Use of Intralesional and Perilesional Human Recombinant Epidermal Growth Factor (hrEGF) in the Local Treatment of Venous Ulcer - Review Article - Expert Recommendation.

Venous Ulcers (VU) represent 60-80% of all leg ulcers and are the final stage of the disease secondary to venous hypertension or valve insufficiency. Conventional treatment that focuses on its etiological factors continues to be the gold standard; however, 30% of ulcers do not heal with this treatment; thus, it has been seen that the use of growth factor can be used as an adjuvant for this pathology. A literature review was carried out to evaluate the evidence from systematic reviews, meta-analyses, case studies, and quantitative studies that respond to the objective of this analysis review in the different databases with specific inclusion criteria with publications between 2002 and 2022, initially finding the topical application of the factor and later, more recently, the intralesional and perilesional application, the latter being an alternative treatment for this type of pathology and generating some recommendations for using the Factor.

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications - A consensus document of the International Union of Phlebology-2023.

BACKGROUND: Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. OBJECTIVES: To categorise contraindications to sclerotherapy based on the available scientific evidence. METHODS: An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. RESULTS: Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh the risk of harm or the risks may be mitigated by other measures include pregnancy, postpartum and breastfeeding; hypercoagulable states with risk of VTE; risk of neurological adverse events; risk of cardiac adverse events and poorly controlled chronic systemic illness. Conditions and circumstances where Warnings and Precautions should be considered before proceeding with sclerotherapy include risk of cutaneous necrosis or cosmetic complications such as pigmentation and telangiectatic matting; intake of medications such as the oral contraceptive and other exogenous oestrogens, disulfiram and minocycline; and psychosocial factors and psychiatric comorbidities that may increase the risk of adverse events or compromise optimal treatment outcomes. CONCLUSIONS: Sclerotherapy can achieve safe clinical outcomes provided that (1) patient-related risk factors and in particular all material risks are (1a) adequately identified and the risk benefit ratio is clearly and openly discussed with treatment candidates within a reasonable timeframe prior to the actual procedure; (1b) when an individual is not a suitable candidate for the proposed intervention, conservative treatment options including the option of 'no intervention as a treatment option' are discussed; (1c) complex cases are referred for treatment in controlled and standardised settings and by practitioners with more expertise in the field; (1d) only suitable individuals with no absolute contraindications or those with relative contraindications where the benefits outweigh the risks are offered intervention; (1e) if proceeding with intervention, appropriate prophylactic measures and other risk-mitigating strategies are adopted and appropriate follow-up is organised; and (2) procedure-related risk factors are minimised by ensuring the treating physicians (2a) have adequate training in general phlebology with additional training in duplex ultrasound, procedural phlebology and in particular sclerotherapy; (2b) maintain their knowledge and competency over time and (2c) review and optimise their treatment strategies and techniques on a regular basis to keep up with the ongoing progress in medical technology and contemporary scientific evidence.

The First Latin American Consensus on Superficial and Perforating Venous Mapping.

With the aim of obtaining a map which is useful as a diagnostic tool and therapeutical orientation, complementing the written report of duplex ultrasound venous study, Latin-American Scientific Societies of Phlebology, Vascular Surgery and Vascular Imaging were invited to participate, through their regional representatives, to the First Consensus of Superficial and Perforating Venous Mapping. A consensus process using a modified Delphi method was carried out. An International Working Group was formed, which developed a Prototype of the Venous Mapping that worked as a starting point for consensus, and was presented in a first virtual meeting of 54 experts (societies' representatives) when the methodology was explained. For the consensus process, two rounds of self-administrated questionnaires with feedback were used. In the first questionnaire a 100% consensus was obtained in the 15 statements (an agreement range of 85.2% to 100%) In the analysis of qualitative data, three categories according to the actions to implement were identified - actions which involved no action, minor changes and major changes. This analysis was used to build the second questionnaire, which reached a consensus in its six statements (agreement range of 87.1% to 98.1%). A final consensus on every field proposed was established with the approval of all the experts consulted and it was presented at a third online meeting. The document of the superficial and perforating venous mapping reached by consensus is presented hereafter.

Características epidemiológicas, clínicas y microbiológicas de la infección del tracto urinario neonatal en un hospital en Medellín, 2013-2017 / Epidemiologic clinical and microbiological features of neonatal urinary tract infection in a hospital in Medellín, 2013-2017

RESUMEN Objetivo: describir las características epidemiológicas, clínicas y microbiológicas de la infección del tracto urinario neonatal. Métodos: estudio descriptivo retrospectivo en neonatos con infección urinaria hospitalizados en una institución de Medellín entre enero del 2013 y diciembre del 2017. Se recolectaron datos de las historias clínicas. Las variables cualitativas se expresaron en forma de frecuencias absolutas y relativas, las cuantitativas se presentaron como promedio y desviación estándar o mediana y rangos intercuartílicos. Resultados: se incluyeron 65 pacientes. Los uropatógenos más comunes fueron Escherichia coli (52 %) y Enterococcus faecalis (20 %). Las manifestaciones clínicas más frecuentes fueron la fiebre (46 %), la ictericia (38 %) y las apneas (15 %). La proteína Creactiva elevada se presentó en el 28 % de los casos. En el uroanálisis, el hallazgo anormal predominante fueron las esterasas leucocitarias en el 65 %. Hubo 15 casos (23 %) de infecciones nosocomiales. Por ecografía renal se encontró una malformación genitourinaria en el 25 % de los pacientes. De los 35 neonatos con cistouretrografía miccional hospitalaria, el 17 % tenía reflujo vesicoureteral, el 67 % tuvo ecografía renal normal y el 83 % tuvo un aislamiento diferente a Escherichia coli. Dos pacientes presentaron bacteriemia y uno meningitis. Conclusión: la infección urinaria neonatal tuvo manifestaciones clínicas variadas, donde la fiebre y la proteína C reactiva no fueron marcadores comunes de la respuesta inflamatoria. En este estudio una ecografía renal normal no descarta la posibilidad del reflujo vesicoureteral, por ello debe tenerse en cuenta otros criterios para seleccionar los pacientes que requieren de estudio de reflujo.

SUMMARY Objective: To describe de epidemiological, clinical, and microbiological features of neonatal urinary tract infection. Methods: A descriptive retrospective study of neonates with urinary tract infection admitted to Clinica Universitaria Bolivariana (Medellín, Colombia) between January 2013 and December 2017. Data about urinary tract infection features were collected from the clinical records of the hospital. For data analysis, qualitative variables were presented as absolute and relative frequencies, and quantitative variables were presented as mean and standard deviation or median and interquartile ranges. Results: Sixty-five patients were included. The most common uropathogens were Escherichia coli (52%) and Enterococcus faecalis (20%). The most frequent clinical features were fever (46%), jaundice (38%) and apneas (15%). Of 21 patients, 28% had C reactive protein raised. Urine dipstick test was positive for leukocyte esterase in 65%. There were 15 nosocomial infections (23%). Renal ultrasound was performed in all patients, of which 25% had congenital anomalies of the kidney and urinary tract. Voiding cystourethrogram was performed in 35 patients, of which 17% had vesicoureteral reflux; 67% of them had a normal renal ultrasound and 83% of them had a non-Escherichia coli bacteria isolation. Two patients had bacteremia and one patient had meningitis. Conclusions: neonatal urinary tract infection is a disease with multiple clinical manifestations, where fever and C-reactive protein weren't common marker of inflammatory response. In this study, having a normal renal ultrasound doesn't discard the possibility of having vesicoureteral reflux, and other criteria should be considered to select which patients need studies for vesicoureteral reflux.

Neonatal bilateral acute retinal necrosis in a neonate with a history of severe intrauterine growth restriction.

We present the case of a baby girl born at term with severe intrauterine growth restriction (IUGR) to a gravida 1 mother who was previously healthy and HIV negative. The newborn was evaluated by an ophthalmologist because of her history of IUGR and was diagnosed with intraretinal hemorrhages associated with areas of peripheral retinal necrosis at the posterior pole of both eyes. A diagnosis of acute retinal necrosis of presumed viral origin due to cytomegalovirus virus was considered, and the infant was started on and responded well to valganciclovir.

Congenital Tuberculosis as a Result of Disseminated Maternal Disease: Case Report.

Although tuberculosis is highly prevalent worldwide, congenital tuberculosis is one of the least common manifestations of the disease. The diagnosis is usually difficult because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy and delivery. We present the case of a preterm neonate with congenital tuberculosis, born to a previously healthy mother who had developed severe disseminated tuberculosis during her pregnancy. Once the diagnosis was confirmed in the mother, the congenital infection was confirmed by isolation of Mycobacterium tuberculosis in gastric aspirates, and positive polymerase chain reaction in a cerebrospinal fluid examination. Treatment for tuberculosis with a four-drug regimen resulted in an adequate clinical response in both the mother and infant.

Actualizando discursos: trazos de historia de la psiquiatria y de la salud pública en el contexto iberoamericano

Cada uno de los capitulos de este libro constituye un ensayo reflexivo en torno a las construcciones conceptuales que cpnfiguran nuevas formas de pensar la salud pública y la psiquiatría, en la perspectiva de una epistemología de las ciencias sociales. Cada uno de los autores brinda descripciones históricas y análisis, con innovación en el uso de fuentes documetnales, en favor de una historia que rescata ciertas particularidades de procesos locales o nacionales. En general todos ellos introducen a una analítica de los conceptos y a nuevas ofrmas de la interpretación en común de trabajos sobre historia de la psiquiatría con trabajos sobre historia de la salud pública se debe a cierto proceso de configuración de las líneas de indagación que en ambos campos se han visibilizado en el ejercício de la observación histórica que sobre las realidades urbanas modernas, han reconocido en Iberoamérica, en mútiples trabajos, la visibilización del alienado mental y del Estado, entre finales del siglo XIX y primeras décadas del siglo XX, generaba las estrategias biopolíticas y de saneamiento del cuerpo social.(AU)

Sífilis e higiene moral en la ciudad de Medellín: observaciones clínicas de cipriano Mejía a comienzos del siglo XX / Syphilis and moral hygiene in the city of Medellín: clinical observations of Cipriano Mejía at the beginning of the 20th century

Inscritos en la perspectiva del análisi de la historia de lasa ciencias, en el sentido de las transformaciones de los campos de saber, para esteartículo acudimos a las aportaciones analíticas que sobre el problemas de la sífilis en la ciudad de Medellín realizao el médico Cipriano Mejía Mejía en 1920. El texto de este médico antioqueño, que constituye el trabajo de la tesus para obtener el título de doctor en medicina y cirugía de la Universidad de antioquia es una muestra de la preocupación de los médicos y autoridades de higiene de la ciudad frente al flagelo creciente, que esa época constituían las enfermedades venéreas y especificamente el de la sífilis.(AU)

Infección urinaria de la comunidad en pacientes pediátricos de la Clínica Universitaria Bolivariana: etiología, presentación clínica, factores de riesgo y respuesta clínica a la terapia empírica inicial / Urinay tract infection from the community in pediatric patiens of the clinica Universitari Bolivariana: etimology, clinical presentation, risk factors and clinical response to initial empirical therapy

Objetivo: describir las características clínicas, reconocer los posibles factores de riesgo (FR) para ITU, el perfil de sensibilidad antibiótica, evaluar el protocolo institucional y la respuesta clínica a la terapia empírica inicial.Metodología: estudio transversal prospectivo realizado entre febrero/2009-enero/2010. Resultados: ingresaron 47 pacientes, 25 hombres (53.2%) vs. 22 mujeres (46.8%). El rango de edad más frecuente para ITUen ambos sexos fue 1-24 meses (76.5%), es decir, hay un claro predominio en el género masculino (58.3%). Se encontraron FR en 51.1% de los pacientes y en 21.2% se presentaron dos o más FR. Los principales fueron: ITU previa (19.1%),malformaciones de la vía urinaria (17%), estreñimiento (12.7%), mala higiene (12.7%), reflujo vesico-ureteral (6.4%). Los principales agentes etiológicos fueron: Escherichia coli (31), Proteus mirabilis (5), Klebsiella pneumoniae (3) y Citrobacter freudii (2); 2 y 5 aislamientos presentaron beta lactamasas de espectro extendido (#LEE) y #-lactamasas tipo AmpC, respectivamente. La defervescencia como respuesta a la terapia empírica inicial con aminoglucósidos ocurrió en las primeras 36 horas en lamayoría de los pacientes (87%) con ITU febril, independiente del perfil de resistencia. Conclusiones: la ITU febril fue la principal presentación clínica con un alto porcentaje de FR identificados solo por interrogatorio y examen físico dirigido. Se aislaron bacterias de la comunidad que fueron #LEE+ o AmpC+. Desde el punto de vista institucionalel uso de aminoglucósidos son una buena alternativa para el tratamiento inicial debido a su alta efectividad clínica y bajo perfil de resistencia.

Objective: to describe the clinical characteristics, identify possible risk factors (RF) for UTI, describe antibiotic sensitivity profiles, evaluate the institutional empirical antibiotic protocol and the clinical response to initial empirical therapy. Methods: cross-sectional observational study from february/2009 to january /2010. Results: 47 patients were admitted, 25 males (53,2%) and 22 females (46,8%). The most frequent age group in both sexes was 1-24 months (76,5%), predominating in the male gender (58,3%). RF were found in 51,1% of the patients and 21,2%showed two or more RF. The main ones being: previous UTI (19.1%), urinary tract malformations (17%), constipation (12,7%), bad higiene (12.7%), vesicoureteral reflux (6,4%). The main aetiological agents isolated were: Escherichia coli (31), Proteusmirabilis (5), Klebsiella pneumoniae (3) and Citrobacter freudii (2); 2 and 5 isolates had extended spectrum beta-lactamases (#LEE) and AMP C #-lactamases, respectively. Resolution of fever occurred in the first 36 hours in the majority of the patients (87%), independent of resistance profile of the isolates. This being a reliable parameter of clinical response to empirical anitbiotic therapy with aminoglycosides. Conclusions: febrile UTI was the main clinical presentation with a high percentage of RF identified only by history and physical examination. #LEE+ or AmpC+ bacteria were isolated from the community. At an institutional level the use of aminoglycosides are a good alternative for the initial treatment due to the good clinical response and low level of resistance.

Síndrome de prune belly (ciruela pasa): reporte de un caso / Prune belly syndrome: a case report

El síndrome de prune belly es una rara anomalía congénita. Se trata de una triada compuesta por ausencia, deficiencia o hipoplasia de la musculatura de la pared abdominal, criptorquidia bilateral y malformación del tracto urinario (dilatación). Se presenta el caso de un bebé, de sexo masculino y con diagnóstico imagenológico in utero de megavejiga, valvas uretrales posteriores parciales y dilatación de los uréteres. Luego del nacimiento, las características fenotípicas fueron sugestivas del síndrome de prune belly (ciruela pasa). Los estudios complementarios confirmaron la ausencia de testículos en escroto, reflujo vésico ureteral bilateral y estenosis de la uretra proximal. La uro resonancia magnética con reconstrucción en 3D reportó que ambos riñones presentaban alteración en su morfología con quistes en su interior, hipoplasia renal derecha, uréteres dilatados y tortuosos, vejiga distendida con divertículo del uraco y deficiencia de los músculos rectos abdominales. Como complicaciones se presentaron una infección urinaria febril y una enfermedad renal crónica secundaria. Una vez los eventos infeccioso y obstructivo fueron resueltos la función renal se estabilizó y se procedió a realizar vesicostomía. El paciente fue dado de alta en condición estables, con manejo de la vesicostomía, profilaxis para infección urinaria y seguimiento periódico. La reconstrucción de su tracto urinario se realizará al segundo año de vida y de acuerdo con la evolución de su función renal.

Prune belly syndrome is a rare congenital anomaly. It is a triad consisting of absence, deficiency or hypoplasia of wall abdominal muscles, bilateral cryptorchidy, and urinary tract (dilatation) malformation. As an example, take the case of a male baby with in utero diagnostic of megacystis, partial posterior urethral valves, and dilated ureters. After birth, the phenotypic characteristics were suggestive of prune belly syndrome. Complementary studies confirmed the absence of testes in scrotum, bilateralvesicourereteral reflux and stricture of the proximal urethra. Magnetic resonance with 3D reconstruction reported that both kidneys had alterations in their morphology with interior cysts, right renal hypoplasia, long and tortuous ureters, distendedbladder with diverticulum of urachus and deficiency of abdominal muscles. There were complications like febrile urinary tract infection and secondary chronic kidney disease. Once the infectious and obstructive events were resolved the renal function was stabilized and the surgical approach was vesicostomy. The patient was discharged in stable condition, with vesicostomy management, prophylaxis for urinary tract infection and regular follow. The urinary tract reconstruction will be in the second year of life and according to evolution of his kidney function.

Desplazamiento y aislamiento. Alienados mentales en la ciudad de Medellín. 1878-1930 / Displacement and isolation. Mental illness in the city of Medellin. 1878-1930

La observación sobre la ciudad de Medellín en el contexto de la historia urbana, generó un sorprendente cuadro de temas sobre higiene y salud pública, entre los que encontramos el caso de los alienados mentales y los dispositivos de control propuestos por las autoridades civiles y los médicos. De 1880 hasta 1950 Medellín vivió el proceso de modernización, que la convirtió en polo de atracción de los desplazamientos de población al interior de la provincia de Antioquia. El Ferrocarril garantizó desde los pueblos vecinos la movilización masiva de población, entre la que llegaron no pocos alienados mentales. A finales del siglo XIX, las autoridades crearon la Casa de Alienados para dar asilo a estas personas, esta institución se convirtió a comienzos del siglo XX en Manicomio Departamental y a mediados del siglo XX en el Hospital Mental de Antioquia. El aislamiento de los locos da cuenta del comienzo del proceso de constitución e institucionalización del saber psicopatológico, de la autoridad médica y la medicalización de la demencia en Antioquia a comienzos del siglo XX (AU)

The observation in the city of Medellín within the framework of urban history generated a surprising picture of subjects in hygiene and public health, among which we found the case of mental illness and the control systems proposed by civilian authorities and doctors. In Medellín, between 1880 and 1950, the modernization process went on, turning its pole of attraction on population displacements to the interior of the province of Antioch. As a result of Railroad I, there was a massive mobility of population from the neighboring towns, including some mentally ill people. At the end of the 19th century, the authorities created a house of asylum for these people, which became the Mental Hospital in the middle of the 20th century. The isolation of the mentally ill people reports both medical authority and the beginning of the constitution process and institutionalization of the psychopathology and medicalization of mental diseases in Antioquia at the beginning of the 20th century (AU)

Desplazamiento y aislamiento. Alienados mentales en la ciudad de Medellín. 1878-1930 / Displacement and isolation. Mentally ill in the city of Medellín. 1878-1930

La observación sobre la ciudad de Medellín en el contexto de la historia urbana, generó un sorprendente cuadro de temas sobre higiene y salud pública, entre los que encontramos el caso de los alienados mentales y los dispositivos de control propuestos por las autoridades civiles y los médicos. De 1880 hasta 1950 Medellín vivió el proceso de modernización, que la convitión en polo de atracción de los desplazamientos de población al interior de la provincia de Antioquia. El Ferrocarril garantizó desde los pueblos vecinos la movilización masiva de población, entre la que llegaron no ocos alienados mentales. A finales del siglo XIX, las autoridades crearon la Casa de Alienados para dar asilo a estas personas, esta institución se convertió a comiezos del siglo XX en Manicomio Departamental y a mediados del siglo XX en el Hospital Mental de Antioquia. El aislamiento de los locos da cuentra del comienzo del proceso e constitución e institucionalización del saber psicopatológico, de la autoridad médica y la medicalización de la demencia en Antioquia a comienzos del siglo XX. [AU]

Características clínicas, epidemiológicas y de susceptibilidad a los antibióticos en casos de bacteriemia por Klebsiella pneumoniae en neonatos / Clinical, epidemiological and antimicrobial susceptibility features in cases of bacteremia by Klebsiella pneumonia in newborns

Objetivo: Describir los posibles factores de riesgo asociados a la bacteriemia por Klebsiella pneumoniae; reconocer las características clínicas y; describir el perfil de susceptibilidad a los antibióticos. Métodos: Estudio descriptivo de una serie de casos. Se incluyeron los neonatos que presentaron un hemocultivo positivo para K. pneumoniae entre junio de 2004 a diciembre de 2005 y su información demográfica, clínica, epidemiológica y de susceptibilidad a los antibióticos. Resultados: Se identificaron 30 pacientes con igual distribución por género. Veinticinco (83,3 por ciento) neonatos presentaron un aislamiento multirresistente y 5 (16,6 por ciento) multisensible. De las características al nacimiento predominaron los recién nacidos pretermino con un peso inferior a 2000 gr. y con riesgo séptico. Los posibles factores de riesgo presentes previos a la bacteriemia no variaron entre el grupo multirresistente y el multisensible, con la excepción del uso de antibióticos (100 por ciento vs. 60 por ciento). Los diagnósticos asociados más frecuentes al momento de la bacteriemia fueron la trombocitopenia (17/25 vs. 3/5) y la bacteriemia asociada a catéter (5/25 vs. 1/5). Conclusiones: los factores de riesgo asociados a la bacteriemia por K. pneumoniae no difieren mucho de los descritos para la infección por este agente. La presencia de K. pneumoniae BLEE positiva sin el uso previo de cefalosporinas de 3ra generación sugiere que existe una flora seleccionada que coloniza de forma rápida a los pacientes. Estos resultados permiten hacer una aproximación inicial al problema de la bacteriemia y sientan las bases para estudios de casos y controles...

Objective: to describe the possible risk factors associated to bacteremia caused by Klebsiella pneumoniae, recognizing the clinic characteristics and describing the antimicrobial susceptibility. Methods: descriptive study from a case series. There were included newborns that had positive blood cultures by K. pneumoniae between june 2004 and december 2005, with their demographic, clinic and epidemiological information and the antimicrobial susceptibility. Results: there were identified 30 patients with an equal distribution by gender. Twenty five (83,3 %) newborns presented a multiresistant isolation and 5 (16,6 %), a multisensitive isolation. Of the characteristics to birth prevailed the preterm newborns with an inferior weight to 2000 gr, and with a septic risk. The possible risk factors that the patients had before the development of the bacteremia did not changed between the multiresistantand multisensitive group, except for the use of antibiotics (100 % vs. 60 %). The diagnosis more frequently associated to the development of bacteremia were thrombocytopenia (17/25 vs. 3/5) and associated catheter bacteremia (5/25 vs. 1/5). Conclusions: the risk factors associated to bacteremiaby Klebsiella pneumoniae did not changed compared to the previously described for the infection caused by this bacteria. The presence of positive ESBL K. pneumoniae not associated with the previous use of third generation cephalosporins suggests that there exists a selection at edflora that colonizes rapidly the patients. This results letus have an initial approximation to the problem of the bacteremia and are the base for future case and control studies.

Serological markers and risk factors for hepatitis B and C viruses in patients infected with human immunodeficiency virus

Both hepatitis B and hepatitis C viruses (HBV and HCV) infection are common in HIV-infected individuals as a result of shared risk factors for acquisition. A serological study for HBV and HCV was performed in 251 HIV-positive individuals from Medellín, Colombia. A qualitative RT-PCR for HCV was done in 90 patients with CD4+ T-cell count < 150 per mm³. Serological markers for HBV infection were present in 97 (38.6 percent) patients. Thirty six of them (37.1 percent) had isolated anti-HBc. A multivariate analysis indicated that the following risk factors were significantly associated with the presence of these markers: age (OR = 1.05, 95 percent CI: 1.01-1.08), pediculosis pubis (OR = 1.83, 95 percent CI: 1.01-3.33), men who have sex with men and women (OR = 3.23, 95 percent CI: 1.46-7.13) and men who have sex only with men (OR = 3.73, 95 percent CI: 1.58-8.78). The same analysis restricted to women showed syphilis as the only significant risk factor. Thus, HBV infection was considerably associated with high risk sexual behavior. HCV was present in only two (0.8 percent) of HIV patients. Both of them were positive by RT-PCR and anti-HCV. This low frequency of HIV/HCV coinfection was probably due to the uncommon intravenous drug abuse in this population. The frequent finding of isolated anti-HBc warrants molecular approaches to rule out the presence of cryptic HBV infection.

La infección por los virus de la hepatitis B y hepatitis C (VHB y VHC) es frecuente en individuos infectados por el VIH como resultado de compartir factores de riesgo para su contagio. Se realizó un estudio serológico para el VHB y VHC en 251 individuos VIH positivos de la ciudad de Medellín, Colombia. En 90 pacientes con un recuento de linfocitos T < 150 células por mm³ se hizo una PCR-RT cualitativa para el VHC. Se encontraron marcadores serológicos para la infección por el VHB en 97 (38.6 por ciento) pacientes. Treinta y seis de 97 (37.1 por ciento) tuvieron un anti-HBc aislado. El análisis multivariado indicó que los factores de riesgo significativos asociados a la presencia de estos marcadores fueron: edad (OR = 1.05, 95 por ciento IC: 1.01-1.08), pediculosis púbica (OR = 1.83, 95 por ciento IC: 1.01-3.33), hombres que tienen sexo con hombres y mujeres (OR = 3.23, 95 por ciento IC: 1.46-7.13) y hombres que tienen sexo solo con hombres (OR = 3.73, 95 por ciento IC: 1.58-8.78). El mismo análisis restringido a mujeres mostró que la sífilis fue el único factor de riesgo significativo. Por lo tanto, la infección por el VHB fue considerablemente asociada a conductas sexuales de alto riesgo. El VHC se presentó en solo 2 (0.8 por ciento) de los pacientes VIH. Ambos pacientes fueron positivos por la PCR-RT y los anti-VHC. La baja frecuencia de la coinfección VIH/VHC fue probablemente debido al bajo uso de drogas intravenosas en esta población. El hallazgo frecuente de anti-HBc como marcador aislado asegura estudios moleculares para descartar la presencia de infección críptica por el VHB.

Serological markers and risk factors for hepatitis B and C viruses in patients infected with human immunodeficiency virus.

Both hepatitis B and hepatitis C viruses (HBV and HCV) infection are common in HIV-infected individuals as a result of shared risk factors for acquisition. A serological study for HBV and HCV was performed in 251 HIV-positive individuals from Medellín, Colombia. A qualitative RT-PCR for HCV was done in 90 patients with CD4+ T-cell count < 150 per mm(3). Serological markers for HBV infection were present in 97 (38.6%) patients. Thirty six of them (37.1%) had isolated anti-HBc. A multivariate analysis indicated that the following risk factors were significantly associated with the presence of these markers: age (OR = 1.05, 95% CI: 1.01-1.08), pediculosis pubis (OR = 1.83, 95% CI: 1.01-3.33), men who have sex with men and women (OR = 3.23, 95% CI: 1.46-7.13) and men who have sex only with men (OR = 3.73, 95% CI: 1.58-8.78). The same analysis restricted to women showed syphilis as the only significant risk factor. Thus, HBV infection was considerably associated with high risk sexual behavior. HCV was present in only two (0.8%) of HIV patients. Both of them were positive by RT-PCR and anti-HCV. This low frequency of HIV/HCV coinfection was probably due to the uncommon intravenous drug abuse in this population. The frequent finding of isolated anti-HBc warrants molecular approaches to rule out the presence of cryptic HBV infection.

La práctica médica en Cartagena de la Colonia al siglo XX / Medical practice in Cartagena from the Colony up to the XXth century

Compara tres casos de médicos que trabajaron en la ciudad de Cartagena, em momentos diferentes. Distingue varios niveles de la experiencia médica en sus formas de reconocimiento social, en pleno tránsito de la medicina privada a la medicina social.

La práctica médica en Cartagena de la Colonia al siglo XX / Medical practice in Cartagena from the Colony up to the XXth century

Compara tres casos de médicos que trabajaron en la ciudad de Cartagena, em momentos diferentes. Distingue varios niveles de la experiencia médica en sus formas de reconocimiento social, en pleno tránsito de la medicina privada a la medicina social.(AU)