Hypervirulent Strains of Neisseria meningitidis and Clinical Manifestations in Children With Invasive Meningococcal Disease.

BACKGROUND: Hypervirulent clonal complex (cc) have been associated with higher incidence and case fatality rate of invasive meningococcal disease (IMD). The aim of this study was to describe the clinical manifestations of the hypervirulent cc of meningococcus in children. METHODS: Retrospective study in patients hospitalized by IMD microbiologically confirmed at three children's tertiary health care centers in Santiago, Chile, between 2010 and 2018. Demographic, clinical information and determination of the cc and factor H binding protein (fHbp) alleles were performed. RESULTS: In total 93 cases were evaluated, sequence typing was available for 91 cases, and 87 (95.6%) had a cc assigned; 63.7% were MenW and 31.8% MenB. The median age was 9 months, 67% were male and 18.7% had any comorbidity. A 26.4% presented neurological deficit, 25.3% petechiae and 20% diarrhea. Sixty-seven percent were admitted to the pediatric intensive care unit (PICU) and the case fatality rate was 9.9%. Regarding cc and fHbp alleles, ST11, ST41/44 and allele 22 were the most frequently identified, with 63.7%, 19.8% and 72.5%, respectively. We found statistically significant differences between the cc and presence of petechiae, diagnosis of meningococcemia plus meningitis, admission and days in PICU and advanced support. Allele 22 for fHbp was associated with the absence of petechiae, low suspicion of IMD, less diagnosis of meningitis+meningococcemia, PICU admission, advanced support and adrenal insufficiency. CONCLUSION: Epidemiological and microbiological surveillance of IMD should integrate clinical and laboratory components, including molecular and genetic characterization, to enrich the dynamic understanding of the clinical evolution of IMD.

Superdiseminadores durante la pandemia del SARS-CoV-2 en Cartagena, Colombia / Super-spreaders during SARS-CoV-2 pandemic in Cartagena, Colombia

Resumen Introducción: la diseminación de agentes infecciosos en una población puede ocurrir de forma homogénea o heterogénea. El SARS-CoV-2 tiene transmisión heterogénea por los superdiseminadores (SD, individuos con ciertas características que transmiten la infección a un 80% de la población expuesta). Objetivos: describir las características de los SD en los primeros casos de la COVID-19 en Cartagena, Colombia. Metodología: estudio de vigilancia epidemiológica realizado entre el 25 de febrero y el 20 de abril del 2020 por el Comité de infecciones de la clínica Gestión Salud y el Departamento Administrativo Distrital de Salud, a casos sospechosos, confirmados por RT-PCR para SARS-CoV-2 y contactos estrechos de casos confirmados de COVID-19. Resultados: en 30 días se confirmaron dos pacientes SD, 21 casos secundarios (10 y 11, cada uno) y dos terciarios. El 1er SD inició síntomas 48 horas después de la exposición, fue hospitalizado al séptimo día de iniciado los síntomas y falleció a las 72 horas de hospitalización. El 2do SD hospitalizado por cetoacidosis diabética, con posterior hallazgo de anosmia y disgeusia, permaneció en UCI un mes. De los casos secundarios, el 9,5% (2/21) fue hospitalizado en UCI, 47% (10/21) en sala general y 42% (9/21) estuvo en cuarentena. El 61% (14/23) de los contagiados fue personal de la salud. Conclusiones: los SD son importantes en la dinámica de transmisión de infecciones. El no reconocimiento o el diagnóstico errado en un paciente con infección por SARS-CoV-2, junto con la transferencia interhospitalaria, son las principales causas de la generación de un número desproporcionado de casos secundarios.

Summary Introduction: The dissemination of infectious agents in a population can occur both in a homogeneous or heterogeneous way. SARS-CoV-2 has heterogeneous transmission by superspreaders (SS) (people with certain characteristics that transmit the infection to 80% of the exposed population). Objective: To describe the characteristics of SS in the first cases of COVID-19 in Cartagena, Colombia. Methodology: Epidemiological surveillance study carried out in Cartagena from February 25 to April 20, 2020, by the infection committee of Clínica Gestión Salud and the administrative department of health, on suspected cases, confirmed by RT-PCR for SARS-CoV-2, and close contacts of those confirmed cases for coronavirus infection. Results: In 30 days, two SS patients were confirmed, 21 secondary cases (10 and 11, each one), and two tertiary cases. The 1st SS began symptoms 48 hours after exposure, he was hospitalized on the 7th day after symptoms began and died 72 hours after hospitalization. The 2nd SS hospitalized for diabetic ketoacidosis, with subsequent finding of anosmia and dysgeusia, remained in the ICU one month. Of the secondary cases, 9.5% (2/21) were hospitalized in the ICU, 47% (10/21) in the general ward and 42% (9/21) were quarantined. Sixty one percent (14/23) of those infected were from health personnel Conclusions: SS are important in the dynamics of transmission infectious diseases. Failure to identify or misdiagnosis a patient with COVID-19, together with hospital transfer, are the main causes of the generation of a disproportionate number of secondary cases.

Sequelae at Hospital Discharge in 61 Children With Invasive Meningococcal Disease, Chile, 2009-2019.

BACKGROUND: Invasive meningococcal disease (IMD) is an unpredictable and severe infection caused by Neisseria meningitidis . Its case fatality rate could vary from 9.7% to 26% and up to 36% of survivors may experience long-term sequelae, representing a challenge for public health. AIMED: To describe the sequelae at hospital discharge caused by IMD in children between years 2009-2019. METHODS: Cross-sectional study performed in 2 pediatric hospitals. Patients with microbiologically confirmed diagnosis of IMD from 2009 to 2019 were included. Bivariate and logistic regression analysis were performed. RESULTS: The records of 61 patients were reviewed and included. Sixty-seven percent were male, median age 9 months (interquartile range 4-27), 72% were admitted to intensive care unit. Thirty-seven (60.5%) had at least 1 sequela (75% and 37% in patients with or without meningitis, respectively). The most frequents sequelae were neurological 72%, hearing loss 32%, and osteoarticular 24%. Significant differences were found comparing patients with and without sequelae: drowsiness 67.6% versus 41.7% ( P = 0.04), irritability 67.6% versus 25% ( P = 0.01), meningeal signs 62.2% versus 29.2% ( P = 0.01). In logistic regression analysis, postdischarge follow-up had OR 21.25 (95% confidence intervals [CI]: 4.93-91.44), irritability had OR 8.53 (95% CI: 1.64-44.12), meningeal signs had OR 8.21 (95% CI: 0.71-94.05), invasive mechanical ventilation had OR 8.23 (95% CI: 0.78-85.95), meningitis plus meningococcemia OR 1.70 (95% CI: 0.18-15.67) to have sequelae, while children with meningococcemia and vomiting had a OR 0.04 (95% CI: 0.00-0.36) and OR 0.27 (95% CI: 0.03-2.14), respectively. N. meningitidis serogroup W (MenW) was isolated in 54.1% (33/61), and N. meningitidis serogroup B (MenB) in 31.1% (19/61) of cases. A significant difference was found in osteoarticular sequelae ( P = 0.05) between MenB and MenW. There was a decrease in cases after the meningococcal conjugate vaccine against serogroups A, C, W and Y was implemented (2015-2019). CONCLUSIONS: IMD remains as a public health concern. A high rate of sequelae was found in pediatric patients in our series, even in the clinical manifestations other than meningitis. Neurological sequelae were the most prevalent. Multidisciplinary follow-up protocols to reduce long-term impact must be urgently established to assess all children with IMD.

Identification of the nasopharyngeal carriage of Neisseria meningitidis by 16S rRNA Gene sequencing in asymptomatic adolescents and young adults in Cartagena, Colombia (2019-2020).

The bacterium Neisseria meningitidis, a strictly human pathogen, can cause meningitis, meningococcemia, sepsis, and death; repeatedly it scause outbreaks around the world. The frequency of asymptomatic carriage is often high in adolescents and young adults, increasing the invasive meningococcal disease risk and likelihood of transmission. However, detailed analyses of meningococcal carriage in this population in Colombia, particularly in coastal areas, are lacking. In this study, the prevalence and characteristics of Neisseria meningitidis carriage were evaluated in asymptomatic adolescents and young adults (11-25 years old) in Cartagena, Colombia. Oropharynx samples were collected from participants between August and December 2019. The phenotypic identification of bacteria was performed by conventional methods and biochemical testing. Molecular identification to the species level was performed by 16S rRNA gene sequencing. In total, 12 of 648 samples were positive for Neisseria meningitidis by 16S rRNA sequencing, indicating a prevalence of 1.9%. Isolates were classified into four invasive serogroups (A, B, C, and W) by a comparative sequence analysis of the ribosomal gene. Despite the occurrence of meningococcal disease in Cartagena city in the last several years, the frequency of oropharyngeal carriage in adolescents and young adults was low. Serogroup A had not been previously reported in nasopharyngeal samples in Colombia. This is the first report of Neisseria meningitidis on the Colombian Caribbean coast based on 16S rRNA sequencing and is expected to guide the development of vaccination and follow-up strategies.

Identification of the nasopharyngeal carriage of Neisseria meningitidis by 16S rRNA Gene sequencing in asymptomatic adolescents and young adults in Cartagena, Colombia (2019-2020)

Abstract The bacterium Neisseria meningitidis, a strictly human pathogen, can cause meningitis, meningococcemia, sepsis, and death; repeatedly it scause outbreaks around the world. The frequency of asymptomatic carriage is often high in adolescents and young adults, increasing the invasive meningococcal disease risk and likelihood of transmission. However, detailed analyses of meningococcal carriage in this population in Colombia, particularly in coastal areas, are lacking. In this study, the prevalence and characteristics of Neisseria meningitidis carriage were evaluated in asymptomatic adolescents and young adults (11-25 years old) in Cartagena, Colombia. Oropharynx samples were collected from participants between August and December 2019. The phenotypic identification of bacteria was performed by conventional methods and biochemical testing. Molecular identification to the species level was performed by 16S rRNA gene sequencing. In total, 12 of 648 samples were positive for Neisseria meningitidis by 16S rRNA sequencing, indicating a prevalence of 1.9%. Isolates were classified into four invasive serogroups (A, B, C, and W) by a comparative sequence analysis of the ribosomal gene. Despite the occurrence of meningococcal disease in Cartagena city in the last several years, the frequency of oropharyngeal carriage in adolescents and young adults was low. Serogroup A had not been previously reported in nasopharyngeal samples in Colombia. This is the first report of Neisseria meningitidis on the Colombian Caribbean coast based on 16S rRNA sequencing and is expected to guide the development of vaccination and follow-up strategies.

[Type 1 diabetes mellitus and Graves Basedow's disease, a case of Autoimmune Polyglandular Syndrome]. / Diabetes mellitus tipo 1 y enfermedad de Graves Basedow, un caso de Síndrome Poliglandular Autoinmune.

INTRODUCTION: Type 1 diabetes mellitus (T1DM) is one of the most frequent autoimmune diseases in childhood. Its diagnosis requires the search for other autoimmune diseases. OBJECTIVE: to present the case of a pediatric patient with two rare concomitant autoimmune endocrine diseases. CLINICAL CASE: A 12-year-old male with no significant morbid history, is hospitalized due to a 3-month clinical pic ture of fatigue, eye pain, intermittent eyelid edema, goiter, polyphagia, polydipsia, polyuria, and weight loss (12 kilograms), compatible with T1DM and Graves-Basedow disease. It was confir med by laboratory tests which showed elevated glycemia (207 mg/dL, HbA1C 10.9%), suppressed TSH (< 0.01 uIU/mL), elevated FT4 (6.99 ng/dL), and the presence of anti-autoantibodies thyroid peroxidase, antithyroglobulin, and anti-TSH receptor, along with suggestive ultrasound findings. Therefore, we established the diagnosis of autoimmune polyglandular syndrome (APS) 3A and initiated treatment with insulin, propranolol, and thiamazole. The patient evolved satisfactorily and was discharged with outpatient follow-up. CONCLUSION: We present the case of an adolescent who presented APS due to T1DM and hyperthyroidism. This APS may be more common than is reported in clinical practice. The alteration of two or more endocrine glands or other autoimmune diseases should make us suspect its diagnosis, with important clinical implications, such as co morbidity and quality of life prognosis.

Costs of acute otitis media in children in a city of the Colombian Caribbean coast. / Costos de la otitis media aguda en niños de una ciudad de la costa caribe colombiana

INTRODUCTION: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. OBJECTIVE: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. MATERIALS AND METHODS: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD $308). RESULTS: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP $254,903, i.e., USD $179). The total economic burden was COP $22,503,141 (USD $11,250), the indirect costs per episode were COP $101,402 (USD $51), and the average care time spent by parents was 3.7 days. CONCLUSION: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments.

Introducción. La otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimado. Objetivo. Estimar los costos de la otitis media aguda en pacientes pediátricos en Cartagena, Colombia. Materiales y métodos: Se hizo un estudio prospectivo de microcosteo entre el 2014 y el 2015. Se determinaron los costos directos e indirectos de la otitis media aguda mediante encuestas a los padres o cuidadores. La pérdida de productividad se estimó con base en el salario mínimo legal vigente mensual del 2014 (COP $616.000) (USD $308). Resultados. Se presentaron 62 episodios de otitis media aguda. Los costos económicos totales por episodio fueron de COP $358.954 (desviación estándar, DE: ± $254.903) (USD $179). La carga económica total fue de COP $22'503.141 (USD $11.250), los costos indirectos por episodio fueron de COP $101.402 (USD $51) y el tiempo promedio empleado por los padres en el cuidado fue de 3,7 días. Conclusiones. Los costos estimados de la otitis media aguda en el presente estudio fueron menores a los estimados en países con ingresos altos y similares a los de países con ingresos bajos como Nigeria, según una revisión bibliográfica. La información sobre los costos totales directos e indirectos de la otitis es necesaria para la adopción de decisiones en salud pública y para hacer evaluaciones económicas completas de costo-efectividad.

Costs of acute otitis media in children in a city of the Colombian Caribbean coast / Costos de la otitis media aguda en niños de una ciudad de la costa caribe colombiana

Abstract Introduction: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. Objective: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. Materials and methods: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD $308). Results: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP $254,903, i.e., USD $179). The total economic burden was COP $22,503,141 (USD $11,250), the indirect costs per episode were COP $101,402 (USD $51), and the average care time spent by parents was 3.7 days. Conclusion: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments.

Resumen Introducción. La otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimado. Objetivo. Estimar los costos de la otitis media aguda en pacientes pediátricos en Cartagena, Colombia. Materiales y métodos: Se hizo un estudio prospectivo de microcosteo entre el 2014 y el 2015. Se determinaron los costos directos e indirectos de la otitis media aguda mediante encuestas a los padres o cuidadores. La pérdida de productividad se estimó con base en el salario mínimo legal vigente mensual del 2014(COP$616.000) (USD$308). Resultados. Se presentaron 62 episodios de otitis media aguda. Los costos económicos totales por episodio fueron de COP $358.954 (desviación estándar, DE: ± $254.903) (USD $179). La carga económica total fue de COP $22'503.141 (USD $11.250), los costos indirectos por episodio fueron de COP $101.402 (USD $51) y el tiempo promedio empleado por los padres en el cuidado fue de 3,7 días. Conclusiones. Los costos estimados de la otitis media aguda en el presente estudio fueron menores a los estimados en países con ingresos altos y similares a los de países con ingresos bajos como Nigeria, según una revisión bibliográfica. La información sobre los costos totales directos e indirectos de la otitis es necesaria para la adopción de decisiones en salud pública y para hacer evaluaciones económicas completas de costo-efectividad.

Estrategias para mejorar el nivel de resiliencia en adolescentes embarazadas / Strategies to Improve the Resilience Level in Pregnant Adolescents / Estratégias para melhorar a nível de resiliência em adolescentes grávidas

El embarazo en la adolescencia es un problema con implicaciones médicas y psicosociales que puede afectar negativamente la vida futura, que amerita manejo multidisciplinario y no solo atención obstétrica. Es importante realizar en adolescentes gestantes estrategias que mejoren su nivel de resiliencia. Objetivo: Identificar estrategias que se asocien con mejoría en la resiliencia de las adolescentes embarazadas. Método: Revisión integrativa mediante búsqueda electrónica de artículos sobre estrategias para mejorar la resiliencia de adolescentes embarazadas, que estuviesen incluidos en las bases de datos Pubmed, ScienceDirect, EBSCOhost, OvidSP, SciELO y Dialnet, publicados entre 2005 y 2015, en inglés o en español. Resultados: Se identificaron 33 artículos, de los cuales cuatro se ajustaban al objetivo y tenían información considerada relevante. Se requieren más estudios para respaldar la eficacia de las intervenciones, ya que algunos resultados favorables observados, se han establecido en condiciones de adversidad diferentes al embarazo. No obstante, las principales estrategias identificadas para mejorar el nivel de resiliencia en adolescentes embarazadas fueron: familismo, apoyo social, consejería grupal centrada en la persona y sicología cognitiva Ad-Din con el componente de espiritualidad. Conclusión: Son insuficientes los estudios sobre estrategias para incrementar la resiliencia en adolescentes embarazadas; no obstante, familismo, apoyo social y consejería centrada en la persona son estrategias que se pueden utilizar.

Introduction: Adolescence pregnancy is a problem with medical and psychosocial complications that can adversely affect the future life. In that sense, it not only requires obstetrical attention but multidiscipline management. It is important to use strategies that allow to improve the resilience level in pregnant adolescents. Objective: To identify strategies associated with improvement in the resilience level of pregnant adolescents. Method: It was carried out an integrative review about strategies to improve the resilience level in pregnant adolescents by means of electronic research with articles that were included in Pubmed, ScienceDirect, EBSCOhost, OvidSP, SciELO, and Dialnet databases, published between 2005 and 2015 in English or Spanish. Results: Thirty-three articles were identified: four of them were adjusted to the objective and had relevant information. It is required more information to support the operation 's efficiency because some positive results that were observed befo re have been established in adversity conditions different from pregnancy. However, the main identified strategies to improve the resilience level in pregnant adolescents were: Familism, social and group support, focused on the person, also, Ad-Din cognitive psychology with the spiritual component. Conclusión: The studies about strategies are insufficient to improve the resilience level in pregnant adolescents, however, familism, social and group support focused on the person are strategies that should be more used.

Introdução: A gravidez na adolescência é um problema com implicações médicas e psicossociais que podem afetar negativamente a vida futura, que merece não só a gestão multidisciplinar e cuidados obstétricos. É importante realizar em adolescentes grávidas, estratégias para melhorar o seu nível de resiliência. Objetivo: Identicar estratégias que estão associados com a melhora no nível de resiliência de adolescentes grávidas. Metodo: Revisão integrativa por estratégias de busca eletrônica para aumentar a resiliência da gravidez na adolescência, que foram incluídos no Pubmed, ScienceDirect, EBSCOhost, OvidSP, SciELO e os dados Dialnet e publicados entre 2005-2015, em inglês ou espanhol. Resultados: Foram identificados 33 artigos, dos quais quatro eram consistentes com o objectivo e tiveram informações consideradas relevantes. Mais estudos são necessários para apoiar a eficácia das intervenções, como alguns resultados favoráveis observados foram estabelecidas sob diferentes adversidades gravidez. No entanto, as principais estratégias identificadas para melhorar o nível de resiliência em adolescentes grávidas foram: familismo, apoio social, grupo de aconselhamento centrada nas pessoas e psicologia cognitiva Ad-Din com o componente da espiritualidade. Conclusão: São estudos suficientes sobre estratégias para aumentar o nível de resiliência em adolescentes grávidas; no entanto, familismo, assistência social e psicológica centrada na pessoa estão programadas estratégias utilizadas.

Derrame pericárdico y taponamiento cardiaco / Pericardial effusion and cardiac tamponade

Resumen El derrame pericárdico es la acumulación de más de 50 ml de líquido en el espacio pericárdico. La etiología es muy diversa ya que puede ser de causa idiopática o deberse a enfermedades primarias del pericardio, como las pericarditis de cualquier etiología, o por enfermedades sistémicas como el infarto agudo de miocardio y la rotura cardiaca contenida; o por cirugía cardiaca, hemorragia intrapericárdica, enfermedades metabólicas, transudación serosa (anasarca) y quilopericardio, entre otras. El estudio diagnóstico del derrame pericárdico siempre debe guiarse por la epidemiología local y requiere alta sospecha clínica. Cuando el derrame pericárdico se complica con taponamiento cardiaco, constituye una emergencia médica que requiere identificación e intervención inmediatas. Se exponen cuatro casos de pacientes con derrame pericárdico asociado a tuberculosis, mixedema, uremia y lupus, quienes desarrollaron taponamiento cardiaco.

Abstract Pericardial effusion is defined as the accumulation of more than 50 ml of fluid in the pericardiac space. Its origin is very diverse since it can be an idiopathic cause or be due to primary diseases of the pericardium, such as pericarditis of any origin. It can also be due to systemic diseases, such as acute myocardial infarction and contained cardiac rupture, as well as due to heart surgery, intra-pericardiac haemorrhage, metabolic diseases, serous transudation (anasarca), and chylopericardium, among others. The diagnostic work-up of pericardial effusion must always be guided by the local epidemiology, and requires a high clinical suspicion. When the pericardial effusion is complicated by cardiac tamponade, it constitutes a medical emergency that requires immediate identification and treatment. Four cases are presented on patients with pericardiac effusions associated with tuberculosis, myxoedema, uraemia, and lupus, and who developed cardiac tamponade.

Endocarditis infecciosa derecha como primera manifestación de leucemia linfoblástica aguda en niños / Right-sided infective endocarditis as a first manifestation of acute lymphoblastic leukaemia in children

Resumen Introducción: La endocarditis infecciosa del lado derecho representa el 5 al 10% de los casos de endocarditis infecciosa en adultos, menos frecuente en niños. Serie de casos: Caso 1: Niña de 12 años de edad con fiebre y antecedentes de trauma en cadera izquierda por caída. Desarrolló dificultad respiratoria, choque, neumonía bilateral y celulitis en cadera izquierda. Los hemocultivos fueron positivos para Staphylococcus aureus resistente a meticilina (SARM), en tanto que el ecocardiograma mostró vegetación en la válvula tricúspide. Por bicitopenia continua se le realizó aspiración de médula ósea diagnosticándose leucemia linfocítica aguda. Recibió vancomicina durante seis semanas y posteriormente inició quimioterapia. Caso 2: Niña de 5 años de edad, con fiebre, dificultad respiratoria, reacción leucemoide y bicitopenia, desarrolló choque con neumonía bilateral y hepatoesplenomegalia, hemocultivos positivos para SARM. El ecocardiograma mostró vegetación en válvula tricúspide y se realizó aspiración de médula ósea diagnosticándose leucemia linfocítica aguda; falleció. Conclusión: Se reporta la concomitancia de endocarditis infecciosa derecha por SARM en pacientes con leucemia linfocítica aguda, patología con baja incidencia descrita.

Abstract Introduction: Right-sided infective endocarditis, represents from 5% to 10% of infective endocarditis in adults, which is less frequent in children. Case Series: Case 1: A 12 year-old girl with fever and a history a left hip injury due to a fall. She developed breathing difficulties, shock, bilateral pneumonia, and cellulitis in the left hip. The blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA), as such that the echocardiogram showed growth in the tricuspid valve. Due to persistent bicytopenia, a bone marrow aspirate was performed, with acute lymphocytic leukaemia being diagnosed. She received vancomycin for six weeks and chemotherapy was subsequently started. Case 2: A 5 year-old girl, with fever, breathing difficulties, a leukemoid reaction, and bicytopenia, developed shock with bilateral pneumonia, and hepato-splenomegaly, as well as positive blood cultures for MRSA. The echocardiogram showed growth in the tricuspid valve, and the bone marrow aspirate performed helped diagnose an acute lymphocytic leukaemia. The patient died. Conclusion: Right-sided infective endocarditis, concomitant with MRSA, is reported in patients with acute lymphocytic leukaemia, a disease with a low reported incidence.

Violencia doméstica en adolescentes embarazadas: caracterización de la pareja y prevalencia de las formas de expresión / Domestic violence in pregnant adolescents: characterization of the partners and prevalence ofthe different forms of expression / Violência doméstica em adolescentes grávidas: caracterização do casal e prevalência das formas de expressão

Introducción: El embarazo en adolescentes y la violencia doméstica (VD) son problemas mundiales, cuya prevalencia está influenciada por factores culturales. Objetivo: caracterizar a las embarazadas adolescentes y a sus parejas sexuales y determinar la prevalencia de VD psicológica, física y sexual. Metodología: estudio transversal en 406 adolescentes colombianas gestantes. Se registraron las características sociodemográficas y se aplicaron las escalas Are you being abused? y Abuse Assessment Screen. La primera establece la VD por la pareja y la segunda, la VD en alguna época, en el último año o en el embarazo. Resultados: edad: 16,5 ± 1,5 años; 92,9 % en adolescencia tardía; promedio de escolaridad 9 años; deserción escolar al quedar en embarazo: 50,0 %; dependencia de los padres antes y después del embarazo: 70,0 %. Frecuencia de VD por la pareja 7,1 %; VD física 6,7 %; VD psicológica 3,7 % y VD sexual 2,2 %. VD por la pareja, el marido u otra persona: 12,4 %; maltrato físico o emocional por la pareja u otra persona: 21,7 %; miedo a la pareja: 3,4 %. El consumo de alcohol todos los fines de semana por la pareja fue un factor significativo de riesgo para VD. Conclusión: es alta la frecuencia de VD contra las adolescentes embarazadas y el consumo de alcohol por parte de la pareja es un factor de riesgo importante para sufrirlá.

Introduction: Pregnancy in adolescents and domestic violence (DV) are worldwide problems. Their prevalence is influenced by cultural factors. Objectives: To characterize pregnant adolescents and their sexual partners, and to determine the prevalence of psychological, physical and sexual DV. Methodology: Cross-sectional study of 406 Colombian pregnant teenagers. Socio-demographic data were collected, and the scales “Are you being abused?” and “Abuse Assessment Screen” were applied. The former identifies domestic violence by the partner, and the latter, DV at any moment, the last year or during pregnancy. Results: Age: 16.5 ± 1.5 years, 92.9 % were in late adolescence, average years of schooling: nine; 50 % dropped out from school when they became pregnant; 70 % depended on their parents, both before and after pregnancy. DV by the partner: 7.1 %; physical DV: 6.7 %; psychological DV: 3.7 %; sexual DV: 2.2 %. DV by partner/husband/other person: 12.4 %; physical or emotional abuse by partner/another person: 21.7 %; fear from the partner: 3.4 %. There was significant association between alcohol consumption by the partner every weekend and DV. Conclusion: Frequency of DV against pregnant adolescents is high and alcohol consumption by the partner is an important risk factor for it.

Introdução: A gravidez em adolescentes e a violência doméstica (VD) são problemas mundiais, cuja prevalência está influenciada por fatores culturais. Objetivo: Caracterizar às grávidas adolescentes e a seus parceiros sexuais e determinar a prevalência de VD psicológica, física e sexual. Metodologia: Estudo transversal em 406 adolescentes colombianas gestantes. Se registraram as características sócio-demográficas e se aplicaram as escalas are you being abused? e Abuse Assessment Screen. A primeira estabelece a VD pelo companheiro e a segunda, a VD em alguma época, no último ano ou na gravidez. Resultados: Idade: 16,5 ± 1,5 anos; 92,9 % em adolescência tardia; média de escolaridade 9 anos; deserção escolar ao ficar grávida: 50,0 %; dependência dos pais antes e depois da gravidez: 70,0 %. Frequência de VD pelo companheiro 7,1 %; VD física 6,7 %; VD psicológica 3,7 % e VD sexual 2,2 %. VD pelo companheiro, o marido ou outra pessoa: 12,4 %; maltrato físico ou emocional pelo companheiro ou outra pessoa: 21,7 %; medo do companheiro: 3,4 %. O consumo de álcool todos os fins de semana pelo casal foi um fator significativo de risco para VD. Conclusão: É alta a frequência de VD contra as adolescentes grávidas e o consumo de álcool por parte do companheiro é um fator de risco importante para sofrê-la.

Infección por virus del Zika en el embarazo, impacto fetal y neonatal / Zika virus infection in pregnancy, fetal and neonatal impact

Zika virus (ZV) is an arbovirus transmitted by Aedes aegypti and A. albopictus. The neurotropic profile of this virus is known since 1952. The main finding related to ZV in America is microcephaly. Two hypotheses are tested on its involvement in the central nervous system: its neurotropic feature and the direct effect of ZV on the placenta. Malformations and clinical findings on fetal development comprise congenital Zika syndrome. RT-PCR and serology (IgM) are useful for definitive diagnosis. However, we should keep in mind first that the viremia in pregnant women can stay for a longer period of time, and second, a positive IgM for Zika should be properly interpreted in an endemic area to other flavivirus. It is suggested to be part of TORCHS-Z complex the ZV infection in endemic areas.

El virus del Zika (VZ), arbovirus, es transmitido por Aedes aegypti y A. albopictus. Desde 1952 se conoce su perfil neurotrópico. El principal hallazgo relacionado con la infección en las Américas, es la microcefalia. Dos hipótesis se plantean sobre su afectación en el sistema nervioso central: su característica neurotrópica per se, y el efecto directo del virus sobre la placenta. Las malformaciones y hallazgos clínicos sobre el desarrollo fetal conforman el síndrome de Zika congénito. La reacción de polimerasa en cadena-transcriptasa reversa (RPC-TR) y serología (IgM) son útiles para el diagnóstico definitivo; sin embargo, debe tenerse en cuenta, primero, que la viremia en las mujeres embarazadas puede permanecer por un período más prolongado y segundo, que una IgM positiva para Zika, debe ser adecuadamente interpretada en un medio endémico para otros flavivirus. Se propone a la infección por el VZ, en zonas endémicas, como parte del complejo TORCHS-Z.

[Zika virus infection in pregnancy, fetal and neonatal impact]. / Infección por virus del Zika en el embarazo, impacto fetal y neonatal.

Zika virus (ZV) is an arbovirus transmitted by Aedes aegypti and A. albopictus. The neurotropic profile of this virus is known since 1952. The main finding related to ZV in America is microcephaly. Two hypotheses are tested on its involvement in the central nervous system: its neurotropic feature and the direct effect of ZV on the placenta. Malformations and clinical findings on fetal development comprise congenital Zika syndrome. RT-PCR and serology (IgM) are useful for definitive diagnosis. However, we should keep in mind first that the viremia in pregnant women can stay for a longer period of time, and second, a positive IgM for Zika should be properly interpreted in an endemic area to other flavivirus. It is suggested to be part of TORCHS-Z complex the ZV infection in endemic areas.

Prevalencia de baja autoestima y nivel de resiliencia bajo, en gestantes adolescentes de poblaciones del caribe colombiano / Prevalence of low self-esteem and low level of resilience in pregnant teenagers from populations of the Colombian Caribbean

INTRODUCCIÓN: El embarazo en la adolescencia es un importante problema de salud pública, con repercusiones médicas, psicológicas y sociales, relacionado con el inicio coital temprano sin protección anticonceptiva. OBJETIVO: Estimar la prevalencia de baja autoestima (BAE) y nivel de resiliencia bajo (NRB), en un grupo de gestantes adolescentes. MÉTODO: Estudio descriptivo transversal en gestantes adolescentes, del departamento de Bolívar, Caribe Colombiano. Se utilizó formulario para identificar características socio-demográficas de las gestantes y su compañero, historia gineco-obstétrica, estado psicoemocional con la gestación, apoyo familiar y de pareja. Se incluyó la escala de autoestima de Rosenberg y la de resiliencia de Wagnild y Young. RESULTADO: 406 gestantes adolescentes. Edad media: 16,5±1,5. La gran mayoría abandonó la escuela al quedar embarazada. La puntuación media de autoestima: 27,8±3,9. El 76,8% tuvieron nivel normal de autoestima y el 23,2% BAE (p<0,05). La puntuación promedio de resiliencia: 125,0±17,8. El 8,6% tuvo nivel de resiliencia alto, 57,2% nivel de resiliencia moderado y 34,2% NRB (p<0,05). Hubo correlación positiva significativa de resiliencia con: autoestima, edad de la gestante, edad del compañero, edad del primer coito, años entre primera relación sexual y edad de la gestante, años entre menarquia y primera relación coital, años entre menarquia y la edad de quedar en embarazo, años de estudio, número de controles prenatales y de ecografías acompañada por el compañero. La autoestima solo se correlacionó positiva y significativamente con la edad de la gestante. Las gestantes adolescentes que no se sentían felices o no tenían apoyo del compañero, tuvieron un significativo NRB (OR: 3,7[IC95%:1,3-10,3]). CONCLUSIÓN: La prevalencia para BAE fue de 23,2% y de 34,2% para NRB. Estos resultados señalan que se debe efectuar intervención durante el embarazo en adolescentes para elevar los niveles de autoestima y de resiliencia.

INTRODUCTION: Teenage pregnancy is a major problem of public health with medical, psychological and social consequences associated with early initiation of intercourse without sufficient contraceptive protection. OBJECTIVE: To estimate the prevalence of Low Self-esteem (LSE) and Low Level of Resilience (LLR) in a group of pregnant adolescents. METHODS: Cross-sectional study carried out in adolescents, in urban and rural areas of the department of Bolivar in the Colombian Caribbean pregnant. A questionnaire was applied to identify sociodemographic characteristics of the pregnant women and their partners, gynecological and obstetrical history, health history, psycho-emotional state with pregnancy, family support and partner. The Rosenberg self-esteem scale and Wagnild and Young resilience scale were included. RESULTS: Participated 406 pregnant adolescents. The average age was: 16.5±1.5 years. A large majority left school when they became pregnant. The average self-esteem score was 27.8±3.9. The 76.8% of pregnant women had normal level of self-esteem and LSE 23.2% (p<0.05). The average score resilience was 125.0±17.8. The 8.6% had higher level of resilience, 57.2% moderate level of resilience and 34.2% LLR (p<0.05). Statistically significant positive correlation was estimated resilience: self-esteem, age of pregnancy, age of partner, age at first intercourse, years between first intercourse and the age of pregnancy, years between menarche and first intercourse, years between menarche and age to get pregnant, years of education, number of prenatal ultrasounds and accompanied by the partner. Only self-esteem was positively correlated significantly with the age of the mother. Pregnant adolescents who did not feel happy or do not have support from partner have a significant LLR (OR 3.7[95%CI: 1.3-10.3]). CONCLUSION: The prevalence of LSE was 23.2% and 34.2% for LLR. These results indicate that intervention should be performed during adolescent pregnancy to raise levels of self-esteem and resilience.

Disfunción sexual en mujeres climatéricas afrodescendientes del Caribe Colombiano / Sexual dysfunction in climacteric women of African descent from the Colombian Caribbean region

Introducción: Colombia es el tercer país americano con mayor población afrodescendiente, después de Estados Unidos y Brasil. Objetivo: calcular la prevalencia de disfunción sexual (DS) en mujeres climatéricas afrodescendientes. Metodología: estudio transversal con el Índice de Función Sexual Femenina (FSFI), en mujeres afrodescendientes saludables (40-59 años), hijas de padres de raza negra, naturales de municipios del Caribe Colombiano, voluntarias, anónimas y captadas en sus comunidades. A mayor puntaje mejor sexualidad. La DS se establece con un puntaje total de 26,55 o menos. Resultados: se estudiaron 461 mujeres; 305 de ellas (66,2%) con actividad sexual, 70,8% eran premenopáusicas y 29,2%, posmenopáusicas. Los puntajes promedio de los dominios fueron: deseo (4,1 ± 1,1), excitación (4,4 ± 1,0), lubricación (4,9 ± 1,0), orgasmo (4,7 ± 1,0), satisfacción (5,3 ± 1,0) y dolor (4,3 ± 1,5). La media del puntaje total fue 27,7 ± 4,7 y la prevalencia de disfunción sexual, 38,4%. El hábito de fumar (OR: 3,3 [IC95%: 1,0-10,6; p = 0,041] y la hipertensión arterial (OR: 2,2 [IC95%: 1,1-4,4; p = 0,026] incrementaron el riesgo de DS, mientras que la escolaridad mayor de diez años (OR: 0,4 [IC95%: 0,2-0,8; p = 0,003] lo redujo. La prevalencia de DS aumentó con el cambio en el estado menopáusico (p <0,001). Todos los dominios se deterioraron, excepto el dolor, con el paso a la posmenopausia (p <0,001). Conclusión: en mujeres afrodescendientes del Caribe Colombiano, una de cada tres premenopáusicas y la mitad de las posmenopáusicas presentan DS.

Introduction: After the United States and Brazil, Colombia is the third American country with the greatest population of African descent. Objective: To estimate the prevalence of sexual dysfunction (SD) in climacteric women of African descent. Methods: Cross sectional study carried out with the Female Sexual Function Index (FSFI), in healthy women, whose mother and father were of black race, living in municipalities from the Colombian Caribbean region, who volunteered to anonymously participate in the study, and were recruited in their communities. Higher scores correlated with better sexuality. Results: 461 women were studied; 305 (66.2%) with sexual activity; 70.8% were premenopausal and 29.2%, postmenopausal. Average scores of the domains were: Sexual desire (4.1 ± 1.1), sexual arousal (4.4 ± 1.0), lubrication (4.9 ± 1.0), orgasm (4.7 ± 1.0), satisfaction (5.3 ± 1.0) and pain (4.3 ± 1.5). Average total score was 27.7 ± 4.7. Prevalence of SD was 38.4%. Smoking (OR: 3.3 [IC95%: 1.0-10.6; p = 0.041] and arterial hypertension (OR: 2.2 [IC95%:1.1-4.4; p = 0.026] increased the risk of SD, while schooling higher than ten years (OR: 0.4 [IC95%: 0.2-0.8; p = 0.003] decreased it. Prevalence of SD increased with the change in the menopausal status (p <0,001). All domains deteriorated, except pain, with the transition to the postmenopausal status (p <0.001). Conclusion: In females of African descent from the Colombian Caribbean region, one third of the premenopausal and half of the postmenopausal have SD.

Problemas severos de vejiga: el principal síntoma menopáusico en indígenas zenúes colombianas / Severe bladder problems: main menopausal symptoms among zenues colombian indigenous women

Objetivo: Identificar el síntoma menopáusico severo más prevalente en mujeres indígenas en etapa de climaterio. Metodología: Se estudiaron mujeres zenúes del resguardo indígena de San Andrés de Sotavento, departamento de Córdoba, en el Caribe colombiano, en diferentes estados me-nopáusicos y entre 40-59 años de edad. Valoradas con "Menopause Rating Scale" (MRS). Resultados: En el estudio se incluyeron 693 mujeres, 295 premenopáusicas y 398 en posmenopausia. Edad promedio de última menstruación: 49.4+3.0. El dominio más deteriorado en las indígenas premenopáusicas fue el somático-vegetativo (2.9+1.6), influenciado por molestias músculo-articulares. En las posmenopáusicas, el más deteriorado fue el domino urogenital (5.5+3.0), por la alta prevalencia de problemas severos de vejiga. La manifestación severa más prevalente entre premenopáusicas fue la sequedad vaginal, junto a molestias músculo-articulares (10.8%), y en posmenopáusicas, los problemas de vejiga (60.3%). Tiene mala calidad de vida el 5.4% de las premenopáusicas y el 52.0% de las postmenopáusicas. Conclusiones: Las indígenas zenúes tienen elevada prevalencia de los síntomas que hacen parte del dominio urogenital, y son los que más influyen para deteriorar la calidad de vida. Las mujeres posmenopáusicas tienen peor calidad de vida y más prevalencia de problemas de vejiga.

Objective: To identify the most prevalent severe menopausal symptoms among indig-enous women in menopause stage. Methodology: Women Zenúes in the indigenous reserve of San Andres de Sotavento, Department of Córdoba, in the Colombian Caribbean, in different stages of menopause. Ages 40-59 years old were studied. Rated with "Menopause Rating Scale" (MRS). Results: 693 women were included in the study, 295 premenopausal and 398 postmeno-pausal. Average age of last menstrual period: 49.4 ± 3.0. The domain more impaired in premenopausal indigenous somatic-vegetative was (2.9 ± 1.6), influenced by muscle-joint discomfort. In postmenopausal women the most impaired domain was urogenital (5.5 + 3.0), the high prevalence of severe bladder problems. The severe occurrence was more prevalent among pre-menopausal vaginal dryness with muscle joint pains (10.8%) and postmenopausal bladder problems (60.3%). 5.4% of premenopausal and 52.0% of post-menopausal women 52.0% have a poor quality of life. Conclusions: Zenúes indigenous women have high prevalence of symptoms that are part of the urogenital domain and have the most influence to impair the quality of life. Post-menopausal women have worse quality of life and prevalence of bladder problems.

Cervical bronchogenic cyst mimicking thyroglossal cyst: case report and literature review.

BACKGROUND: Bronchogenic cysts are rare congenital malformations of ventral foregut development, often with an intrathoracic location. Presentation at the cervical region is very rare. CLINICAL CASE: We present the case of a 29-year-old female who demonstrated a 3-cm medial neck mass in relation to the hyoid cartilage. The mass was painless with a rubbery consistency, moving with tongue movements. Cervical ultrasonography and thyroid scan were suggestive of nonfunctioning thyroglossal cyst. Histopathological examination revealed the presence of a cervical bronchogenic cyst. CONCLUSIONS: Cervical bronchogenic cyst is a rare congenital malformation that usually appears as a painless neck mass. Imaging findings are not specific for differentiating thyroid, thyroglossal, branchial or thymus cyst; therefore, clinical observation of an asymptomatic lateral neck mass in an adult should include the possibility of a bronchogenic cyst in the differential diagnosis.

Carcinoma metaplásico de la mama tipo células escamosos: reporte de caso y revisión de la literatura / Squamous cell-type metaplastic breast carcinoma: case report and literature review

Introducción: el carcinoma metaplásico de la mama tipo células escamosas es una neoplasia maligna poco frecuente que representa un 0,04% de los carcinomas mamarios. Su diagnóstico clínico e imagenológico es complejo dado la similitud con lesiones benignas; sin embargo, su rápido crecimiento alerta sobre su comportamiento agresivo. Debido a los pocos casos en la literatura, no hay un consenso general sobre su diagnóstico y tratamiento. Se presenta un caso con el objetivo de hacer una revisión sobre el tema respecto al diagnóstico histopatológico y factores pronósticos. Caso clínico: se presenta el caso clínico de una paciente de 51 años, con una de masa de 6 cm en mama derecha, cuyos estudios ecográficos reportaron una probable lesión benigna (Breast Imaging Reporting and Data System - BIRADS III). El estudio histopatológico revela una lesión tumoral maligna constituida por células escamosas que tapizan espacios quísticos. Materiales y métodos: para la revisión de la literatura se exploró la base de datos PubMed, con el fin de buscar revisiones sistemáticas, presentación de casos clínicos, estudios clínicos y epidemiológicos con las palabras clave metaplastic breast carcinoma, metaplastic carcinoma, durante el período comprendido entre el 2000-2011. Conclusiones: histopatológicamente, el carcinoma metaplásico de células escamosas puede presentarse como una mezcla de adenocarcinoma con áreas dominantes de diferenciación escamosa, e incluso, en formas escamosas puras, representando plasticidad fenotípica del tumor. El sistema modificado de Scarf-Bloom-Richardson no es aplicable en esta lesión. Los factores pronósticos más importantes son la edad y el tamaño tumoral; sin embargo, algunos estudios consideran las metástasis nodales y el estado de los receptores.

Introduction: squamous cell-type metaplastic breast carcinoma is an unusual malign neoplasia, accounting for 0.04% of breast carcinomas. Its clinical and imagenologic diagnosis is complex, given its similarity with benign lesions; however, its rapid growth alerts doctors concerning its aggressive behavior. No general consensus was found about its diagnosis and treatment due to the few pertinent cases published to date in the literature. A case is presented, aimed at reviewing the topic regarding histopathological diagnosis and prognostic factors. Clinical case: a clinical case of a 51 year-old patient is presented; she had a 6 cm mass in her right breast and ecographic studies (Breast Imaging Reporting and Data System - BIRADS III) reported a probable benign lesion. The histopathological study revealed a malignant tumor consisting of squamous cells lining cystic spaces. Materials and methods: the PubMed database was explored for the literature review, seeking systematic reviews, presentations of clinical cases, clinical and epidemiological studies, using the key words: metaplastic breast carcinoma, metaplastic carcinoma and 2000-2011. Conclusions: histopathologically, metaplastic carcinoma of squamous cells could become presented as a mixture of adenocarcinoma having dominant areas of squamous differentiation and even pure squamous forms, representing the tumor’s phenotypical plasticity. The modified Scarff-Bloom-Richardson system was not applicable regarding this lesion. The most important prognostic factors were age and tumor size; however, some studies considered nodal metastasis and the state of the receptors.

Prolapso de trompa uterina: reporte de casos y revisión de la literatura / Fallopian tube prolapse: case reports and literature review

Objetivo: el prolapso de la trompa uterina constituye una complicación quirúrgica poco frecuente y habitualmente ocurre de manera secundaria a la histerectomía vaginal. Dicha patología constituye un reto diagnóstico dado el espectro de lesiones benignas y malignas a nivel del cuello uterino. El presente reporte de casos tiene como objetivo revisar la literatura respecto a la etiología, el diagnóstico y el tratamiento de la entidad. Materiales y métodos: se presentan tres casos de prolapso de trompa uterina, así como una revisión de la literatura, a través de una búsqueda electrónica en las bases de datos Medline vía PubMed, Hinari, SciELO y EMBASE, para recopilar información publicada, tanto en inglés como en español, de los últimos 5 años. Conclusión: el prolapso de trompa uterina poshisterectomía, ya sea vaginal o abdominal, es una complicación quirúrgica anómala. El diagnóstico definitivo se realiza por medio del estudio histopatológico, al evidenciar tejido tubárico asociado a un infiltrado inflamatorio. Para su tratamiento, diferentes técnicas quirúrgicas han sido propuestas con el objetivo de resecar, ya sea parcial o totalmente, la trompa prolapsada con reparo de la apertura vaginal.

Objective: fallopian tube prolapsed is a rare surgical complication, usually occurring secondary to vaginal hysterectomy. Such pathology forms a diagnostic challenge, given the spectrum of cervical benign and malign lesions. The present case reports were aimed at revising the literature regarding the pertinent etiology, diagnosis and treatment. Materials and methods: three cases of fallopian tube prolapse are presented, as well as a literature review involving a search of PubMed via Medline, Hinari, SciELO and EMBASE databases to compile relevant information published in both English and Spanish during the last 5 years. Conclusion: post-hysterectomy fallopian tube prolapse, whether vaginal or abdominal, is a rare surgical complication. Definitive diagnosis is made by histopathological study when tubal tissue associated with inflammatory infiltrate has been shown. Different surgical techniques have been proposed for its treatment aimed at partially or totally removing the prolapsed tube and repairing the vaginal opening.