Diagnosis and treatment of articular manifestations of systemic lupus erythematosus / Diagnóstico y tratamiento de las manifestaciones articulares del lupus eritematoso sistémico

ABSTRACT Articular involvement in Systemic Lupus Erythematosus (SLE) is well recognized as one of the most common manifestations of the disease. This article reviews the recent knowledge of the clinical manifestations, diagnostic techniques and therapies used for the treatment of joint involvement in SLE. The degree of articular involvement is characterized by widespread heterogeneity in terms of clinical presentation and severity. It may range from minor arthralgia without erosions or deformity to erosive arthropathy and severe functional disability. Inflammatory musculoskeletal manifestations are described as a major cause of pain impacting daily activities and as a major determinant of quality-of-life impairment. Thus, physicians must be aware of articular involvement in SLE. Lupus arthritis diagnosis may be challenging, due to the frequently mild synovitis. The introduction of new more sensitive imaging techniques, such as ultrasound, and MRI have contributed significantly to improving the diagnosis of osteoarticular involvement in SLE. There are several treatment options for the management of joint manifestations in patients with SLE. The choice of treatment will depend on the type and pattern of joint involvement, its severity, and the characteristics of the patient.

RESUMEN El compromiso articular en lupus eritematoso sistémico (LES) es bien reconocido como una de las manifestaciones más comunes de la enfermedad. En el presente artículo se revisa la evidencia reciente sobre las manifestaciones clínicas, las técnicas de diagnóstico y los tratamientos utilizados para tratar el compromiso articular en el LES. El grado de compromiso articular se caracteriza por la amplia heterogeneidad en su presentación clínica y su gravedad. Puede variar desde artralgia leve sin erosiones o deformidad, hasta una artropatía erosiva y discapacidad funcional. Se describen las manifestaciones inflamatorias musculoesqueléticas como la principal causa de dolor que afecta las actividades de la vida cotidiana y como uno de los principales factores determinantes del deterioro de la calidad de vida. Por lo tanto, los médicos deben estar conscientes del compromiso articular en LES. El diagnóstico de la artritis lúpica puede ser difícil debido a la sinovitis, usualmente leve. El advenimiento de nuevas técnicas de imágenes más sensibles, como la ecografía y la resonancia magnética, ha contribuido significativamente a mejorar el diagnóstico del compromiso osteoarticular en LES. Existen varias opciones de tratamiento para las manifestaciones articulares en pacientes con LES. La opción de tratamiento dependerá del tipo y del patrón del compromiso articular, así como de las características del paciente.

Poliautoinmunidad en síndrome de Sjögren / Multiple autoimmunity in Sjögren's syndrome

RESUMEN La poliautoinmunidad se define como la presencia de más de una enfermedad autoinmune (EA) bien caracterizada en un mismo paciente. Es una condición frecuente en pacientes con síndrome de Sjögren (SS) y sigue un patrón de agrupamiento. Las EA más frecuentes observadas en el SS son la enfermedad tiroidea autoinmune, la artritis reumatoide y el lupus eritematoso sistémico. El estudio de este fenómeno aporta claves importantes para entender los mecanismos comunes de las EA.

ABSTRACT Multiple autoimmunity is defined as the presence of more than one well-defined autoimmune disease (AD) in a single patient. Multiple autoimmunity is a frequent condition in Sjögren's syndrome (SS) and follows a grouping pattern. The most frequent ADs observed in SS are autoimmune thyroid disease, rheumatoid arthritis, and systemic lupus erythematosus. The study of multiple autoimmunity provides important clues for elucidating the common mechanisms of ADs.

Recomendaciones ante el COVID-19 para la práctica de otología y audiología / Recomendations for the practice of otology and audiology during COVID-19

Hasta el momento, no se conoce con certeza si el virus SARS-CoV-2 se encuentra en la mucosa que recubre la trompa de Eustaquio, el oído medio o la mastoides, aunque es bastante probable que sí lo esté, dada la relación de vecindad anatómica y fisiológica que existe con la mucosa de la naso y orofaringe, ubicaciones en las que claramente se ha documentado alta carga viral. Actualmente, se encuentra en construcción científica la definición de los aspectos relacionados con la seguridad en la práctica integral otológica en el contexto de la pandemia de la enfermedad por coronavirus 2019 (COVID-19). Este documento pretende recopilar el conocimiento y las experiencias nacionales e internacionales relacionados con la pandemia, para ser aplicados en el día a día en la práctica médica como especialistas. Es pertinente aclarar que el contenido de estos lineamientos deberá ser actualizado a medida que se conozca nueva información o evidencia, puesto que esta se encuentra en constante y rápida evolución.

Until now, it is not known with certainty if the SARS-CoV-2 virus is found in the mucosa that covers the Eustachian tube, the middle ear and the mastoid, but it is quite probable that it is, given the relationship that exists with the mucosa of the nasopharynx and oropharynx, anatomical sites where a high viral load has clearly been documented. The definition of safety-related aspects for the otological practice is currently under construction in the context of the 2019 coronavirus disease pandemic (COVID-19). This document aims to gather the national and international knowledge and experiences related in order to be applied in the day to day of our medical practice as specialists. It is important to mention that the content of these guidelines should be updated as new information or evidence becomes known since it is constantly changing.

La reparación simbólica a víctimas de desaparición forzada, olvido o perdón / The Symbolic Reparation to Victims of Enforced Disappearance, Forgetfulness, and Forgiveness

Resumen En el marco jurídico colombiano, es inadmisible que un país que se en maraca en un estado social de derecho, el legislativo a pesar de evidenciar en su contexto una necesidad de aprobar leyes para luchar contra la desaparición forzada, haya dejado de cumplir con sus deberes éticos de legislar en un momento crucial que la sociedad colombiana, lo demandaba.

Abstract In the Colombian legal framework, it is inadmissible that a country, which is framed in a rule of law, the legislature despite of giving clear, in its context, of a need to pass laws in order to fight enforced disappearance, has stopped fulfilling its ethical duties of legislating at a crucial moment, which was demanded by the Colombian society.

Subcutaneous abatacept in rheumatoid arthritis: A real-life experience.

OBJECTIVES: To assess the effectiveness, safety, and drug survival of subcutaneous (SC) abatacept (ABA) in a cohort of rheumatoid arthritis (RA) patients in a real-world setting. METHODS: This was a retrospective cohort study from 2014 to 2018 in which patients with RA (1987 ACR criteria) were included. Patients were evaluated at a single rheumatology outpatient center in Bogotá, Colombia. The patients were classified according to their treatment background: biological-naïve (n = 65), switched from IV to SC ABA administration (125 mg-wk) (n = 32), and inadequate response to biological DMARD (n = 62). The primary endpoint was a change in DAS28-CRP and RAPID3 from baseline to 12 months. A linear mixed effect model was used to correlate repeated measures. Adverse events were assessed and recorded during each visit to the rheumatology center. Several Cox proportional hazard regression models were used to test if there were any differences in drug survival curves based on seropositivity for rheumatoid factor (RF), and anti-Cyclic Citrullinated Peptide Antibodies (anti-CCP). Statistical analysis was done using software R version 3.4.4. RESULTS: A total of 159 patients were included. Baseline characteristics of patients were as follows: female gender 84%, median age of 54 years (IQR 16), median disease duration 10 years (11), RF positive 96%, anti-CCP positive 89%, erosive disease 55%, median DAS28-CRP 5.0 (2), and median RAPID3 17 (10). Concomitant use of methotrexate and SC ABA monotherapy were reported at 52% and 30% respectively. Demographics and disease characteristics were similar for all groups, except for baseline DAS28-CRP, and RAPID3 in the group that switched route of administration. The interaction between time and group was significant (p = 0.0073) for RAPID3. Infections, constitutional symptoms, and headaches were the most frequent AEs. Retention rate corresponded to 60% at 48 months. The most frequent reason for drug suspension was loss of efficacy. Median time of treatment for SC ABA was 31 months (IQR 30). The only association that reached statistical significance was anti-CCP concentration [Q1-Q4] (p = 0.005). According to the Cox proportional hazard regression model, there were significant differences between survival curves for Q1 (HR 0.15; 0.03-0.64 95% CI; p = 0.0096), and Q2 (HR 0.28; 0.08-0.92 95% CI; p = 0.0363) compared to the seronegative group. CONCLUSIONS: The results showed an improvement in RA disease activity and physical function in patients under SC ABA treatment. Patients switching from IV to SC administration of ABA had lower activity and functional impairment at baseline. SC ABA demonstrated a good safety profile consistent with previously published data. Patients with baseline levels of anti-CCP antibody concentrations had better drug survival than seronegative patients.

Sarcoma de Ewing extraesquelético de rápido crecimiento en paciente de 2 años: Reporte de caso / Fast growing extraskeletal Ewing sarcoma in a 2 year old patient: Case report

El sarcoma de Ewing forma parte de una familia de tumores que se caracterizan por presentar translocaciones que involucran al gen EWS y algún miembro de la familia ETS que posee un dominio de unión al ADN. Se presenta el caso de un paciente de dos años de edad con una masa cervical de crecimiento rápido que por compresión local comprometió estructuras nerviosas manifestándose inicialmente con un retardo en el neurodesarrollo. Se diagnosticó Sarcoma de Ewing/Tumor neuroectodérmico primitivo por biopsia. Este es un tipo de tumor raro con una presentación inusual a nivel cervical; el cual debe tenerse en cuenta al momento de evaluar pacientes con masas cervicales en especial las de crecimiento rápido con el fin de dar un tratamiento preciso y oportuno.

Ewing's sarcoma is part of a family of tumors that is characterized by translocations that involve the EWS gene and a member of the ETS family that has a DNA binding domain. The case of a two-year-old patient who was admitted in our institution because of a rapidly growing cervical mass associated to neurodevelopment setback and functional gradual loss due to nerve compression. Ewing's sarcoma / primitive neuroectodermal tumor was diagnosed by biopsy. This is a rare type of tumor with an unusual presentation in this location; which should be taken into account when assessing a patient with cervical masses, especially those of rapid growth in order to provide an accurate and opportune treatment for improving outcomes.

Guillain-Barré syndrome in Colombia: where do we stand now?

Guillain-Barré syndrome (GBS) is a rapid-onset muscle weakness disease caused by the immune-mediated damage of the peripheral nervous system. Since there is an increase incidence of GBS cases in Latin America, particularly in Colombia, and most of them are currently preceded by Zika virus (ZIKV) infection, we aimed to assess the available evidence of the disease in Colombia through a systematic literature review. Out of 51 screened abstracts, only 16 corresponded to articles that met inclusion criteria, of which 15 were case reports or case series. A total of 796 cases of GBS were reported in the included articles. The majority of patients were males (66.8 %) and younger than 50 years old (94 %). An infectious disease before the onset of GBS was registered in 31 % of patients, with gastrointestinal or respiratory symptoms being the most frequently observed. In those cases in which electrodiagnostic tests were performed, the most common subphenotype was acute inflammatory demyelinating polyneuropathy (17 %). Death was reported in 15 % of patients. Data regarding GBS in Colombia is scant and heterogeneous. Taking into account the burden of the disease and the recent rise of GBS cases associated with ZIKV, a careful patient evaluation and a systematic collection of data are warranted. A form to data gathering is proposed.

Septic sacroiliitis in the late postpartum due to Escherichia cóli / Sacroiliitis séptica por Escherichia cóli en el puerperio tardío

Septic sacroiliitis is an unusual condition, and due to its non-specific symptoms, the diagnosis is often delayed. It should be suspected in cases in which inflammatory back pain and systemic inflammatory signs co-exist, especially in people with risk factors, such as postpartum. The case is presented of a woman, who in the late postpartum, presented with sacroiliitis and severe sepsis due to Escherichia coli. This is the second report of a case of septic sacroiliitis due to E. coli associated with pregnancy.

La sacroiliitis séptica es una condición inusual, a menudo el diagnóstico se hace de forma tardía debido a la poca especificidad de los síntomas. Debe ser sospechada en casos donde coexista dolor lumbar inflamatorio y signos de respuesta inflamatoria sistémica, especialmente en personas con factores de riesgo tales como el puerperio. En este artículo reportamos el caso de una mujer quien durante el puerperio tardío presentó sacroiliitis por Escherichia coli y sepsis grave secundaria, siendo este el segundo caso reportado de sacroiliitis séptica por Escherichia coli asociada al embarazo.

La fecundación in vitro, un derecho negado en colombia: a denied rigth in colombia / In vitro fecundation: um direito negado na colômbia / A fecundação in vitro

La oportunidad convertida en posibilidad de conformar una familia, como núcleo esencial de la sociedad, no solo está dada por la unión de un hombre con una mujer o, como en los últimos pronunciamientos constitucionales, por la unión de parejas del mismo sexo, quienes, por voluntad personal y autonomía deciden no tener hijos o tenerlos sin limitación alguna al número de ellos. Sin embargo, no todas las personas tienen las capacidades biológicas óptimas para la fecundación y procreación de manera natural, por lo cual deben acudir a realizarse diferentes tratamientos médicos especializados para tener una expectativa de crear su prole o descendencia, con la ayuda de los avances científicos, en un estado donde el acceso a la biotecnología tiene unos costos elevados, que hacen que su acceso sea limitado. Dentro de estos tratamientos médicos se encuentra la Fecundación In Vitro (FIV), procedimiento mediante el cual, la fecundación del óvulo por el espermatozoide se hace en laboratorio y es implantado en el útero y no de manera natural, es decir, a través de una relación sexual, tratamiento que tiene unos costos bastante onerosos. La Corte Constitucional en sentencias de tutela ha señalado algunos casos excepcionales para autorizar la FIV, pero supeditados a negligencias de las EPS y a una correlación entre la enfermedad y la vida, a partir de la conexidad, más no por la libre determinación de tener hijos, argumentando, para justificar esta discriminación en que el Estado Colombiano no puede soportar los costos de este tipo de tratamientos, ya que no se encuentran incluidos en el (Plan Obligatorio de Salud) POS, indicado que cada pareja o mujer que quiera constituir una familia debe sufragar, por sus propios medios los costos del tratamiento y finalmente señalando que existe la adopción como posibilidad para tener hijos, negando así el derecho a tener hijos de sangre.

The opportunity of building a family, as society basic core, is not only given by the marriage of a man and a woman. The last constitutional declarations also include same sex couples and people who are willing by their personal choice and autonomy, without limitations in the quantity of children. Nevertheless, not all the people have the biological capacity for fecundation and procreation. That is why they have to look up for diverse treatments at specialized medical centers to be able to create a family. In vitro fecundation (IVF) is one of the treatments offered. This procedure consists in the laboratory manipulation to inseminate the ovule with the spermatozoid and implant the fertilized ovule in the uterus. In Colombia, the access to these kind of treatment is limited, expensive and is not covered by the health insurance system. Some Constitutional Court precepts have pointed out that it could be some exceptional cases where the Health System has the obligation to cover the IVF expenses, due to negligence and a correlation between sickness and life. The precepts do not consider the free willing of having children and also states that Colombia is not able to support the expenses of the IVF, because is not included in the basic plan of health coverage. Finally suggesting that the adoption is a more feasible opportunity and denying the right of having children by blood.

A oportunidade de construir uma família, como núcleo básico da sociedade, não é apenas dada pelo casamento de um homem e uma mulher. As últimas declarações constitucionais também incluem casais do mesmo sexo e pessoas que estão dispostas por sua escolha pessoal e autonomia, sem limitações na quantidade de crianças. No entanto, nem todas as pessoas têm a capacidade biológica para a fecundação e procriação. É por isso que eles têm que procurar por diversos tratamentos em centros médicos especializados para ser capaz de criar uma familia. A fecundação in vitro (IVF) é um dos tratamentos oferecidos. Este procedimento consiste na manipulação laboratorial para inseminar o óvulo com o espermatozóide e implantar o óvulo fecundado no útero. Na Colômbia, o acesso a esse tipo de tratamento é limitado, caro e não é coberto pelo sistema de seguro de saúde. Alguns preceitos do Tribunal Constitucional apontaram que podem ser alguns casos excepcionais em que o Sistema de Saúde tem a obrigação de cobrir as despesas de FIV, por negligência e correlação entre doença e vida. Os preceitos não consideram a vontade livre de ter filhos e também afirma que a Colômbia não é capaz de suportar as despesas da FIV, porque não está incluído no plano básico de cobertura de saúde. finalmente é notar que não há a adoção como uma possibilidade de ter filhos, negando assim o direito a ter filhos com sangue.

Familial Aggregation and Segregation Analysis in Families Presenting Autoimmunity, Polyautoimmunity, and Multiple Autoimmune Syndrome.

Studies documenting increased risk of developing autoimmune diseases (ADs) have shown that these conditions share several immunogenetic mechanisms (i.e., the autoimmune tautology). This report explored familial aggregation and segregation of AD, polyautoimmunity, and multiple autoimmune syndrome (MAS) in 210 families. Familial aggregation was examined for first-degree relatives. Segregation analysis was implemented as in S.A.G.E. release 6.3. Data showed differences between late- and early-onset families regarding their age, age of onset, and sex. Familial aggregation of AD in late- and early-onset families was observed. For polyautoimmunity as a trait, only aggregation was observed between sibling pairs in late-onset families. No aggregation was observed for MAS. Segregation analyses for AD suggested major gene(s) with no clear discernible classical known Mendelian transmission in late-onset families, while for polyautoimmunity and MAS no model was implied. Data suggest that polyautoimmunity and MAS are not independent traits and that gender, age, and age of onset are interrelated factors influencing autoimmunity.

Cardiovascular disease in latin american patients with systemic lupus erythematosus: a cross-sectional study and a systematic review.

Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE). Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed. Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%-79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition. Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors.

Novel risk factors for cardiovascular disease in rheumatoid arthritis.

Since cardiovascular disease (CVD) is the most common cause of mortality in patients with rheumatoid arthritis (RA), we aimed to determine factors associated with such a complication in a large series of Colombian patients. This was a cross-sectional analytical study in which 800 consecutive Colombian patients with RA were assessed for variables associated with CVD. Furthermore, a systematic literature review was performed to address the state of the art about non-traditional risk factors for CVD in RA. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed in data extraction, analysis, and reporting of articles selected. Hypercholesterolemia, type 2 diabetes mellitus, abnormal body mass index, abdominal obesity, and current smoking were all traditional risk factors significantly associated with CVD in Colombians. As non-traditional risk factors, familial autoimmunity, more than 10 years of duration of the disease, patients working on household duties, use of systemic steroids, and low education level were associated with CVD in the studied population. Out of a total of 9,812 articles identified in PubMed and Scopus databases, 140 fulfilled the eligibility criteria and were included. Through this systematic review, several factors and outcomes related to CVD were confirmed and identified. These were categorized into genetics, RA-related, and others. Traditional risk factors do not completely explain the high rates of CVD in patients with RA; thus, novel risk factors related to autoimmunity are now recognized predicting the presence of CVD as strong as traditional risk factors. Our results may assist health professionals and policymakers in making decisions about CVD in patients with RA.

Cardiovascular disease in rheumatoid arthritis: a systematic literature review in latin america.

Background. Cardiovascular disease (CVD) is the major predictor of poor prognosis in rheumatoid arthritis (RA) patients. There is an increasing interest to identify "nontraditional" risk factors for this condition. Latin Americans (LA) are considered as a minority subpopulation and ethnically different due to admixture characteristics. To date, there are no systematic reviews of the literature published in LA and the Caribbean about CVD in RA patients. Methods. The systematic literature review was done by two blinded reviewers who independently assessed studies for eligibility. The search was completed through PubMed, LILACS, SciELO, and Virtual Health Library scientific databases. Results. The search retrieved 10,083 potential studies. A total of 16 articles concerning cardiovascular risk factors and measurement of any cardiovascular outcome in LA were included. The prevalence of CVD in LA patients with RA was 35.3%. Non-traditional risk factors associated to CVD in this population were HLA-DRB1 shared epitope alleles, rheumatoid factor, markers of chronic inflammation, long duration of RA, steroids, familial autoimmunity, and thrombogenic factors. Conclusions. There is limited data about CVD and RA in LA. We propose to evaluate cardiovascular risk factors comprehensively in the Latin RA patient and to generate specific public health policies in order to diminish morbi-mortality rates.

Nefrotoxicidad inducida por medicamentos / Drug-induced nephrotoxicity

La presente revisión incluye la descripción de los diferentes tipos de nefrotoxicidad inducida por medicamentos de acuerdo a su clasificación histopatológica, mecanismo de generación, presentación clínica y medicamentos más frecuentemente implicados. Para esta revisión fue realizada una búsqueda sistemática en el Index Medicus de artículos relacionados publicados a partir de 1999, los cuales fueron seleccionados de acuerdo a su pertinencia. La nefrotoxicidad inducida por medicamentos es un hallazgo de gran importancia clínica, debido a su alta frecuencia y potencial severidad, así como al desconocimiento de medidas preventivas en muchos casos. Las principales alteraciones renales producidas por medicamentos se pueden clasificar histopatológicamente, según la función renal alterada. De este modo, se encuentra la necrosis tubular aguda, la nefritis intersticial, la lesión glomerular y las alteraciones vasculares, que a su vez incluyen la microangiopatía trombótica, la aterosclerosis y la vasculitis. Finalmente, se hace una revisión de algunos medicamentos de uso habitual con alto potencial de nefrotoxicidad, haciendo énfasis en las recomendaciones de uso clínico dirigidas a optimizar la seguridad renal de estos productos...

This review includes a description of the different types of drug-induced nephrotoxicity (DIN) according to histopathologic classification, generation mechanism, clinical presentation and drugs most frequently involved. For this review, a systematic search was conducted in the Index Medicus for articles published since 1999, which were selected according to their relevance. The DIN is a finding of major clinical importance due to their high frequency and potential severity, and the lack of preventive measures in many cases. The main renal impairments caused by drugs can be classifi ed histopathologically according to altered renal function. Thus, there is the acute tubular necrosis, interstitial nephritis, glomerular injury and vascular changes that in turn include thrombotic microangiopathy, atherosclerosis and vasculitis. Finally, some commonly used drugs with high potential for nephrotoxicity are reviewed, with emphasis on recommendations for clinical use to optimize the renal safety of these products...

Implante coclear bilateral / Bilateral cochlear implant

Son múltiples los beneficios en la implementación de implantes cocleares bilaterales, como son la localización que puede mejorar hasta en un 95% comparados con la adaptación monoaural, el entendimiento en ambientes ruidosos adicionan hasta el 19% y la inteligibilidad del lenguaje aumenta hasta 6 dB compradas con la implantación unilateral y mejoran, al igual, aspectos en la calidad de vida como la integración en colegios normo oyentes, comunicación telefónica o lenguaje para comunicarse con oyentes no entrenados, existen varias técnicas para la cirugía simultanea (en un mismo procedimiento) o secuencial (en dos intervenciones), los resultados difieren según el tiempo de evolución de la sordera y/o el tiempo trascurrido entre implantes. Sin embargo, existen argumentos válidos que restringen su uso: relación costo-beneficio, futuras tecnologías, riesgos quirúrgicos y consecuencias vestibulares indeterminadas. Este articulo realiza una revisión de la literatura sobre los implantes cocleares bilaterales que pueda ayudar a trazar protocolos futuros.

Implementing bi lateral cochlear implants has numerous benefits. Some of these benefits can be the improvement of the localization skills up to 95% in comparison to the mono aural adaptation, the understanding ability in noisy environments is increased in to 19 % and intelligibility of the language is enhanced up to 6 dB in comparison to the unilateral implant. Also, they improve some of the everyday aspects for quality of life such as being able to integrate into schools with normal hearing skilled students, telephone communication or the language to communicate with audiences that have not been trained. There are several techniques to perform simultaneous surgery (in one single procedure) or sequential surgery (in two different operations), the results may vary according to the type of evolution deafness has and / or the time that has elapsed between implants. However, there some valid arguments that restrict its use: the cost- benefit ratio, future technologies, surgical risks and undetermined vestibular consequences. This article is intended to make a revision on the existing literature on bi lateral cochlear implants that may help layout future protocols.

Audifono de implantacion total CARINA: reporte del primer caso en America Latina / Fully implantable hearing aid CARINA: First case report in Latin America

Los implantes de oído medio proporcionan una buena alternativa de amplificación para los individuoscon hipoacusia neurosensorial moderada a severa. De igual forma, los audífonos de implantación total pueden ayudar a pacientes con atresia congénita del conducto auditivo externo. Estos sistemas tienen ventajas tan importantes, como dejar el conducto auditivo externo abierto. Los audífonos de implantación total, permiten la realización de actividades como la natación y el baño cada mañana,conservando los beneficios auditivos.

Reconstruccion de cadena osicular con protesis de titanio en la Universidad Militar Nueva Granada, Bogota, Colombia. Resultados preliminares / Ossicualar chain reconstruction with titanium prosthesis at the Universidad MIlitar Nueva Granada Bogota, colombia. Preliminary results

Objetivo: Se evaluaron los resultados de la reconstrucción de cadena osicular con prótesis de titanioen 2 hospitales universitarios de tercer nivel en Bogotá, Colombia.Materiales y métodos: Este es un reporte preliminar de un estudio descriptivo prospectivo que incluye48 prótesis utilizadas entre 2005 y 2006. De los 48 pacientes se realizó seguimiento completo en 42 casos, se utilizaron prótesis de reconstrucción osicular total (TORP) en 30 casos y prótesis de reconstrucción osicular parcial (PORP) en 18 casos. El seguimiento promedio fue de 8,6 meses, la comparación pre y posoperatoria así como los criterios de éxito están acordes a las guías de la AAOHNS, la osiculoplastia se realizó sola (9 pacientes) o asociada a otros procedimientos (39 pacientes), la recopilación de datos y el análisis estadístico se realizó con el programa SPSS 11.1.Resultados: El cierre promedio del gap aire-óseo (ABG) menor a 20 dB se logró en el 56,6 por ciento de los casos y según el tipo de prótesis el TORP fue del 51,8 por ciento y el PORP del 61,5 porciento, la tasa de extruciones fue del 6,1 por ciento (3 pacientes)Discusión Los resultados son comparables con el resto de la literatura y además no demuestranningún factor que contribuya al éxito de las prótesis PORP sobre las TORP.

[Exactness of transcutaneous sonography in the diagnosis of gastric wall lesions]. / Exactitud de la sonografía transcutánea en el diagnóstico de lesiones de pared gástrica.

OBJECTIVE: Our objective was to determine sensitivity, especificity and predictive values of transcutaneous sonography for detecting gastric wall lesions. MATERIALS AND METHODS: This prospective study was performed from March 1999 to April 2000 on 150 patients referred for transcutaneous sonography by the Endoscopic Service Unit. Sonographic examinations were performed using RT 4000 General Electric equipment with 5 Mhz transducer and replenishment of stomach with fluid. All scanning was done by the same sonographer, who was unaware of endoscopic, tomographic, or upper gastrointestinal series features. Results from sonography were compared with gastrointestinal tract endoscopy. Sensitivity, specificity, and predictive values were determined using contingency statistical procedure. Sonographic examination accuracy was calculated evaluating sensitivity and specificity confidence intervals (CI). Kappa index was calculated. Diagnostic accuracy differences observed between tumoral and non-tumoral lesions by sonography were evaluated by chi 2 probe. RESULTS: Sensitivity of 85% (95% CI, from 75.2 to 94.8%) and specificity of 90% (95% CI, from 86 to 93.9%) were obtained. Positive predictability was 78% and negative predictability was 94%. Diagnostic accuracy was 87%. Kappa index was 0.717. There were 35 no false-positive results (19 tumoral lesions and 16 non-tumoral lesions), seven false-negative results (one tumoral lesion and six non-tumoral lesions) and 10 false-positive results (two tumoral lesions and eight non-tumoral lesions). Only one of 20 tumoral lesions were diagnosed by ultrasound whereas from 22 non-tumoral lesions were not diagnosed 6 (chi 2 = 3.74, p > 0.05). CONCLUSION: Transcutaneous sonography is a rapid, low cost and non-invasive method that may be useful to establish clinic diagnosis and in the first steps of gastric wall lesions evaluation, it is valuable in assessment of diagnostic orientation for the referring clinic.