Myelopathy due to copper deficiency: A case series and review of the literature / Mielopatía por déficit de cobre: serie de casos y revisión de la literatura.

Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.

El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial.

Mielopatía por déficit de cobre: serie de casos y revisión de la literatura / Myelopathy due to copper deficiency: A case series and review of the literature

El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial. Se deben incluir siempre la determinación de los niveles de cobre dentro del abordaje diagnóstico de todo paciente con enfermedad gastrointestinal crónica, con diarrea crónica, síndrome de mala absorción o reducción significativa de la ingestión en la dieta, y que desarrolle síntomas neurológicos sugestivos de compromiso de los cordones, ya que se ha reportado que el retraso en el diagnóstico de las mielopatías se asocia con pobres desenlaces neurológicos.

Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.

A Case of Complex Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction Caused by Extension of Type A Aortic Dissection into the Left Main Coronary Artery.

Aortic dissection extending into the left main coronary artery is rare and carries high mortality, especially when resulting in extensive myocardial infarction. Here we report a case of retrograde extension of type A aortic dissection into the left main coronary artery causing ST-segment elevation myocardial infarction managed by complex percutaneous coronary intervention, which resulted in temporary stabilization of the patient. We briefly review current literature on this approach.

Predicting the Unknown and the Unknowable. Are Anthropometric Measures and Fitness Profile Associated with the Outcome of a Simulated CrossFit® Competition?

The main objective of this research was to find associations between the outcome of a simulated CrossFit® competition, anthropometric measures, and standardized fitness tests. Ten experienced male CrossFit® athletes (age 28.8 ± 3.5 years; height 175 ± 10.0 cm; weight 80.3 ± 12.5 kg) participated in a simulated CrossFit® competition with three benchmark workouts ("Fran", "Isabel", and "Kelly") and underwent fitness tests. Participants were tested for anthropometric measures, sit and reach, squat jump (SJ), countermovement jump (CMJ), and Reactive Strength Index (RSI), and the load (LOAD) corresponding to the highest mean power value (POWER) in the snatch, bench press, and back squat exercises was determined using incremental tests. A bivariate correlation test and k-means cluster analysis to group individuals as either high-performance (HI) or low performance (LO) via Principal Component Analysis (PCA) were carried out. Pearson's correlation coefficient two-tailed test showed that the only variable correlated with the final score was the snatch LOAD (p < 0.05). Six performance variables (SJ, CMJ, RSI, snatch LOAD, bench press LOAD, and back squat LOAD) explained 74.72% of the variance in a k = 2 means cluster model. When CrossFit® performance groups HI and LO were compared to each other, t-test revealed no difference at a p ≤ 0.05 level. Snatch maximum power LOAD and the combination of six physical fitness tests partially explained the outcome of a simulated CrossFit competition. Coaches and practitioners can use these findings to achieve a better fit of the practices and workouts designed for their athletes.

RF Energy Absorption in Human Bodies Due to Wearable Antennas in the 2.4 GHz Frequency Band.

Human exposure to electromagnetic fields produced by two wearable antennas operating in the 2.4 GHz frequency band was assessed by computational tools. Both antennas were designed to be attached to the skin, but they were intended for different applications. The first antenna was designed for off-body applications, i.e. to communicate with a device placed outside the body, while the second antenna model was optimized to communicate with a device located inside the body. The power absorption in human tissues was determined at several locations of adult male and female body models. The maximum specific absorption rate (SAR) value obtained with the off-body antenna was found on the torso of the woman model and was equal to 0.037 W/kg at 2.45 GHz. SAR levels increased significantly for the antenna transmitting inside the body. In this case, SAR values ranged between 0.23 and 0.45 W/kg at the same body location. The power absorbed in different body tissues and total power absorbed in the body were also calculated; the maximum total power absorbed was equal to 5.2 mW for an antenna input power equal to 10 mW. Bioelectromagnetics. 2020;41:73-79 © 2019 Wiley Periodicals, Inc.

Autologous hematopoietic stem cell transplantation in a patient with refractory seropositive myasthenia gravis: A case report.

Myasthenia gravis is a neuromuscular autoimmune disease characterized by fatigable weakness of skeletal muscles that results from an antibody-mediated immunological attack directed at acetylcholine postsynaptic receptors. Autologous hematopoietic stem cell transplantation is considered as a treatment option in refractory cases of myasthenia gravis. A 56-year-old Colombian male presented with six months of progressive hoarseness and dysphagia, with a positive repetitive stimulation test suggestive of end plate neuromuscular disease. Myasthenia gravis was confirmed with serology testing that reported presence of circulating acetylcholine postsynaptic receptors antibodies. The patient received several lines of pharmacological treatment and thymectomy without control of symptoms, requiring admission to the intensive care unit and mechanical ventilation in two occasions. Patient underwent autologous hematopoietic stem cell transplantation and has been in complete clinical remission for 65 months. Hematopoietic stem cell transplantation is a well-tolerated treatment that should be considered over conventional therapy in selected patients with refractory myasthenia gravis.

Association Between Electronic Cigarette Use and Myocardial Infarction.

INTRODUCTION: Electronic cigarettes (e-cigarettes) are promoted as a less risky alternative to conventional cigarettes and have grown in popularity. Experimental and clinical evidence suggests that they could increase the risk of myocardial infarction. METHODS: The National Health Interview Surveys of 2014 (n=36,697) and 2016 (n=33,028) were used to examine the cross-sectional association between e-cigarette use (never, former, some days, daily) and cigarette smoking (same categories) and myocardial infarction in a single logistic regression model that also included demographics (age, gender, BMI) and health characteristics (hypertension, diabetes, and hypercholesterolemia) using logistic regression. Data were collected in 2014 and 2016 and analyzed in 2017 and 2018. RESULTS: Daily e-cigarette use was independently associated with increased odds of having had a myocardial infarction (OR=1.79, 95% CI=1.20, 2.66, p=0.004) as was daily conventional cigarette smoking (OR=2.72, 95% CI=2.29, 3.24, p<0.001). Former and some day e-cigarette use were not significantly associated with having had a myocardial infarction (p=0.608 and p=0.392) whereas former (OR=1.70, p<0.001) and some day cigarette smoking (OR=2.36, p<0.001) were. Odds of a myocardial infarction were also increased with history of hypertension (OR=2.32, p<0.001); high cholesterol (OR=2.36, p<0.001); and diabetes (OR=1.77, p<0.001); and age (OR=1.65 per 10 years, p<0.001). Women (OR=0.47, p<0.001) had lower odds of myocardial infarction. CONCLUSIONS: Daily e-cigarette use, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction.

Encefalopatía de Wernicke y polineuropatía asociada a déficit de complejo B después de una cirugía bariátrica / Wernicke´s encephalopathy and polyneuropathy associated with vitamin B complex deficiency after a bariatric surgery

La cirugía bariátrica es un tratamiento que garantiza una pérdida de peso sustancial y duradera, y beneficios tangibles respecto a condiciones médicas asociadas a la obesidad. El aumento del número de cirugías bariátricas ha llevado también a un aumento de las complicaciones relacionadas con ella, incluyendo la encefalopatía de Wernicke y la polineuropatía por deficiencia de vitaminas del complejo B. En este artículo se reporta un caso de encefalopatía de Wernicke siete semanas después de la cirugía, enfatizando en la importancia de reconocer el espectro de la sintomatología para hacer un diagnóstico temprano, que permita intervenir en la fase reversible de esta enfermedad potencialmente letal.

Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.

Enfermedad de Marburg como variante de esclerosis múltiple: presentación de un caso atípico / Marburg's variant of multiple sclerosis: report of an atypical case

Se presenta el caso de una paciente de 58 años con esclerosis múltiple diagnosticada en el 2007 tratada con inter-ferón y metilprednisolona; con pobre respuesta en el último año, durante el cual presentó múltiples episodios de exacerbación. Consultó por deterioro neurológico rapidamente progresivo, de una semana de evolución, con un puntaje en la escala de Glasgow de 4/15 (apertura ocular: 2, respuesta verbal: 1, respuesta motora: 1). El caso fue evaluado en junta médica y se consideró como un cuadro atípico de la variante Marburg de esclerosis múltiple. La paciente fue manejada con inmunoglobulina y mitoxantrona, sin mejoría clínica; posteriormente presentó choque distributivo y falleció.

We present a 58 years old woman with multiple sclerosis diagnosed in 2007, she was treated with interferon and methylprednisolone with a stable disease until last year. Recently she had had multiple episodes of exacerbations. Patient was admitted for a rapidly progressive neurological deterioration. When evaluated the patient had a Glasgow scale of 4/15 (Best eye response: 2, Best verbal response: 1, Best motor response: 1). Case was evaluated in a medical board, and was considered an atypical Marburg variant of multiple sclerosis. She was treated with immunoglobulin and mitoxantrone without clinical improvement. Later she developed a distributive shock leading to death.

[Wernicke´s encephalopathy and polyneuropathy associated with vitamin B complex deficiency after a bariatric surgery]. / Encefalopatía de Wernicke y polineuropatía asociada a déficit de complejo B después de una cirugía bariátrica.

Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.

Encefalopatía de Wernicke posterior a cirugía bariátrica: más que una pérdida de peso: [revisión] / Wernicke encephalopathy following a bariatric surgery: more than a weight loss: [review]

La encefalopatía de Wernicke y polineuropatía por deficiencia de tiamina (vitamina B1) es una de las posibles complicaciones neurológicas que comúnmente se presentan en pacientes sometidos a cirugías bariátricas. Al tener un aumento del número de procedimientos también se ha observado un aumento de estas complicaciones relacionadas a déficit vitamínico, y haciendo de esta condición relevante que debería conocerse por todos los profesionales de la salud; ya que su pronóstico está estrechamente relacionado con su prevención prequirúrgica y con la instauración rápida del tratamiento al tener una sospecha diagnóstica. La siguiente es una revisión de la literatura acerca de esta entidad; su presentación clínica, factores de riesgo, diagnóstico diferencial, tratamiento y pronóstico.

Wernicke encephalopathy and polyneuropathy related with Thiamine deficiency, is one of the possible neurologic complications that are commonly presented in patients who undergo bariatric surgery. With increasing number of bariatric procedures done there is also an increase in complications related to vitamin deficiency, making this a relevant condition that must be known by all healthcare professionals; mainly because its prognosis is closely related to its pre-surgical prevention and the prompt treatment when there is a clinical suspicious of the condition. The following in a literature review about this condition; its clinical presentation, risk factors, differential diagnosis, treatment and prognosis.

[Risk factors associated with the prevalence of arterial hypertension in adults in Bucaramanga, Colombia]. / Factores de riesgo asociados con la prevalencia de hipertensión arterial en adultos de Bucaramanga, Colombia.

OBJECTIVE: To assess the prevalence of high blood pressure (PHBP) and its association with age, sex, socioeconomic status (SES), and body mass index (BMI = kg/m2). MATERIAL AND METHODS: A cross-sectional survey was carried out in 1996, in a random sample of 356 adults aged 20 and older, residents of Bucaramanga, Colombia. Weight, height, and blood pressure readings were obtained, plus data on age and gender. Robust linear and log-binomial regression was used to estimate the independent effect of different risk factors on systolic (SBP) and diastolic (DBP) blood pressure and HBP. RESULTS: Mean SBP and DBP were significantly higher in men (122.5 and 88.1 mmHg) than in women (117.2 and 75.4 mmHg). The adjusted SBP increased with age, more in men than in women; DBP did not change with age. For each unit increase in BMI, SBP and DBP increased 0.76 and 0.69 mmHg, respectively. SBP was 6.8 and DBP was 9.8 mmHg higher in low-SES than in high-SES subjects. The adjusted PHBP increased with age and was higher in subjects > or = 50 years than in those 20-30 years old. Sex had no significant effect on PHBP (p = 0.795). For each unit increase in BMI the PHBP increased 3%, and low-SES subjects had a PHBP 1.84 times higher than high-SES subjects. CONCLUSIONS: A high PHBP was found. There is a great potential for prevention by weight control. Further studies are needed to confirm the increasing PHBP in low-SES subjects and to identify its causes.

Factores de riesgo asociados con la prevalencia de hipertensión arterial en adultos de Bucaramanga, Colombia / Risk factors associated with the prevalence of arterial hypertension in adults in Bucaramanga, Colombia

OBJECTIVE: To assess the prevalence of high blood pressure (PHBP) and its association with age, sex, socioeconomic status (SES), and body mass index (BMI = kg/m2). MATERIAL AND METHODS: A cross-sectional survey was carried out in 1996, in a random sample of 356 adults aged 20 and older, residents of Bucaramanga, Colombia. Weight, height, and blood pressure readings were obtained, plus data on age and gender. Robust linear and log-binomial regression was used to estimate the independent effect of different risk factors on systolic (SBP) and diastolic (DBP) blood pressure and HBP. RESULTS: Mean SBP and DBP were significantly higher in men (122.5 and 88.1 mmHg) than in women (117.2 and 75.4 mmHg). The adjusted SBP increased with age, more in men than in women; DBP did not change with age. For each unit increase in BMI, SBP and DBP increased 0.76 and 0.69 mmHg, respectively. SBP was 6.8 and DBP was 9.8 mmHg higher in low-SES than in high-SES subjects. The adjusted PHBP increased with age and was higher in subjects > or = 50 years than in those 20-30 years old. Sex had no significant effect on PHBP (p = 0.795). For each unit increase in BMI the PHBP increased 3, and low-SES subjects had a PHBP 1.84 times higher than high-SES subjects. CONCLUSIONS: A high PHBP was found. There is a great potential for prevention by weight control. Further studies are needed to confirm the increasing PHBP in low-SES subjects and to identify its causes.

Clasificación del TOAST en la práctica clínica de un hospital universitario / TOAST classification in the clinical practice in a universitary hospital

La clasificación de la enfermedad cerebrovascular inquémica por subtipos conlleva el doble interés de permitir un mejor y más rápido tratamiento para el paciente y una más fácil y adecuada caracterización de los factores de riesgo, lo que facilita la prevención secundaria. El objetivo del estudio fue evaluar la factibilidad de clasificar la enfermedad cerebrovascular isquémica según los parámetros utilizados por el TOAST, en los pacientes atendidos en un hospital universitario de la ciudad de Bogotá. La aplicación de los criterios dwe TOAST generó una alta proporción de ECV de etiología no determinada. La falta de estudios de los vasos intracerebrales ocasiona una sobreestimación de este grupo y una subestimación de pacientes con múltiples factores de riesgo y de gran vaso. Esta limitación obliga a replantear su uso en nuestro medio