Hipercalcemia asociada a hiperparatiroidismo primario: enfoque y manejo a partir de un caso clínico

Introducción: el calcio es el electrolito más abundante del cuerpo humano y la hipercalcemia es el trastorno común causado normalmente por el hiperparatiroidismo primario o malignidad, su manejo depende de la presentación y causa subyacente. Además, una proporción de casos se presentan como una emergencia, lo que conlleva a una mortalidad significativa. Objetivo: mostrar un caso inusual de presentación clínica de hipercalcemia asociada a hiperparatiroidismo primario y, asimismo, dar una breve revisión acerca del enfoque y el manejo de esta patología. Presentación del caso: paciente femenina de 32 años, antecedente de adenoma paratiroideo no resecado y pancreatitis, asiste por tres días de dolor abdominal de tipo cólico y de moderada intensidad, acompañado de episodios eméticos de contenido alimentario, paraclínicos iniciales con hipercalcemia severa, electrocardiograma con bloqueo auriculoventricular grado I, gases arteriales con alcalosis respiratoria aguda e hiperlactatemia. También se le practicó un TAC de abdomen donde este apareció con tumores pardos. Se ingresó a la UCI para la administración de líquidos endovenosos, diuréticos de asa y cinacalcet, pero no presentó mejoría, por lo que se indicó terapia de hemodiálisis. Discusión y conclusión: la hipercalcemia es un hallazgo frecuente. El hiperparatiroidismo primario y la neoplasia maligna son las dos causas más frecuentes de aumento de los niveles de calcio sérico y, en conjunto, representan alrededor del 90 % de todos los casos, donde los valores en suero varían entre el calcio total (8,5 y 10,5 mg/dl) y el iónico (1,16-1,31). La concentración sérica de Ca 2+ está estrechamente relacionada por las acciones de la hormona paratiroidea y el calcitriol, donde el hiperparatiroidismo primario ocurre como resultado de adenomas, hiperplasias y carcinoma. Las manifestaciones clínicas y la severidad van a estar correlacionadas con el tiempo de duración de la enfermedad, los niveles de calcio y de PTH. Dentro del tratamiento, este será guiado por su causa, sin embargo, es posible clasificarlo en tratamiento urgente y no urgente. Además, el enfoque de la hipercalcemia aguda severa es un reto diagnóstico dadas las múltiples causas que pueden llevar a este trastorno hidroelectrolítico y la rápida instauración de tratamiento que se requiere cuando es detectada.

Background: Calcium is the most abundant electrolyte in the human body, hypercalcemia is a common disorder usually caused by primary hyperparathyroidism or malignancy. A proportion of cases presenting as an emergency, leading to significant mortality. The management of hypercalcemia depends on the presentation and underlying cause. Purpose: to present an unusual case of clinical presentation of hypercalcemia associated with primary hyperparathyroidism, as well as to give a brief review about the approach and management of this pathology. Case presentation: A 32-year-old female patient, with a history of unresected parathyroid adenoma and pancreatitis, attended for 3 days of abdominal pain, moderate intensity, accompanied by emetic episodes of food content, initial paraclinical findings showed severe hypercalcemia, electrocardiogram with block grade I atrioventricular, arterial gases with acute respiratory alkalosis and hyperlactatemia. CT of the abdomen with brown tumors. She was admitted to the ICU for administration of intravenous fluids, loop diuretics, and cinacalcet without showing any improvement, so hemodialysis therapy was indicated. Discussion and conclusion: hypercalcemia is a frequent finding. Primary hyperparathyroidism and malignancy are the two most common causes of elevated serum calcium levels, together accounting for about 90 % of all cases. Serum values vary between total calcium 8.5 and 10.5 mg/dl and ionic 1.16- 1.31. Serum Ca 2+ concentration is closely related by the actions of parathyroid hormone and calcitriol. Primary hyperparathyroidism occurs as a result of adenomas, hyperplasias, or carcinoma. The clinical manifestations and severity will be correlated with the duration of the disease, calcium and PTH levels. Within the treatment, this will be guided by its cause, however, it is possible to classify it into urgent and non-urgent treatment. The approach to severe acute hypercalcemia is a diagnostic challenge given the multiple causes that can lead to this hydroelectrolyte disorder and the rapid establishment of treatment that is required when it is detected.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

Hipokalemia de gradiente transtubular alto: una propuesta práctica para su enfoque / High transtubular gradient hypokalemia: a practical proposal for its focus

Resumen El potasio es un ion de predominio intracelular involucrado en múltiples funciones esenciales para mantener la homeostasis celular. Por lo anterior, sus concentraciones a nivel plasmático se encuentran estrechamente reguladas mediante el sistema renal y endocrino, además de estar afectado ante situaciones como la acidosis, cambios en la osmolaridad plasmática y concentración de otros electrolitos. La hipokalemia es un trastorno electrolítico común en la práctica clínica causado por el aporte inadecuado o pérdidas excesivas. Su enfoque diagnóstico requiere de una apropiada historia clínica que incluya antecedentes personales patológicos, farmacológicos, y un examen físico detallado con determinación del estado de volemia e hidratación del paciente, así como la medición de otros electrolitos a nivel plasmático y ocasionalmente en orina. El gradiente transtubular de potasio es una herramienta útil para direccionar posibles causas. Dentro de las causas de hipokalemia de gradiente transtubular elevado se encuentra el síndrome de Bartter.

Abstract Potassium is a predominantly intracellular ion involved in multiple essential functions to maintain cellular homeostasis. Therefore, its variations at the plasma level are tightly regulated by the renal and the endocrine systems; in addition to being affected by situations such as acidosis, changes in plasma osmolality and concentration of another electrolytes. Hypokalemia is a common electrolyte disorder in clinical practice affected by reporting excessive damage or loss. Its diagnostic approach requires a complete medical record that includes personal pathological and pharmacological information, a specific physical examination with certain conditions like patient's blood volume and hydration status, as well as the measurement of other electrolytes at the plasma level and occasionally in urine. The transtubular potassium gradient is a useful tool to address possible causes. Bartter syndrome is one of the causes of elevated transtubular gradient hypokalemia.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, diagnóstico y manejo de la infección por SARS-CoV-2/COVID-19 en paciente pediátrico con enfermedad renal crónica o lesión renal aguda asociada a COVID-19 / Colombian consensus of experts on evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2 / COVID-19 infection in pediatric patients with chronic kidney disease or acute kidney injury associated with COVID-19

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Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la lesión renal aguda por SARS-CoV-2/COVID-19 / Colombian consensus of experts on recommendations informed in the evidence for the prevention, diagnosis and management of acute kidney injury by SARS-CoV-2/COVID-19

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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con Enfermedad Renal Crónica en diálisis / Colombian Expert Consensus on Evidence-Informed Recommendations for the Prevention, Diagnosis, and Management of SARS-CoV-2 / COVID-19 Infection in Patients with Chronic Kidney Disease on Dialysis

Resumen Introducción: Las personas con diálisis de mantenimiento se consideran una población en alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. La periodicidad de la diálisis, la organización y la demanda en las unidades de diálisis y las limitaciones de alfabetización en salud poblacional limitan el cumplimiento del aislamiento y el distanciamiento social. Objetivo: Desarrollar, mediante un consenso de expertos, recomendaciones informadas en evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Materiales y métodos: Se realizó una revisión rápida de literatura en Pubmed, Embase y sociedades científicas. La calidad de evidencia fue evaluada según el tipo de estudio incluido. El acuerdo se definió para cada recomendación con umbral de al menos 70% de aprobación. La fuerza de las recomendaciones fue graduada como fuerte o débil. Resultados: El colectivo fue consultado entre el 17 y 19 de mayo de 2020. Se obtuvo respuesta de 44 expertos clínicos que declararon conflicto de interés previo a la consulta. El acuerdo de las recomendaciones estuvo entre 70,5 y 100%. Se presentan las recomendaciones de un colectivo experto para la prevención, el diagnóstico y el manejo de infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Conclusión: Debido a la reciente aparición de la infección por SARS-CoV-2 y las incertidumbres respecto a la prevención, el diagnóstico y el manejo, las recomendaciones presentadas se conciben como un estándar colombiano que permita garantizar un cuidado centrado en las personas con enfermedad renal crónica y la protección de los profesionales de la salud.

Abstract Introduction: People with chronic dialysis are considered a population at high risk of SARS CoV2 infection and its derived complications and death. The need to go to strict dialysis schedules, the high demand in the kidney facilities and the difficulties derived from the time and space organization in the rooms in the face to the pandemic added to the difficult learning, teaching and adapting new protocols manifest the needed of standard recommendation according to this problem in people who couldn't have an ideal isolation. Objective: Develop through an expert consensus, evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2/COVID-19 infection in patients with chronic kidney disease on Dialysis. Materials and methods: We carried out a quick literature review, PubMed, Embase and scientific societies were consulted. The quality of the evidence was considered according to the type of study included. The agreement threshold defined for each recommendation was > 70% approval among experts. The strength of the recommendations was rated as strong or weak. Results: Between May 17 and 19, 2020, was conformed a team of 44 clinical experts who declared their interest conflict prior to the consultation. The agreement of the recommendations was between 70.5% and 100%. The recommendations were separated in prevention, early identification, and diagnostic, isolation in hemodialysis facilities and peritoneal dialysis, and team protection. Ethical considerations also were included. Conclusion: Due to the recent appearance of SARS-CoV-2 infection and the uncertainties regarding prevention, diagnosis and management, the recommendations presented are conceived as a Colombian standard that allows guaranteeing focused care for people with chronic kidney disease and the protection of health team.

Facial Clinimetric Evaluation Scale and Synkinesis Assessment Questionnaire Translation into Brazilian Portuguese: A Validation Study

Abstract Introduction Facial nerve palsy results in both functional disability and psychological morbidity. There are several well-established grading scales to quantify the quality of life of these patients. Objective Translate and validate the Facial Clinimetric Evaluation (FaCE) scale and Synkinesis Assessment Questionnaire (SAQ) to Brazilian Portuguese. Methods This study adopted a forward-backward translation method and performed cross-cultural adaptation. A pilot study was conducted to correct any confusing language and to evaluate content validity. A validation study was then performed. Internal consistency of the Brazilian Portuguese version of the FaCE and SAQ items was evaluated by Cronbach's alpha coefficient. Construct validity was assessed by Spear- man's Rank Correlation Coefficient between FaCE and SAQ scores to eFACE, House- Brackmann, Short Form 12 (SF-12) and Facial Disability Index (FDI) (sub)scores. Results A total of 90 patients were included. Cronbach's alpha for total domain scored 0.881 for FaCE and 0.809 for SAQ. FaCE total score correlation to eFACE total and House- Brackmann showed Spearman's r value of 0.537 and -0.538, respectively (p < 0.001). SAQ correlation to eFACE synkinesis subdomain was -0.449 (p < 0.001). No correlation was found between SAQ and HB score. FaCE total score correlations were of 0.301 and 0.547 for SF-12 PCS and MCS, respectively (p < 0.001). Correlation between FaCE total and FDI Physical and Social/well-being functions were 0.498 and 0.567 (p < 0.001). Conclusion Brazilian Portuguese FaCE scale and SAQ versions achieved high validity and reliability in the present study. These translated instruments demonstrated good psychometric properties, being proper to use in clinical practice in Brazil and with Brazilian Portuguese speakers.

Recomendaciones para el uso racional de la prueba 25-hidroxivitamina D Resumen de política

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The exponential increase in the request for laboratory tests of 25-Hydroxyvitamin D or [25 (OH) D has ignited the alarms and generated a strong call for attention, since it may reflect deficiencies in the standardization of clinical practice and in the use non-systematic scientific evidence for decision-making in real life, which allows to analyze the indications of the test, its frequency, interpretation and even to assess the impact for health systems, especially when contrasted with the minimum or almost. No effects of the strategy of screening or supplying indiscriminately to the general population, without considering a comprehensive clinical assessment of risks and needs of people. From a purely public health impact point of view, the consequence of massive and unspecified requests is affecting most of the health systems and institutions at the global level. The primary studies that determined average population intake values have been widely used in the formulation of recommendations in Clinical Practice Guidelines, but unfortunately misinterpreted as cut points to diagnose disease and allow the exaggerated prescription of nutritional substitution. The coefficient of variation in routine tests to measure blood levels of 25 (OH) D is high (28%), decreasing the overall accuracy of the test and simultaneously, increasing both the falsely high and falsely low values. The most recent scientific evidence analyzes and seriously questions the usefulness and the real effect of the massive and indiscriminate practice of prescribing vitamin D without an exhaustive risk analysis. The available evidence is insufficient to recommend a general substitution of vitamin D to prevent fractures, falls, changes in bone mineral density, incidence of cardiovascular diseases, cerebrovascular disease, neoplasms and also to modify the growth curve of mothers' children. They received vitamin D as a substitute during pregnancy. The recommendations presented in the document are based on the critical analysis of current evidence and the principles of good clinical practice and invite to consider a rational use of 25 (OH) D tests in the context of a clinical practice focused on people and a comprehensive assessment of needs and risks. The principles of good practice suggest that clinicians may be able to justify that the results of the 25 (OH) D test strongly influence and define clinical practice and modify the outcomes that interest people and impact their health and wellness. Currently there is no clarity on how to interpret the results, and the relationship between symptoms and 25 (OH) D levels, which may not be consistent with the high prevalence of vitamin D deficiency reported. For this reason, it is suggested to review the rationale of the request for tests for systematic monitoring of levels of 25 (OH) D or in all cases where substitution is performed. Consider the use of 25 (OH) D tests within the comprehensive evaluation of people with suspicion or confirmation of the following conditions: rickets, osteomalacia, osteoporosis, hyper or hypoparathyroidism, malabsorption syndromes, sarcopenia, metabolic bone disease.

Physicomechanical and thermal analysis of bulk-fill and conventional composites

Abstract The aim of this study was to evaluate the degree of conversion (DC) and the thermal stability of bulk-fill and conventional composite resins. Eleven composite resin samples were prepared to evaluate the DC, Vickers microhardness (VMH), mass and residue/particle loss, glass transition temperature (Tg), enthalpy, and linear coefficient of thermal expansion (CTE) using infrared spectroscopy (FTIR), microdurometer analyses, thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and dilatometry (DIL). The data were subjected to statistical analysis, with a significance level of 95%. DC and VMH were not influenced by the polymerized side of the sample, and statistical differences were recorded only among the materials. Decomposition temperature, melting, and mass and residue loss were dependent on the material and on the evaluation condition (polymerized and non-polymerized). Tg values were similar between the composites, without statistically significant difference, and CTE ranged from 10.5 to 37.1 (10-6/°C), with no statistical difference between the materials. There was a moderate negative correlation between CTE and the % of load particles, by weight. Most resins had a DC above that which is reported in the literature. TGA, Tg, and CTE analyses showed the thermal behavior of the evaluated composites, providing data for future research, assisting with the choice of material for direct or semidirect restorations, and helping choose the appropriate temperature for increasing the DC of such materials.

Facial thread lifting with suture suspension / Rejuvenescimento facial com fios de sustentação

Abstract Introduction: The increased interest in minimally-invasive treatments, such as the thread lifting, with lower risk of complications, minimum length of time away from work and effectiveness in correcting ptosis and aging characteristics has led many specialists to adopt this technique, but many doubts about its safety and effectiveness still limit its overall use. Objective: To analyze data published in the literature on the durability of results, their effectiveness, safety, and risk of serious adverse events associated with procedures using several types of threading sutures. Methods: Literature review using the key words "thread lift", "barbed suture", "suture suspension" and "APTOS". Due to the scarcity of literature, recent reports of facial lifting using threads were also selected, complemented with bibliographical references. Result: The first outcomes of facial lifting with barbed sutures remain inconclusive. Adverse events may occur, although they are mostly minor, self-limiting, and short-lived. The data on the maximum effect of the correction, the durability of results, and the consequences of the long-term suture stay are yet to be clarified. Conclusion: Interest in thread lifting is currently high, but this review suggests that it should not yet be adopted as an alternative to rhytidectomy.

Resumo Introdução: O maior interesse por tratamentos minimamente invasivos, como os fios de sustentação, com menor risco de complicações, mínimo tempo de afastamento das atividades laborais e eficazes em corrigir a ptose e as rítides características do envelhecimento fez muitos especialistas adotarem essa técnica, porém muitas dúvidas sobre sua segurança e eficácia limitam sua adoção de forma geral. Objetivo: Analisar dados publicados na literatura sobre longevidade dos resultados, sua eficácia, segurança e seu risco de eventos adversos graves associados aos procedimentos com vários tipos de sutura. Método: Revisão de literatura com as palavras-chave thread lift, barbed suture, suture suspension e Aptos. Devido à escassez de literatura, foram também selecionados relatos recentes de rejuvenescimento facial com uso de fios, complementados com trabalhos das referências bibliográficas. Resultado: Os primeiros resultados da suspensão facial com fios com garras permanecem inconclusivos. Os eventos adversos podem ocorrer, embora em sua maioria sejam pequenos, autolimitados e de curta duração. Os dados sobre o efeito máximo da correção, a longevidade dos resultados e as consequências da permanência dos fios em longo prazo não são claros. Conclusão: O interesse pelo lifting com fios está em alta no momento, mas esta revisão sugere que ele não deve ser apresentado como opção a uma ritidoplastia.

Renal compromise in a patient with Wegener's granulomatosis: clinical case and literature review / Compromiso renal en un paciente con granulomatosis de Wegener: caso clínico y revisión de la literatura

Absctrat Wegener's granulomatosis (WG) is characterized by small vessel vasculitis that affects the upper respiratory tract, lungs and kidneys. Renal involvement may occur between 40 and 100% of cases. The disease varies from asymptomatic to fulminant rapidly progressive glomerulonephritis forms, leading to terminal renal failure in days. Methodology We present a case of a patient diagnosed with WG in the Hospital de San José in Bogotá, Colombia, and a literature review focused on renal involvement. Literature search was conducted in the following databases: PubMEed, LILAC, SciELO and Cochrane. Articles in english and spanish were selected and no restriction date was made, but at least 70% of selected references were published after 2010. Conclusions Renal involvement in patients with WG is common and can be lethal. A high percent may even require renal replacement therapy, although patients can return to normal renal function. Factors associated with return to normal renal function are unclear, but it depends on early therapy and high doses of immunomodulators. Rituximab has shown greater effectiveness and fewer side effects than conventional treatments, so it's a valid therapeutic option for the management of patients with WG and renal involvement.

Resumen El presente manuscrito se hace con el fin de reportar un caso del tema en mención y realizar una revisión de la literatura disponible más reciente con respecto al diagnóstico y tratamiento. Antecedentes La granulomatosis de Wegener (GW) se caracteriza por ser una vasculitis de pequeños vasos que afecta generalmente la vía respiratoria alta, pulmones y riñones. La afección renal puede presentarse entre el 40 % y el 100 % de los casos. La enfermedad varía en su presentación clínica, desde formas asintomáticas hasta glomerulonefritis rápidamente progresiva, llevando a la insuficiencia renal terminal en pocos días. Metodología Se realiza la presentación del caso de una paciente diagnosticada con granulomatosis de Wegener (GW) en el Hospital San José (Bogotá, Colombia), y se muestra una revisión de la literatura enfocada en el compromiso renal de la patología. La revisión bibliográfica se realizó en las bases de datos: PubMEed, LILAC, SciELO y Cochrane, seleccionando para revisión artículos en inglés y español, sin restricción de fecha, pero asegurándose de que el 70 % de las referencias seleccionadas se hubieran publicado después del año 2010. Conclusiones El compromiso renal en pacientes con GW es frecuente y puede llegar a ser letal. Una proporción de pacientes considerable puede llegar a requerir terapia de reemplazo renal, con potencial recuperación de la función renal. No están claros los factores que se asocian al retorno de la función renal normal, pero sí se ha descrito que se asocia a tratamiento temprano con altas dosis de inmunomoduladores. El rituximab es un medicamento con uso frecuente en estos pacientes, que ha demostrado efectividad y menores efectos secundarios que los tratamientos convencionales, constituyendo una opción válida para el manejo de pacientes con GW y compromiso renal asociado.

Consenso Colombiano para la estratificación, diagnostico, Tratamiento y Prevención de la Infección por citomegalovirus en Pacientes Adultos con trasplante renal / Colombian consensus for stratification, diagnosis, treatment and prevention of cytomegalovirus infection in adults patients with renal transplant

El citomegalovirus es una de las principales causas de infección y enfermedad en receptores de trasplante renal, con un notorio impacto en términos de morbilidad, mortalidad y costos. Sin embargo, no existe en Colombia una práctica clínica estandarizada entre los centros de trasplante, por lo cual, es de suma importancia disponer de guías con el fin de orientar la estratificación, el diagnóstico de laboratorio, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal. A través de la metodología ADAPTE para la evaluación de calidad y transculturización de guías de práctica clínica a nuestro medio, un grupo multidisciplinario realizó una revisión sistemática de la literatura: se seleccionaron las guías internacionales, las cuales fueron evaluadas con el instrumento AGREE II en términos de calidad. Con la guía base seleccionada se buscó la evidencia existente para contestar a las preguntas, de acuerdo con el método de desarrollo de recomendaciones GRADE. Se realizaron recomendaciones para la estratificación, el diagnóstico, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal en Colombia.

Cytomegalovirus is a primary cause of infection and illness in patients who have had renal transplantation, with a significant impact on morbidity, mortality and economic costs. However, there is no standardized clinical practice in transplant centers in Colombia, and it is important to have guidelines to stratify, diagnose, treat and prevent cytomegalovirus infection and disease. Through ADAPTE's methodology for the quality evaluation and adaptation of clinical practice guidelines in our setting, a multidisciplinary group carried out a systematic review of the medical literature, selecting international guidelines that were evaluated with the AGREE-II instrument in terms of quality. With each selected guideline, an evidence table was constructed and the GRADE strategy was performed to develop recommendations. Recommendations related to stratification, laboratory diagnosis, treatment and prevention of infections and disease caused by cytomegalovirus in adult transplant patients were developed.

Leucemia Congénita, Presentación de Dos Casos y revisión de la Literatura / Congenital Leukemia. Report of Two Cases and Review of the Literature

La leucemia congénita es una enfermedad bastante rara en la práctica clínica con un curso rápido y fatal. Sus características clínicas y biológicas difieren de las encontradas en niños de mayor edad. Se han observado casos tanto de tipo mieloide como linfoide,pero la leucemia mieloide aguda parece predominar. Se presentan dos casos de leucemia congénita clasificados morgológicamente; el primero correspondiente a una leucemia mieloide aguda M3 y el segundo a una leucemia linfoide aguda L1. En ambos pacientes se destacaron hallazgos como hepatoesplenomegalia, palidez mucocutánea generalizada y leucocitosis (más de 100x10 9/L). Los estudios citogenéticos no revelaron ninguna anomalía cromosómica esturctural, pero en el caso 1 se encontró hiperdiploidía

Epifisiodesis parcial unilateral: informe preliminar / Partial unilateral epiphysiodesis: preliminar report

A dos grupos de niños con genu valgo o varo excesivo se les practicó una epifisiodesis parcial unilateral que permitió que el crecimiento restante alineara la extremidad. En el grupo I (16 extremidades), se utilizó una guía de predicción para determinar la edad ósea en que se debía efectuar la epifisiodesis parcial. En el grupo II (15 extremidades) sólo se estimó la edad para efectuar el procedimiento. La epifisiodesis parcial se efectuó mediante la técnica abierta descrita por Phemister, o mediante la técnica percutánea descrita por Bowen; en el grupo I la corrección del genu valgo/varo siguió la evolución precicha, mientras que el grupo II hubo diferencia promedio de 9.1 grados. La técnica percutánea dio el mismo resultado que la técnica abierta. Nuestra conclusión es que el genu valgo/varo en niños con un adecuado potencial de crecimiento puede ser corregido usando la guía de predicción de crecimiento para determinar la edad ósea adecuada en que debe efectuarse el procedimiento percutáneo que da un resultado cosméticamente excelente.

Tratamiento quirúrgico del pie equipo varo aducto congénito idiopático mediante una nueva técnica de liberación de partes blandas / Surgical treatment of congenital idiopatic talpes equino-varus by a new technique of soft tissue release

Se presenta una nueva técnica para el tratamiento del pie equino varo gongénito idiopático (PEVACI), que consiste en una incisión semicircular porterior, más alta en su parte porterior, a través de la cual se hace Z-plastía del tendón de Aquiles, capsulectomía tibio-astragalina y astrágalo9calcánea, resección de ligamento astrágalo-calcáneo y tibio-astragalino posterior; corte de los ligamentos peroneo-astragalino posterior, y peroneo-calcáneo. Se secciona el tibial posterior en su inserción del escafoides, se secciona el aductor del dedo grueso en su origen, y se libera y reseca el nódulo maestro de Henry, y se seccionan los ligamentos en resorte y bifurcado. Sección del lado medial de la cápsula calcáneo-cuboidea. Se hace una segunda incisión esterna. de 2 centímetros, oblicua abajo y atrás sobre la articulación calcáneo-cuboidea y se corta su cápsula dorsal, lateral y plantar. Una vez alineado el pie se enclava por atrás del astrágalo hacia el escafoides con un alambre de kirschner 0.62, y lo mismo se hace con un segundo clavo calcáneo-cuboideo. Con esta técnica se operaron 19 pacientes (28 pies). Los resultados fueron ocho pies excelentes, 14 con buen resultado, cuatro regulares y dos malos. Se presentó valgo del retropié en tres casos y aducto del antepié (blando) en 12 pies, de los cuales nueve fueron intervenidos antes del año de edad, es decir, tempranamente. La únicas complicación se presentó en dos pies (un paciente) en quien los yesos se recorrieron. Requirió una nueva serie de yesos y cirugía de revisión para alargar el tendón de Aquiles y seccionar las cápsulas por vía posterior.

Infusión intraósea en pediatría / Intraosseus infusion in pediatrics

Se analizan en este trabajo los resultados obtenidos en una serie de 20 niños en quienes se realizó la técnica de infusión intraosea. No se presentaron complicaciones de importancia clínica o radiográficas que contraindiquen el uso de esta técnica en forma más rutinaria y como una opción a la vía intravenosa convencional.

Atrofia muscular espinal de Werdnig-Hoffman grupo II, Informe de un caso con instrumentación de la columna / Werdnig-Hoffman group II spinal muscular athrophy. Repot of a case of spila instrumentation

Se presenta una niña con un padecimiento raro, la enfermedad de Werdnig-Hoffman, que se manifestó sobre todo por imposibilidad de gatear y de sostenerse en pie; en la radiografía tenía escoliosis toracolumbar derecha, luxación de cadera y una importante oblicuidad pélvica. Se le corrigió la escoliosis de 90 a 30 grados y la cifosis de 55 a 35 grados. La paciente falleció a los ocho meses de oprada, por neumonía bacteriana bilateral.