Late-Presenting Eosinophilic Granulomatosis with Polyangiitis as Cause of Pulmonary Fibrosis: A Case-Based Review.

Introduction: Eosinophilic granulomatosis with polyangiitis (eGPA) is a necrotising vasculitis of small and medium calibre vessels, which affects mostly patients in their fourth to sixth decade of life, and it is a very uncommon aetiology for pulmonary fibrosis. Clinical case: A Hispanic 72-year-old female patient presents with a history of lower extremities pain, paraesthesia, oedema, and occasional macroscopic haematuria. During her hospitalisation, the patient presents, and images showed findings compatible with pulmonary fibrosis and alveolar haemorrhage, which require a biopsy, establishing the diagnosis of an eGPA. Discussion: eGPA is a low-incidence autoimmune vasculitis, with a high number of phenotypes which explain the broad clinical spectrum, but recent advances has helped to understand the physiopathology and its link with other conditions like pulmonary fibrosis. Conclusion: Early diagnosis and management of this condition is mandatory because it is the only factor that change the outcome of the patients.

Assessing the reproducibility and predictive value of objective cough measurement for successful withdrawal of invasive ventilatory support in adult patients.

BACKGROUND: Utilizing clinical tests, such as objective cough measurement, can assist in predicting the success of the weaning process in critically ill patients. METHODS: A multicenter observational analytical study was conducted within a prospective cohort of patients recruited to participate in COBRE-US. We assessed the capability of objective cough measurement to predict the success of the spontaneous breathing trial (SBT) and extubation. Intra- and inter-observer reproducibility of the cough test and was evaluated using the intraclass correlation coefficient (ICC) and Cohen's weighted kappa. We used receiver operating characteristic curves (ROC-curve) to evaluate the predictive ability of objective cough measurement. RESULTS: We recruited 367 subjects who were receiving invasive mechanical ventilation. A total of 451 objective cough measurements and 456 SBTs were conducted. A significant association was found between objective cough measurement and successful SBT (OR: 1.68; 95% CI 1.48-1.90; p = 0.001). The predictive capability of the objective cough test for SBT success had a ROC-curve of 0.58 (95% CI: 0.56-0.61). Objective cough measurement to predict successful extubation had a ROC-curve of 0.61 (95% CI: 0.56-0.66). The intraobserver reproducibility exhibited an ICC of 0.94 (95% CI: 0.89-0.96; p < 0.001), while the interobserver reproducibility demonstrated an ICC of 0.72 (95% CI: 0.51-0.85; p < 0.001). The intraobserver agreement, assessed using Cohen's weighted kappa was 0.94 (95% CI: 0.93-0.99; p < 0.001), whereas the interobserver agreement was 0.84 (95% CI: 0.67 - 0.10; p < 0.001). CONCLUSIONS: The objective measurement of cough using the method employed in our study demonstrates nearly perfect intra-observer reproducibility and agreement. However, its ability to predict success or failure in the weaning process is limited.

Distal Duodenal Stricture Secondary to Mesenteric Fibromatosis (Intra-Abdominal Desmoid Tumor) of the Jejunum.

Introduction: Mesenteric fibromatosis (intra-abdominal desmoid tumor) is rare, with only a few cases reported in the literature. Clinical symptoms range from asymptomatic, nausea, early satiety, abdominal pain, and gastrointestinal bleeding. Although histologically benign, such a tumor may become locally invasive, and aggressive forms contribute to significant morbidity and mortality. Case Presentation: We report the case of a 52-year-old West African male with a 1-year history of intermittent hematochezia and intermittent bloating. Colonoscopy revealed a 4-mm rectal polyp and internal hemorrhoids. Esophagogastroduodenoscopy revealed a severe duodenal stricture 4-5 cm distal to the ampulla. Further work-up with contrast-enhanced computed tomography of the abdomen and pelvis revealed a 5.0 × 3.7 × 4.3-cm mass within the mesentery, encasing the distal portion of the duodenum. Exploratory laparotomy was performed, and the mass was excised from the jejunum. Histopathology findings and immunohistochemical analysis revealed the diagnosis to be mesenteric fibromatosis (desmoid tumor), positive for nuclear ß-catenin and SMA, and negative expression of STAT6, desmin, caldesmon, pan-cytokeratin, or c-KIT. The Ki67 index is <1%. Conclusion: This case report highlights the diagnostic challenges of mesenteric fibromatosis due to its nonspecific clinical presentation. Recognizing uncommon presentations of mesenteric fibromatosis and risk factors aids in early diagnosis, management, and treatment. Importantly, this also aids in the prevention of complications such as intestinal obstruction, bowel ischemia, and fistula formation.

[Construct validity of the TECS questionnaire for the quality of teamwork in surgery]. / Validez de constructo del cuestionario TECS para la calidad del trabajo en equipo en cirugía.

Objective: To assess the construct validity and reliability of the Trabajo en Equipo en Cirugía (TECS) questionnaire. Method: The questionnaire was administered to 401 undergraduate students who were doing surgery practices at three universities. An exploratory factor analysis was performed on the first 200 observations, and a confirmatory factor analysis on the remaining ones. The reliability of the instrument was established with Cronbach's alpha. Results: The average age of the study population was 22 years (± 1.4) and 65.5% were women. The factors "Student's disposition towards teamwork", "Structure of the work environment" and "Leadership and collaboration in the work team" showed excellent internal consistency with a Cronbach's alpha of 0.94. The results in the exploratory factor analysis showed adequate goodness of fit with the empirical data. Conclusions: The TECS is a valid (content and construct) and reliable instrument to assess the quality of teamwork in surgery in medical students.

Objetivo: Realizar la validación de constructo y el análisis de confiabilidad del cuestionario Trabajo en Equipo en Cirugía (TECS). Método: El cuestionario se aplicó a 401 estudiantes de pregrado que cursaban prácticas en cirugía en tres universidades. Sobre las primeras 200 observaciones se realizó un análisis factorial exploratorio, y sobre las restantes un análisis factorial confirmatorio. La confiabilidad del instrumento fue establecida con el alfa de Cronbach. Resultados: La edad promedio de la población en estudio fue de 22 años (± 1.4) y el 65.5% eran mujeres. Los factores «Disposición del estudiante hacia el trabajo en equipo¼, «Estructura del ambiente de trabajo¼ y «Liderazgo y colaboración en el equipo de trabajo¼ mostraron una excelente consistencia interna, con un alfa de Cronbach de 0.94. Los resultados en el análisis factorial exploratorio mostraron una adecuada bondad de ajuste con los datos empíricos. Conclusiones: El TECS es un instrumento válido (contenido y constructo) y confiable para evaluar la calidad del trabajo en equipo en cirugía en estudiantes de medicina.

Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19.

BACKGROUND: Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. METHODS: A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. RESULTS: A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546-0.632) and 0.567 (95% CI: 0.526-0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628-0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582-0.667) and 0.706 (95% CI: 0.669-0.742), respectively. CONCLUSION: PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19.

Sputum Biomarkers in Wood and Tobacco Smoke Etiotypes of Chronic Obstructive Pulmonary Disease.

Introduction: There is a need to better understand the etiotypes of chronic obstructive pulmonary disease (COPD) beyond the tobacco-smoke (TS-COPD). Wood smoke COPD (WS-COPD) is characterized by greater airway compromise, milder emphysema, and slower rate of lung function decline than TS-COPD. However, it is unclear if these two etiotypes of COPD have differences in sputum biomarker concentrations. Objective was to compare sputum levels of selected sputum biomarkers between WS-COPD and TS-COPD, and healthy controls. Methods: Eighty-eight women (69±12 years) were recruited and classified into: WS-COPD (n=31), TS-COPD (n=29) and controls (n=28). Using ELISA, we determined induced sputum levels of metalloproteinase 9 (MMP-9), chemokine ligand 5 (CCL5), interleukin-8 (IL-8), chemokine ligand 16 (CCL16/HCC-4) and vascular endothelial growth factor (VEGF-1). Differences were analyzed by Kruskal-Wallis and Mann-Whitney-U tests and correlation between airflow limitation and biomarkers by Spearman's test. Results: At similar degree of airflow obstruction, anthropometrics and medications use, the level of sputum CCL5 was higher in TS-COPD than WS-COPD (p=0.03) without differences in MMP-9, IL-8, CCL16/HCC-4, and VEGF-1. Women with WS-COPD and TS-COPD showed significantly higher sputum levels of MMP-9, IL-8 and CCL5 compared with controls (p<0.001). FEV1% predicted correlated negatively with levels of MMP-9 (rho:-0.26; P=0.016), CCL5 (rho:-0.37; P=0.001), IL-8 (rho:-0.42; P<0.001) and VEGF (rho:-0.22; P=0.04). Conclusion: While sputum concentrations of MMP-9, IL-8, and CCL5 were higher in COPD women compared with controls, women with TS-COPD had higher levels of CCL5 compared with those with WS-COPD. Whether this finding relates to differences in pathobiological pathways remains to be determined.

Comparison of the Diagnostic Performance of Five Clinical Questionnaires for Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) remains one of the most prevalent pathologies in the world and is among the leading causes of mortality and morbidity, partially due to underdiagnosis. The use of clinical questionnaires to identify high-risk individuals to take them to further diagnostic procedures has emerged as a strategy to address this problem. Objective: To compare the performance of the COULD IT BE COPD, CDQ, COPD-PS, LFQ, and PUMA questionnaires for COPD diagnosis. Methods: A cross-sectional study was carried out on subjects who underwent spirometry in the third-level center. Data were collected between January 2015 and March 2020. Bivariate analysis was performed between the study variables and the presence of COPD. The area under the receiver operating characteristics curve (AUC-ROC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for each questionnaire were calculated. The AUC-ROCs were compared with the DeLong test, considering a p value <0.05 statistically significant. Results: 681 subjects met the inclusion criteria and were taken to the final analysis. The prevalence of COPD was 27.5% (187/681). The mean age of the subjects was 65.9 years (SD ± 11.79); 46.3% (315/681) were female, and 83.6% (569/681) reported respiratory symptoms. Statistically significant relationship was found for COPD diagnosis with male sex, older age, respiratory symptoms, and exposure to wood smoke (p value <0.05). The AUC-ROCs of the questionnaires were between 0.581 and 0.681. The COULD IT BE COPD questionnaire had a lower discriminatory capacity AUC-ROC of 0.581, concerning the other scores (DeLong test, p = 0.0002). Conclusion: The CDQ, COPD-PS, LFQ, PUMA, and COULD IT BE COPD questionnaires have acceptable performance for the diagnosis of COPD together with low sensitivity and specificity. Therefore, its use must be complemented with other diagnostic tests or techniques such as pulmonary function tests.

Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin - propensity score matching study.

BACKGROUND: Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE. METHODS: A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test. RESULTS: Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61). CONCLUSION: In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.

The effect of combining different sampling tools on the performance of electromagnetic navigational bronchoscopy for the evaluation of peripheral lung lesions and factors associated with its diagnostic yield.

BACKGROUND: We assessed the performance of Electromagnetic navigational bronchoscopy (ENB) as a standalone diagnostic technique and the performance of different sampling tools used during the procedure. METHODS: We recruited 160 consecutive patients who underwent ENB for peripheral lung lesions (PLL) at a tertiary care centre. The diagnostic performance of ENB and sampling tools was assessed using a logistic regression model and a ROC-curve in which the dependent variable was diagnostic success. A multivariate model was built to predict diagnostic success before performing ENB to select the best candidates for the procedure. RESULTS: Most patients with PLLs in the study were male (65%), with a mean age of 67.9 years. The yield was 66% when the most common techniques were used together as suction catheter + transbronchial biopsy forceps (TBBx) + bronchoalveolar lavage + bronchial washing (p < 0.001) and increased to 69% when transbronchial needle aspiration (TBNA) and cytology brush were added (p < 0.001). Adding diagnostic techniques such as TBBx and TBNA resulted in an increase in diagnostic performance, with a statistically significant trend (p = 0.002). The logistic model area-under the ROC-curve for diagnostic success during ENB was 0.83 (95% CI:0.75-0.90; p < 0.001), and a logit value ≥ 0.12 was associated with ≥ 50% probability of diagnostic success. CONCLUSIONS: ENB, as a stand-alone diagnostic tool for the evaluation of PLLs when performed by experienced operators using a multi-modality technique, has a good diagnostic yield. The probability of having a diagnostic ENB could be assessed using the proposed model.

Utilization of spontaneous breathing trial, objective cough test, and diaphragmatic ultrasound results to predict extubation success: COBRE-US trial.

BACKGROUND: The results of clinical and weaning readiness tests and the spontaneous breathing trial (SBT) are used to predict the success of the weaning process and extubation. METHODS: We evaluated the capacity of the cuff leak test, rate of rapid and shallow breathing, cough intensity, and diaphragmatic contraction velocity (DCV) to predict the success of the SBT and extubation in a prospective, multicenter observational study with consecutive adult patients admitted to four intensive care units. We used receiver operating characteristic (ROC) curves to assess the tests' predictive capacity and built predictive models using logistic regression. RESULTS: We recruited 367 subjects who were receiving invasive mechanical ventilation and on whom 456 SBTs were performed, with a success rate of 76.5%. To predict the success of the SBT, we derived the following equation: (0.56 × Cough) - (0.13 × DCV) + 0.25. When the cutoff point was ≥ 0.83, the sensitivity was 91.5%, the specificity was 22.1%, and the overall accuracy was 76.2%. The area under the ROC curve (AUC-ROC) was 0.63. To predict extubation success, we derived the following equation: (5.7 × SBT) + (0.75 × Cough) - (0.25 × DCV) - 4.5. When the cutoff point was ≥ 1.25, the sensitivity was 96.8%, the specificity was 78.4%, and the overall accuracy was 91.5%. The AUC-ROC of this model was 0.91. CONCLUSION: Objective measurement of cough and diaphragmatic contraction velocity could be used to predict SBT success. The equation for predicting successful extubation, which includes SBT, cough, and diaphragmatic contraction velocity values, showed excellent discriminative capacity.

Signal processing and machine learning algorithm to classify anaesthesia depth.

BACKGROUND: Poor assessment of anaesthetic depth (AD) has led to overdosing or underdosing of the anaesthetic agent, which requires continuous monitoring to avoid complications. The evaluation of the central nervous system activity and autonomic nervous system could provide additional information on the monitoring of AD during surgical procedures. METHODS: Observational analytical single-centre study, information on biological signals was collected during a surgical procedure under general anaesthesia for signal preprocessing, processing and postprocessing to feed a pattern classifier and determine AD status of patients. The development of the electroencephalography index was carried out through data processing and algorithm development using MATLAB V.8.1. RESULTS: A total of 25 men and 35 women were included, with a total time of procedure average of 109.62 min. The results show a high Pearson correlation between the Complexity Brainwave Index and the indices of the entropy module. A greater dispersion is observed in the state entropy and response entropy indices, a partial overlap can also be seen in the boxes associated with deep anaesthesia and general anaesthesia in these indices. A high Pearson correlation might be explained by the coinciding values corresponding to the awake and general anaesthesia states. A high Pearson correlation might be explained by the coinciding values corresponding to the awake and general anaesthesia states. CONCLUSION: Biological signal filtering and a machine learning algorithm may be used to classify AD during a surgical procedure. Further studies will be needed to confirm these results and improve the decision-making of anaesthesiologists in general anaesthesia.

The Challenges of Spirometric Diagnosis of COPD.

Chronic obstructive pulmonary disease (COPD) is one of the top causes of morbidity and mortality worldwide. Although for many years its accurate diagnosis has been a focus of intense research, it is still challenging. Due to its simplicity, portability, and low cost, spirometry has been established as the main tool to detect this condition, but its flawed performance makes it an imperfect COPD diagnosis gold standard. This review aims to provide an up-to-date literature overview of recent studies regarding COPD diagnosis; we seek to identify their limitations and establish perspectives for spirometric diagnosis of COPD in the XXI century by combining deep clinical knowledge of the disease with advanced computer analysis techniques.

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Liver abscess due to Granulicatella adiacens in an immunocompetent patient: Case report. / Absceso hepático por Granulicatella adiacens

Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.

Los abscesos hepáticos piógenos por Granulicatella adiacens son infecciones asociadas a una alta mortalidad, principalmente en pacientes inmunocomprometidos. Los principales microorganismos asociados a los abscesos hepáticos son Klebsiella pneumoniae y Escherichia coli, aunque pueden ser polimicrobianos. Sin embargo, los informes de casos que describen la infección hepática por G. adiacens son muy escasos. Se presenta el caso de un paciente adulto inmunocompetente que presentó 15 días de evolución de picos febriles cuantificados asociados a astenia, adinamia, escalofríos, ictericia y coluria. El examen clínico inicial reveló un tinte ictérico generalizado sin dolor abdominal, y presión arterial con tendencia a la hipotensión. Se sospechó neoplasia biliopancreática confluente, colangitis secundaria y sepsis de origen biliar, y se inició reanimación con líquidos y antibioterapia. Se tomaron hemocultivos y estudios diagnósticos complementarios. En el ultrasonido hepatobiliar, se observó un absceso de 73 x 62 mm en el segmento IV; la vía biliar y el páncreas se encontraron dentro de los límites normales. Se realizaron múltiples pruebas moleculares de detección de microorganismos (FilmArray), y se identificó a G. adiacens como el principal agente patógeno. El paciente completó el manejo antibiótico con ciprofloxacina, vancomicina y metronidazol en buenas condiciones y fue dado de alta con éxito. Este es el primer absceso hepático piógeno reportado causado por G. adiacens en un paciente inmunocompetente, en quien el diagnóstico microbiológico temprano en conjunto con el tratamiento antibiótico dirigido y el drenaje percutáneo de la lesión fueron determinantes en el resultado clínico.

SARS-CoV-2: Air pollution highly correlated to the increase in mortality. The case of Guadalajara, Jalisco, México.

Objectives: To determine whether air pollution or changes in SARS-CoV-2 lineages lead to an increase in mortality. Methods: Descriptive statistics were used to calculate rates of infection (2020-2021). RT-PCR was used to compare viral loads from October 2020 to February 2021. Next-generation sequencing (NGS) (n = 92) was used to examine and phylogenetically map SARS-CoV-2 lineages. A correlative "air pollution/temperature" index (I) was developed using regression analysis. PM2.5, PM10, O3, NO2, SO2, and CO concentrations were analyzed and compared to the mortality. Results: The mortality rate during the last year was ∼32%. Relative SARS-CoV-2 viral loads increased in December 2020 and January 2021. NGS revealed that approximately 80% of SARS-CoV-2 linages were B.1.243 (33.7%), B1.1.222 (11.2%), B.1.1 (9%), B.1 (7%), B.1.1.159 (7%), and B.1.2 (7%). Two periods were analyzed, the prehigh- and high-mortality periods and no significant lineage differences or new lineages were found. Positive correlations of air pollution/temperature index values with mortality were found for IPM2.5 and IPM10. INO2. ISO2, and ICO but not for O3. Using ICO, we developed a model to predict mortality with an estimated variation of ∼±5 deaths per day. Conclusion: The mortality rate in the MZG was highly correlated with air pollution indices and not with SARS-CoV-2 lineage.

Descripción de la composición corporal en una cohorte de oficiales activos en el Ejército de Colombia

La composición corporal en población militar es indispensable en la caracterización del estado nutricional, lo cual representa la acumulación de grasa, huesos, agua y músculo total en el cuerpo. Objetivo: Describir y analizar variables de la composición corporal en datos recolectados de una muestra de oficiales del Ejército Nacional de Colombia. Metodología: Estudio descriptivo entre oficiales con la finalidad determinar la composición corporal y bioimpedancia con el estado nutricional como un indicador de riesgos sobre la salud, utilizando un tallímetro, báscula con precisión de 100 gramos, cinta antropométrica flexible, compás de pequeños diámetros y de pliegues cutáneos. Se consideró un valor de p estadísticamente significativo <0,05. Resultados: La muestra de oficiales recolectada está compuesta por un total de 96 sujetos, con una división de rangos militares de la siguiente manera: teniente (n= 28), capitán (n=23), mayor (n=15), teniente coronel (n=10), subteniente (n=4) y coronel (n=1). La diferencia de edad y peso entre el grupo de oficiales superiores y subalternos fue de 11,33 años (p=0,089) y 1,42 kilogramos (p=0,235), respectivamente. El valor esperado de la flexibilidad fue diferente entre grupos, siendo mayor en el grupo de oficiales subalternos (p=0,016). Conclusión: Las variables de composición corporal no presentaron diferencias estadísticamente significativas entre los grupos oficiales superiores y subalternos.

Background: Body composition in the military population is essential in the characterization of nutritional status, representing the accumulation of fat, bone, water, and total muscle in the body. Objective: Describe and analyze variables of the CP data collected from a sample of officers of the Colombian National Army. Methodology: Descriptive study among officers in order to determine body composition and bioimpedance with nutritional status as an indicator of health risks, using a height rod, a scale with a precision of 100 grams, a flexible anthropometric tape, a small diameter compass and skinfold compass. A statistically significant p value of <0.05 is considered. Results: The sample of officers collected is composed of a total of 96 subjects with a division of military ranks as follows: lieutenant (n= 28), captain (n=23), major (n=15), lieutenant colonel ( n=10), second lieutenant (n=4) and colonel (n=1). The difference in age and weight between the group of senior and junior officers was 11.33 years (p=0.089) and 1.42 kilograms (p=0.235), respectively. The expected value of flexibility is different between groups, being higher in the group of junior officers (p=0.016). Conclusion: The body composition variables did not present statistically significant differences between the superior and subordinate official groups.

Achenbach Syndrome in Primary Care: A Case Report.

Paroxysmal hematoma of the fingers, or Achenbach syndrome, is a rare vascular disorder of benign course and unknown etiology. The clinical manifestations are sudden onset, paroxysmal spontaneous subcutaneous hematomas, and edema and pain in the fingers and hands. The clinical course is self-limited and does not leave permanent sequela. The diagnosis is clinical, and complementary studies are often unnecessary. We present the clinical case of a 69-year-old woman diagnosed with Achenbach syndrome in a primary care center in Colombia.

Musicoterapia en pacientes con la COVID-19

Introducción: La musicoterapia puede ser utilizada para influenciar en el estado físico y emocional de pacientes diagnosticados con la COVID-19. Se realiza una revisión sistemática exploratoria que incluye estudios observacionales y ensayos clínicos; Pubmed y Scopus fueron las bases de datos empleadas para la realización de la búsqueda. Además, se incluyen registros de ensayos clínicos de la Plataforma de Registros Internacionales de Ensayos Clínicos de la Organización Mundial de la Salud. Objetivo: Explorar la literatura médica disponible, sobre el impacto clínico de la musicoterapia en pacientes diagnosticados con la COVID-19. Desarrollo: De 39 documentos encontrados se incluyen 2 artículos: un ensayo clínico y un reporte de caso, con una población total de 41 pacientes. Se encuentra evidencia médica que respalda el impacto clínico favorable sobre la saturación de oxígeno, rehabilitación física y síntomas asociados al estrés en pacientes con diagnóstico de la COVID-19 con y sin requerimiento de soporte ventilatorio. Conclusiones: La musicoterapia es una herramienta útil en el tratamiento y rehabilitación no farmacológica de pacientes con la COVID-19; sin embargo, son necesarios nuevos estudios clínicos con mayor número de poblaciones muestrales y mayor tiempo de seguimiento.

Background: Music therapy can be used to influence the physical and emotional state of patients diagnosed with COVID-19. An exploratory systematic review was carried out including observational studies and clinical trials, Pubmed and Scopus were the databases used to carry out the literature search. In addition, clinical trial registries from the World Health Organization International Clinical Trials Registry Platform are included. Objective: To explore the available medical literature on the clinical impact of music therapy in patients diagnosed with COVID-19. Development: Of 39 documents found in the search, two articles are included: a clinical trial and a case report, with a total population of 41 patients. Medical evidence is found to support the favorable clinical impact on oxygen saturation, physical rehabilitation and symptoms associated with stress in patients diagnosed with COVID-19 with and without the need for ventilatory support. Conclusions: Music therapy is a useful tool in the non-pharmacological treatment and rehabilitation of patients with COVID-19. However, new clinical studies with a larger number of sample populations and follow-up times using music therapy in this disease are necessary.

Penfigoide ampolloso de origen idiopático

Introducción: El penfigoide ampolloso es una dermatosis vesicular ampollosa autoinmunitaria subepidérmica, asociada a la formación de autoanticuerpos que reconocen autoantígenos en la zona de la membrana basal. El tratamiento inmunomodulador con corticoides es la primera línea en el control de la enfermedad. Objetivo: Presentar el caso clínico de un paciente con diagnóstico de penfigoide ampolloso de origen idiopático. Caso clínico: Paciente masculino de 81 años con lesiones ampollosas dolorosas a la palpación de contenido serohemático, tamaño variado, bordes regulares y base eritematosa a nivel generalizado. La evaluación inicial sugiere diagnóstico de penfigoide ampolloso e infección bacteriana activa de las lesiones en la piel. Se solicitan exámenes de laboratorio e imágenes diagnósticas, se descartan etiologías infecciosas, autoinmunes o neoplásicas asociadas, se inicia tratamiento con corticosteroides intravenosos con adecuada evolución clínica. Finalmente, no se identifican enfermedades asociadas a las lesiones ampollosas del paciente. Conclusión: El penfigoide ampolloso es una entidad poco frecuente, con una elevada tasa de mortalidad si se realiza un diagnóstico y tratamiento tardío. Reconocer las principales manifestaciones y variantes clínicas de esta enfermedad permite un oportuno enfoque diagnóstico y terapéutico, este último basado en el control de la respuesta inflamatoria contra la piel y otros órganos.

Introduction: Bullous pemphigoid is a subepidermal autoimmune bullous vesicular dermatosis associated with the formation of autoantibodies that confirm autoantigens in the basement membrane area. Immunomodulatory treatment with corticosteroids is the first line in the control of the disease. Objective: To present the clinical case of a patient diagnosed with a bullous pemphigoid of idiopathic origin. Clinical case: 81-year-old male patient with blistering lesions that are painful on palpation with serohematic content, varied in size, regular borders and a generalized erythematous base; that the initial evaluation suggests a diagnosis of bullous pemphigoid and active bacterial infection of the skin. Laboratory tests and diagnostic images are requested, infectious, autoimmune or associated neoplastic etiologies are ruled out, treatment with intravenous corticosteroids is started with adequate clinical evolution. Finally, no diseases associated with the patient's blistering lesions were identified. Conclusion: Bullous pemphigoid is a rare entity, with a high mortality rate if a late diagnosis and treatment is performed. Recognizing the main manifestations and clinical variants of this disease allows for a timely diagnostic and therapeutic approach, the latter based on the control of the inflammatory response against the skin and other organs.

Linfoma de células T/natural killer extranodal de tipo nasal enmascarado en una sinusopatia

Introducción: El linfoma de células T citotóxico/natural killer extranodal de tipo nasal es poco frecuente, pero con alta tasa de mortalidad. Las manifestaciones clínicas de la enfermedad pueden simular una infección de senos paranasales. Objetivo: Presentar las manifestaciones clínicas de un paciente de 34 años de edad con diagnóstico de linfoma de células T citotóxico/natural killer extranodal de tipo nasal. Caso clínico: Se presenta un paciente masculino de 34 años de edad con rinorrea verdosa fétida recurrente y obstrucción en fosa nasal derecha. En la evaluación inicial sugiere sinusitis crónica, sin embargo, debido al empeoramiento de las manifestaciones clínicas se realiza una tomografía computarizada que muestra lesiones sugestivas de infiltración neoplásica, una biopsia de la lesión confirma el diagnóstico de linfoma de células T/natural killer extranodal de tipo nasal. Conclusiones: Los linfomas de células T citotóxico/natural killer extranodal de tipo nasal son considerados neoplasias poco frecuentes, caracterizadas por el patrón rápidamente progresivo con afectación ósea; en su etapa inicial presenta manifestaciones clínicas similares a una sinusitis. La tomografía computarizada y la histopatología, son indispensables en el diagnóstico de la enfermedad.

Introduction: Nasal-type extranodal natural killer/cytotoxic T-cell lymphoma is rare but has a high mortality rate. The clinical manifestations of the disease can mimic a paranasal sinus infection. Objective: To present the clinical manifestations of a 34-year-old patient diagnosed with nasal-type extranodal natural killer/cytotoxic T-cell lymphoma. Clinical case: A 34-year-old male patient with recurrent greenish fetid rhinorrhea and obstruction in the right nostril is presented. In the initial evaluation, it suggests chronic sinusitis, however, due to the worsening of the clinical manifestations, a computed tomography is performed that shows lesions suggestive of neoplastic infiltration, a biopsy of the lesion confirms the diagnosis of T-cell lymphoma/extranodal natural killer. Conclusions: Nasal-type extranodal natural killer/cytotoxic T-cell lymphomas are considered rare neoplasms characterized by a rapidly progressive pattern with bone involvement; in its initial stage it presents clinical manifestations similar to sinusitis. Computed tomography and histopathology are essential in the diagnosis of the disease.