Probiotic Effect of Streptococcus dentisani on Oral Pathogens: An In Vitro Study.

Probiotics, including Streptococcus dentisani, have been proposed as an alternative to re-establish the ecology of the oral cavity and inhibit the formation of pathogenic biofilms. The main objective of this work was to assess the probiotic ability of S. dentisani against Streptococcus mutans, Streptococcus mitis, and Candida albicans biofilms. The ability of the strains to form a monospecies biofilm and the probiotic potential of S. dentisani using the competition, exclusion, and displacement strategies were determined. All strains were moderate biofilm producers. The ability of S. dentisani to compete with and exclude S. mutans and S. mitis during biofilm formation was not significant. However, S. dentisani significantly reduced pathologic streptococcal biofilms using the displacement strategy. Also S. dentisani reduced the formation of the C. albicans biofilm mainly through competition and displacement. In vitro, S. dentisani exhibited probiotic potential to reduce the formation of potentially pathogenic biofilms. Further investigation is required to understand the biofilm-inhibiting mechanisms exhibited by this probiotic strain.

A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms.

The present 21-day daily diary study (conducted 2021-2022) tested anger and racism-related vigilance as potential transdiagnostic mediators linking exposure to racial and ethnic discrimination (RED) to distress (negative affect and stress, respectively). The data analytic sample included N = 317 Mexican-origin adolescents (Mage = 13.5 years; 50.8% male, 46.7% female; 2.5% non-binary) from the Midwestern United States. Results from longitudinal mediation models revealed significant mediation effects through anger and racism-related vigilance, respectively, in the association between daily RED and daily distress, both within and across adolescents. Implications for theory, research, and practice are discussed so that future work can leverage these novel findings toward promoting the well-being of Mexican-origin adolescents, especially those who live in contexts of ethnoracial adversity.

Yearly and Daily Discrimination-Related Stressors and Mexican Youth's Mental Health and Sleep: Insights From the First Wave of a Three-Wave Family Study.

OBJECTIVE: Research is needed to examine discrimination-related stressors and their social and psychological shaping of mental health and sleep outcomes of Latinx youth. The background, design, and methodology of a longitudinal study of Mexican families in Indiana and the initial findings of associations between discrimination-related stressors and youth mental health and sleep outcomes are presented. METHOD: Initiating wave 1 of a 3-wave (yearly) longitudinal study, investigators surveyed an ethnically homogeneous sample of 344 Mexican-origin adolescents (ages 12-15) and their primary caregivers, assessing risks and protective factors for mental health and sleep outcomes. Youth also completed a one-time 21-day daily diary after wave 1. Self-reported measures of youth mental health, sleep, and discrimination across wave 1 and the daily diary were evaluated to compare the cross-sectional (wave 1) and daily associations between discrimination and youth mental health and sleep outcomes. RESULTS: Of youth, 88.1% reported at least one incident of lifetime discrimination. Almost one-third had elevated depressive symptoms, 44.5% had probable generalized anxiety disorder, and 50.9% had poor sleep quality. Between-youth correlations at wave 1 and in the daily diary were consistent in that perceived racial discrimination was positively correlated with worse mental health and poorer sleep quality. Smaller within-youth correlations were observed in the daily diary, but there was striking variability in the effect of discrimination across youth. CONCLUSION: The present results illustrate the powerful methods of combining yearly and daily time data to investigate how and for whom discrimination-related stressors lead to adverse outcomes. DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. CLINICAL TRIAL REGISTRATION INFORMATION: Seguimos Avanzando - Latino Youth Coping With Discrimination; https://clinicaltrials.gov/; NCT04875208.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico.

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

Anti-GM-CSF Neutralizing Autoantibodies in Colombian Patients with Disseminated Cryptococcosis.

BACKGROUND: Cryptococcosis is a potentially life-threatening fungal disease caused by encapsulated yeasts of the genus Cryptococcus, mostly C. neoformans or C. gattii. Cryptococcal meningitis is the most frequent clinical manifestation in humans. Neutralizing autoantibodies (auto-Abs) against granulocyte-macrophage colony-stimulating factor (GM-CSF) have recently been discovered in otherwise healthy adult patients with cryptococcal meningitis, mostly caused by C. gattii. We hypothesized that three Colombian patients with cryptococcal meningitis caused by C. neoformans in two of them would carry high plasma levels of neutralizing auto-Abs against GM-CSF. METHODS: We reviewed medical and laboratory records, performed immunological evaluations, and tested for anti-cytokine auto-Abs three previously healthy HIV-negative adults with disseminated cryptococcosis. RESULTS: Peripheral blood leukocyte subset levels and serum immunoglobulin concentrations were within the normal ranges. We detected high levels of neutralizing auto-Abs against GM-CSF in the plasma of all three patients. CONCLUSIONS: We report three Colombian patients with disseminated cryptococcosis associated with neutralizing auto-Abs against GM-CSF. Further studies should evaluate the genetic contribution to anti-GM-CSF autoantibody production and the role of the GM-CSF signaling pathway in the immune response to Cryptococcus spp.

Características epidemiológicas de la endocarditis infecciosa. Experiencia de seis años / Epidemiological characteristics of infective endocarditis. Six years of experience

Resumen Introducción: La endocarditis infecciosa continúa siendo una condición amenazante para la vida, que puede afectar cualquier órgano y sistema, con alta mortalidad, atribuible principalmente a Staphylococcus aureus. Implica un reto diagnóstico y terapéutico, que requiere un cuidado multidisciplinario. Objetivo: Describir las características clínicas y microbiológicas en pacientes con endocarditis infecciosa. Materiales y método: Estudio observacional descriptivo basado en la revisión de historias clínicas en un centro médico de referencia en Medellín, Colombia, incluyendo pacientes mayores de 18 años hospitalizados durante el periodo de enero de 2011 a febrero de 2017. Resultados: 130 pacientes, con edad promedio de 53 años (± 16). La hipertensión arterial y la enfermedad renal crónica fueron la comorbilidad más frecuente (55% y 38%, respectivamente). La fiebre fue el síntoma cardinal (90%). Predominó la endocarditis infecciosa de válvula nativa (85.7%), afectando principalmente la mitral (40%). El agente etiológico más frecuente fue S. aureus (sensible a oxacilina 44%), y se complicaron con embolia el 52.5% y con falla cardiaca el 30.8%. La mortalidad intrahospitalaria fue del 39.2%. Conclusiones: La endocarditis infecciosa tiene variadas manifestaciones clínicas, entre las que destacan la embolia sistémica y la falla cardiaca aguda, que condicionan una mortalidad elevada (mayor que la reportada en otros estudios). El aislamiento microbiológico más frecuente es el bacteriano, principalmente S. aureus, como lo muestra la tendencia global.

Abstract Background: Infective endocarditis continues to be a life-threatening condition, can involve every organ system, with high mortality, attributable mainly to Staphylococcus aureus. It implies a diagnostic and therapeutic challenge, which requires multidisciplinary care. Objective: To describe the clinical and microbiological characteristics in patients with infectious endocarditis. Materials and method: Descriptive observational study, based on the review of medical records in a reference medical center in Medellín, Colombia. Including patients over 18 years hospitalized during the period from January 2011 to February 2017. Results: 130 patients, with an average age of 53 years (± 16). Hypertension and chronic kidney disease was the most common comorbidity (55% and 38%, respectively). Fever was the cardinal symptom (90%). Native valve infective endocarditis predominated (85.7%), mainly affecting the mitral valve (40%). The most frequent etiologic agent was Staphylococcus aureus (oxacillin sensitive 44%), embolism was the main complication by 52.5% followed by heart failure (30.8%). In-hospital mortality was 39.2%. Conclusions: Infective endocarditis has varied clinical manifestations, including systemic embolism and acute heart failure, which lead to high mortality (higher than that reported in other studies). The most frequent microbiological isolation is bacterial, mainly Staphylococcus aureus, as shown by the global trend.

[Clinical behavior of infection and disease caused by non-tuberculous mycobacteria in Latin America: Scoping review]. / Comportamiento clínico de la infección y enfermedad causada por micobacterias no tuberculosas en Latinoamérica: Revisión de alcance.

Reports of infection and/or disease caused by non-tuberculous mycobacteria (NTM) are becoming increasingly frequent. This scope review describes the epidemiological and clinical trend of infection/disease caused by NTM in Latin America. OVID MEDLINE, Embase and LILACS databases were explored for relevant articles. After filtering, we included 44 articles, representing an overall population of 2,826 subjects diagnosed with NTM infection and disease; the majority of the publications included subjects from Brazil and Colombia (75%), cross-sectional studies were the most common (36.6%), most subjects were male (61.3%) and the median age of subjects was 40.1 years. Disease by NTM was reported in 37 publications, extrapulmonary presentation was the most frequent (54%), main comorbidities were other pulmonary diseases, HIV, cystic fibrosis, diabetes and malnutrition, as reported in 13 studies; tuberculosis diagnosis previous to NTM disease was reported in 15 articles. Aesthetic procedures were reported in 12 articles while clinical procedures were reported in 3 articles. Several NTM species were reported, being Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) and M. kansasii (9.1%) the most frequent. Culture and molecular testing were the main methods for diagnosis and identification. Scientific literature on NTM from Latin American countries is scarce. There is an urgent need to conduct studies on the frequency and clinical impact of NTM infections, in order to accurately identify the current morbidity and mortality associated with NTM in Latin American. It is also important to strengthen the local diagnostic capacity and the existing networks focused on studying NTM.

Cada vez son más frecuentes los reportes de aislamientos y enfermedades producidas por micobacterias no tuberculosas (MNT). Esta revisión de alcance describe el comportamiento epidemiológico y clínico de la infección y enfermedad por MNT en Latinoamérica. Se realizó la búsqueda en las bases de datos MEDLINE vía OVID, Embase y LILACS. Después de la depuración, se incluyeron 44 artículos que representaron una población global de 2826 sujetos, a quienes se les diagnosticó infección y enfermedad por MNT; la mayoría de las investigaciones incluyeron sujetos de Brasil y Colombia (75%); los estudios transversales fueron los más frecuentes (36,6%), el sexo masculino fue el más afectado (61,3%), mientras que la mediana de edad fue 40,1 años. En 37 artículos se reportó enfermedad por MNT, siendo la localización extrapulmonar (54%) la más frecuente; las principales comorbilidades fueron las enfermedades pulmonares, VIH/sida, fibrosis quística, diabetes y desnutrición, reportadas en 13 estudios; en 15 artículos se reportó tuberculosis previa al evento por MNT. En 12 artículos se evidenciaron procedimientos estéticos; en tres, procedimientos clínicos previos. Se reportó variedad de especies de MNT, siendo Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) y M. kansasii (9,1%) las más frecuentes. El método más usado para diagnosticar e identificar la enfermedad por MNT fue el cultivo, recientemente se agregaron también las pruebas moleculares. La literatura científica latinoamericana sobre la infección/enfermedad por MNT es escasa. Es apremiante conducir estudios de frecuencia e impacto clínico y fortalecer la capacidad diagnóstica y las redes de organizaciones existentes enfocadas al estudio de micobacterias para conocer la verdadera morbimortalidad asociada a las MNT en Latinoamérica.

Educación médica en tiempos de pandemia por SARS-CoV2 / Medical education in SARS-CoV2 pandemic times

Resumen Objetivo: la emergencia del SARS-CoV2 ha generado cambios acelerados en la educación médica dadas las necesidades de distanciamiento social. Se espera que la enfermedad sea endémica y que deban implementarse a largo plazo estrategias efectivas de enseñanza. Esta revisión buscó identificar cuáles estrategias han sido implementadas por las instituciones de educación médica durante la pandemia por SARS-CoV-2 para mantener sus actividades. Metodología: revisión sistemática de la literatura en bases de datos MEDLINE, Taylor and Francis, Lilacs, ERIC, EMBASE, SAGE, SCOPUS y SPRINGER y otras fuentes en inglés, español, francés y portugués hasta abril de 2020 sobre la relación entre educación médica, pandemia y coronavirus. Se realizó una categorización de los hallazgos dependiendo del tipo de estudio y tema abordado. Resultados: de los 1490 artículos identificados, 84 fueron incluidos en esta revisión. La mayoría de los estudios correspondieron a comentarios (n=31) seguidos de las cartas al editor (n=22). El país que más artículos ha producido son los Estados Unidos (n=35), seguido del Reino Unido (n=13). Cincuenta y siete (67.8%) presentan estrategias en los pregrados del área de la salud y 22 en residencias médicas. La mayoría de los artículos se concentran en estrategias didácticas y administrativas. Solo 13 artículos corresponden a estudios analíticos. Conclusión: la implementación de estrategias de comunicación efectiva, ambientes de aprendizaje mixtos y secuenciales, así como el fortalecimiento de la telesalud en un marco de profesionalismo y protección de la salud mental son las estrategias que más se han implementado durante la pandemia. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1928).

Abstract Objective: the emergence of SARS-CoV2 has caused accelerated changes in medical education due to the need for social distancing. The disease is expected to be endemic and that long-term effective teaching strategies will need to be implemented. This review sought to identify the strategies that have been implemented by medical education institutions during the SARS-CoV-2 pandemic to maintain their activities. Methods: a systematic review of the literature in the Medline, Taylor and Francis, LILACS, ERIC, Embase, SAGE, Scopus and Springer databases, along with other sources in English, Spanish, French and Portuguese, up to April 2020, regarding the relationship between medical education, the pandemic and coronavirus. The findings were categorized according to the type of study and topic covered. Results: of the 1,490 articles found, 84 were included in this review. Most of the studies were commentaries (n=31), followed by letters to the editor (n=22). The country which has produced the most articles is the United States (n=35), followed by the United Kingdom (n=13). Fifty-seven (67.8%) present strategies in undergraduate health programs, and 22 in medical residencies. Most of the articles focus on didactic and administrative strategies. Only 13 articles are analytical studies. Conclusion: the implementation of effective communication strategies, mixed and sequential learning settings, and strengthening of telehealth within a framework of professionalism and mental health protection are the strategies most frequently implemented during the pandemic. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1928).

Health Insurance Access Among US Citizen Children In Mexico: National And Transborder Policy Implications.

More than 500,000 US citizen migrant children were residing in Mexico in 2015, and more than half of them had limited, inadequate health insurance despite their citizenship status. The majority of these children lived in Mexican states near the US border. Despite these numbers, knowledge regarding these children and their health has been scarce. To address these knowledge gaps, we analyzed data from the 2015 Mexican Intercensal Survey to examine whether the health insurance status of US citizen migrant children in Mexico is linked to individual, household, and state factors. We compared rates of insured US citizen migrant children with rates among those who were underinsured. We found high rates of underinsurance among US citizen migrant children, especially in northern Mexican border states. Parental education, labor-force participation, urban residence, and border residence partially accounted for these children's probability of being insured. Our results have implications for binational policies that extend health care protection to US citizen migrant children through reintegration assistance for their parents, an expedited dual-citizenship application process, and exempting these children from the automatic cancellation of US-based health benefits.

Comportamiento clínico de la infección y enfermedad causada por micobacterias no tuberculosas en Latinoamérica: Revisión de alcance / Clinical behavior of infection and disease caused by non-tuberculous mycobacteria in Latin America: scoping review

Cada vez son más frecuentes los reportes de aislamientos y enfermedades producidas por micobacterias no tuberculosas (MNT). Esta revisión de alcance describe el comportamiento epidemiológico y clínico de la infección y enfermedad por MNT en Latinoamérica. Se realizó la búsqueda en las bases de datos MEDLINE vía OVID, Embase y LILACS. Después de la depuración, se incluyeron 44 artículos que representaron una población global de 2826 sujetos, a quienes se les diagnosticó infección y enfermedad por MNT; la mayoría de las investigaciones incluyeron sujetos de Brasil y Colombia (75%); los estudios transversales fueron los más frecuentes (36,6%), el sexo masculino fue el más afectado (61,3%), mientras que la mediana de edad fue 40,1 años. En 37 artículos se reportó enfermedad por MNT, siendo la localización extrapulmonar (54%) la más frecuente; las principales comorbilidades fueron las enfermedades pulmonares, VIH/sida, fibrosis quística, diabetes y desnutrición, reportadas en 13 estudios; en 15 artículos se reportó tuberculosis previa al evento por MNT. En 12 artículos se evidenciaron procedimientos estéticos; en tres, procedimientos clínicos previos. Se reportó variedad de especies de MNT, siendo Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) y M. kansasii (9,1%) las más frecuentes. El método más usado para diagnosticar e identificar la enfermedad por MNT fue el cultivo, recientemente se agregaron también las pruebas moleculares. La literatura científica latinoamericana sobre la infección/enfermedad por MNT es escasa. Es apremiante conducir estudios de frecuencia e impacto clínico y fortalecer la capacidad diagnóstica y las redes de organizaciones existentes enfocadas al estudio de micobacterias para conocer la verdadera morbimortalidad asociada a las MNT en Latinoamérica.

Reports of infection and/or disease caused by non-tuberculous mycobacteria (NTM) are becoming increasingly frequent. This scope review describes the epidemiological and clinical trend of infection/disease caused by NTM in Latin America. OVID MEDLINE, Embase and LILACS databases were explored for relevant articles. After filtering, we included 44 articles, representing an overall population of 2,826 subjects diagnosed with NTM infection and disease; the majority of the publications included subjects from Brazil and Colombia (75%), cross-sectional studies were the most common (36.6%), most subjects were male (61.3%) and the median age of subjects was 40.1 years. Disease by NTM was reported in 37 publications, extrapulmonary presentation was the most frequent (54%), main comorbidities were other pulmonary diseases, HIV, cystic fibrosis, diabetes and malnutrition, as reported in 13 studies; tuberculosis diagnosis previous to NTM disease was reported in 15 articles. Aesthetic procedures were reported in 12 articles while clinical procedures were reported in 3 articles. Several NTM species were reported, being Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) and M. kansasii (9.1%) the most frequent. Culture and molecular testing were the main methods for diagnosis and identification. Scientific literature on NTM from Latin American countries is scarce. There is an urgent need to conduct studies on the frequency and clinical impact of NTM infections, in order to accurately identify the current morbidity and mortality associated with NTM in Latin American. It is also important to strengthen the local diagnostic capacity and the existing networks focused on studying NTM.

[Ex-Utero Intrapartum Treatment for airway management in congenital giant neck masses]. / Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello.

INTRODUCTION: Congenital head and neck masses are associated with perinatal asphyxia and brain injury, increasing the risk of death. The EXIT (Ex Utero Intrapartum Treatment) technique con sists of ensuring the newborn's airway while is still receiving placental support. This technique has not been standardized in developing countries. OBJECTIVE: To describe the clinical outcomes of two infants who underwent the EXIT technique. CLINICAL CASE: We present two cases, one with lymphatic malformation diagnosed at 20 weeks of gestational age (WGE) and the second one, a preterm newborn with thyromegaly and polyhydramnios, diagnosed at 35 WGE. In both cases, during the C-section, the EXIT technique was performed with a team of a neonatologist, a gyne cologist, an anesthesiologist, a pediatric surgeon, an otolaryngologist, a nurse, and a respiratory therapist. In both patients, the neonatologist achieved to secure the airway through orotracheal intubation at the first attempt. In the first case, lymphatic malformation was confirmed and re ceived sclerotherapy, and the second one was diagnosed with congenital hypothyroidism which was managed with levothyroxine. The patients needed invasive mechanical ventilation for 7 and 9 days, respectively, and were discharged without respiratory complications. CONCLUSIONS: In these patients, the EXIT technique was a safe procedure, carried out without inconvenience. A multi disciplinary approach and the availability of a neonatal intensive care unit are needed to reduce potential complications and ensure postnatal management. Timely prenatal diagnosis is essential to perform this technique.

Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello / Ex-Utero Intrapartum Treatment for airway management in congenital giant neck masses

Resumen: Introducción: Las masas congénitas de cabeza y cuello se asocian a asfixia perinatal e injuria cerebral con elevada mortalidad. La técnica EXIT (Ex Útero Intrapartum Treatment) consiste en asegurar la vía aérea del neonato, sin interrumpir la oxigenación y perfusión materno-fetal a través del soporte placentario. Esta técnica no ha sido estandarizada en países de medianos ingresos. Objetivo: Describir el caso clínico de 2 neonatos manejados mediante la técnica EXIT. Caso Clínico: Se reportan dos casos, uno con malformación linfática diagnosticada a la semana 20 gestación y el segundo con tiromegalia y polihidramnios diagnosticados a la semana 35 de gestación. En ambos casos, duran te la cesárea se realizó la técnica EXIT con un equipo conformado por neonatólogo, ginecólogo, anestesiólogo, cirujano pediatra, otorrinolaringólogo, enfermero y terapeuta respiratorio. En los dos pacientes se logró asegurar la vía aérea mediante intubación orotraqueal al primer intento. En el caso 1 se confirmó la malformación linfática y recibió escleroterapia, y en el caso 2 se diagnosticó hipotiroidismo congénito asociado a bocio, que fue manejado con levotiroxina. Los pacientes se mantuvieron 7 y 9 días con ventilación mecánica invasiva respectivamente y egresaron sin complicaciones respiratorias. Conclusiones: La técnica EXIT en estos casos fue un procedimiento seguro, llevado a cabo sin inconvenientes. Se necesita un equipo multidisciplinario y la disponibilidad de una unidad de cuidados intensivos neonatales, con el objetivo de reducir potenciales complica ciones y garantizar el manejo postnatal. Para lograr su ejecución, es indispensable el diagnóstico prenatal oportuno.

Abstract: Introduction: Congenital head and neck masses are associated with perinatal asphyxia and brain injury, increasing the risk of death. The EXIT (Ex Utero Intrapartum Treatment) technique con sists of ensuring the newborn's airway while is still receiving placental support. This technique has not been standardized in developing countries. Objective: To describe the clinical outcomes of two infants who underwent the EXIT technique. Clinical Case: We present two cases, one with lymphatic malformation diagnosed at 20 weeks of gestational age (WGE) and the second one, a preterm newborn with thyromegaly and polyhydramnios, diagnosed at 35 WGE. In both cases, during the C-section, the EXIT technique was performed with a team of a neonatologist, a gyne cologist, an anesthesiologist, a pediatric surgeon, an otolaryngologist, a nurse, and a respiratory therapist. In both patients, the neonatologist achieved to secure the airway through orotracheal intubation at the first attempt. In the first case, lymphatic malformation was confirmed and re ceived sclerotherapy, and the second one was diagnosed with congenital hypothyroidism which was managed with levothyroxine. The patients needed invasive mechanical ventilation for 7 and 9 days, respectively, and were discharged without respiratory complications. Conclusions: In these patients, the EXIT technique was a safe procedure, carried out without inconvenience. A multi disciplinary approach and the availability of a neonatal intensive care unit are needed to reduce potential complications and ensure postnatal management. Timely prenatal diagnosis is essential to perform this technique.

Challenges for generations in higher education in health / Desafíos para las generaciones en la educación superior en salud

The characteristics of information and communication technology use in today's society create a series of challenges within health sciences higher education learning scenarios. The objective of this article is to present several problematic cases which illustrate these challenges and propose ways to handle them. The main element at the disposal of health sciences higher education professors is the establishment of rules and clear limits in the interaction with the new generations. Learning scenarios in which information technologies for communication are used in an emotionally safe atmosphere of trust should be the goal of curricula in health sciences higher education.

Resumen Las características de uso de tecnologías de la información y la comunicación en la sociedad actual generan una serie de desafíos en los escenarios de aprendizaje para la educación superior en salud. Este artículo tiene como objetivo presentar varios casos problemáticos que dan cuenta de estos desafíos y propuestas de cómo manejarlos. El principal elemento con el que cuentan los profesores en educación superior en salud es el establecimiento de reglas y límites claros en el relacionamiento con las nuevas generaciones. Unos escenarios de aprendizaje que hagan uso de las tecnologías de la información en la comunicación, en un ambiente de confianza y emocionalmente seguros deberían ser el objetivo de los currículos en educación superior en salud.

Telemedicina en trasplante hepático. Revisión rápida de la literatura / Telemedicine in liver transplantation. Brief review of the literature

Introducción. La tecnología de la información y la comunicación en la atención en salud viene en aumento en Colombia, al igual que en el resto del mundo. El uso de la telemedicina para el manejo y seguimiento del paciente con patologías crónicas ha demostrado gran utilidad. En el área del trasplante hepático en particular, la telemedicina busca, entre otras cosas, reducir las dificultades de acceso a cuidados especializados. Objetivo. Identificar si la atención por telemedicina en pacientes con trasplante hepático tiene desenlaces clínicos similares en cuanto a mortalidad, rechazo del injerto y adherencia, comparada con la atención presencial. Metodología. Revisión rápida de la literatura en las bases de datos MEDLINE, EMBASE, LILACS, Cochrane, Web Of Science y Google Scholar con los términos telemedicina y trasplante hepático, sin límite temporal ni de idiomas. Se incluyeron estudios de corte transversal, ensayos clínicos de asignación aleatoria y cuasi-experimentales que evaluaran adherencia o complicaciones asociadas a trasplante hepático. La revisión de artículos y extracción de datos fue realizada en forma independiente por ambos autores y resumida en forma cualitativa. No se consideró metaanálisis dada la alta heterogeneidad prevista de los estudios. Resultados. Se incluyeron un total de cinco artículos, todos con alto riesgo de sesgos, cuyos estudios fueron realizados en centros de los Estados Unidos. Ninguno de ellos evaluó los desenlaces de mortalidad o rechazo del injerto. Se identificó adherencia a los seguimientos, similar a la atención tradicional. Un estudio demostró disminución significativa en la proporción de pacientes excluidos para ingresar al protocolo de trasplante. Conclusión. Se requieren estudios para determinar si la atención bajo telemedicina tiene desenlaces clínicos similares a la atención personal, durante el seguimiento de pacientes con trasplante hepático.

Introduction. Information and communication technology in health care is increasing in Colombia as in the rest of the world. The use of telemedicine for the management and monitoring of patients with chronic pathologies has proved to be very useful. Specifically, in the area of liver transplantation telemedicine seeks, among other things, to reduce the difficulties of access to specialized care. Objective. To identify whether care through telemedicine in patients with liver transplantation has similar clinical outcomes in terms of mortality, graft rejection and adherence, compared with face-to-face care. Methodology. Brief literature review in MEDLINE, EMBASE, LILACS, Cochrane, Web Of Science and Google Scholar databases with the terms telemedicine and liver transplantation, without time or language limitation. We included cross-sectional studies, randomized and quasi-experimental clinical trials that evaluated adherence or complications associated with liver transplantation. The review of articles and data extraction was carried out independently by both authors and summarized qualitatively. Meta-analysis was not considered given the high expected heterogeneity of the studies. Results. A total of five articles were included, all with a high risk of bias, in centers in the United States. None of them evaluated mortality outcomes or graft rejection. Follow-up adherence was identified similar to traditional care. One study showed a significant decrease in the proportion of patients excluded to enter the transplant protocol. Conclusion. Studies are required to determine if care through telemedicine has clinical outcomes similar to personal care, during the follow-up of patients with liver transplantation.

Presentación atípica anogenital de virus herpes simple en un adulto VIH positivo, manejo exitoso con foscarnet: reporte de caso / Atypical anogenital herpes simple virus infection in an hiv patient, successfully treatment with foscarnet: a case report

Las lesiones anogenitales hipertróficas, pseudotumorales y similares a placas, son presentaciones atípicas del virus herpes simple (VHS). Estas lesiones desarrollan resistencia a los tratamientos y se presentan en inmunocomprometidos, especialmente aquellos con infección por el virus de inmunodeficiencia humana (VIH). Presentamos el caso de un paciente masculino de 38 años de edad, VIH/SIDA, con antecedente de carcinoma escamocelular infiltrante de canal anal, con lesiones múltiples hipertróficas anogenitales y exudativas, a quien se le confirma infección por VHS-1, sin respuesta a aciclovir ni valaciclovir a dosis óptimas, el cual resuelve con 21 días de foscarnet intravenoso. Nuestro caso muestra la importancia de considerar el uso de foscarnet en adultos con infección de VIH y del VHS, que no respondan a tratamiento de primera línea, en un país donde no hay esquemas establecidos de manejo para este tipo de presentaciones y donde existe la limitante de no haber disponibilidad en pruebas para resistencia a antivirales.

Pseudotumoral, hypertrophic, plaque-like anogenital ulcers are atypical features of herpes simplex infection. These ulcers develop treatment resistance and they appear in immunocompromised mainly those infected by human immunodeficiency virus. We present a 38 years-old man with AIDS and personal history of infiltrative squamous carcinoma of anal canal with multiple hypertrophic and exudative ulcers secondary to VHS-1 etiology without response to acyclovir neither valacyclovir at optimal doses but complete answer with 21 days of foscarnet treatment. Our case highlights the role of foscarnet in adults with HIV-HSV coinfection that don't respond to frst line treatment in a country that doesn't have clear treatment recommendations in these cases and with the limitations of absence of antiviral resistance test.

Dolor abdominal crónico en adultos / Chronic abdominal pain in adults

Resumen El dolor abdominal es una causa frecuente de consulta para el médico general. Corresponde al 1% de la consulta externa ubicándose como la novena causa externa y la segunda en los servicios de urgencias en Colombia. Cuando éste es crónico, rara vez es tributario de manejo quirúrgico, pero impacta negativamente en la calidad de vida de los pacientes. Un enfoque anatómico y fisiopatológico permiten un adecuado diagnóstico y tratamiento por parte del médico. Siendo así, este trabajo tiene como objetivo revisar los elementos base para el enfoque del dolor abdominal crónico y proponer un algoritmo diagnóstico para estos casos. MÉD.UIS. 2018;31(1):47-55.

Abstract Abdominal pain is a frequent chief complaint for primary care physician. It explains 1% of outpatient visits ranking 9th in the office and 2nd in the emergency room. Chronic pain, rarely needs surgical management but declines quality of life. An anatomic and physiophatologic approach result in a correct diagnosis and treatment by the physician. This work aims to review the major elements for the study of chronic abdominal pain and to propose a clinical diagnostic algorithm in these cases. MÉD.UIS. 2018;31(1):47-55.

Linfoma primario del corazón: causa poco común de síndrome de falla cardiaca / Primary cardiac lymphoma: an uncommon cause of heart failure

Resumen Objetivo: Describir una causa poco común de síndrome de falla cardiaca aguda como lo es el linfoma primario del corazón. Métodos: Presentación de un caso con antecedentes y cuadro clínico de ingreso, manejo instaurado y desenlace. Resultados y conclusiones: Los tumores cardiacos malignos son bastante infrecuentes, más aún el linfoma cardiaco, por lo que no se considera en el diagnóstico diferencial del médico. Se presenta un nuevo caso en la literatura del linfoma cardiaco manifestado como síndrome de falla cardiaca aguda

Abstract Motivation: To describe an uncommon cause of acute cardiac failure such as primary cardiac lymphoma. Methods: Presentation of a case with medical history and clinical records of admission, established management and outcomes. Results and conclusions: Malignant cardiac tumours are quite infrequent, even more so with cardiac lymphoma, which is why they usually are not taken into consideration by physicians when making a differential diagnosis. A new case of cardiac lymphoma manifesting as acute cardiac failure syndrome is presented in the literature.

Heart disease characteristics in patients with systemic lupus erythematosus / Características de la afección cardíaca de los pacientes con lupus eritematoso sistémico

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by periods of activity and remission in which any organ can be affected. Cardiovascular involvement represents an important cause of mortality in SLE patients after infections. Indeed, valvular involvement in a patient with cutaneous lupus is considered the first sign of a systemic condition. These patients may have an isolated condition in the pericardium, myocardium, endocardium, valves and vascular bed or an overall involvement. Cardiac alterations may be present in more than 50% of patients at any stage of disease progression, especially in men, who have a higher risk of cardiovascular disorders. This paper is a review of the characteristics of cardiac involvement in SLE patients and its clinical manifestations, diagnosis and treatment.

El lupus eritematoso sistémico (LES) es una enfermedad de etiología autoinmune caracterizada por episodios de crisis y remisiones, en la que se puede afectar cualquier órgano. Luego de las infecciones, las afecciones del sistema cardiovascular explican una parte importante de la mortalidad en pacientes con LES. De hecho, el compromiso valvular en un paciente con lupus cutáneo fue el primer indicio para considerar que esta era una enfermedad sistémica. En dichos pacientes se puede afectar aisladamente cualquier estructura cardiovascular: pericardio, miocardio, endocardio, válvulas y lechos vasculares, y también puede ocurrir compromiso global. Las alteraciones cardíacas se pueden encontrar en cualquier etapa de la evolución de la enfermedad y suelen estar presentes en la mitad o más de los pacientes especialmente en hombres, que tienen más riesgo de compromiso cardiovascular. El presente artículo es una revisión de las características de la afección cardíaca en los pacientes con LES; se incluyen sus manifestaciones clínicas, el diagnóstico y el tratamiento.