[Willingness to receive the COVID-19 vaccine in the population aged 80 years and older in Colombia 2021]. / Disposición a recibir la vacuna contra COVID-19 en población de 80 y más años en Colombia 2021.

Objective: Colombia designed and adopted a vaccination plan against COVID-19 that will immunize 35 million people. The aim study was to know the willingness to accept the vaccination against COVID-19. Methods: A telephone survey of 11,721 people aged 80 and over, affiliated with a health insurer, was carried. The respondents were the affiliates or their relatives or caregivers. Results: The average age was 85.0 years (SD: 4.5), with no differences between sexes; 3,344 (28.5%) referred a previous diagnostic test for COVID-19 and 73 were positive for an incidence of 622.8 per 100,000 people (95%CI: 491-778). Regarding the attitude with the vaccination against SARS-CoV-2, 1/4 respondents refrained from giving an opinion or was neutral. When the respondent was a relative, the acceptance of the vaccine was 60.4% (95% CI: 59.5-61.3) with differences by gender: men 62.2% (95% CI: 60.8-63.6) and women of 59.2 (95% CI: 58.0-60.3), P < 0.05. When the respondent was the potential recipient of the vaccine, the acceptance of the vaccine was 61.7% (95% CI: 59.4-64.0) and also differed by gender: 70.2% in men (95% CI: 66, 9-73.5) and 55.1% in women (95% CI: 52.0-58.3), P < 0.05. Conclusion: The relatively low acceptance of vaccination against COVID-19 in Colombia poses significant challenges to achieve herd immunity that allows control of the pandemic.

A user-centered approach to developing a new tool measuring the behavioural and social drivers of vaccination.

BACKGROUND: Children around the world remain under-vaccinated for many reasons. To develop effective vaccine delivery programmes and monitor intervention impact, vaccine programme implementers need to understand reasons for under-vaccination within their local context. The World Health Organization (WHO) Working Group on the Behavioural and Social Drivers of Vaccination (BeSD) is developing standardised tools for assessing childhood vaccine acceptance and uptake that can be used across regions and countries. The tools will include: (1) a validated survey; (2) qualitative interview guides; and (3) corresponding user guidance. We report a user-centred needs assessment of key end-users of the BeSD tools. METHODS: Twenty qualitative interviews (Apr-Aug 2019) with purposively sampled vaccine programme managers, partners and stakeholders from UNICEF and WHO country and regional offices. The interviews assessed current systems, practices and challenges in data utilisation and reflections on how the BeSD tools might be optimised. Framework analysis was used to code the interviews. RESULTS: Regarding current practices, participants described a variety of settings, data systems, and frequencies of vaccination attitude measurement. They reported that the majority of data used is quantitative, and there is appetite for increased use of qualitative data. Capacity for conducting studies on social/behavioural drivers of vaccination was high in some jurisdictions and needed in others. Issues include barriers to collecting such data and variability in sources. Reflecting on the tools, participants described the need to explore the attitudes and practices of healthcare workers in addition to parents and caregivers. Participants were supportive of the proposed mixed-methods structure of the tools and training in their usage, and highlighted the need for balance between tool standardisation and flexibility to adapt locally. CONCLUSIONS: A user-centred approach in developing the BeSD tools has given valuable direction to their design, bringing the use of behavioural and social data to the heart of programme planning.

Prognosis of root canal treatment in teeth with preoperative apical periodontitis: a study with cone-beam computed tomography and digital periapical radiography.

AIM: This observational cohort study aimed: (i) to determine retrospectively after a 1- to 12-year follow-up period, the strength and independence of the association of various patient-, tooth- and treatment-related prognostic variables with the outcome of root canal treatment in patients with pre-therapeutic apical periodontitis; and (ii) to establish the concordance between those predictors evaluated by both cone-beam computed tomography (CBCT) and digital periapical radiography (DPR). METHODOLOGY: The study cohort included 125 teeth in 84 individuals. The postoperative clinical signs/symptoms, plus DPR/CBCT-PAI estimations, were used to determine the healing outcome. For statistical analysis, results were dichotomized into completely healed periapical structures versus persistent disease cases. The association between candidate predictor variables with persistent disease was analysed individually and adjusted for confounders using a multivariate binary logistic regression model. RESULTS: The success rate was 53.6%. After logistic regression analysis, mandibular tooth location, periapical lesion size >10 mm, poor quality of the coronal restoration, lack of magnification/illumination, lack of disinfection of gutta-percha, time elapsed to definitive coronal restoration >1 week and poor density of root canal filling remained as robust predictors of failures. Concordance between DPR and CBCT scores varied from moderate to almost perfect agreement. CONCLUSIONS: The findings of this study suggest that several tooth- and treatment-related predictor variables, including tooth location, periapical radiolucency size, quality of the coronal restoration, magnification/illumination, disinfection of gutta-percha, time elapsed to definitive coronal restoration, as well as, the density of root canal filling may act strongly and independently for determining the root canal treatment outcome in teeth with pre-therapeutic apical periodontitis.

Biomarcadores moleculares: una nueva herramienta en el diagnóstico de la preeclampsia / Molecular biomarkers: A new tool for the diagnosis of pre-eclampsia

La preeclampsia es una complicación frecuente del embarazo, asociada a altas tasas de morbimortalidad materna y fetal. Es de gran importancia el diagnóstico oportuno y la vigilancia activa en el abordaje de esta dolencia. En la actualidad la historia ginecoobstétrica constituye la única herramienta disponible para estratificar el riesgo de desarrollar esta condición, sin embargo, no es suficiente. Dada la compleja y aún desconocida fisiopatología de la preeclampsia, los biomarcadores moleculares surgen como una posible herramienta de tamización de este trastorno, que muestran un alto potencial en los estudios realizados en la actualidad; sin embargo, aún no se ha determinado la utilidad clínica de estas moléculas, y no se ha estandarizado un biomarcador específico que logre predecir la aparición de la enfermedad. Por lo tanto, es necesario llevar a cabo estudios más grandes y complejos donde se logre determinar la verdadera utilidad clínica de estas moléculas

Pre-eclampsia is a common complication during pregnancy that is associated with high rates of maternal and foetal morbidity and mortality, so a timely diagnosis and active surveillance are essential in the management of this condition. Obstetrical gynaecological history is currently the only tool available to stratify the risk of developing this condition. However, this is not sufficient, given the complex and still unknown pathophysiology of pre-eclampsia. Molecular biomarkers have emerged as a possible screening tool for this disorder, showing great potential in current studies. However, the clinical usefulness of these molecules has not yet been determined, and a specific biomarker has not been standardised to predict the development of the disease. It is therefore necessary to carry out larger and more complex studies to determine the true clinical utility of these molecules

Presentación de un quiste óseo aneurismático mandibular de gran tamaño. Reporte de un caso y revisión de la literatura / Presentation of an aneurysmal bone cyst mandibular of great size. A case report and review of the literature

Un quiste es una cavidad patológica que puede contener una sustancia líquida, semilíquida o gaseosa. Aparecen como consecuencia de una reacción inflamatoria (quistes inflamatorios) o por causa no conocida (quistes del desarrollo). Comúnmente la cavidad está recubierta por una cápsula constituida por un tejido conectivo subyacente y un epitelio en el lumen, excepto en los pseudoquistes que carecen de tejido epitelial, como es el caso que nos ocupa donde presentamos un paciente con quiste óseo aneurismático (QOA). Esta lesión se presenta con una frecuencia del 1,2% de los quistes maxilares y 2% de los que aparecen en todo el organismo. El objetivo de este trabajo es elaborar una revisión de la literatura y presentar un caso clínico de un paciente de 21 años de raza negra, masculino que consultó al servicio de cirugía maxilofacial de la Facultad de Odontología de la Universidad de Antioquia, por presentar un aumento de volumen en cuerpo mandibular derecho. Al examen radiográfico se encuentra una imagen radiolúcida de gran tamaño. Al paciente se le practicaron dos biopsias previas que dieron un diagnóstico distinto (tumor odontogénico queratoquístico y quiste radicular inflamatorio) pero el diagnóstico definitivo del espécimen quirúrgico fue quiste óseo aneurismático (QOA). Se escribe su manejo y se hace una revisión de la literatura (AU)

A cyst is a pathologic cavity that can contain a liquid substance, semi-liquid or gaseous. Appear as a result of an inflammatory reaction (inflammatory cysts) or for reasons not known (cysts of development). Commonly the cavity is covered by a capsule formed by connective tissue and underlying a epithelium in the lumen, except in the pseudocysts that lack of epithelial tissue, as is the case where we present a patient with aneurysmal bone cyst (QOA). This injury occurs with a frequency of 1.2 % of the cysts maxillary and 2% of those who appear throughout the body. The objective of this paper is to present a clinical case of a patient of 21 years of black male that consulted to the maxillofacial surgery service of the Faculty of Dentistry at the University of Antioquia, by presenting a volume increase in right mandibular body. The radiographic examination is a radiolucent image of great size. The patient will be practiced two previous biopsies that gave a diagnosis other than (odontogenic tumor queratocyst and radicular cyst inflammatory) but the definitive diagnosis of the surgical specimen was aneurysmal bone cyst (QOA). It describes its handling and is performed a review of the literature (AU)

Conservación de mango Tommy Atkins mínimamente procesado mediante la aplicación de un recubrimiento de aloe vera (Aloe barbandensis Miller) / Conservation of minimally processed mango Tommy Atkins by applying an aloe vera (Aloe barbandensis Miller) coating

Antecedentes: El mango es una fruta climatérica que puede ver limitada su comercialización debido a la deficiencia en sistemas de procesamiento y conservación que ocasionan pérdidas poscosecha en la cadena agroindustrial. Los frutos mínimamente procesados y tratados con recubrimientos comestibles representan una alternativa para mitigar la perecibilidad del fruto, conservando sus atributos de calidad y ofreciendo al consumidor un producto de fácil consumo y almacenamiento. Objetivos: Conservar y prolongar la vida útil de mango Tommy Atkins mínimamente procesado con la aplicación de un recubrimiento comestible de Aloe vera, evaluando su efectividad mediante el análisis de parámetros físicos, fisicoquímicos, respiratorios, microbiológicos y sensoriales durante almacenamiento refrigerado. Métodos: El recubrimiento comestible fue preparado con gel mucilaginoso de aloe vera en una Concentración de 50 % P/P en dilución y homogenizado con cera carnauba y glicerol, para luego ser aplicado por inmersión en los frutos previamente cortados y secados en estufa. Se diseñaron cuatro tratamientos experimentales: C, R, PreREC y CA, almacenados en refrigeración durante un periodo de 12 de días, en los que se evaluó parámetros como firmeza, color, porcentaje de pérdida de peso, pH, Brix, acidez (%), tasas respiratorias, conteos microbiológicos y descriptores sensoriales por medio de un perfil de aproximación multidimensional. Los datos fueron procesados mediante ANOVA y por el método de comparaciones múltiples LSD. Resultados: Las muestras tratadas con el recubrimiento (R y PreREC) mostraron un retraso en la pérdida de la firmeza, menores cambios de color, una menor pérdida de peso, un aumento menos acelerado del pH y de °Brix y valores más elevados de acidez con respecto a los tratamientos control. Se lograron tasas bajas de consumo de O2 y una producción controlada de CO2 en comparación a las muestras sin tratar. A nivel microbiológico, el recubrimiento disminuyó el crecimiento de mesófilos, mohos y levaduras; mientras que sensorialmente, descriptores como la firmeza, calidad general, olor y sabor característico mostraron una mayor calificación por parte del panel sensorial. Conclusiones: El recubrimiento permitió conservar por 3 días más las muestras de mango mínimamente procesado respecto a los tratamientos control.

Background: Mango is a climacteric fruit which can limit its marketing due to some deficiencies in processing and preservation systems that cause postharvest losses in the agribusiness and value chain. Minimally processed fruits and edible coatings represent an alternative to decrease the perishability of fruits, preserving its quality attributes and offering to consumers an easy product to use and storage. Objetives: The aim of this study was to conserve and extend the shelf life of minimally processed "Tommy Atkins" mango covered by an edible coating made of aloe vera mucilage, assessing its effectiveness by analyzing physical, physicochemical, respiratory, microbiological and sensory parameters during refrigerated storage. Methods: The edible coating was prepared with aloe vera, which is a mucilaginous gel, in a concentration of 50% w/w in dilution and homogenized with carnauba wax and glycerol. Then aloe vera was applied by immersion in the pre-cut fruits and dried in stove. Four experimental treatments were designed: C, R, PreREC and CA, stored under refrigeration for a period of 12 days, in which parameters such as strength, color, percentage weight loss, pH, Brix, acidity (%), respiratory rates, microbiological counts, and sensory descriptors were evaluated by a multidimensional approach profile. Data were analyzed using ANOVA and the LSD multiple comparison method. Results: Samples treated with the edible coating (R y PreREC) showed a delay in the loss of firmness, less color changes, less loss of weight, a less increase in pH and Brix values, and a higher acidity compared to the control treatments. Low rates of O2 consumption and controlled CO2 production compared to untreated samples were achieved. Coating decreased the growth of mesophilic, molds and yeasts; while sensory descriptors as firmness, overall quality, characteristic odor and taste showed a higher rating by the sensory panel. Conclusions: Edible coating made of aloe vera gel allowed to keep for 3 more days samples of minimally processed mango compared to control treatments.

Treatment costs of diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia.

OBJECTIVE: We estimate treatment costs associated with diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia and assess similarities or differences with previous cost estimations in developing countries of the Americas. METHODS: Macro-costing methods were used to carry out an analysis of diarrhea and all-cause pneumonia costs in Colombia in 2010. The perspective of the health care system was taken. Data were extracted from a health insurer database that includes information on health service utilization among 130,800 children from low-income households. Lengths of stay for hospital admissions and frequencies of cases at all levels of care registered in the database were estimated. RESULTS: There were 1456 diarrheal disease cases among the 130,800 children (aged ≥ 60 months) included in the study. The median cost per case was $27.10 (interquartile range [IQR]: $15.60-77.40). A total of 1545 all-cause pneumonia cases were reported to the insurer in 2010, resulting in a frequency of 1181 cases per 100,000 children (95% confidence interval [CI]=1122, 1240). The overall cost of all-cause pneumonia cases was $858,791, and the median cost per case treated was $263 (IQR: $27-546). Comparisons by level of care showed that costs were significantly different for the two diseases (p<.05). Costs for the diseases did not differ by age group (p>.05). CONCLUSIONS: Diarrhea and all-cause pneumonia constitute a significant economic and health burden in Colombia. The relatively large size of our sample allowed us to provide reliable national estimates of the costs associated with these diseases. Our results for Colombia are similar to previous estimates from developing countries in the Americas. These data provide valid estimates that may be used decision makers in other countries to make appropriate recommendations on the introduction of rotavirus and pneumococcal vaccines.

Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS).

BACKGROUND: Interest in patient safety (PS) is growing exponentially, fuelled by epidemiological research unveiling the extent of unsafe care. However, there is little information about the frequency of harm in developing and transitional countries. To address this issue, the authors performed a study known as the Iberoamerican Adverse Event Study, through a collaborative between the governments of Argentina, Colombia, Costa Rica, Mexico and Peru, the Spanish Ministry of Health, Social Policy and Equality, the Pan American Health Organization and the WHO Patient Safety. METHODS: The study used a cross-sectional design, involving 58 hospitals in the five Latin American countries, to measure the point prevalence of patients presenting an adverse event (AE) on the day of observation. All inpatients at the time of the study were included. RESULTS: A total of 11 379 inpatients were surveyed. Of these, 1191 had at least one AE that the reviewer judged to be related to the care received rather than to the underlying conditions. The estimated point prevalence rate was 10.5% (95% CI 9.91 to 11.04), with more than 28% of AE causing disability and another 6% associated with the death of the patient. Almost 60% of AE were considered preventable. CONCLUSIONS: The high rate of prevalent AE found suggests that PS may represent an important public-health issue in the participating hospitals. While new studies may be needed to confirm these results, these may already be useful to inspire new PS-improvement policies in those settings.

Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica / IBEAS design: adverse events prevalence in Latin American hospitals

Objetivos. Describir las características y metodología del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica, que persigue realizar una aproximación a la magnitud, trascendencia e impacto de los eventos adversos (EA); identificar áreas y problemas prioritarios de la seguridad del paciente; incrementar la masa crítica de profesionales involucrados en la seguridad del paciente e incorporar a la agenda de los países objetivos y actividades para mejorar la seguridad del paciente. Método. Estudio sobre la seguridad de los pacientes. Ámbito: 35 hospitales de 5 países: Argentina, Colombia, Costa Rica, México y Perú, a través del análisis de los efectos adversos identificados. Diseño de prevalencia utilizando la revisión de la historia clínica. Resultados. Se describen las implicaciones en el uso del diseño transversal en el estudio de EA, tanto en los recursos necesarios como en la validez interna y en la utilidad para la gestión de riesgos sanitarios. Conclusiones. El diseño transversal es eficiente en tiempo y recursos y fácil de realizar, y aunque no permite estudiar la totalidad del episodio de hospitalización, ha demostrado ser capaz para sostener un sistema de vigilancia. Debido a un posible sesgo de supervivencia, los EA que ocasionen un ingreso se verán sobrerrepresentados, y también aquellos relacionados con la infección nosocomial o los que sean difícilmente identificables si no se ve al paciente. La comunicación con el personal de planta (mientras el paciente está hospitalizado) favorece el juicio de la causalidad del efecto adverso y de su evitabilidad(AU)

Objectives. To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. Methods. A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. Results. The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. Conclusions. The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention(AU)

[IBEAS design: adverse events prevalence in Latin American hospitals]. / Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica.

OBJECTIVES: To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. METHODS: A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. RESULTS: The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. CONCLUSIONS: The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention.

Conservación de Fresa (Fragaria x ananassa Duch cv. Camarosa)) mediante la aplicación de recubrimientos comestibles de gel mucilaginoso de penca sábila (Aloe barbadensis Miller) y cera de carnaúba / Conservation of strawberry (Fragaria x ananassa Duch cv. Camarosa) by edible coating application of sabila gel mucilage (Aloe barbadensis Miller) and carnauba wax

La fresa es un fruto de elevada aceptación entre los consumidores, y como cultivo ofrece una permanenciasignificativa durante todos los meses del año, con buen posicionamiento en sus precios. El objetivo de este estudio fue aumentar la vida útil de la fresa (Fragaria x ananassa Duch cv. Camarosa), mediante la aplicación de dos recubrimientos comestibles desarrollados a partir del gel mucilaginoso de penca sábila (Aloe barbadensis Miller) y cera de carnaúba. A partir de los resultados obtenidos se concluyó que el recubrimiento comestible de gel mucilaginoso de penca sábila condujo a un aumento en la vida útil de las fresas de por lo menos 10 días, con disminución de la pérdida de humedad, del índice de respiración, y conservación de la firmeza, sin ocasionar cambios perceptibles en el color, en comparación con los frutos utilizados como tratamiento control.

The strawberry is a well accepted fruit by consumers. Its culture presents a significant yield in all months of the year and enjoys a good price positioning. The objective of this study was to extend the strawberry (Fragaria x ananassa Duch cv. Camarosa) shelf life by applying two edible coatings developed from the Aloe vera (Aloe barbadensis Miller) mucilaginous gel and carnauba wax. From the results obtained it was concluded that the use of edible coatings from Aloe vera mucilaginous gel and carnauba wax led to an increase of at least ten days in the strawberry shelf life, with reduced moisture loss and respiration rate. Besides, conservation of firmness without showing noticeable changes in color was observed, in comparison to the fruits used as a control.

Evaluation of feature extraction techniques on event-related potentials for detection of attention-deficit/hyperactivity disorder.

Event-related potentials (ERPs) are one of the most informative and dynamic methods of monitoring cognitive processes, which are widely used in clinical research to deal a variety of psychiatric and neurological disorders as attention-deficit/hyperactivity disorder (ADHD). This work proposes an extraction and selection methodology for discriminating between normal and pathological patients with ADHD by using ERPs. Three different sets of features (morphological, wavelets, and nonlinear based) are analyzed, looking for the best classification accuracy. The results show that the wavelet features provided a good discriminative capability, but it improved by combining all the set of features and applying a feature selection algorithm, reaching a maximum accuracy rate of 91.3%.

Diagnóstico de la enfermedad carotídea arterioesclerotica / Diagnosis of carotid disease

Objetivos: (1) diseñar y evaluar una técnica de angiorresonancia 3D contrastada (ARM 3D) para el diagnóstico de la estenosis carotídea y compararla con la ecografía triplex (eco triplex) y la arteriografía por sustracción digital (ASD), esta última como estándar de referencia. (2) Evaluar la factibilidad de adicionar a la técnica anterior secuencias anatómicas y angiográficas del cerebro. Materiales y métodos: en 39 pacientes (78 carótidas) se estudió la bifurcación carotídea con ASD, angiorresonancia 3D con doble inyección y eco triplex. Se utilizó el método descrito en el estudio NASCET para cuantificar el grado de estenosis. Cada examen fue evaluado por observadores diferentes que no conocían el resultado de los otros métodos. Adicionalmente, se obtuvieron imágenes del cerebro y se describieron dichos hallazgos. Resultados: la angiorresonancia 3D con técnica de doble inyección detectó el 98 por ciento del grupo de carótidas clasificadas como normal-leves, el 83 por ciento de las estenosis moderadas, el 88 por ciento de las estenosis graves y el 100 por ciento de las oclusiones. Adicionalmente, dos errores diagnósticos (oclusiones falsas) de la ASD fueron identificados efectivamente por la ARM 3D. La eco triplex detectó el 92 por ciento del grupo normal-leve, el 33 por ciento de las estenosis moderadas, el 86 por ciento de las graves y todas las oclusiones encontradas con la ASD, pero la ecografía sobrestimó una estenosis leve a oclusión (falsa oclusión). La correlación estadística entre el estándar de referencia ASD y la ARM 3D fue buena a excelente, para los diferentes grados de estenosis (K>0,7 y K>0,9, respectivamente). En todos los pacientes se logró una evaluación adecuada del cerebro con resonancia. Conclusión: esta investigación sugiere que la ARM 3D con técnica de doble inyección tiene el potencial para remplazar la ASD en el diagnóstico y seguimiento de la enfermedad carotídea

[Vascular hereditary dementia CADASIL type in Colombia. III. Linkage analysis to notch3 gene]. / Demencia vascular hereditaria tipo CADASIL en Colombia. III. Análisis de ligamiento a Notch3.

OBJECTIVE: To perform linkage analysis between the Short Tandem Repeats (STR) microsatellite markers D19S923, D19S929, D19S22, which are in strong genetic linkage to Notch3 gene in order to contrast the hypothesis that the vascular hereditary dementia phenotype described in a multigenerational extended pedigree from Colombia correspond to CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). Even we know that using techniques as the Single Strand Conformational Polymorphisms (SSCP) could determine mutations in Notch3, the rationality of this approach is that intronic variations could not be defined and that we are interested in determine if some forms of the clinical presentation and its phenotypic variability make part of CADASIL. INTRODUCTION: The CADASIL phenotype is caused by mutations in the Notch3 gene. Clinical features of CADASIL are: 1. Recurrent cerebra-vascular episodes; 2. Migraine history; 3. History of transitory ischemic attack and, 4. Behavior changes and dementia. MATERIAL AND METHODS: By using SIMLINK we showed that the extended genealogy had the enough power to detect significant LOD (logarithm of oods) score values when Notch3 was considered the disorder cause. Linkage analysis was carried out by using parametric and non parametrical methods. The Elston-Stewart general method was used as the parametrical analysis and the sib pair method as the non-parametrical one. We perform simulations changing the affection status codification by including as affected or not including those individuals with migraine. Furthermore, in order to detect the stability of the results, we changed the penetrance values, the genetic frequencies on both, the marker loci and the affection locus. RESULTS: The maximum pair-wise LOD score was 2.04 which was detected at the marker D19S23 with q= 0.11cM. This distance correspond exactly with the Notch3 location. That is 100 times more probable that there is linkage that there is not. In other words this probability could be explained as if the phenotype correspond to CADASIL than to other vascular dementia. The non parametric results were compatibles with the parametric ones. When the migraine symptom was considered as a part of the affected status, the LOD score values showed not linkage. CONCLUSIONS: The results of the linkage analysis to these STR microsatellite markers suggest that the vascular hereditary dementia phenotype described in this family correspond to CADASIL caused by a polymorphism on the Notch3 gene. On the contrary, these same results suggest that the migraine phenotype is not a part of the progressive dementia.

[Priapism in the adult: report of 15 cases]. / Priapisme de l'adulte: a propos de 15 cas.

OBJECTIVES: The practical approach to the treatment of priapism is complicated by the rarity of this disease. Treatments for impotence by intracavernous injection of vasodilators have considerably increased the incidence of prolonged erections, although "antidote" protocols, when instituted rapidly, ensure detumescence in most cases. The objective of this study was to define a practical and rigorous approach based on comparison of our results with those reported in the literature concerning the management of priapism. METHODS: This series consists of fifteen consecutive cases observed in adults over a ten-year period. The pathophysiology and aetiologies are recalled. The authors evaluate the percentage of detumescence after primary treatment and after retreatment and discuss the incidence of secondary impotence. This information is compared with the data of the literature in order to define a practical approach. RESULTS: After a trial intracavernous injection of vasoconstrictors, creation of a cavernospongiosa fistula provided the best results with a 60% detumescence rate after primary treatment and 80% after retreatment. All treatments combined, 53.3% of good results were obtained after primary treatment and 66.7% after retreatment. In the long-term, 50% of patients with a sufficient follow-up are impotent. CONCLUSIONS: As a result of systematic surveillance of patients treated by an intracavernous injection protocol, the number of priapisms induced in our institution has remained stable over recent years. Patients treated for priapism within 36 hours have a better short-term and long-term prognosis.

Single daily dose amikacin in paediatric patients with severe gram-negative infections.

Twenty-five children with serious Gram-negative infections were treated in a prospective study with amikacin 20 mg/kg administered in a single daily dose as a 30 min iv infusion for 4 to 12 days. In nine cases the amikacin was combined with beta-lactam antibiotics. Escherichia coli were the most frequent bacteria isolated followed by K. pneumoniae, Providencia and Enterobacter spp. and Pseudomonas aeruginosa with MICs ranging from 1 to 16 mg/l. Mean (+/- S.D.) peak and trough concentrations of days 1 and 4 of therapy ranged from 49 +/- 13.5 to 53.6 +/- 13.4 mg/l and 6 + 1.4 to 7.7 +/- 4.1 mg/l respectively. All patients were clinically and bacteriologically cured. No significant adverse reactions were observed. The results suggest that administration of a single daily dose of 20 mg/kg amikacin should be considered practical and safe in children. Further studies are needed.

Aztreonam in the treatment of aerobic, gram-negative bacillary infections in pediatric patients.

Aztreonam was administered to 20 children diagnosed as having any of the following infections: urinary tract infection, pneumonia, meningitis, and abscess of the appendix. Haemophilus influenzae, Escherichia coli, and Klebsiella pneumoniae were isolated. The minimum inhibitory concentrations of aztreonam for these bacteria ranged from 0.03 to 0.5 micrograms/ml. All patients were clinically and bacteriologically cured within 5-16 days of treatment. Six months after completion of therapy, patients who had had meningitis appeared to be free of any neurologic sequelae. The antibiotic was well tolerated by all patients.

Hernia diafragmatica subcostosternal.Presentacion de un caso. / Subcostosternal diaphragmatic hernia. Report of a case

Se presenta el caso de una nina de diez anos, con una hernia subcostosternal (hernia de Margagni), cuyos sintomas la hicieron consultar a una institucion hospitalaria especializada en cardiologia y cuyo tratamiento quirurgico fue exitoso.Se discuten aspectos diagnosticos, clinicos y quirurgicos de la entidad