In vitro toxicity of fine and coarse particulate matter on the skin, ocular and lung microphysiological cell-culture systems.

Particulate matter (PM) has been associated with adverse effects on human health, causing allergies, skin and eye irritation and corrosion, respiratory tract irritation, headaches, bronchoconstriction, cardiopulmonary diseases such as asthma, chronic obstructive pulmonary disease (COPD), lung cancer, reproductive problems, premature deaths, and epigenetic changes that lead to a wide variety of cancers, among other health conditions. The air quality in the Medellín - Colombia presents fluctuations that oscillate between the maximum permissible levels established at the national level and by the WHO, which represents a latent risk to people's health. Although important efforts have been made to quantify the different levels of pollution and administrative measures have been established to mitigate air pollution, little research work has been done to establish the relationship between these levels of pollutants and the effects on biological systems. The objective of the present research was to make a morphological and chemical characterization of particulate matter (PM) captured with a commercial air filter and a electrospun nanofiber membrane and evaluate the cytotoxicity of the each PM extracts in monolayer and co-culture models which recreate microphysiological systems of lung, skin and cornea and propose the possible cellular interactions that lead the cytotoxic response of the chemical compounds found in particulate matter in cities. The morphology and elemental chemical characterization were done with scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM - EDS). For the polycyclic aromatic hydrocarbons detection was made with a chromatographic method accoupled to mass spectrometer. Finally, the cytotoxicity was made in monolayers of A549, HEK001, and SIRC cell lines and microphysiological systems consisting of two-cell layer construct to resemble the interaction between fibroblast and epithelial cells that comprises naturally the corneal, skin and lung tissue. We performed three different cocultures models with BALB/3T3 clone A31 as a feeder layer, using porous Transwell® inserts in the in-contact and non-contact way. Monolayer and co-culture models were exposed to coarse and fine PM (1, 2, and 5 mg/mL) and the cell viability was evaluated at 24 h using an MTT assay. The electrospun nanofibers membranes demonstrates higher efficiency to capture PM with different sizes and high concentration of polycyclic aromatic hydrocarbons, heavy metals, and other chemical compounds responsible of many human diseases. Cytotoxic effects of MP were observed in all models at higher concentration; however, models exposed to fine PM exhibited a significant reduction in cell viability compared to those exposed to coarse PM. In addition, multilayer models are more resistant to PM exposure than monolayer models. Furthermore, the study indicated that, depending on the seeding strategy, different results might be observed: the non-contact model showed higher resistance to PM exposure than in-contact for SIRC and HEK001, but A549 monolayers showed the highest viability response. This study demonstrates the usefulness of applying co-culture models to assess environmental pollutant toxicity, in addition to being a potential alternative method to animal testing for risk assessment.

Estimulación de nervio vago en epilepsia refractaria y callosotomía previa sin mejoría. Reporte de caso / Vagus nerve stimulation in refractory epilepsy and previous callosotomy without vimprovement. Case report / Estimulação do nervo vago em epilepsia refratária e calosotomia prévia sem melhora. Relato de caso

La epilepsia refractaria tanto generalizada como focal, es una patología sumamente incapacitante, para el tratamiento de la misma se ha establecido a la callosotomía desde hace décadas como primera línea quirúrgica para su control, la cual puede presentar efectos secundarios importantes como síndrome de desconexión y pérdida de memoria, sin embargo, existen pacientes que no responden a la callosotomía y necesitan nuevas líneas de tratamiento, buscando en la estimulación de nervio vago una respuesta a su condición. Descripción del caso de estudio. Se presenta el caso de paciente masculino de 24 años de edad con antecedente patológico de convulsiones tipo tónico clónicas generalizadas confirmadas por video electroencefalograma de 24 horas, de predominio nocturno de 13 años de evolución, es sometido a 2 regímenes farmacológicos antiepilépticos diferentes en un período de 7 años de duración, posteriormente diagnosticado con epilepsia refractaria, por lo que se realiza callosotomía sin control de su cuadro clínico, el mismo año se realiza estimulación de nervio vago, presentando resultados favorables en su evolución. Conclusión. Luego de evidenciar el presente caso de estudio se concluye que el tratamiento de epilepsia refractaria con la colocación de un estimulador de nervio vago izquierdo asociado a un correcto régimen FAE es una alternativa muy eficaz para considerar en estos pacientes.

Refractory epilepsy, both generalized and focal, is an extremely disabling pathology. For its treatment, callosotomy has been established for decades as the first surgical line for its control, which can present important side effects such as disconnection and loss syndrome. by heart, however, there are patients who do not respond to callosotomy and need new lines of treatment, looking for an answer to their condition in vagus nerve stimulation. Description of the case study. We present the case of a 24-year-old male patient with a pathological history of generalized tonic-clonic seizures confirmed by a 24-hour video electroencephalogram, predominantly nocturnal for 13 years, undergoing 2 different antiepileptic pharmacological mechanisms over a period of 7 years in duration, later diagnosed with refractory epilepsy, for which callosotomy was performed without control of its clinical picture, the same year vagus nerve stimulation was performed, presenting favorable results in its evolution. Conclution. After evidencing the present case study, it is concluded that the treatment of refractory epilepsy with the placement of a left vagus nerve stimulator associated with a correct AED regimen is a very effective alternative to consider in these patients.

A epilepsia refratária, tanto generalizada quanto focal, é uma patologia extremamente incapacitante. Para seu tratamento, a calosotomia se estabeleceu há décadas como a primeira linha cirúrgica para seu controle, que pode apresentar importantes efeitos colaterais como desconexão e síndrome de perda., há pacientes que não respondem à calosotomia e precisam de novas linhas de tratamento, buscando resposta para sua condição na estimulação do nervo vago. Descrição do estudo de caso. Apresentamos o caso de um doente do sexo masculino, 24 anos, com antecedentes patológicos de crises tónico-clónicas generalizadas confirmadas por videoeletroencefalograma de 24 horas, predominantemente nocturnas há 13 anos, submetido a 2 mecanismos farmacológicos antiepilépticos diferentes ao longo de 7 anos de duração, posteriormente diagnosticada com epilepsia refratária, para a qual foi realizada calosotomia sem controle de seu quadro clínico, no mesmo ano foi realizada estimulação do nervo vago, apresentando resultados favoráveis em sua evolução. Conclusão. Depois de evidenciar o presente estudo de caso, conclui-se que o tratamento da epilepsia refratária com a colocação de um estimulador de nervo vago esquerdo associado a um esquema correto de DEA é uma alternativa muito eficaz a ser considerada nesses pacientes.

Comparación entre inmunomoduladores y crioterapia para el tratamiento de lesiones genitales en mujeres con VPH / Comparison between immunomodulators and cryotherapy for the treatment of genital lesions in women with HPV / Comparação entre imunomoduladores e crioterapia para o tratamento de lesões genitais em mulheres com HPV

El virus del papiloma humano es una infección prevalente, que puede infectar cualquier mucosa del cuerpo y causar verrugas genitales externas o condilomas genitales y cáncer de cuello uterino. El tratamiento es difícil con una alta recurrencia y persistencia de las mismas, lo que afecta mayormente a mujeres jóvenes. El objetivo del presente estudio fue realizar una comparación entre inmunomoduladores y crioterapia para el tratamiento de lesiones genitales en mujeres con VPH. Se realizó una revisión bibliográfica de la literatura científica, entre inmunomoduladores y crioterapia para el tratamiento de lesiones genitales en mujeres con VPH de los últimos 20 años, donde se identificaron publicaciones de revisiones sistemáticas y metaanálisis. Se concluyó que la elección de los inmunomoduladores al igual que la crioterapia es mejor utilizarlos cuando existe lesiones clínicas inducidas por el VPH en la región genital y perianal en mujeres, dependiendo de la cantidad, el tamaño, la gravedad, la ubicación de las verrugas y las preferencias del paciente.

Human papillomavirus is a prevalent infection, which can infect any mucosa of the body and cause external genital warts or genital warts and cervical cancer. Treatment is difficult with a high recurrence and persistence of the same, which mainly affects young women. The objective of the present study was to compare immunomodulators and cryotherapy for the treatment of genital lesions in women with HPV. A narrative bibliographic review of the scientific literature was carried out, between immunomodulators and cryotherapy for the treatment of genital lesions in women with HPV of the last 20 years, where publications of systematic reviews and meta-analyses were identified. It was concluded that the choice of immunomodulators, like cryotherapy, is better used when there are clinical lesions induced by HPV in the genital and perianal region in women, depending on the number, size, severity, location of the warts and patient preferences.

O papilomavírus humano é uma infecção prevalente, que pode infectar qualquer mucosa do corpo e causar verrugas genitais externas ou verrugas genitais e câncer cervical. O tratamento é difícil com alta recorrência e persistência da mesma, que acomete principalmente mulheres jovens. O objetivo do presente estudo foi comparar imunomoduladores e crioterapia para o tratamento de lesões genitais em mulheres com HPV. Foi realizada uma revisão bibliográfica narrativa da literatura científica, entre imunomoduladores e crioterapia para tratamento de lesões genitais em mulheres com HPV dos últimos 20 anos, onde foram identificadas publicações de revisões sistemáticas e metanálises. Concluiu-se que a escolha de imunomoduladores, como a crioterapia, é melhor utilizada quando há lesões clínicas induzidas pelo HPV na região genital e perianal em mulheres, dependendo do número, tamanho, gravidade, localização das verrugas e preferências da paciente.

Psychosis associated with suspected SARS-CoV-2 encephalitis with response to steroids: a case report.

INTRODUCTION: The SARS-Cov-2 infection has multiple neurologic manifestations including encephalitis in multiple cases reported, however the psychosis as principal manifestation of this condition is infrequently. CASE REPORT: We report the case of a 48-year-old woman with a confirmed diagnosis of SARS-CoV-2 who developed paranoid and self-referential ideas with behavioural alteration and multiple findings on mental examination. Encephalitis associated with Covid-19 was suspected due to the neurological clinical presentation (persistent despite resolve hypoxaemia and systemic symptoms) and brain magnetic resonance image (MRI) that showed asymmetric hippocampal hyperintensities, although cerebrospinal fluid and electroencephalogram (EEG) were normal. The patient received medical treatment with methylprednisolone for 5 days with complete resolution of her symptoms. DISCUSSION: The current SARS-CoV-2 pandemic has neurological complications either by direct involvement or by para-infectious or post-infectious phenomena. Encephalitis occurs in a small proportion of the cases, while psychiatric symptoms have been described in a variable percentage of the events. However, a psychotic picture such as the one reported in our case is unusual. MRI, cerebrospinal fluid and EEG are important for the diagnostic evaluation of these patients but not obligatory to the diagnosis. The treatment of this condition with corticosteroids has been successful even in cases associated with Anti-NMDA. Our case is the second reported in Colombia, the first to be associated with psychosis.

Haploidentical Stem Cell Transplant with Post-Transplant Cyclophosphamide in Pediatric Hemophagocytic Lymphohistiocytosis.

PURPOSE: Primary hemophagocytic lymphohistiocytosis is a severe and uncommon disease affecting pediatric patients. Genetic abnormalities have been related to altered apoptosis and exaggerated inflammatory reactions. Chemoimmunotherapy and stem cell transplantation are treatment options, but transplant is the only curative treatment. Here we aim to describe the treatment with hematopoietic stem cell transplantation with a novel strategy and the outcomes. METHODS: An observational, descriptive, case series study was performed in pediatric patients of two high complexity medical centers in Colombia. Data was collected retrospectively between 2015 and 2020. RESULTS: We describe five pediatric cases with a diagnosis of primary hemophagocytic lymphohistiocytosis. All were treated with replete-cell haploidentical hematopoietic stem transplantation, reduced-intensity conditioning, and post-transplant cyclophosphamide, in two high-complexity centers in Colombia. All patients are alive, and one is receiving management for chronic graft-versus-host disease. CONCLUSION: To the best of our knowledge, there are few reports in the literature with this strategy, promising a possible alternative when there are no other donor options.

Meta-analysis of hematopoietic stem cell transplantation in major histocompatibility complex class II deficiency.

Major histocompatibility complex class II deficiency is a rare case of PID. Specific recommendations for hematopoietic stem cell transplant, the only curative treatment option, are still lacking. This meta-analysis aims to identify the factors associated with better prognosis in these patients. Thirteen articles reporting 63 patients with major histocompatibility complex class II deficiency that underwent hematopoietic stem cell transplant were included. The median age for hematopoietic stem cell transplant was 18 months. The most common source of transplant was bone marrow, with alternative sources as umbilical cord blood emerging during recent years. The highest proportion of engraftment was seen with umbilical cord. Engraftment was higher in patients with matched donors, with better overall survival in patients with reduced-intensity conditioning. Graft-vs-host disease developed in 65% of the patients, with grades I-II being the most frequently encountered. There was a higher mortality in patients with myeloablative conditioning and no engraftment. There was an inverse correlation between survival and stage of graft-vs-host disease. The main cause of mortality was infectious disease, mostly secondary to viral infections. Ideally, matched grafts should be used, and reduced-intensity conditioning should be considered to reduce early post-transplant complications. GVHD and viral prophylaxis are fundamental.

Synthesis, Biological Evaluation and In Silico Computational Studies of 7-Chloro-4-(1H-1,2,3-triazol-1-yl)quinoline Derivatives: Search for New Controlling Agents against Spodoptera frugiperda (Lepidoptera: Noctuidae) Larvae.

The insecticidal and antifeedant activities of five 7-chloro-4-(1H-1,2,3-triazol-1-yl)quinoline derivatives were evaluated against the maize armyworm, Spodoptera frugiperda (J.E. Smith). These hybrids were prepared through a copper-catalyzed azide alkyne cycloaddition (CuAAC, known as a click reaction) and displayed larvicidal properties with LD50 values below 3 mg/g insect, and triazolyl-quinoline hybrid 6 showed an LD50 of 0.65 mg/g insect, making it 2-fold less potent than methomyl, which was used as a reference insecticide (LD50 = 0.34 mg/g insect). Compound 4 was the most active antifeedant derivative (CE50 = 162.1 µg/mL) with a good antifeedant index (56-79%) at concentrations of 250-1000 µg/mL. Additionally, triazolyl-quinoline hybrids 4-8 exhibited weak inhibitory activity against commercial acetylcholinesterase from Electrophorus electricus (electric-eel AChE) (IC50 = 27.7 µg/mL) as well as low anti-ChE activity on S. frugiperda larvae homogenate (IC50 = 68.4 µg/mL). Finally, molecular docking simulations suggested that hybrid 7 binds to the catalytic active site (CAS) of this enzyme and around the rim of the enzyme cavity, acting as a mixed (competitive and noncompetitive) inhibitor like methomyl. Triazolyl-quinolines 4-6 and 8 inhibit AChE by binding over the perimeter of the enzyme cavity, functioning as noncompetitive inhibitors. The results described in this work can help to identify lead triazole structures from click chemistry for the development of insecticide and deterrent products against S. frugiperda and related insect pests.

Recidiva de carcinoma nasosinusal relacionado con el virus del papiloma humano con características similares al adenoide quístico / Recurrence of human papillomavirus-related carcinoma with adenoid cystic-like features

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Comparación de las características y curso clínico de la endocarditis infecciosa por Staphylococcus aureus meticilino sensible versus meticilino resistente / Characteristics and clinical course of endocarditis due to Methicillin-sensitive versus methicillin-resistant Staphylococcus aureus

Resumen Introducción: Staphylococcus aureus es uno de los agentes causales más comunes de la endocarditis infecciosa. Se reportan pocos estudios en Latinoamérica acerca de las diferencias entre los perfiles de resistencia a la meticilina. Objetivo: Describir las características y el curso clínico de los pacientes con S. aureus sensible a meticilina frente al resistente. Métodos: Estudio observacional retrospectivo, cohorte histórica de pacientes adultos con diagnóstico confirmado de endocarditis entre los años 2011 y 2015. Se seleccionaron pacientes positivos para S. aureus comparando las características y el curso clínico entre los casos S. aureus sensible a meticilina frente al resistente. Resultados: Se estudiaron 86 pacientes con endocarditis. 28 (33%) tenían infección por S. aureus. 21 (75%) tenían endocarditis por S. aureus sensible a meticilina y 7 (25%) por S. aureus resistente a meticilina. En el grupo S. aureus sensible a meticilina, 11 (52,3%) fueron infecciones asociadas a atención en salud. La mayoría de casos de S. aureus resistente a meticilina fueron (85,7%) adquiridos en comunidad. La mortalidad de endocarditis por S. aureus sensible a meticilina fue superior a la causada por el resistente (33,3% vs. 14%). Conclusiones: S. aureus sigue siendo el agente más frecuente en endocarditis, más comúnmente el sensible a la meticilina. Los eventos embólicos y la gravedad fueron mayores en S. aureus sensible a meticilina. La mayor proporción de endocarditis debido a S. aureus resistente a meticilina se adquirió en la comunidad, por lo que se sugiere iniciar cobertura empírica contra S. aureus resistente a meticilina en todo caso de endocarditis adquirida en la comunidad.

Abstract Introduction: Staphylococcus aureus is one of the most common sources of infectious endocarditis. There are few studies in Latin America that report on the differences between the methicillin resistance profiles. Objective: To describe the characteristics and clinical course of patients with methicillin-sensitive S. aureus (MSSA) compared to methicillin-resistance S. aureus (MRSA) Methods: An observational, retrospective study was conducted on a historical cohort of adult patients with a confirmed diagnosis of endocarditis between the years 2011 and 2015. Patients positive for S. aureus were selected and the characteristics and clinical course and the cases of MSSA were compared with those of MRSA. Results: A total of 86 patients with endocarditis were included, of whom 28 (33%) had an infection due to S. aureus, and 21 (75%) had endocarditis due to methicillin-sensitive S. aureus, and 7 (25%) due to MRSA. In the MSSA group, 11 (52.3%) were infections associated with health care. The majority (85.7%) of cases of MRSA were community acquired. The endocarditis mortality due to MSSA was higher than that caused by MRSA (33.3% vs. 14%). Conclusions: S. aureus continues to be the most common agent in endocarditis, with MSSA being more common. The embolic events and the severity were greater in MSSA. The majority of endocarditis due to MRSA is acquired in the community, and for this reason it is suggested starting empirical cover against MRSA in all cases of community acquired endocarditis.

Manejo clínico de hemorragia subaracnoidea por aneurisma intracraneal en una mujer embarazada en Quito, Ecuador: reporte de caso / Clinical management of subarachnoid haemorrhage due to intracranial aneurysm in a pregnant woman in Quito, Ecuador: Case report

RESUMEN Objetivo: describir el diagnóstico y manejo de la hemorragia subaracnoidea secundaria a un aneurisma arterial cerebral accidentado en la primera mitad del embarazo. Materiales y métodos: se presenta el caso de una mujer de 26 años en su segundo embarazo, sin abortos previos y con una cesárea anterior, que fue atendida en un centro de referencia de atención materno perinatal ubicado en Quito, Ecuador, por diagnóstico de hemorragia subaracnoidea durante la decimoséptima semana de gestación. En la panangiografía cerebral se observó un aneurisma cerebral de cuello ancho en la arteria temporal anterior con sangrado. Resultados: se realizó un tratamiento con prótesis endovascular y microespirales, con control de la hemorragia. Posteriormente, la paciente requirió doble antiagregación plaquetaria con clopidogrel y ácido acetilsalicílico que se mantuvo hasta una semana antes del parto. A la paciente se le realizó una cesárea electiva en la que nació un niño sano de 37,2 semanas. Conclusión: el tratamiento endovascular con la colocación de microespirales, asociado al uso de antiagregantes plaquetarios, es una alternativa por considerar en gestantes en la primera mitad del embarazo. Se requieren más estudios clínicos para establecer conductas terapéuticas bien fundamentadas en el manejo de estos casos.

ABSTRACT Objective: To describe the diagnosis and management of a case of subarachnoid haemorrhage secondary to arterial cerebral aneurysm during the first half of gestation. Materials and methods: A 26-year-old woman during a second pregnancy, with no prior miscarriages, and one previous cesarean section seen at a maternal and perinatal care referral centre located in Quito, Ecuador, with a diagnosis of subarachnoid haemorrhage at seventeen weeks of pregnancy. Cerebral pan-angiography showed a wide-neck cerebral aneurysm of the anterior temporal artery with bleeding. Results: Treatment was performed using endovascular stenting and coiling. Later, the patient required dual anti-platelet therapy with clopidogrel and acetylsalicylic acid, maintained up to a week before delivery. Elective cesarean section was performed and the patient was delivered of a healthy baby at 37.2 weeks of gestation. Conclusion: Endovascular treatment with the use of micro-coils, associated with anti-platelet aggregation therapy is an option to consider in pregnant women during the first half of gestation. Further clinical studies are needed in order to identify more fundamental therapeutic approaches for the management of these cases.

Hemophagocytic Lymphohistiocytosis Associated with Salmonella typhi Infection in a Child: A Case Report with Review of Literature.

We present the case of an 8-year-old girl with hemophagocytic lymphohistiocytosis secondary to a Salmonella typhi infection. She received antibiotic treatment and intravenous immunoglobulin with complete resolution of the symptoms. We present a review of previously reported pediatric cases and propose a gradual approach to treatment.

Tipo de derivación urinaria en el paciente llevado a cistectomía radical, participación del urólogo y tasa de filtración de la anastomosis intestinal / Type of urinary diversion in the patient led to a radical cystectomy, participation of the urologist, and filtration rate of intestinal anastomosis

Objetivo Conocer la prevalencia de cistectomías radicales que se realizan en centros especializados en Colombia, definiendo tipo de derivación intestinal, participantes en su creación, segmento intestinal utilizado y tasa de filtración. Materiales y métodos Se realizó una encuesta a instituciones de salud colombianas que realizan cistectomías radicales de manera rutinaria, se analizaron variables como número de procedimientos por año, segmento intestinal utilizado, tipo de especialidad participante en la anastomosis intestinal y la tasa de filtración de esta. Resultados Quince instituciones colombianas respondieron la encuesta, el número de cistectomías realizadas por año fue: 5/15 (33,3%) más de 15 cirugías al año, 4/15(26,6%) entre 11 y 15 procedimientos al año, 3/15 (20%) entre 5 y 10 y otro 3/15 (20%) entre 1 y 5 cistectomías al año. El 93,3% de las instituciones realizan Bricker como derivación más común; solo una institución (6,7%) lleva a cabo ureterostomías cutáneas. Con respecto a los participantes en la creación de la anastomosis de las 14 instituciones, en 9 (64,2%) es realizada por cirujano general, en 4 (28,5%) la lleva a cabo un urólogo y en una (7,4%) la derivación es realizada por coloproctólogo. La gran mayoría de los centros tiene una incidencia baja de filtración intestinal. Conclusiones En la gran mayoría de las instituciones colombianas el cirujano general y en menor medida el urólogo participan en la creación de la anastomosis intestinal como parte del protocolo de la institución. La filtración es una complicación poco frecuente pero con alta morbimortalidad. Se requiere de entrenamiento por parte del urólogo en formación para lograr mejores resultados.

Objective To determine the prevalence of radical cystectomies that are performed in specialist centres in Colombia, defining the type of intestinal derivation, participants in its creation, intestinal segment used, and filtration rate. Materials and methods A survey was conducted in Colombian health institutions that routinely perform radical cystectomies. An analysis was made of the variables, such as number of procedures per year, intestinal segment used, specialty participating in the intestinal anastomosis, and the rate of filtration. Results A total of 15 health institutions responded to the survey. The number of cystectomies performed per year was; 5/15 (33.3%) with greater than 15 surgeries per year, 4/15 (26.6%) with between 11 and 15 procedures per year, 3/15 (20%) between 5­10/year, and another 3/15 (20%) between 1­5 cystectomies per year. Most (93.3%) of the institutions performed a Bricker as the most common derivation, with only one institution (6.7%) performing cutaneous ureterostomies. As regards the participants in the creation of the anastomosis of the 14 institutions, 9 (64.2%) were performed by a general surgeon, by a urologist in 4 (28.5%), and a coloproctologist performed the shunt in one (7.4%). The vast majority of centres have a low incidence of intestinal filtration. Conclusions In the great majority of Colombian institutions, the general surgeon, and to a lesser extent the urologist, participate in the creation of intestinal anastomosis as part of the protocol of the institution. Filtration is a rare complication, but with a high morbidity and mortality. Training by the urologist during training is required to achieve better results.

Catatonia y delirium: síndromes que pueden confluir en el paciente neuropsiquiátrico / Catatonia and Delirium: Syndromes that may Converge in the Neuropsychiatrie Patient

Resumen Introducción: La catatonia y el delírium son 2 síndromes diferentes e independientes. La catatonia es un síndrome psicomotor asociado a una variedad de enfermedades de diferentes causas médicas y está caracterizado por ausencia de actividad, inducción de posturas pasivas contra gravedad, la oposición o ausencia de respuesta ante estímulos externos, flexibilidad cérea, estereotipias, manierismos y ecofenómenos, entre otros. El delirium se caracteriza por alteraciones de la conciencia y cognitivas, principalmente atención y orientación, habitualmente de aparición aguda, que tiende a fluctuar durante el día y con evidencia de que la alteración es una consecuencia fisiológica directa de una enfermedad, una intoxicación o la abstinencia de alguna sustancia. A pesar de las diferencias y que las clasificaciones excluyen la posibilidad de que estos síndromes puedan presentarse juntos, varios reportes de casos y estudios en grupos de pacientes han planteado que pueden darse las 2 condiciones conjuntamente. Material y métodos: En el presente estudio se detectó a 16 pacientes hospitalizados en quienes concomitaban ambos síndromes, identificados mediante la escala Delirium rating scale-R (DRS-98) y la escala de Bush y Francis de Catatonia (BFCRS). Resultados: Se siguió el desenlace durante la hospitalización y su condición clínica al egreso. Estos pacientes en su mayoría tenían diagnósticos neurológicos, tuvieron una hospitalización larga, requirieron tratamiento con antipsicóticos y benzodiacepinas y sufrieron frecuentes complicaciones. Conclusiones: Catatonia y delirium son síndromes que pueden presentarse al mismo tiempo, lo que lleva a que los pacientes tengan peor desenlace y mayor riesgo de complicaciones.

Abstract Introduction: Catatonia and delirium are two different and independent syndromes. Catatonia is a psychomotor syndrome associated with a variety of diseases of different medical causes and is characterised by lack of activity, induction of passive postures against gravity, opposition or absence of response to external stimuli, waxy flexibility, stereotypies, mannerisms and echophenomena. Delirium is characterised by consciousness and cognitive alterations, mainly attention and orientation and usually of acute onset, which tend to fluctuate during the day and with evidence that the alteration is a direct physiological consequence of a disease, intoxication or substance withdrawal. Despite the differences and the fact that the classifications exclude the possibility that these syndromes may manifest together, several case reports and studies in groups of patients have postulated that the two conditions can occur together. Material and methods: In this study we identified 16 hospitalised patients who experienced both syndromes at the same time as confirmed by the Delirium Rating Scale-Revised (DRS-98) and the Bush-Francis Catatonia Rating Scale (BFCRS). Results: Patient outcome was followed during hospitalisation and the patients' clinical condition upon discharge. These patients had mostly neurological diagnoses, long hospital stays, required treatment with antipsychotics and benzodiazepines and had frequent complications. Conclusions: Catatonia and delirium are syndromes that can present at the same time, resulting in worse patient outcome and an increased risk of complications.

[Catatonia and Delirium: Syndromes that may Converge in the Neuropsychiatric Patient]. / Catatonia y delírium: síndromes que pueden confluir en el paciente neuropsiquiátrico.

INTRODUCTION: Catatonia and delirium are two different and independent syndromes. Catatonia is a psychomotor syndrome associated with a variety of diseases of different medical causes and is characterised by lack of activity, induction of passive postures against gravity, opposition or absence of response to external stimuli, waxy flexibility, stereotypies, mannerisms and echophenomena. Delirium is characterised by consciousness and cognitive alterations, mainly attention and orientation and usually of acute onset, which tend to fluctuate during the day and with evidence that the alteration is a direct physiological consequence of a disease, intoxication or substance withdrawal. Despite the differences and the fact that the classifications exclude the possibility that these syndromes may manifest together, several case reports and studies in groups of patients have postulated that the two conditions can occur together. MATERIAL AND METHODS: In this study we identified 16 hospitalised patients who experienced both syndromes at the same time as confirmed by the Delirium Rating Scale-Revised (DRS-98) and the Bush-Francis Catatonia Rating Scale (BFCRS). RESULTS: Patient outcome was followed during hospitalisation and the patients' clinical condition upon discharge. These patients had mostly neurological diagnoses, long hospital stays, required treatment with antipsychotics and benzodiazepines and had frequent complications. CONCLUSIONS: Catatonia and delirium are syndromes that can present at the same time, resulting in worse patient outcome and an increased risk of complications.

Caracterización del realce meníngeo intracraneal / Intracranial Meningeal Enhancement Characterization

Objetivo: Describir las características del realce meníngeo intracraneal (RMI) como hallazgo en resonancia magnética y su comportamiento según las diferentes patologías asociadas descritas en la literatura científica. Materiales y métodos: Estudio descriptivo de corte transversal realizado con información recolectada de 89 estudios, entre enero y diciembre de 2011, en los cuales se encontró realce meníngeo como hallazgo positivo en la lectura original. Cada estudio fue sometido a nueva revisión por un neurorradiólogo para la caracterización morfológica del realce meníngeo. Resultados: Las causas más frecuentes de RMI fueron enfermedad metastásica (21,3 %), etiología infecciosa (21,3 %), antecedente de cirugía intracraneal (20,2 %) y neoplasias primarias (13,5 %). Del total de las infecciones del sistema nervioso central (19 casos) se documentó infección por VIH en 12 pacientes (70,6 %). El paciente con antecedente quirúrgico de mayor antigüedad fue sometido a craneotomía 17 años antes de la toma de la resonancia magnética incluida en el estudio, en la cual persiste el realce aunque no se han definido signos de recidiva por imagen o por clínica hasta 2015. El tipo de realce más frecuente fue el leptomeníngeo (46,1 %), seguido del mixto (43,8 %) y el paquimeníngeo (10,1 %). En el subgrupo de realce leptomeníngeo, las etiologías más frecuentes fueron infecciosa (31,7 %), enfermedad metastásica (19,5 %) y neoplasias primarias (17,1 %), persistiendo esta tendencia en el subgrupo de realce paquimeníngeo. En el subgrupo de realce mixto, la etiología posquirúrgica fue la primera causa (35,9 %), seguida de la enfermedad metastásica (23,1 %) y las infecciones (18 %). En los casos de etiología infecciosa se encontró un predominio del patrón de realce leptomeníngeo, nodular y difuso, sin realce paquimeníngeo, como único tipo de realce. Conclusión: Aunque un patrón de realce meníngeo determinado no es indicativo de una patología específica, el estudio detallado de sus características puede aportar información que permite plantear grupos diagnósticos, particularmente en casos de etiología neoplásica o infecciosa, aporte de relevancia en casos en que el realce meníngeo anormal es la única alteración evidente en una resonancia magnética.

Objective: To describe the characteristics of intracranial meningeal enhancement (IME) as magnetic resonance imaging findings and their behavior under different associated conditions as described in the scientific literature. Materials and methods: Descriptive cross-sectional study with data collected from the images archive between January and December of 2011, obtaining 89 eligible studies in which it was determined, in the original reading, presence of IME as positive finding. Each study was subjected to further review by a neuroradiologist of the institution for morphological characterization of the IME. Results: The most common causes of IME were: metastatic disease (21.3%), infectious etiology (21.3%), history of intracranial surgery (20.2%) and primary neoplasms (13.5%). Of total CNS infections (19 cases), HIV infection was documented in 12 patients (70.6%). The patient with the oldest surgical history underwent craniotomy 17 years before performing the MRI included in the study, with persistance of IME with no signs of recurrence defined by image or clinical manifestations up to 2015. The most frequent IME type was leptomeningeal (LME) (46.1%), followed by mixed (MME) (43.8%) and pachymeningeal (PME) (10.1%) enhancements. In the subgroup of LME, the most common etiologies were: infectious (31.7%), metastatic disease (19.5%) and primary neoplasms (17.1%). This trend persisted in the subgroup of PME. In the subgroup of MME, post-surgical etiology was the leading cause (35.9%), followed by metastatic disease (23.1%) and infections etiologies (18%). Conclusion: Although a particular pattern of meningeal enhancement is not indicative of a specific pathology, detailed study of its features can provide information that allow the proposal of diagnostic groups, particularly in cases of neoplastic or infectious etiology, relevant contribution in cases where the abnormal meningeal enhancement is the only anormality in MRI.

Niveles de impulsividad y riesgo de alcoholismo en personas pertenecientes a barras bravas en la ciudad de Ibagué - Colombia / Levels of impulsivity and risk of alcoholism in adults Belonging to "barras bravas" in the city of ibagué - Colombia

El objetivo de este trabajo es determinar la relación entre niveles de impulsividad y riesgo de alcoholismo en adultos pertenecientes a "barras bravas" en la ciudad de Ibagué (Tolima) a partir de la aplicación del test de CAGE, la Escala de Impulsividad de Plutchik (EI) y una ficha de caracterización sociodemográfica. Se utilizó un modelo correlacional de corte transversal. Los hallazgos evidencian niveles bajos (78%) y promedios de impulsividad (20%). El 28% no presenta problemas relacionados con el alcohol, mientras que el 36% tiene indicios de consumo y el restante 36% dependencia alcohólica. Se hallaron correlaciones bajas entre las puntuaciones, la correlación significativa fue de tipo directamente proporcional entre edad y riesgo de alcoholismo (r= 0,287; p= 0.43), lo que indica que a mayor edad mayor es el riesgo de alcoholismo. © Revista Colombiana de Ciencias Sociales.

The objective of this study was to determine the relationship between levels of impulsivity and risk of alcoholism in adults belonging to "barras bravas" in the city of Ibagué (Tolima) from the application of the CAGE test, the scale of impulsiveness of Plutchik (EI) and a socio-demographic characterization data sheet. A correlational cross-sectional model was used. The findings show low levels (78%) and averages of impulsivity (20%). The 28% do not show problems related with alcohol, while 36% have signs of consumption and 36% alcoholic dependence. There were found low correlations between such scores, the significant correlation was directly proportional between age and risk of alcoholism (r = 0,287, p = 0.43) indicating that a greater age, greater is the risk of alcoholism.

Validación de la Lista de Chequeo de Psicopatía-Revisada (PCL-R) en población carcelaria masculina de Colombia * / Validation of the Psychopathy Check-List Revised (PCL-R) in Colombian Male Jail Inmates

Introducción: La psicopatía se caracteriza por un patrón permanente de déficit afectivo y falta de respeto por los derechos de los otros y las normas sociales. La Lista de Chequeo de Psicopatía Revisada (PCL-R, por su sigla en inglés) es un instrumento de medición compuesto por 20 ítems y es uno de los más utilizados para investigación en psicopatía y trastorno de la personalidad antisocial. Objetivo: Validar la PCL-R en población colombiana carcelaria de sexo masculino. Método: Se hicieron dos traducciones al español y dos traducciones en sentido inverso de cada uno de los ítems. También, una traducción al español y en sentido inverso del instructivo. La validez de apariencia fue evaluada por un grupo de expertos. Se examinó la validez de contenido, consistencia interna, reproducibilidad prueba-reprueba e interevaluador. Resultados: En el análisis factorial para la validez de contenido se encontraron 4 dominios que explican el 61,1% de la varianza. La consistencia interna de la escala fue alta (alfa de Cronbach=0,94), al igual que la reproducibilidad pruebareprueba (CCI=0,83, IC 95%: 0,68-0,91) e interevaluador (CCI=0,92, IC 95% 0,86-0,96). Conclusiones: La versión en español de la PCL-R para la población carcelaria colombiana de sexo masculino muestra buenas propiedades psicométricas.

Introduction: Psychopathy is characterized by a pattern of constant affective deficit and lack of respect for other people's rights and social norms. The Psychopathy Check-List Revised (PCL-R) is an instrument of measurement composed of 20 items and it is one of the most used in psychopathy and antisocial personality disorder research. Objective: To validate the PCL-R in Colombian male inmates. Methods: Two translations into Spanish and two back-translations for each of the items were done. The instruction manual was also translated into Spanish and back-translated. Face validity was assessed by a group of experts. Content validity was examined as well as internal consistency, test-retest and inter-rater reproducibility. Results: In the factor analysis for the content validity, four domains were found which explained 61.1% of the variance. The internal consistency was high (Cronbach's Alpha=0.94). Similarly, the test-retest and inter-rater reproducibility were ICC=0.83, 95% CI: 0.68-0.91 and ICC=0.83, 95% CI: 0.86-0.96, respectively. Conclusions: The Spanish version of the PCL-R for Colombian male jail inmates shows good psychometric properties.

Morbimortalidad en la unidad de cuidados intensivos pediátricos del Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2001-2005 / Morbidity and mortality at a pediatric intensive care unit in Medellín, Colombia, 2001-2005

Introducción: el aumento en el número y la complejidad de las Unidades de Cuidados Intensivos Pediátricos (UCIP), sumado a su alto costo, ha estimulado el interés y la necesidad de evaluar su funcionamiento, la eficacia de la labor realizada y la calidad de los servicios que prestan, mediante indicadores asistenciales que se derivan de estudios descriptivos de morbimortalidad. Objetivo: describir las causas de morbilidad y mortalidad y las características sociodemográficas de los niños admitidos a la UCIP del Hospital Universitario San Vicente de Paúl (HUSVP) de Medellín, Colombia, en el período comprendido entre el primero de enero de 2001 y el 31 de diciembre del 2005. Metodología: estudiodescriptivo y retrospectivo de corte transversal, en el que por medio de una aleatorización simple se hizo la selección de 328 historias de pacientes que ingresaron a la UCIP duranteel período de estudio. Se tabularon y analizaron estadísticamente los datos obtenidos de la revisión de las historias. Resultados: se encontró que 59,8% de los pacientes eran de sexo masculino, 40,9% eran menores de 1 año y 43% provenían del área metropolitana del valle de Aburrá. La edad promedio fue 44 meses. Solamente 47% tenían afiliación a la seguridad social. Las principales causas de admisión a la UCIP fueron: infección respiratoria(23,8%), ingresos postquirúrgicos (23,5%), falla respiratoria (18,6%), choque séptico (16,5%) y malformaciones congénitas (13,1%); el promedio de estancia fue 5 días. Requirieron ventilación mecánica 52,4% de los pacientes, 26% de los cuales presentaron alguna complicaciónderivada de ella. La mortalidad general fue 21,6% y los pacientes de sexo masculino miprovenientes del área metropolitana fueron los más afectados. Las principales causas de muerte fueron:falla orgánica múltiple (26,8%) y choque séptico (19,7%). 56% de las muertes ocurrieron durante las primeras 48 horas después de la admisión a la UCIP...

Introduction: increase in the number andcomplexity of pediatric intensive care units (PICU), added to their high cost, have stimulated interest in evaluating their functioning, efficiency and qualityby means of markers derived from descriptive studies of morbidity and mortality. Objective: to describe the causes of morbidity and mortality, as well as the social and demographic characteristics of patients admitted to the PICU of Hospital UniversitarioSan Vicente de Paúl (HUSVP) in Medellín, Colombia, between January 1, 2001 and December 31, 2005. Methodology: descriptive and retrospective cross section study. 328 patient charts were randomly selected and then reviewed. All information wastabulated and statistically analyzed. Results: 59.8% of the patients were males, 40.9% were under oneyear of age, and 43% came from the metropolitan area around Medellín. Average age at admission was 44 months. Only 47% of the patients had some type of health insurance. The main causes for admission to the PICU were: respiratory infection (23.8%), postsurgical cases (23.5%), respiratory failure (18.6%), septic shock (16.5%) and congenital malformations (13.1%). Average length of stay was 5 days.Mechanical ventilation was required by 52.4%, and 26% of them suffered from some complication. Mortality was 21.6%, affecting mainly male patientsfrom the metropolitan zone around Medellín. 56% of the deaths occurred during the first 48 hours after admission to the PICU. The main causes of deathwere multiple organ failure (26.8%) and septic shock (19.7%). Discussion: infants are the group at greater risk for admission to a PICU, most frequently due to respiratory and infectious problems, which may reflect faults in the promotion and prevention programs at the lowest levels of the health caresystem. Mortality was high in comparison with that at other PICUs in Latin America...