Corrigendum: D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: a multi-national case series from different waves.

[This corrects the article DOI: 10.3389/fmed.2023.1103842.].

D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves.

Introduction: Variable D-dimer trends during hospitalization reportedly result in distinct in-hospital mortality. In this multinational case series from the first and second waves, we show the universality of such D-dimer trends. Methods: We reviewed 405 patients with COVID-19 during the first wave admitted to three institutions in the United States, Italy, and Colombia, and 111 patients admitted to the U.S. site during the second wave and 55 patients during the third wave. D-dimer was serially followed during hospitalization. Results: During the first wave, 66 (15%) patients had a persistently-low pattern, 33 (8%) had early-peaking, 70 (16%) had mid-peaking, 94 (22%) had fluctuating, 30 (7%) had late-peaking, and 112 (26%) had a persistently-high pattern. During the second and third waves, similar patterns were observed. D-dimer patterns were significantly different in terms of in-hospital mortality similarly in all waves. Patterns were then classified into low-risk patterns (persistently-low and early-peaking), where no deaths were observed in both waves, high-risk patterns (mid-peaking and fluctuating), and malignant patterns (late-peaking and persistently-high). Overall, D-dimer trends were associated with an increased risk for in-hospital mortality in the first wave (overall: HR: 1.73) and stayed the same during the second (HR: 1.67, p < 0.001) and the third (HR: 4.4, p = 0.001) waves. Conclusion: D-dimer behavior during COVID-19 hospitalization yielded universal categories with distinct mortality risks that persisted throughout all studied waves of infection. Monitoring D-dimer behavior may be useful in the management of these patients.

Association between right ventricular dysfunction and in-hospital mortality in surges of SARS-CoV-2 infection attributed to the Alpha, Delta, and Omicron variants.

Background: Right ventricular (RV) dysfunction in acute COVID-19 was reported to be associated with poor prognosis. We studied the association between parameters of RV dysfunction and in-hospital mortality during the surges caused by different SARS-CoV-2 variants. Methods: In a retrospective single-center study, we enrolled 648 consecutive patients hospitalized with COVID-19 [66 (10 %) hospitalized during the alpha variant surge, 433 (67 %) during the delta variant surge, and 149 (23 %), during the omicron variant surge]. Patients were reported from a hospital with an underreported population of mostly African American and Hispanic patients. Patients were followed for a median of 11 days during which in-hospital death occurred in 155 (24 %) patients [Alpha wave: 25 (38 %), Delta Wave: 112 (26 %), Omicron wave: 18 (12 %), p < 0.001]. Results: RV dysfunction occurred in 210 patients (alpha: 32 %, 26 %, delta: 29 %, and omicron: 49 %, p < 0.001) and was associated with higher mortality across waves, however, independently predicted in-hospital mortality in the Alpha (HR = 5.1, 95 % CI: 2.06-12.5) and Delta surges (HR = 1.6, 95 % CI: 1.11-2.44), but not in the Omicron surge. When only patients with RV dysfunction were compared, the mortality risk was found to decrease significantly from the Alpha (HR = 13.6, 95 % CI: 3.31-56.3) to the delta (HR = 1.93, 95 % CI: 1.25-2.96) and to the Omicron waves (HR = 11, 95 % CI: 0.6-20.8). Conclusions: RV dysfunction continues to occur in all strains of the SARS-CoV-2 virus, however, the mortality risk decreased from wave to wave likely due to evolution of better therapeutics, increase rate of vaccination, or viral mutations resulting in decrease virulence.Registration number of clinical studies: BronxCare Hospital center institutional review board under the number 05 13 21 04.

Disruption of cardio-pulmonary coupling in myopathies: Pathophysiological and mechanistic characterization with special emphasis on nemaline myopathy.

The heart and lung are in continuous reciprocal interaction that creates a functional and anatomical reserve referred to as cardiopulmonary coupling (CPC). Disruption of CPC can occur due to various cardiac or pulmonary pathologies but also can occur in patients with myopathies. Nemaline myopathy (NM) is a skeletal muscle heterogeneous disorder due to contractile proteins' gene mutations that impact lung and cardiac mechanics and thus is expected to adversely affect CPC in a complex manner. We present a case of NM and we review the literature on cardiac and pulmonary effects of myopathy-related disruption of CPC.

Tissue Doppler derived biphasic velocities during the pre and post-ejection phases: patterns, concordance and hemodynamic significance in health and disease.

BACKGROUND: Pre-(PRE) and post-ejection (POE) velocities by mitral annular tissue Doppler (TD) are biphasic and may be related to myocardial deformations. We investigated the predominance and concordance of TD-PRE and POE velocities and their effect on myocardial functions in controls and in heart failure (HF) patients. METHODS: Retrospectively, 84 HF patients [57.6 years, 28(33%) females, NYHA: 2.3 ± 0.6, EF: 55 ± 15%, 52(62%) preserved EF, and 32(38%) reduced EF], 42 normal young controls, and 26 asymptomatic age matched controls were included. Echocardiography was done and from mitral annular tissue Doppler recordings, the biphasic PRE and POE velocity signals were identified and compared between groups. RESULTS: While controls had almost always predominantly positive PRE and negative POE, HF had more negative PRE and positive POE. Moreover, almost all controls exhibited normal concordance (positive PRE and negative POE). HF exhibited more abnormal concordance which was significantly associated with worse NYHA, and parameters of diastolic and systolic functions. Opposite PRE and POE velocities correlated significantly in all groups (PREp vs POEn: young:r = 0.52, p < 0.001, age controls:r = 0.79, p < 0.001, HFpEF: r = 0.56, p < 0.001, HFrEF: r = 0.42, p = 0.018; PREn vs POEp: young: r = 0.25,p = 0.1, age controls: r = 0.42, p = 0.04, HFpEF: r = 0.43, p = 0.004, HFrEF: r = 0.61, p < 0.001) and the ratios PRE-P/N and POE-N/P correlated significantly with E/e' in HF only. CONCLUSIONS: In physiological state, TD signals are predominantly positive during PRE and negative during POE. Opposite PRE and POE velocities corelate, representing the PRE-generation and POE-reversal of shortening-stretch relationships, the attenuation of which in HF may be related to elevated LV filling pressures. In HF, partially or completely reversed concordance of PRE and POE is associated with progressive worsening of clinical and hemodynamic profiles.

Anticoagulation for hypercoagulability in severe critical COVID-19: A case series of fading and fatal cycles of microthrombosis.

The pathophysiology of the COVID-19 involves a systemic hypercoagulable state and systemic micro-thrombosis which can cause fatal consequences. Despite that anticoagulation seems an intuitive therapeutic option, the US National Institute of Health has issued a warning against its use in critically ill patients. We present five cases of imaging-proven or clinically suspected hypercoagulability with hemodynamic compromise despite therapeutic anticoagulation. We describe the patients with thoughts on links between pathophysiology and the laboratory values, clinical course, and imaging studies in each case. All patients presented to the hospital with symptoms and chest imaging suggestive of COVID-19 pneumonia. All patients presented with severe hypoxia requiring mechanical ventilation, and received full anticoagulation for treatment of hypercoagulable state suggested by elevated D-dimer. All but one patient received alteplase for thrombolytic therapy of suspected massive pulmonary embolism (PE). On the basis of this case series, hypercoagulability in COVID-19 is a late manifestation of the disease that persists despite anticoagulation, is cyclic in nature based on D-dimer despite thrombolysis, and is fatal if it rebounds. The use of anticoagulation and thrombolysis in these patients seemed harmful or non-beneficial. Early intervention before D-dimer elevation and hemodynamic compromise may benefit in preventing thromboembolic burden. .

Combined atrioventricular longitudinal strain rate during isovolumic contraction predicts pulmonary capillary wedge pressure in patients with systolic dysfunction.

BACKGROUND: Reportedly, mitral annular velocities derived by tissue Doppler imaging (TDI)-during isovolumic contraction (IVV) can predict pulmonary capillary wedge pressure (PCWP) in heart failure patients with depressed ejection fraction (EF). We investigated the use of color TDI-derived left atrial (LA) and left ventricular (LV) longitudinal strain rate (SR) during isovolumic contraction (IC) to predict the invasively measured PCWP. METHODS AND RESULTS: Forty patients referred with symptoms of heart failure were prospectively studied [age: 56±8 years, 12 (30%) females, and mean LVEF: 51±14%]. PCWP was measured invasively immediately after echocardiography. Mitral annular IVV was measured for all patients and SR during the IC and ejection were measured for the LV (LVSR-IC, LVSR-Ej) as well as the LA (LASR-IC, and LASR-Ej). Atrioventricular SR during IC and Ej (AVSR-IC, AVSR-Ej) was calculated as the sum of the LV and LA values. Patients were classified and compared based on their EF into 19 (49%) with EF≥55%, and 21 (51%) with EF<55%. No significant differences were noted for age, sex, risk factors, and medications between both patients with EF≥55% and EF<55%. Compared to EF≥55%, patients with EF<55% had lower IVV (4.63±1.2 vs. 7.01±1.9 cm/s, P<0.001), LVSR-Ej (1±0.3 vs. 1.2±0.2, P=0.03), LASR-IC (1.3±0.6 vs. 1.9±1, P=0.03), LASR-Ej (1.5±0.5 vs. 2.6±1.3 s-1, P=0.001), AVSR-IC (2±0.8 vs. 2.7±1.06 s-1, P=0.023), and AVSR-Ej (2.5±0.6 vs. 3.9±1.1 s-1, <0.001). LVSR-IC, LVSR-Ej, LASR-IC, AVSR-IC, and IVV correlated with PCWP in only in EF<55%, with the strongest correlation noted for AVSR-IC (r=-0.72, <0.001). Other correlates with PCWP in EF<55% were E/e' and left atrial volume (r=0.47, 0.7, P=0.04, 0.001; respectively). Multivariate regression revealed that in patients with EF<55% AVSR-IC was the only independent predictor of PCWP. Finally, IVV correlated with LVSR-IC and LASR-IC and this correlation became strongest with AVSR-IC (r=0.77, 0.001). CONCLUSION: The combined LV and LA longitudinal SR during IC as represented by AVSR-IC showed a strong correlation with PCWP in patients with depressed EF. The correlation between mitral annular IVV and PCWP in those patients can be a product of this combination and may a function of atrioventricular mechanical coupling.

COVID-19 in the Healthy Patient Population: Demographic and Clinical Phenotypic Characterization and Predictors of In-Hospital Outcomes.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) can infect patients in any age group including those with no comorbid conditions. Understanding the demographic, clinical, and laboratory characteristics of these patients is important toward developing successful treatment strategies. Approach and Results: In a retrospective study design, consecutive patients without baseline comorbidities hospitalized with confirmed COVID-19 were included. Patients were subdivided into ≤55 and >55 years of age. Predictors of in-hospital mortality or mechanical ventilation were analyzed in this patient population, as well as subgroups. Stable parameters in overall and subgroup models were used to construct a cluster model for phenotyping of patients. Of 1207 COVID-19-positive patients, 157 met the study criteria (80≤55 and 77>55 years of age). Most reliable predictors of outcomes overall and in subgroups were age, initial and follow-up d-dimer, and LDH (lactate dehydrogenase) levels. Their predictive cutoff values were used to construct a cluster model that produced 3 main clusters. Cluster 1 was a low-risk cluster and was characterized by younger patients who had low thrombotic and inflammatory features. Cluster 2 was intermediate risk that also consisted of younger population that had moderate level of thrombosis, higher inflammatory cells, and inflammatory markers. Cluster 3 was a high-risk cluster that had the most aggressive thrombotic and inflammatory feature. CONCLUSIONS: In healthy patient population, COVID-19 remains significantly associated with morbidity and mortality. While age remains the most important predictor of in-hospital outcomes, thromboinflammatory interactions are also associated with worse clinical outcomes regardless of age in healthy patients.

Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version.

BACKGROUND: There are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. METHODS: K-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients. RESULTS: A total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders. CONCLUSIONS: The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.

Gestión social del conocimiento y análisis prospectivo de su incidencia en la universidad contemporánea / Social management of knowledge and prospective analysis of its incidence in the contemporary university

La gestión del conocimiento es una de las funciones sustantivas de las instituciones de la educación superior, es la misión social, la razón de ser que tienen las diferentes instituciones, por medio de la cual logran difundir sus conocimientos y contribuir con el desarrollo socio productivo y cultural de la colectividad. El propósito del presente artículo es analizar la necesidad de la endogenización de las funciones sustantivas; la gestión del conocimiento, la academia y la investigación, en relación con la gestión del conocimiento dentro de las universidades. El vínculo universidad-sociedad, es uno de los puntos que demuestran la pertinencia de la gestión del conocimiento, al incidir de manera positiva en el desarrollo socio-económico del país y en el logro del bienestar humano establecido dentro del Plan del Buen Vivir, al poner en práctica la inclusión, socialización y democratización de la educación

Knowledge management is one of the substantive roles of the higher education institutions, it is the social mission, the reason for the existence of the different institutions through which the spread of knowledge and contribution to the social, productive and cultural development of the community are achieved. The purpose of the present work is to analyze the need of endogenization of substantive roles such as knowledge management, the academy and the research in relation to the relevance of knowledge management in universities. The university-society link is one of the points that shows the knowledge management relevance that positively influences on the country's social and economic development and reaches the welfare of the human being established in the Good Living Plan, as it implements inclusion, socialization as well as democratization of education

Gestión social del conocimiento y análisis prospectivo de su incidencia en la universidad contemporánea / Social management of knowledge and prospective analysis of its incidence in the contemporary university

La gestión del conocimiento es una de las funciones sustantivas de las instituciones de la educación superior, es la misión social, la razón de ser que tienen las diferentes instituciones, por medio de la cual logran difundir sus conocimientos y contribuir con el desarrollo socio productivo y cultural de la colectividad. El propósito del presente artículo es analizar la necesidad de la endogenización de las funciones sustantivas; la gestión del conocimiento, la academia y la investigación, en relación con la gestión del conocimiento dentro de las universidades. El vínculo universidad-sociedad, es uno de los puntos que demuestran la pertinencia de la gestión del conocimiento, al incidir de manera positiva en el desarrollo socio-económico del país y en el logro del bienestar humano establecido dentro del Plan del Buen Vivir, al poner en práctica la inclusión, socialización y democratización de la educación(AU)

Knowledge management is one of the substantive roles of the higher education institutions, it is the social mission, the reason for the existence of the different institutions through which the spread of knowledge and contribution to the social, productive and cultural development of the community are achieved. The purpose of the present work is to analyze the need of endogenization of substantive roles such as knowledge management, the academy and the research in relation to the relevance of knowledge management in universities. The university-society link is one of the points that shows the knowledge management relevance that positively influences on the country's social and economic development and reaches the welfare of the human being established in the Good Living Plan, as it implements inclusion, socialization as well as democratization of education(AU)

Acciones estratégicas para la integración endógena de las funciones sustantivas universitarias desde la gestión del conocimiento / Strategic tasks for the endogenous integrality of the university substantive functions from the knowledge management

La integración de las funciones sustantivas de las universidades deviene un reto actualmente y la gestión del conocimiento constituye la misión social, la razón de ser de los diferentes centros de altos estudios, por medio de la cual logran difundir sus saberes y experiencias, así como contribuir al desarrollo socioproductivo y cultural de la colectividad. En el presente artículo se proponen acciones necesarias para endogenizar las funciones sustantivas universitarias desde ese tipo de gestión, a partir de la aplicación de métodos empíricos que permitieron conocer los criterios de educandos y docentes en relación con el problema objeto de esta investigación y revelaron a través de los resultados obtenidos,la fragmentación de los procesos sustantivos universitarios que ha estado limitando la producción del conocimiento científico en las instituciones de educación superior

The integration of the substantive functions of the universities becomes a challenge at present and the knowledge management constitutes the social mission, the reason of the different high studies institutions, by means of which they are able to diffuse their knowledge and experiences, as well as to contribute to the social, productive and cultural development of the collectivity. In this work, necessary tasks for endogenize the university substantive functions from that type of management are proposed, with the use of empiric methods that allowed to know the students and teaching staff criteria related to the object of this investigation, and they revealed through the results obtained, the fragmentation of the university substantive processes which have been limiting the production of the scientific knowledge in the higher education institutions

Acciones estratégicas para la integración endógena de las funciones sustantivas universitarias desde la gestión del conocimiento / Strategic tasks for the endogenous integrality of the university substantive functions from the knowledge management

La integración de las funciones sustantivas de las universidades deviene un reto actualmente y la gestión del conocimiento constituye la misión social, la razón de ser de los diferentes centros de altos estudios, por medio de la cual logran difundir sus saberes y experiencias, así como contribuir al desarrollo socioproductivo y cultural de la colectividad. En el presente artículo se proponen acciones necesarias para endogenizar las funciones sustantivas universitarias desde ese tipo de gestión, a partir de la aplicación de métodos empíricos que permitieron conocer los criterios de educandos y docentes en relación con el problema objeto de esta investigación y revelaron a través de los resultados obtenidos,la fragmentación de los procesos sustantivos universitarios que ha estado limitando la producción del conocimiento científico en las instituciones de educación superior(AU)

The integration of the substantive functions of the universities becomes a challenge at present and the knowledge management constitutes the social mission, the reason of the different high studies institutions, by means of which they are able to diffuse their knowledge and experiences, as well as to contribute to the social, productive and cultural development of the collectivity. In this work, necessary tasks for endogenize the university substantive functions from that type of management are proposed, with the use of empiric methods that allowed to know the students and teaching staff criteria related to the object of this investigation, and they revealed through the results obtained, the fragmentation of the university substantive processes which have been limiting the production of the scientific knowledge in the higher education institutions(AU)

Motivaciones de los estudiantes universitarios para continuar con su formación académica en programas de posgrado / Undergraduate students motivations to enroll in graduate programs / Motivação dos estudantes universitários para continuar seu treinamento acadêmico em programas de pós-graduação

Resumen Introducción. La educación se ha consolidado como estrategia que promueve el desarrollo del conocimiento y la formación de las comunidades y la formación avanzada constituye el medio para incrementar el capital intelectual de las sociedades. Objetivo. Identificar las principales motivaciones que tienen los estudiantes universitarios para continuar un proceso de formación avanzada en instituciones de Educación Superior. Metodología. Aplicación de un cuestionario auto-administrado a 728 estudiantes universitarios, de séptimo semestre en adelante, de la ciudad de Medellín. Se exploraron siete dimensiones relacionadas con la motivación para continuar sus estudios. Resultados. Se destacan factores motivacionales por parte de los estudiantes como la exigencia académica y las modalidades presenciales de la oferta académica para continuar con su proceso de formación avanzada. Conclusiones. Las Instituciones de Educación Superior deben considerar el contexto social en el que se enmarcan, así como sus propósitos fundacionales, para responder de manera adecuada a las necesidades de formación avanzada que se requiere en sus entornos.

Abstract Introduction. Education has been consolidated as a strategy to promote the development of knowledge and community vocational training; and the advanced academic degrees as the way to rise the intellectual capital in the society. Objective. Through an exploratory analysis, we try to identify the main undergraduate students motivations to enroll in a graduate program. Methodology. We applied a self-application questionnaire to 728 undergraduate students in the last semesters of their vocational training, at Medellin-Colombia. We explored seven dimensions related to the motivations to study a graduate program. Results. The undergraduate students' motivations to enroll in a graduate program are influenced by academic high level offered and traditional education (non-virtual) methodology of the advanced academic degrees. Conclusions. The Higher Education Institutions have to consider the social context in which they are inmerse, besides their foundational principles, to response effectively to the needed from people to enroll in graduate programs.

Resumo Introdução. A educação foi consolidada como uma estratégia que promove o desenvolvimento do conhecimento e a formação de comunidades, e o treinamento avançado é o meio para aumentar o capital intelectual das sociedades. Objetivo. Identificar, através de uma análise exploratória, as principais motivações que os estudantes universitários têm para continuar um processo de treinamento avançado em instituições de ensino superior. Metodologia. Aplicação de um questionário autoadministrado a 728 estudantes universitários, a partir do sétimo semestre, da cidade de Medellín. Foram exploradas sete dimensões relacionadas à motivação para continuar seus estudos. Resultados. Os fatores motivacionais por parte dos alunos, como o requisito académico e as modalidades face a face da oferta académica, são destacados para continuar com seu processo de treinamento avançado. Conclusões. As instituições de ensino superior devem considerar o contexto social em que são enquadradas, bem como seus objetivos fundamentais, para responder adequadamente às necessidades de treinamento avançado exigido em seus ambientes.

Taponamiento cardiaco por pericarditis lúpica: reporte de dos casos / Cardiac tamponade due to lupic pericarditis: report of two cases

La serositis es uno de los hallazgos clínicos en pacientes con lupus eritematoso sistémico.Cuando se presenta a nivel de pericardio, generalmente causa derrames pericárdicos cró-nicos que no generan inestabilidad hemodinámica en el paciente. Presentamos 2 casosclínicos de mujeres con lupus con derrame pericárdico que lleva a taponamiento cardiaco,presentación inusual de esta manifestación clínica del lupus eritematoso sistémico...

Serositis is one of the clinical findings in patients with systemic lupus erythematosus. Whenis present generally causes chronic pericardial effusions and not generate hemodynamicinstability in the patient. We present two cases of women with lupus with pericardial effusionleading to cardiac tamponade, unusual presentation of this clinical manifestation insystemic lupus erythematosus...

Consumo de estatinas y asociación con la elevación en los niveles de creatina fosfoquinasa / Statin use and association with elevated levels of creatine phosphokinase

Introducción: las estatinas son medicamentos hipolipemiantes asociados con miotoxicidad como efecto adverso. Objetivo: determinar la asociación entre el uso de estatinas y la elevación de la creatinafosfoquinasa. Materiales y métodos: se realizó un estudio transversal en pacientes consecutivos que asistieron al Laboratorio Clínico Hematológico (Medellín, Colombia) para la determinación del perfil lipídico. Se incluyeron 661 pacientes, 329 en el grupo de estatinas y 332 en el de no estatinas.A todos se les midieron los niveles séricos de creatina fosfoquinasa y se consideraron como elevados los niveles superiores a 170 mg/dL. Se estableció un nivel de significancia menor de 0,05. Resultados: se registró mayor proporción de pacientes con creatina fosfoquinasa elevada en el grupo con consumo de estatinas (64,9% frente a 47% en el grupo de no estatinas; razón de disparidad: 2,01; intervalo de confianza del 95%: 1,21-3,32; p= 0,0085). No se encontró asociación entre la elevación de la creatina fosfoquinasa y la presencia de dolor (razón de disparidad: 0,78; intervalo de confianza del 95%: 0,40-1,50; p= 0,5615), fatiga (razón de disparidad: 0,85; intervalo de confianza del 95%: 0,45-1,61; p= 0,7385) y debilidad muscular (razón de disparidad: 1,46; intervalo de confianzadel 95%: 0,68-3,12; p= 0,4333); aunque el grupo de estatinas presentó mayor frecuencia de dolor (razón de disparidad: 2,96), fatiga (razón de disparidad: 1,98) y debilidad muscular (razón de disparidad: 4,19). Conclusiones: el consumo de estatinas se relaciona con síntomas musculares y elevación de creatina fosfoquinasa, sin relación entre la elevación de creatina fosfoquinasa y la presencia de síntomas musculares.

Introduction: statins are a class of lipid-lowering medications associated with the adverse effect of myotoxicity. Objetive: To determine the association between statin use and creatine phosphokinase elevation. Materials and methods: A cross-sectional study, involving consecutive patients attending in the clinical laboratory Laboratorio Clinico Hematologico (Medellin, Colombia) for a serum lipid profile test was performance. A total of 661 patients were included, 329 belonged to the statin group and 332 to the non-statin group. All patients were tested for serum creatine phosphokinase and were considered elevated the serum levels higher than 170 mg/dL. The threshold for significance was set as p-value less than 0.05. Results: Creatine phosphokinase levels were more elevated in the statin group (64.9% versus 47% in non-statin group; odds ratio: 2.01; 95% confidence interval: 1.21-3.32, p= 0.0085). No association was found between the degree of creatine phosphokinase elevation and the presence of muscular pain (odds ratio: 0.78; 95% confidence interval: 95%, 0.40-1.50, p= 0.5615), fatigue (odds ratio: 0.85; 95% confidence interval: 0.45-1.61, p= 0.7385) or muscle weakness (odds ratio: 1.46; 95% confidence interval: 0.68-3.12, p= 0.4333). However, the statin group exhibited greater frequency of muscle pain (odds ratio: 2.96), fatigue (odds ratio: 1.98) and muscle weakness (odds ratio: 4.19). Conclusions: statin use is associated with a higher frequency of muscular symptoms and higher creatine phosphokinase levels, with no relationship between creatine phosphokinase elevation and the presence of muscle symptoms.

Valoración de los métodos de análisis de dentición mixta de Moyers y Tanaka-Johnston, en la predicción del diámetro mesiodistal de caninos y premolares no erupcionados / Assessment of Moyers and Tanaka-Johnston mixed dentition analyses for the prediction of mesiodistal diameters of unerupted canines and premolars

INTRODUCCIÓN: el objetivo de esta investigación fue valorar si los métodos de Moyers(M) percentil (p) 75, p85, p95 y Tanaka-Johnston(TJ), usados para predecir el diámetro mesiodistal de caninos y premolares no erupcionados, sobreestiman o subestiman el diámetro de sus respectivos sucedáneos. MÉTODOS: estudio de evaluación tecnológica diagnóstica en 56 modelos de yeso de escolares de Medellín, clase I esquelética, incisivos, caninos y bicúspides permanentes erupcionados, seguidos desde 6 a 12 años de edad. Se midió el diámetro mesiodistal de los dientes y se aplicaron los métodos predictivos de Tanaka-Johnston, Moyers p75, p85, p95. Se comparó el valor predicho y el real, utilizando la prueba t-Student relacionada y la de Wilcoxon. La reproducibilidad de los métodos se calculó con los coeficiente de correlación intraclase (CCI) (IC95%), y el nivel, de acuerdo con los límites Bland y Altman al 95%. RESULTADOS: en el arco superior se observaron diferencias significativas con el valor real en las mediciones de T-J y Mp95. En arco inferior todos los métodos fueron diferentes del valor real (p > 0,05), excepto Mp75. La reproducibilidad fue mayor en arco superior con T-J, seguido de Mp85; en el arco inferior el método de Mp75 tuvo mejor reproducibilidad, seguido de Mp85. En arco superior se encontró que T-J sobreestima la medición real en promedio 0,333 mm (IC95% 2,100;1,434), y en el arco inferior Mp75 sobreestima en 2,14 (IC95% -2,020;1,592). CONCLUSIÓN: el mejor método predictivo para el arco superior es el de Tanaka-Johnston, y para el arco inferior es el de Moyers al percentil 75, aunque ambos sobreestiman el valor real, presentan adecuada reproducibilidad.

INTRODUCTION: the objective of this study was to determine whether the methods of Moyers (M) percentile (p) 75, p85, p95 and Tanaka-Johnston (TJ), used in the prediction of the mesiodistal diameter of unerupted canines and premolars, either overestimate or underestimate their respective succedaneous diameter. METHODS: diagnostic technology assessment in 56 plaster models of schoolchildren from Medellin, with class I skeletal and permanent erupted incisors, canines, and bicuspids, with follow-ups from 6 to 12 years of age. The teeth mesiodistal diameter was measured by the predictive methods of Tanaka-Johnston and Moyers p75, p85, p95. The predicted and actual values were evaluated by means of related Student's t test and Wilcoxon test. These methods' reproducibility was calculated by intraclass correlation coefficient (ICC) (95% CI), and their level was calculated using Bland-Altman 95% limits. RESULTS: : in the upper arch, significant actual value differences were observed with the T-J and Mp95 measurements. In the lower arch, the values of all the methods were different to the actual value (p > 0.05), except Mp75. Reproducibility was higher in the upper arch with T-J, followed by Mp85; in the lower arch, Mp75 was the method with the best reproducibility, followed by Mp85. In the upper arch, T-J overestimates the actual measurement by 0,333 mm in average (95% CI 2,100;1,434), and in the lower arch Mp75 overestimates by 2,14 (95% CI-2,020;1,592). CONCLUSSION: the best predictive method for the upper arch is Tanaka-Johnston, and for the lower arch, Moyers at the 75th percentile; although both methods overestimate the actual value, they show adequate reproducibility.

ANÁLISIS BIOMECÁNICO DE LA EPIFISIOLISIS DE LA CABEZA FEMORAL: COMPARACIÓN ENTRE FÉMURES SANOS Y ENFERMOS

En este trabajo se desarrolla un análisis por elementos finitos cuyo objetivo principal es determinar las diferencias de tensiones en la placa de crecimiento que se producen entre fémures sanos, con epifisiolisis unilateral y con epifisiolisis bilateral, para evaluar sus posibles causas. Se elaboraron los modelos de elementos finitos correspondientes a 45 pacientes. Los resultados mostraron un patrón de esfuerzos similar en todos los grupos de fémures y, además, la aparición de tensiones mayores en el grupo con epifisiolisis con respecto al grupo control. Se observó también que el valor del ángulo axial-fisis dependía significativamente del tipo de fémur analizado, y, además, una mayor influencia de los factores geométricos en la incidencia de la enfermedad, en comparación con la del índice de masa corporal.

In this work, a finite element analysis (FEA) is accomplished to study the differences of stresses in the growth plate, that are produced in healthy and unhealthy femurs, and to evaluate the possible causes of this illness. Finite element models of 45 patients were developed. The results demonstrated a similar pattern of stresses in all the groups of femurs and also the appearance of greater stresses in the group with slipped capital femoral epiphysis than in the control group. It was also observed a strong dependency on the value of the axial-fisis angle from the group of femur analyzed and a bigger influence of the geometric factors than of the body mass index, in the incidence of the illness.

Estudio inmunogenético en personal de salud con alto riesgo de infección para el VHB hipo y no respondedores a la vacuna de la hepatitis B / Immunogenetic study in high risk personnel for hepatitis B infection

En el presente estudio se tomaron 9 individuos hiporrespondedores todos personal de salud de la clínica San Pedro Claver, con alto riesgo de infección VHB, entre los 30 y 35 años de edad y 5 hombres entre los 35 y 50 años. Para la selección de este grupo se tomaron en cuenta criterios como por ejemplo que el esquema de vacunación estuviera completo con dosis y vía de inoculación adecuadas. Además que sus niveles séricos de Anti-HBs se encontraran menores o iguales a 10 mUI/ml. También se le dió gran importancia al estado de salud de este grupo, pues no se admitían individuos que tuvieran algún grado de compromiso inmunológico. Periodicamente se les realizó titulación de Anti-HBs para realizar una valoración sérologica de la respuesta. Posteriormente se les practicó una tipificación HLA clase I y II para determinar si era un factor genéticamente controlado el causante de la mala respuesta ante este antígeno. Además se hizo una medición de subpoblaciones linfocitarias CD3, CD4 y CD8 para ver si el comportamiento celular influye en el nivel de respuesta humoral originando así un déficit en la producción de anticuerpos protectores. Como resultado de todo esto, se puede pensar que este grupo de individuos hiporrespondedores, tienen posiblemente en común, un factor genético que los hace malos respondedores. Y con respecto a las subpoblaciónes linfocitarias CD3, CD4 y CD8 no hubo resultados significativos, ya que fueron sus recuentos completamente normales en todos los sujetos