Characteristics of the out-of-hospital cardiac arrest attended by the medical emergency services in Medellín. A population-based retrospective cohort study / Características del paro cardiaco extrahospitalario atendido por operadores de ambulancias en Medellín. Estudio de cohorte retrospectivo de base poblacional

Abstract Introduction: Every year, five million people around the world experience an out-of-hospital cardiac arrest (OHCA) and less than 40 % receive any assistance before the arrival of the Emergency Medical Services (EMS). Ambulance operators (AO) take care of people experiencing an OHCA, stabilize and then transfer them. In Medellín, Colombia, there is a public AO and several private providers, but the information about an OHCA and the operational characteristics during the response to the event are limited. Objective: To estimate the incidence of OHCA and to explore the factors associated with survival after the event in Medellín city. Methods: Retrospective, population-based cohort study. All the medical records of patients experiencing an OHCA who were assessed and treated by ambulance operators, (AO) of the Emergency Medical Services (EMS) and private agencies in Medellin city were reviewed. Descriptive statistics were used for data analysis and the annual incidence of the event standardized for the general population was estimated. Potential survival-associated factors reported as OR with their corresponding 95% CI were explored. Results: A total of 1,447 patient records with OHCA between 2018 and 2019 were analyzed. The event incidence rate for the number of cases assessed was 28.1 (95 % CI 26.0-30.3) and 26.9 (95 % CI 24.929.1) cases per 100,000 inhabitants/year for 2018 and 2019, respectively; the incidence rate of treated OHCA was 2.6 (95 % CI 2.0-3.3) and 3.2 (95 % CI 2.5-4.0) per 100,000 inhabitants/year, for 2018 and 2019. Survival on arrival at hospitals of treated cases was 14.2 % (95 % CI 5.5-22.8) and 15.5 % (95 % CI 7.4-23.5) for 2018 and 2019, respectively. Conclusions: This study portrays the operating and care characteristics of the population experiencing OHCA in Medellín city. The incidence rate of the event and the survival were lower than those reported in the literature.

Resumen Introducción: Cada año, cinco millones de personas en el mundo presentan paro cardiaco prehospitalario (PCEH), de los cuales menos del 40 % reciben ayuda antes de la llegada de los sistemas de emergencia médica (SEM). Los operadores de ambulancias (OA) atienden a los que sufren un PCEH, su estabilización y posterior traslado. En Medellín, Colombia, existe un OA público y agencias privadas, pero la información acerca del PCEH y las características operacionales durante la respuesta a este evento es escasa. Objetivo: Estimar la incidencia del PCEH y explorar factores asociados a la supervivencia del evento en la ciudad de Medellín. Métodos: Estudio de cohorte retrospectivo de base poblacional. Se revisaron todos los registros médicos de pacientes que presentaron un PCEH que fueron evaluados y tratados por OA del SEM y de agencias privadas de Medellín. Se usaron estadísticos descriptivos para los datos y se estimó la incidencia anual del evento estandarizada para la población general. Se exploraron posibles factores asociados a la supervivencia, reportados como OR con su respectivos IC 95 %. Resultados: Se analizaron 1.447 registros de pacientes con PCEH presentados entre 2018 y 2019. La tasa de incidencia del evento para los casos evaluados fue de 28,1 (IC 95 % 26,0-30,3) y 26,9 (IC 95 % 24,9-29,1) casos por 100.000 habitantes/año, para 2018 y 2019, respectivamente; la tasa de incidencia del PCEH tratado fue de 2,6 (IC 95 % 2,0-3,3) y 3,2 (IC 95 % 2,5-4,0) por 100.000 habitantes/año, para 2018 y 2019. La supervivencia a la llegada a los hospitales de los casos tratados fue 14,2 % (IC 95 % 5,5-22,8) y del 15,5 % (IC 95 % 7,4-23,5) para 2018 y 2019, respectivamente. Conclusiones: Se muestra las características operativas y de atención de la población que presenta un PCEH en Medellín. La tasa de incidencia del evento y la supervivencia fueron menores a las reportadas en la literatura.

El triaje en los servicios de urgencias en hospitales de la subregión suroeste de Antioquia. Estudio observacional descriptivo / Triage in emergency wards of the Southwest subregion of Antioquia. Descriptive observational study

Resumen Objetivo: el objetivo de este estudio fue identificar la implementación del triaje en los servicios de urgencias hospitalarios, posterior a la divulgación de la resolución 5596 de 2015 del Ministerio de Salud de Colombia, en los hospitales de la subregión Suroeste del departamento de Antioquia. Métodos: estudio observacional descriptivo, tipo corte transversal. Se incluyeron los 23 hospitales públicos de los municipios de la subregión suroeste de Antioquia. Se utilizó muestreo no probabilístico, por conveniencia. Los datos se obtuvieron mediante encuesta y técnica de entrevista estructurada. Resultados: la encuesta fue respondida por funcionarios de los hospitales de los 23 municipios del suroeste antioqueño. Sólo 3 instituciones (13 %) tienen una adecuada implementación de resolución 5596 (política de triaje) del ministerio de salud (adherencia a la resolución mayor al 80 %), el 74 % reportaron una adherencia a la resolución > 20 % y ≤ 80 % y 3 instituciones no lograron un porcentaje de adherencia mayor al 20 % a la resolución. Sólo 3 instituciones (13 %) utilizan triaje validado, en otras 3 instituciones (13 %) no saben cuál tipo de triaje usan y en la mayoría de las instituciones (74 %) emplean un triaje no validado internacionalmente. Conclusiones: a pesar de ser una normativa de obligatorio cumplimiento por parte de todos los hospitales del territorio nacional, sólo el 13 % de los hospitales incluidos en el estudio cumplen con los criterios técnicos de la política de triaje del Ministerio de Salud de Colombia.

Abstract Objective: The objective of this study was to identify the implementation of triage in emergency wards, after the release of Resolution 5596 of 2015 of the Ministry of Health of Colombia, in the hospitals of the Southwest subregion of the department of Antioquia. Methodology: Descriptive, cross-sectional study. The 23 public hospitals in the municipalities of the southwestern subregion of Antioquia were included. A convenience non-probabilistic sampling was used. The data were obtained through a survey and structured interview technique. Findings: The survey was answered by hospital officials from the 23 municipalities of southwest Antioquia. Only 3 institutions (13%) have an adequate implementation of the triage service (adherence to the resolution greater than 80%), 74% reported adherence to the resolution > 20% and ≤ 80% and 3 institutions do not achieved a percentage of adherence greater than 20% to the resolution. Only 3 institutions (13%) use validated triage, in 3 other institutions (13%) they do not know what type of triage they use and in most institutions (74%) they use a non-validated triage. Conclusions: in spite of being a mandatory regulation for the hospitals of the national territory, only 13% of the hospitals included in the study comply with the technical criteria of triage policy of the Colombian Ministry of Health.

Cooling of porcine semen in an extender supplemented with isoespintanol / Resfriamento de sêmen suíno em um diluente suplementado com isoespintanol

Spermatozoa experience oxidative, osmotic, chemical, and thermal stresses when cooled, which degrade the quality and fertilizing capacity of the cells. Adding antioxidants to the sperm extender mitigates these alterations. This study evaluated the effect of isoespintanol (ISO) on boar semen subjected to cooling. Fifteen ejaculates from five boars (Susscrofadomestica) were extended in Beltsville thawing solution (BTS) supplemented with 0 µM (control), 5 µM (ISO5), 10 µM (ISO10), 15 µM (ISO15), 20 µM (ISO20), 25 µM (ISO25), and 30 µM (ISO30) of ISO, which were then cooled for five days at 16 °C. Sperm kinetics, total motility (TM), and progressive motility (PM) were evaluated every 24 h using an IVOS computer-assisted sperm analysis (CASA) system. On day 1 and day 5 of cooling, a hypoosmotic test, spectrofluorometry, and flow cytometry were performed to evaluate the following: membrane functionality, measured as a function of hypoosmotic swelling (HOS); total antioxidant capacity (TAC); reactive oxygen species (ROS); and mitochondrial membrane potential (Δ¥M). Regression analysis and comparison of means using the Duncan test were performed. The ISO added had a slight impact on sperm motility, as evidenced by a reduction in TM at 24 h of cooling (but not prior) with the addition of 20 µM of ISO. Similarly, no effect of the ISO on the kinetics and functional integrity of the sperm membrane was observed at 96 h of cooling; however, the regression coefficients indicated that the ISO lowered the rate of decrease in sperm motility and the proportion of rapid spermatozoa relative to the concentration of ISO used. The ISO did not affect the TAC of the cooled semen; however, different concentrations of ISO lowered ROS production in the semen after 96 h of cooling. ISO also impacted the Δ¥M of the spermatozoa at 0 h of cooling, increasing the proportion of low Δ¥M cells and decreasing the proportion of high Δ¥M cells. In conclusion, ISO can reduce the loss of quality and oxidative stress occurring in boar semen during cooling and can modulate the mitochondrial activity of sperm.

Durante a refrigeração, os espermatozoides sofrem estresse oxidativo, osmótico, químico e térmico, que diminuem sua qualidade e afetam sua capacidade de fertilização. A adição de antioxidantes ao diluente espermático é uma alternativa para mitigar essas alterações. O objetivo desta pesquisa foi avaliar o efeito do isospintanol (ISO) na refrigeração do sêmen suíno. Quinze ejaculados de cinco varrascos (Sus scrofa domestica) foram diluídos em BTS suplementado com ISO a 0 (controle), 5 (ISO5), 10 (ISO10), 15 (ISO15), 20 (ISO20), 25 (ISO25) e 30 (ISO30) µM e foram refrigerados por cinco dias a 16 °C. A motilidade total (MT), motilidade progressiva (MP) e cinética dos espermatozóides foram avaliadas a cada 24 h com um sistema CASA IVOS. Nos dias um e cinco de refrigeração, foram avaliadas a funcionalidade da membrana, a capacidade antioxidante total (CAT), as espécies reativas de oxigênio (ROS) e o potencial de membrana mitocondrial (Δ¥M), através do teste hiposmótico (HOS), espectrofluorimetría e citometria de fluxo. Foram realizadas análises de regressão e comparação de médias, pelo teste de Duncan. A adição de ISO teve pouca influência na motilidade espermática, apresentando apenas redução na MT em 24 h de refrigeração, devido à adição de 20 µM. Da mesma forma, não foi observada influência de ISO na cinética e integridade funcional da membrana em 96 horas de refrigeração; porém, os coeficientes de regressão mostraram que ISO produziu menor taxa de diminuição da motilidade e proporção de espermatozoides rápidos dependendo da concentração utilizada. ISO não influenciou significativamente na CAT do sêmen refrigerado; entretanto, diferentes concentrações de ISO reduziram a produção de EROs a partir do sêmen após de 96 h de refrigeração. ISO também influenciou o Δ¥M dos espermatozóides em 0 h de refrigeração, com aumento das células de baixo Δ¥M e diminuição das células de alto Δ¥M. Em conclusão, o isospintanol pode reduzir a perda da qualidade e o estresse oxidativo do sêmen suíno durante a refrigeração e pode modular a atividade mitocondrial do esperma.

Neurotoxicity associated with oxidative stress and inflammasome gene expression induced by allethrin in SH-SY5Y cells.

Pyrethroids, including allethrin, have largely been used as commercial insecticides. The toxicity of allethrin is little known, but it is assumed that, as occurs with other pyrethroids, it could cause alterations of the nervous system and pose both occupational and non-occupational health hazards. To evaluate the neurotoxicity of allethrin we used the MTT assay of SH-SY5Y neuroblastoma cells to determine cell viability. Dose-dependent reductions of cell viability served to compare the vehicle-group and the IC50 for allethrin, which was 49.19 µM. ROS production increased significantly at concentrations of 10-200 µM of allethrin, and NO levels were significantly increased by the effect of allethrin at a minimum concentration of 50 µM. Lipid peroxidation increased by the effect of allethrin at concentrations of 25, 50, 100, and 200 µM. Caspase 3/7 activity was induced by allethrin concentrations of 50, 100, and 200 µM. Here, we suggest that allethrin might affect the inflammasome complex (Caspase-1, NLRP3, and PYDC1) and apoptosis (Bax and Bcl-2) gene expression by mRNA fold change expression levels shown in Caspase-1 (2.46-fold), NLRP3 (1.57-fold), PYDC1 (1.48-fold), and Bax (2.1-fold). These results demonstrated that allethrin induced neurotoxicity effects on SH-SY5Y cells through activation of inflammasome pathways, cell death, and oxidative stress.

Loss of Caveolin-1 Is Associated with a Decrease in Beta Cell Death in Mice on a High Fat Diet.

Elevated free fatty acids (FFAs) impair beta cell function and reduce beta cell mass as a consequence of the lipotoxicity that occurs in type 2 diabetes (T2D). We previously reported that the membrane protein caveolin-1 (CAV1) sensitizes to palmitate-induced apoptosis in the beta pancreatic cell line MIN6. Thus, our hypothesis was that CAV1 knock-out (CAV1 KO) mice subjected to a high fat diet (HFD) should suffer less damage to beta cells than wild type (WT) mice. Here, we evaluated the in vivo response of beta cells in the pancreatic islets of 8-week-old C57Bl/6J CAV1 KO mice subjected to a control diet (CD, 14% kcal fat) or a HFD (60% kcal fat) for 12 weeks. We observed that CAV1 KO mice were resistant to weight gain when on HFD, although they had high serum cholesterol and FFA levels, impaired glucose tolerance and were insulin resistant. Some of these alterations were also observed in mice on CD. Interestingly, KO mice fed with HFD showed an adaptive response of the pancreatic beta cells and exhibited a significant decrease in beta cell apoptosis in their islets compared to WT mice. These in vivo results suggest that although the CAV1 KO mice are metabolically unhealthy, they adapt better to a HFD than WT mice. To shed light on the possible signaling pathway(s) involved, MIN6 murine beta cells expressing (MIN6 CAV) or not expressing (MIN6 Mock) CAV1 were incubated with the saturated fatty acid palmitate in the presence of mitogen-activated protein kinase inhibitors. Western blot analysis revealed that CAV1 enhanced palmitate-induced JNK, p38 and ERK phosphorylation in MIN6 CAV1 cells. Moreover, all the MAPK inhibitors partially restored MIN6 viability, but the effect was most notable with the ERK inhibitor. In conclusion, our results suggest that CAV1 KO mice adapted better to a HFD despite their altered metabolic state and that this may at least in part be due to reduced beta cell damage. Moreover, they indicate that the ability of CAV1 to increase sensitivity to FFAs may be mediated by MAPK and particularly ERK activation.

Optimizing a Noninvasive Oral Sampling Technique for Semicaptive Neotropical Primates in Peru.

Disease surveillance in Neotropical primates (NP) is limited by the difficulties associated with anesthetizing NP for sample collection in remote settings. Our objective was to optimize a noninvasive method of oral sampling from semicaptive NP in Peru. We offered 40 NP at Taricaya Rescue Centre in Madre de Dios, Peru ropes coated in various attractants and measured variables (acceptance of the rope, chewing time, and volume of fluid eluted from ropes) that may affect sample acquisition and quality. We preserved samples by direct freezing in liquid nitrogen or by storing samples in RNA stabilization reagent at room temperature. Sample integrity was measured by testing for mammalian cytochrome b with the use of conventional PCR. The NP successfully chewed on a rope in 82% (125/152) of trials. Overall sample integrity was high, with 96% (44/46) of samples (both directly frozen and stored in stabilization reagent) testing positive for cytochrome b. The number of times that an individual NP was exposed to the rope procedure and NP age were associated with higher acceptance rates and the NP successfully chewing on the rope. We conclude that ropes serve as a feasible noninvasive method of obtaining oral samples from NP at rescue centers and could be used in future studies to evaluate population genetics and for pathogen surveillance for population health monitoring.

Low dose intrathecal morphine for hip arthroplasty / Dosis baja de morfina intratecal para artroplastía de cadera

OBJETIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case-control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.45-14.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI 95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.

OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastia de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastia de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo, p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI95% 1,61-7,82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastia cadera, proporciona analgesia postoperatoria comparable a 100 mcg pero con menor incidencia de efectos adversos relacionados a opioides.

Parche de sangre epidural torácico, de alto volumen, para el tratamiento del Síndrome de Hipotensión Intracraneana Espontánea secundario a fuga cervical de líquido cefalorraquídeo, ¿mejora el período asintomático?. Reporte de caso / High blood volume thoracic epidural patch for the treatment of spontaneous intracranial hypotension syndrome due to cervical cerebrospinal fluid leak, It prolongs the asymptomatic period?. A case report

Mujer de 50 años, con historia de 3 semanas de cefalea ortostática progresiva y síntomas neurológicos inespecíficos, confirmándose higroma subdural a nivel C5 con fuga de líquido cefalorraquídeo compatible con Síndrome de Hipotensión Intracraneal Espontánea (SHIE). Tratamiento médico inicial sin respuesta. Se realiza parche sanguíneo epidural (PSE) a nivel torácico con 20 ml de sangre directo a través de trocar epidural, observándose respuesta terapéutica completa en seguimiento hasta 8 meses. Creemos que un PSE torácico ofrece las ventajas de uno cervical y lumbar y, por lo tanto, debe considerarse una alternativa terapéutica eficaz en este síndrome especialmente en pacientes anatómicamente complejos.

A 50-year-old woman, with a history of three-week orthostatic headache and nonspecific neurological symptoms, has a subdural hygroma at C5 level with a cerebrospinal fluid leakage compatible with Spontaneous Intracranial Hypotension Syndrome (SIHS). Initial conservative treatment has no response. A thoracic epidural blood patch (EBP) is performed, with a 20ml blood volume spread through an epidural needle, with a complete therapeutic response up-to 8 months. We believe that a higher blood volume patch through a thoracic approach gives the advantages of cervical and lumbar EBP, and, therefore, should be considered as a therapeutic alternative especially in technical anatomically difficult patients.

Educación Médica Continua SOPNIA. Experiencia de Implementación de Cursos E-Learning en Neurología Pediátrica / Continuing medical education SOPNIA. Experience of implementing e-learning courses in Pediatric Neur

Resumen: El programa de Educación Médica Continua (EMC) de SOPNIA consiste en actividades científicas orientadas a la actualización permanente en Neurología y Psiquiatría de niños y adolescentes. Está dirigido a socios SOPNIA, médicos especialistas en Neurología Pediátrica, Psiquiatría de la Infancia y Adolescencia y médicos especialistas certificados de especialidades afines (1).Este programa desde el año 2014 inicia cursos de capacitación de post grado vía e-learning, ya que este sistema permite flexibilidad de tiempo, mayores oportunidades para acceso, favorece el desarrollo de competencias y destrezas específicas como el estudio autorregulado, con una modalidad 100% on-line a través de nuestra plataforma vía página web de SOPNIA. Se analiza experiencia realizada.

The continued medical education program (EMC) of SOPNIA consists of scientific activities aimed at updating physicians on pediatric neurology and psychiatry. It is aimed at SOPNIA members, specialists in pediatric neurology, child and adolescent psychiatry and certified physicians of related medial specialties.Since 2014, this program began graduate training via e-learning, for this system allows time flexibility, greater access opportunity, favors the development of specific skills and competencies such as self-regulated study, with a 100% online mode through our platform via SOPNIA website. We analyze our experience.

Aproximación clínica al diagnóstico diferencial de los trastornos del movimiento en la infancia / Clinical approach to the differential diagnosis of childhood movement disorders

El control del movimiento implica redes complejas que relacionan diferentes aspectos de la neuroanatomía, bioquímica, fisiología de los ganglios basales, cerebelo y sus conexiones. En la aproximación clínica de este tipo de trastorno debemos orientarnos según el tipo de movimiento hacia la etiología y, si bien, lo clásico es definir estos trastornos según el tipo de movimiento, existen otras propuestas de un sistema de clasificación que los divide en 4 categorías principales que incluyen: Trastornos Transitorios del Desarrollo, Trastornos del Movimiento Paroxísticos, Trastornos de movimiento secundarios a causas no hereditarias y Trastornos Hereditarios-Metabólicos, que será el enfoque de esta revisión. Palabras claves: desórdenes del movimiento, tics, movimientos paroxísticos, movimientos transitorios del desarrollo. Movimientos hereditarios-metabólicos

The motion control involves complex networks that relate different aspects of neuroanatomy, biochemistry, physiology of the basal ganglia, cerebellum and its connections. The clinical approach of this type of disorder is guided to etiology by the type of movement, and while these disorders have been classically defined according to the type of movement, there is another proposed classification system that divides them in 4 main categories that include: transient developmental movement disorders, paroxysmal movement disorders, non-hereditary and hereditary-metabolic movement disorders, which will be the focus of this review. Key words: disordes of movements, tics, movements of hereditary and metabolic disorders, transient movements of the development