demás), además de las relaciones intrafamiliares y aspectos que faciliten prevenir el consumo de sustancias psicoactivas en los estudiantes.

Abstract. The objective of this study was to stablish the prevalence of psychoactive substances consumption among students and to associate this consumption with the socio-demographic, family structures, and personality traits. The study was set on a public technological institute of Medellin, Colombia during 2016. The next tests were applied once to the students: ASSIT, APGAR Family, NEO-FFI, ERI and a test of sociodemographic variables. The primary outcome in this study was the prevalence of consumption of psychoactive substances among students. In order to stablish the association between psychoactive substances and sociodemographic, family structures, and personality traits, a logistic regression model was fit. A total of 891 students participated in this study. The prevalence of psychoactive substances use among students was 51.6%. The logistic regression conducted on the data proved that males, among 18 to 24 years, with intrafamily deficit, and with low kindness were positively associated with greater PAS use (OR = 2.97, 2.72, 1.63, 9.32, respectively). Kindness aspects (e.g., confidence, frankness, counseling, sensitivity to others) and family relationships should be improved in order to prevent psychoactive substances use among students.

Meningoencefalitis por virus Varicella-Zóster posterior a infección por SARS-CoV2: Reporte de dos casos / Meningoencephalitis caused by Varicella-Zoster virus after SARS-CoV2 infection: Two cases report

RESUMEN La meningoencefalitis por el VZV es una patología poco frecuente que se presenta con la reactivación del virus dentro del organismo. OBJETIVO: Describir la presentación clínica de dos pacientes con neuroinfección por VZV posteriormente a infección por SARS-CoV-2. REPORTE DEL CASO: El primer caso corresponde a un hombre de 59 años con antecedente de neumonía moderada por SARS-CoV-2 que después cursó con meningoencefalitis por VZV y, además, desarrolló un síndrome de Ramsay Hunt. El segundo caso es el de una mujer de 37 años con antecedente de infección leve por SARS CoV-2 con un cuadro de cefalea con signos de alarma, en quien se documentó neuroinfección por VZV

ABSTRACT Meningoencephalitis caused by varicella zoster virus is a rare pathology that presents due to the reactivation of the virus in the organism OBJECTIVE: To describe the clinical presentation of two patients with VZV neuroinfection presented after a SARS CoV-2 infection. CASE REPORT: The first case is a 59 year old male with previous moderate SARS CoV-2 infection who presented meningoencephalitis and was diagnosed with Ramsay Hunt's Syndrome. The second case is a 37 year old female with previous SARS CoV-2 infection who presented with an acute onset headache and was documented with VZV neuroinfection.

Actinomyces y síndrome de Kartagener: Reporte de caso y revisión de la literatura / Actinomyces and Kartagener syndrome: Case report and literature review

RESUMEN El síndrome de Kartagener, el cual hace parte del subgrupo de las discinesias ciliares primarias predispone a infecciones respiratorias recurrentes del tracto respiratorio por Haemophilus influenzae, Staphylococcus aureus y Streptococcus pneumoniae. Se describe a continuación el caso de un paciente con diagnóstico de síndrome de Kartagener en quien se documentó colonización por Pseudomonas fluorescens y neumonía con empiema asociado por Actinomyces spp, una asociación poco frecuente en la literatura.

ABSTRACT Kartagener syndrome, which is part of the subgroup of the primary ciliary dyskinesias, predisposes to recurrent respiratory tract infections due to Haemophilus influenzae, Staphylococcus aureus and Streptococcus pneumoniae. The case of a patient with a diagnosis of Kartagener syndrome in whom colonization by Pseudomonas fluorescens and pneumonia complicated with empyema by Actinomyces spp is a rare association in the literature, which is described below.

Valoración de la resiliencia en escolarizados: línea base para programas de intervención, Antioquia, 2018 / Assessment of resilience in schoolchildren: baseline for intervention programs, Antioquia, 2018 / Valoração da resiliência em escolarizados: línea base para programas de intervenção, Antioquia, 2018

Resumen Objetivo: determinar los niveles de resiliencia en los estudiantes de 12 a 17 años de las instituciones públicas urbanas de las subregiones del departamento de Antioquia, Colombia. Método: transversal en 2185 estudiantes y en muestras independientes por subregión, a quienes se les aplicó un cuestionario de valoración de la resiliencia en adolescentes, el JJ46. Se calcularon los niveles de resiliencia y se analizó la relación entre estos con características demográfico-familiares y de vulnerabilidad social. Resultados: en Antioquia predominó la resiliencia media, 53,9%. Los escolarizados de las subregiones Oriente, Suroeste y Norte fueron los que obtuvieron los puntajes más altos de resiliencia, con 57,1%, 53,9% y 50,6%, respectivamente, y los de las subregiones Magdalena Medio, Urabá y Bajo Cauca los menores. En el Valle de Aburrá la resiliencia fue media: 44,2%. Conclusiones: diseñar intervenciones en los escolarizados de los municipios de las subregiones con niveles de resiliencia media e inferior.

Abstract Objective: To determine the levels of resilience in students aged 12 to 17 years of urban public institutions in the subregions of the department of Antioquia, Colombia. Method: Cross-sectional study with 2185 students in independent samples by sub-region to whom the JJ46 questionnaire for assessing resilience in adolescents was applied. Resilience levels were calculated and the relationship between these and demographic-family characteristics and social vulnerability was analyzed. Results: the average resilience, 53.9%, prevailed in the Department of Antioquia. Schoolchildren from the East, Southwest and North subregions obtained the highest resilience scores, with 57.1%, 53.9% and 50.6% respectively, and those from the subregions of Magdalena Medio, Urabá and Bajo Cauca obtained the lower scores. In the Aburrá Valley, resilience was average, 44.2%. Conclusions: There is a need to design interventions in schoolchildren of the municipalities of the subregions with medium and lower levels of resilience.

Resumo Objetivo: determinar os níveis de resiliência nos estudantes de 12 a 17 anos das instituições públicas urbanas das sub-regiões do departamento de Antioquia, Colômbia. Método: transversal em 2185 estudantes e em amostras independentes por sub-região, a quem se lhes aplicou um questionario de valoração da resiliência em adolescentes, o JJ46. Calcularam-se os níveis de resiliência e se analisou a relação entre estes com características demográficofamiliares e de vulnerabilidade social. Resultados: em Antioquia predominou a resiliência media, 53,9%. Os escolarizados das sub-regiões Oriente, Sul-oeste e Norte foram os que obtiveram as pontuações mais altas de resiliência, com 57,1%, 53,9% e 50,6%, respectivamente, e os das sub-regiões Magdalena Médio, Urabá e Baixo Cauca os menores. No Vale de Aburrá a resiliência foi media: 44,2%. Conclusões: desenhar intervenções nos escolarizados dos municípios das sub-regiões com níveis de resiliência media e inferior.

Factors Associated with COVID-19 and Asymptomatic Carriage in Healthcare Workers of a COVID-19 Hospital

ABSTRACT Background: Risk factors for coronavirus disease (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) asymptomatic carriage (AC) in healthcare workers (HCWs) have been scarcely characterized. Objective: The objective of the study was to study factors associated with COVID-19 and AC in HCWs of a COVID-19 academic medical center. Methods: This is a case-control study. Cases were either symptomatic or asymptomatic HCWs with a positive SARS-CoV-2 polymerase chain reaction (PCR) test result between March 16 and May 21 of 2020. Adjusted odds ratios (aOR) were calculated by means of multivariable logistic regression. In addition, each subject was followed for 14 days to inform outcomes. Results: One hundred thirty of 249 (52.2%) symptomatic HCWs had COVID-19; 10 were hospitalized but none died. Of 987 asymptomatic HCWs, 37 (3.7%) were AC; 6 of the remaining 950 asymptomatic HCWs with a negative PCR test result were found to be presymptomatic COVID-19 cases the following 14 days. Nurses were more frequently present in the COVID-19 group (51.5% vs. 37.0%), but multivariable analysis rendered non-significant results. After adjustment for age, comorbidities, and working place, factors found to be associated with AC were: working in wards as a nurse (aOR = 9.19, 95% confidence interval [CI] = 1.05-80.22, p = 0.045), kitchen personnel (aOR = 4.09, 95% CI = 1.55-10.83, p = 0.005), and being a physician (aOR = 0.12, 95% CI = 0.03-0.54, p = 0.006). Conclusions: HCW category was the predominant factor associated with AC of SARS-CoV-2 in this study.

Comparación del tiempo de rotura de la película lagrimal entre el topógrafo corneal y la técnica con fluoresceína, y su correlación con el cuestionario OSDI / Comparison of the tear break time between the corneal topography and the technique with fluoresceine, and its correlation with the OSDI questionnaire

Introducción: El síndrome de ojo seco es una enfermedad subdiagnosticada. El método diagnóstico más utilizado es la medición del tiempo de rotura de la lágrima con fluoresceína (TRLf). Sin embargo, no hay una prueba de referencia.­ Objetivo: Estimar la correlación del TRLf y el tiempo de rotura lagrimal no invasivo (TRLNI) con el puntaje del cuestionario OSDI (Ocular Surface Disease Index). Método: Estudio transversal. Se incluyeron 60 ojos de 30 pacientes mayores de edad que asistían a consulta de oftalmología en una clínica especializada de Cali, Colombia. Se recolectó por medio del cuestionario OSDI la sintomatología asociada y se tomó el TRLNI con el topógrafo corneal por personal calificado. El TRLf se tomó de la historia clínica. Se realizaron correlaciones con método de Kendall, Kappa y Spearman. Resultados: La mediana del TRLf para el ojo derecho (OD) fue de 15.2 s (6.4-22.4) y para el ojo izquierdo (OI) de 15.3 s (6.2-22.6). La mediana del TRLNI para el OD fue de 7.5 s (2.6-17.7) y para el OI de 6.7 s (1.4-17.1). El 36.6% de los pacientes presentaron TRLf < 10 s y el 70.0% por TRLNI. El coeficiente de correlación de Kendall mostró OD tau-b 0,2966 y OI tau-b 0,3065. La correlación del puntaje OSDI y el tiempo de rotura de la lágrima fue negativa, pero no significativa. Conclusiones: El TRLNI fue más corto que el TRLf. La correlación del puntaje del cuestionario OSDI fue moderada para ambos métodos.

Introduction: Dry eye syndrome is a sub diagnose disease. The diagnostic method most commonly used is the fluorescein tear break up time (fBUT). However, there is no gold test. Objective: To estimate the correlation of fBUT, non-invasive tear break up time (NIBUT) and with the score of the Ocular Surface Disease Index (OSDI). Method: Cross-sectional study. 60 eyes of 30 adult patients attending an ophthalmology clinic in Cali, Colombia were included. The associated symptomatology was collected through the OSDI questionnaire and the NIBUT was taken with the corneal topograph by qualified personnel. The fBUT was taken from the medical records. Correlations were made with the method of Kendall, Kappa and Spearman. Results: The median fBUT for the right eye (OD): 15.2 (6.4-22.4 s) and left eye (OS): 15.3 (6.2-22.6). The median of the TRLNI of the OD:7.5 (2.6-17.7 s) and OS 6.7 (1.4-17.1 s). 36.6% of the patients presented fBUT < 10 s and 70.0% due to NIBUT. The Kendall correlation coefficient showed OD: tau-b: 0.2966 and OS: tau-b: 0.3065. The correlation of the OSDI score and tear break time was negative but not significant. Conclusions: NIBUT had shorter tear film rupture time compared to the fluorescein method. The correlation of OSDI questionnaire score was moderate for both methods.

Características de pacientes con desgarros de retina que requirieron fotocoagulación láser en la Clínica de Oftalmología de Cali (2015-2016) / Characteristics of patients with retina trears that required laser photocoagulation in Clínica de Oftalmología de Cali (2015-2016)

Introducción: Entre las causas más frecuentes de disminución de la agudeza visual no reversible está el desprendimiento de retina regmatógeno causado por un desgarro previo. Objetivo: Caracterizar la población con desprendimiento de vítreo posterior (DVP) y desgarros de retina tratados con lasér, y describir sus caracteristicas clínicas y los resultados en el contexto local en una clínica de Cali, Colombia. Método: Historias clínicas de pacientes adultos con DVP no traumático y desgarros de retina sometidos a fotocoagulación láser entre enero de 2015 y julio de 2018. Se recolectaron las características clínicas, los antecedentes patológicos y los resultados. Se hizo un análisis descriptivo de la información. Resultados: Un total de 194 ojos de 184 pacientes, el 52% de sexo masculino, con una mediana de edad de 60 años. Los sintomas se presentaron en el 21% de la población y los desgarros fueron herradura, de ubicacion superotemporal y con hemorragia vítrea en su mayoria. Requirieron retratamiento el 8.7% de los pacientes, los cuales fueron en su mayoría hombres (81.2%), mayores de 60 años, con mayor frecuencia de miopía y hemorragia vítrea en un 62.5%. Conclusiones: La descripción de las características clínicas de la población adulta con DVP y desgarros de retina, sometida a fotocoagulación láser en Cali, Colombia, fue similar a la reportada en la literatura.

Introduction: Among the most frequent causes of non-reversible decreased visual acuity is regmatogenous retinal detachment caused by a previous tear. Objective: To characterize the population with posterior vitreous derangement (PVD) and retinal tears treated with which to describe the clinical characteristics and the results in the local context in a clinic in Cali, Colombia. Method: Clinical records of adult patients with nontraumatic PVD and retinal tears undergoing laser photocoagulation between January 2015 and July 2018. Clinical characteristics, pathological antecedents and results were collected. A descriptive analysis of the information was made. Results: A total of 184 patients and 194 eyes with a median age of 60 years male sex in 52%. Symptoms occurred in 21% of the population and the tears were horseshoe, with a super-temporal location and mostly vitreous hemorrhage. Retention withdrawal 8.7% of patients, who were men 81.2%, older than 60 years, with more frequency of myopia and vitreous hemorrhage in 62.5%. Conclusions: Description of the clinical characteristics of the adult population with PVD and retinal tears, subjected to laser photocoagulation in Cali, Colombia, was similar to the one reported in the literature

Zuccagnia punctata Cav. Essential Oil into Poly(ε-caprolactone) Matrices as a Sustainable and Environmentally Friendly Strategy Biorepellent against Triatoma infestans (Klug) (Hemiptera, Reduviidae)

The main strategies against Triatoma infestans (primary vector responsible for the Chagas disease transmission) are the elimination or reduction of its abundance in homes through the application of insecticides or repellents with residual power, and environmental management through the improvement of housing. The use of plant-derived compounds as a source of therapeutic agents (i.e., essential oils from aromatic plants and their components) is a valuable alternative to conventional insecticides and repellents. Essential oil-based insect repellents are environmentally friendly and provide reliable personal protection against the bites of mosquitoes and other blood-sucking insects. This study investigates, for the first time to our knowledge, the potential repellent activity of Zuccagnia punctata essential oil (ZEO) and poly(ε-caprolactone) matrices loaded with ZEO (ZEOP) prepared by solvent casting. The analysis of its essential oil from aerial parts by GC­FID and GC-MS, MS allowed the identification of 25 constituents representing 99.5% of the composition. The main components of the oil were identified as (−)-5,6-dehydrocamphor (62.4%), alpha-pinene (9.1%), thuja-2, 4 (10)-diene (4.6%) and dihydroeugenol (4.5%). ZEOP matrices were homogeneous and opaque, with thickness of 800 ± 140 µm and encapsulation efficiency values above 98%. ZEO and ZEOP at the lowest dose (0.5% wt./wt., 96 h) showed a repellency of 33 and 73% respectively, while at the highest dose (1% wt./wt., 96 h) exhibited a repellent activity of 40 and 66 %, respectively. On the other hand, until 72 h, ZEO showed a strong repellent activity against T. infestans (88% repellency average; Class V) to both concentrations, compared with positive control N-N diethyl-3-methylbenzamide (DEET). The essential oils from the Andean flora have shown an excellent repellent activity, highlighting the repellent activity of Zuccagnia punctata. The effectiveness of ZEO was extended by its incorporation in polymeric systems and could have a potential home or peridomiciliary use, which might help prevent, or at least reduce, Chagas' disease transmission.

Clinical and epidemiological characteristics of patients diagnosed with covid-19 in a tertiary care center in Mexico City: a prospective cohort study

ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Prevalencia del consumo de sustancias psicoactivas y factores relacionados en soldados regulares adscritos a un batallón de una ciudad colombiana

Objetivo: Calcular la prevalência del consumo de Sustancias Psicoactivas (SPA y su relación con factores personales, demográficas, lúdicas y familiares en soldados adscritos a un batallón de una ciudad colombiana. Método: Estudio cross sectional en una muestra de 384 soldados a los cuales se aplicó el instrumento ASSIST. Se realizó un análisis descriptivo y se calculó la prevalencia de SPA en la vida y a los tres meses, con sus respectivos intervalos de confianza (IC) del 95 %. Se determinó la asociación del desenlace con factores plausibles, por medio de la razón de prevalencias y sus respectivos IC del 95 %. Se construyeron modelos de regresión binomial simple y múltiple y regresión binomial negativos (cálculo de índice-Rate Rations (IRR)) y se calculó la prueba exacta de Fisher. Para determinar las variables candidatas a ingresar al modelo ajustado, se aplicó el criterio de Hosmer-Lemeshow. Resultados: La prevalencia de consumo de SPA en la vida fue del 73,7 % con predominio del consumo de bebidas alcohólicas 58,6 %, del tabaco, 47,9 %, cannabis, 41,1 %, y cocaína, 16,4 %. La prevalencia de consumo de SPA en los últimos tres meses fue del 48,4 %, con hegemonía del tabaquismo, 33,1 %. Conclusiones: El consumo de sustancias psicoactivas es una problemática que debe abordarse desde el factor humano y la gestión social en cualquier organización en general y en particular en el ejército colombiano. Se deben revisar los protocolos de inserción de los soldados regulares que conduzcan a minimizar la incorporación de ciudadanos que consuman sustancias psicoactivas.

Objective: To calculate the prevalence of Psychoactive Substances Abuse and its relationship with personal, demographic, recreational, and family factors in soldiers assigned to a battalion of a Colombian city. Method: Cross-sectional study in a sample of 384 soldiers who were applied the ASSIST test. A descriptive analysis was performed, and the prevalence of PAS was calculated in life and at three months, with their respective 95% confidence intervals (CI). The association of the outcome with plausible factors was determined, using the prevalence ratio and their respective 95% CI. Simple and multiple binomial regression models and negative binomial regression were constructed (calculation of the Index-Rate Rations (IRR)) and the Fisher's exact test was calculated. To determine the variables to adjust the model, the Hosmer-Lemeshow criterion was applied. Results: The prevalence of PAS use in life was 73.7% with a predominance of drug use or alcoholic beverages 58.6%, tobacco 47.9%, cannabis 41.1%, and cocaine 16.4%. The prevalence of PAS use in the last three months was 48.4%, with the prevalence of smoking being 33.1%. Conclusions: The consumption of psychoactive substances is a problem that must be approached from the human factor and social management in any organization, in general, and, particularly, in the Colombian army. The insertion protocols of regular soldiers should be reviewed to minimize the incorporation of citizens who consume psychoactive substances.