Manifestaciones cardiovasculares y síndrome compartimental asociado a mordedura por Phoneutria spp: Reporte de un caso / Cardiovascular manifestations and compartment syndrome associated with bite by Phoneutria spp: case report / Manifestações cardiovasculares e síndrome compartimental associadas à mordida de Phoneutria spp: Relato de caso

Se describen las características sobre el phoneutrismo a propósito de un caso. El phoneutrismo es el término con el que se conoce al accidente ocasionado por la mordedura de la araña phoneutria spp, la cual tiene una relevancia clínica dada por las características tóxicas de su veneno. Se presenta un caso de mordedura de la araña phoneutria spp de un paciente atendido en un hospital de alta complejidad de la ciudad de Medellín, Colombia, con manifestaciones cardiovasculares y hallazgos compatibles con un síndrome compartimental, lo cual es inusual en este tipo de arañas, por lo que se necesitó vigilancia en unidad de alta dependencia y fasciotomía cutánea. En Colombia este tipo de accidentes no son de reporte obligatorio, por tanto existe un alto riesgo de subregistro. Lo llamativo de este caso está en las manifestaciones cardiovasculares y la presencia de síndrome compartimental que no se ha descrito en la literatura con este subespecie de arañas.

The characteristics of phoneutrism are described in relation to a case. Phoneutrism is the term with which the accident caused by the bite of the phoneutria spp spider is known, which has clinical relevance given by the toxic characteristics of its venom. We present a case of a bite by the phoneutria spp spider in a patient treated at a high-complexity hospital in the city of Medellín, Colombia, with cardiovascular manifestations and findings compatible with compartment syndrome, which is unusual in this type of spiders, and required surveillance in a high dependency unit and cutaneous fasciotomy. In Colombia reporting this type of accident is not mandatory; therefore, there is a high risk of underreporting. What is striking about this case is the cardiovascular manifestations and the presence of compartment syndrome that has not been described in the literatura with this genre of spiders.

As características do fonutrismo são descritas em um relatório de um caso. Fonutrismo é o termo usado para descrever o acidente causado pela mordida da aranha Phoneutria spp, que é clinicamente relevante devido às características tóxicas de seu veneno. Apresentamos um caso de mordida de aranha por uma aranha Phoneutria em um paciente tratado em um hospital de alta complexidade na cidade de Medellín, Colômbia, com manifestações cardiovasculares e achados compatíveis com a síndrome compartimental, o que é incomum neste tipo de aranha, exigindo vigilância em uma unidade de alta de-pendência e fasciotomia cutânea. Na Colômbia, este tipo de acidente não é obrigatório, portanto, há um alto risco de subnotificação. O que é impressionante neste caso são as manifestações cardiovasculares e a presença da síndrome compartimental, que não foi descrita na literatura com esta subespécie de aranha.

Lesión renal aguda y nefritis intersticial aguda debido a picadura por escorpión: reporte de caso / Acute kidney injury and acute interstitial nephritis due to scorpion sting: a case report / Lesão renal aguda e nefrite intersticial aguda devido a picadura por escorpião: reporte de caso

El envenenamiento debido a picadora de escorpiones es reportado en diferentes países de Suramérica, en algunos, como México, es un problema de salud pública. En Colombia el accidente por escorpiones no es de reporte obligatorio, por lo que hay subregistro de casos. Los accidentes por este tipo de animales ponzoñosos se asocian a manifestaciones locales, y en casos de gravedad moderada a severa, a problemas cardiovasculares y neurológicos. Sin embargo, es importante reconocer manifestaciones que, aunque reportadas con menos frecuencia, implican gran morbilidad, como la pancreatitis y las alteraciones renales, entre las que está la nefritis. Se reporta el caso de un varón de 46 años, que presentó un accidente por Tytus, con nefritis intersticial. Este es el primer reporte de esta complicación en Colombia. Nuestro objetivo principal es resaltar la importancia de una pronta identificación de casos y un oportuno inicio del tratamiento por parte del personal de la salud, que permitan disminuir la morbilidad y mortalidad de estos pacientes.

Scorpion poisoning is reported in different countries in South America, especially in Mexico, where it has become a public health issue. In Colombia this type of accident is not mandatory to report, therefore, there is underreporting of cases. Accidents caused by these poisonous animals are mainly associated with local manifestations and, in cases of moderate to severe severity, to cardiovascular and neurological problems. Nevertheless, it is important to recognize other manifestations which, despite being reported less frequently, are associated with high morbidity such as pancreatitis and renal alterations, among which is nephritis. The case of a 46-year-old male patient is reported, who had an accident due to Tytus and presented interstitial nephritis. This is the first report of this complication in Colombia, and based on this, the main objective is to highlight the importance of prompt identification and treatment by health personnel, in order to reduce morbidity and mortality in these patients.

O envenenamento devido a picadora de escorpiões é reportado em diferentes países da América Latina, em alguns, como México, é um problema de saúde pública. Na Colômbiao acidente por escorpiões não é de reporte obrigatório, porque há sub-registro de casos. Os acidentes por este tipo de animais peçonhentos se associam a manifestações locais, e em casos de gravidade moderada a severa, a problemas cardiovasculares e neurológicos. Entretanto, é importante reconhecer manifestações que, embora reportadas com menos frequência, implicam grande morbilidade, como a pancreatite e as alterações renais, entre as que está a nefrite. Se reporta o caso de um homem de 46 anos, que apresentou um acidente por Tytus, com nefrite intersticial. Este é o primeiro reporte desta complicação na Colômbia. Nosso objetivo principal é ressaltar a importância de uma breve identificação de casos e um oportuno início do tratamento por parte do pessoal da saúde, que permitam diminuir a morbilidade e mortalidade destes pacientes.

Analysis of blood markers for early breast cancer diagnosis.

PURPOSE: Breast cancer is the most common neoplasm in women and has the highest associated mortality rate. Rapid detection programmes can provide early diagnosis and increase the chances of survival. There are no specific tumor biomarkers for the early phase of the disease. The primary aim of this study was to search a blood biomarker with levels that exceeded the normal range established in the general population that could be used to screen breast cancer. METHODS/PATIENTS: Case-control study. Conventional as well as research (NGAL, EGFR and 8-OHdG) tumor biomarkers were analyzed. RESULTS: A total of 126 women were enrolled (cases: 63 patients with local breast cancer; Controls: 63 healthy women). Significant differences were found in patients with higher levels of the conventional markers, Ca15.3, CEA, Cyfra 21.1 and NSE. However, when commercial cut-off values were used, only Ca 15.13 was significant. In the group of research biomarkers, significantly higher levels of EGFR were found in the control group, and of 8-OHdG in the case group. Using logistic regression analysis and a ROC curve, an equation composed of five markers, Ca 15.3, NSE, NGAL, EGFR and 8-OHdG, which yielded a correct diagnostic probability of breast cancer of 91.8% was obtained. CONCLUSIONS: 8-OHdG has been identified as a new potential marker for screening early stage breast cancer. In addition, a model that combines five blood markers that can be used as a diagnostic test in certain groups of patients has been developed. New studies with a larger sample size are needed to verify the results obtained.

STABILITY OF ANTHOCYANINS FROM Rubus glaucus AND Solanum betaceum Cav.dark-red strain AS AFFECTED BY TEMPERATURE, STORAGE AND WATER ACTIVITY / Efecto de la temperatura, almacenamiento y la actividad de agua sobre la estabilidad de antocianinas de Rubus glaucus y Solanum betaceum Cav.dark-red strain

The stability of sprayed-dried microencapsulated anthocyanins from Andes berry (Rubus glaucus) and Tamarillo (Solanum betaceum), as affected by storage time, water activity (Aw) and temperature was compared. The fruits were osmotically dehydrated with ethanol and the anthocyanin extract was microencapsulated with maltodextrin DE 20 by spray drying. Half life of the anthocyanins; changes in color, total phenolics, and antioxidant activity of the powders, were analyzed during storage at two different temperatures ( 25 °C and 40 °C) and two Aw levels (0.20 and 0.35). A decrease in monomeric anthocyanin was observed in both samples. The half life of the Andes berry pigments ranged between 11 and 32 days while the half life of the tamarillo pigments ranged between 9 and 21 days. A darkening effect occurred in both samples as a result of storage time. The antioxidant activity decreased while the phenolic content increased with time. Antioxidant activity of Andes berry samples was highly correlated with anthocyanin content and total phenolic content while the antioxidant activity of tamarillo samples was highly correlated with total phenolic content. These results would be useful in developing applications for spray-dried anthocyanins as powdered food-grade colorants.

Se comparó el efecto del tiempo de almacenamiento, la temperatura y la actividad de agua (Aw) sobre la estabilidad de antocianinas microencapsuladas de Mora de Castilla (Rubus glaucus) y tamarillo (Solanum betaceum). Las frutas se sometieron a deshidratación osmótica con etanol y el extracto antociánico se microencapsuló con maltodextrina ED 20 por atomización. La vida media de las antocianinas; los cambios en color, fenoles totales y actividad antioxidante se analizaron durante el almacenamiento a dos temperaturas ( 25 °C y 40 °C) y dos niveles de Aw (0,20 y 0,35). Se observó una disminución de la antocianina monomérica en las dos muestras. La vida media de los pigmentos de mora de Castilla varió entre 11 y 32 días, mientras que la vida media de los pigmentos del tamarillo varió entre 9 y 21 días. Hubo oscurecimiento de las muestras como resultado del tiempo de almacenamiento. La actividad antioxidante de las dos muestras dismi-nuyó, mientras que el contenido fenólico aumentó con el tiempo. La actividad antioxi-dante de las muestras de mora de Castilla presentó una alta correlación con los con-tenidos de antocianinas y fenoles totales mientras que la actividad antioxidante de las muestras de tamarillo se correlacionó con el contenido de fenoles totales. Estos resultados son útiles en el desarrollo de aplicaciones de antocianinas microencapsu-ladas como colorantes alimenticios.

Creation of a three-dimensional model of the mandible and the TMJ in vivo by means of the finite element method.

The aim of this study was to develop a three-dimensional finite element model of the mandible, including its TMJ. The model consisted of 7942 nodes and 41,010 elements, which were obtained from a convergence test, done to minimize the result error. It included cancellous and cortical bone, periodontal ligament, masticatory muscles (masseters, temporalis, lateral and internal pterygoids), teeth and the articular disk. All characteristics such as dental, mandibular, and muscle geometry were obtained from a computerized tomography (CT) of a living person. CT sections were scanned and digitized with a CAD software program. After images were adequately assembled, a vertical tracing was done which allowed the definition of a three-dimensional mesh. Modeling of teeth was carried out independently and the periodontal ligament was later included, limiting the alveolar area. Muscles were modeled based on flat-scale photographs and total muscle force was distributed in multiple vectors. The articular disk was generated having 2 mm of thickness with the combination of spring-type (axial stiffness) and gap-type (contact) elements. The model was then analyzed with finite element method (FEM) software where a mesh was generated and values for Poisson's ratio, elasticity, and shear modulus were assigned. These were orthotropic for cancellous and cortical bone, and isotropic for dentin, periodontal ligament, articular disk, and temporal bone. The boundary conditions were defined restricting the nodes on the periphery of the temporal bone. It was therefore possible to generate a three-dimensional finite element model based on information obtained in vivo.

Clinical and programmatic mismanagement rather than community outbreak as the cause of chronic, drug-resistant tuberculosis in Buenaventura, Colombia, 1998.

SETTING: Buenaventura, Colombia. OBJECTIVE: To assess whether antituberculosis drug resistance was generated by poor management or community transmission. DESIGN: Treatment-failure and new tuberculosis (TB) patients identified between May 1997 and June 1998 were interviewed and their treatment histories reviewed. Bacteriologic testing, including drug susceptibility profiles (DSP) and DNA fingerprinting by restriction fragment length polymorphism (RFLP), was performed and human immunodeficiency virus (HIV) testing was offered. RESULTS: DSP and RFLP fingerprints were obtained for isolates from 34 of 64 treatment-failure patients; 25 (74%) were resistant to > or = one drug. Fifteen of the 25 patients consented to HIV testing; none were positive. An average of 2.8 major treatment errors per patient was identified. RFLP from the treatment-failure patients revealed 20 unique isolates and six clusters (isolates with identical RFLP); 4/6 clusters contained isolates with different DSP. Analysis of the RFLP from both treatment-failure and new patients revealed that 44/111 (40%) isolates formed 18 clusters. Four of 47 (9%) new patients had multidrug-resistant TB (MDR-TB). Eleven isolates belonged to the Beijing family, related to the MDR strain W. CONCLUSION: Drug resistance in Buenaventura results from both poor management and community transmission. Dependence on DSP to identify TB transmission is inadequate when programmatic mismanagement is common.

Prevalencia de coronariopatia en pacientes con enfermedad valvular. Clínica Cardiovascular Santa María. Medellín 1988-1993 / Prevalence in coronary findings in patients suffering from valvular disease in the Santamaria Cardiovascular Clinic. 1993 – 1994

Estudio descriptivo retrospectivo, para descubrir los hallazgos coronariográficos de 228 pacientes con enfermedad valvular, en la Clínica Cardiovascular Santa María de Medellín, durante el período de 1988 a 1993. El objetivo fue determinar el patrón de presentación de enfermedad coronaria en pacientes con enfermedad valvular en la población colombiana, para definir los criterios del uso de la arteriografía coronaria. Se encontró una prevalencia de enfermedad coronaria en un 22.8 por ciento, con límite de confianza de 95 por ciento. Se encontró una incidencia de enfermedad coronaria de 1,8 por ciento en pacientes menores de 45 años. La estenosis aórtica estuvo presente en un 21,5 por ciento de los pacientes, siendo ésta la valvulopatía más frecuente. El 30,6 por ciento de los pacientes menores de 45 años. La estenosis aórtica estuvo presente en un 21,5 por ciento de los pacientes, siendo esta la valvulopatía más frecuente. El 30,6 por ciento de los pacientes con estenosis aórtica presentó enfermedad coronaria y el 7,1 por ciento de los pacientes con estenosis mitral presentó enfermedad coronaria...

Enfermedad de Hansen, córnea y anejos oculares

Examinamos 37 pacientes diagnosticados de lepra estudiando sus alteraciones en anejos y córnea. De ellos eran formas lepromatosas, 2 borderline lepromatosas, 2 borderline tuberculoide y 2 tuberculoides. La mayor parte se encontraban entre la 6ª y 7ª década. En 6 casos no encontramos lesiones de ningún tipo. En los restantes observamos una disminución de la agudeza visual directemante relacionada con la duración de la enfermedad. el hallazgo más frecuente fue la madarosis supraciliar, seguido de la falta parcial de pestañas y madarosis. Debilidad del orbicular y/o lagoftalmos encontramos en 6 casos. La opacidades debidas a queratopatías leprosas típicas, queratopatía "en banda", por oxposición pannus y lepromas corneales, fueron los hallazgos corneales más frecuentes. La presencia de neovascularización fue detectada en 5 pacientes. Concluimos destacando la importancia del estudio de la lepra en oftalmología.