Leucoencefalopatia tóxica por inhalación de heroína "Chasing the Dragon": serie de casos / Toxic Leukoencephalopathy by inhaling heroin "Chasing the Dragon": case series

RESUMEN INTRODUCCIÓN: La leucoencefalopatia tóxica es una afección que compromete la sustancia blanca por exposición a sustancias tóxicas. La heroina es una de las implicadas en el desarrollo de la leucoencefalopatia con diferencias exclusivas que suceden con la inhalación según las diversas técnicas en comparación al uso intravenoso, bien sea de la heroína o de otras sustancias psicoactivas. En esta serie describimos cinco casos, de sexo masculino, que desarrollaron leucoencefalopatia espongiforme por heroína (LEH) posterior a la inhalación de vapores, en un hospital del sistema de salud público en la ciudad de Armenia, Colombia. OBJETIVO: El objetivo de este estudio es describir las características demográficas, clínicas, hallazgos de laboratorio e imágenes diagnósticas, así como la mortalidad asociada a LEH en la muestra estudiada. MÉTODOS: Recolección de datos de historias clinicas y búsqueda de imágenes registradas en el Hospital San Juan de Dios de Armenia durante el periodo 2017-2018. RESULTADOS: Se obtienen cinco casos clínicos de pacientes usuarios de vapores inhalados de heroina, quienes ingresan con signos neurológicos de predominio motores y extrapiramidales, con el signo radiológico clásico de "Chasing the Dragon" en estudios de TC cerebral simple en todos los casos. De los cinco casos se presenta un deceso, determinando una mortalidad de 20% comparado con un 25% de mortalidad reportado en la literatura. CONCLUSIONES: La LEH suele estar subdiagnosticada dado que suele confundirse con un trastorno neuropsiquiatríco o de la conducta asociada al consumo de sustancias psicoactivas (SPA), el diagnóstico se realizó con los hallazgos típicos en las imágenes de TC cerebral simple. Se debe tener en cuenta las estadísticas sobre consumo de heroína a la hora de realizar el abordaje de un paciente con historial de consumo de SPA y los signos neurológicos para relacionarlos con esta etiologia y dar un manejo integral a estos pacientes.

ABSTRACT IlNTRODUCTION: Toxic leukoencephalopathy is a condition that compromises the encephalic white matter due to exposure to toxic substances. Heroin is one of those involved in the development of leukoencephalopathy and there are certain differences that occur with its inhalation with the different techniques compared to intravenous use, either heroin or other psychoactive substances. In this serie, we describe five cases of male sex who developed heroin spongiform leukoencephalopathy (HSLE) after inhalation of vapors, in a Hospital of the public health system in the city of Armenia, Colombia. OBJECTIVES: The objective of this study is to describe the demographic and clinical characteristics, laboratory findings and diagnostic images, as well as the mortality associated with HSLE in the sample studied. METHODS: Collection of data from medical records and search of images registered at the San Juan de Dios Hospital in Armenia during the period 2017-2018. RESULTS: Five clinical cases were obtained of patients who were users of inhaled heroin vapors and were admitted to the hospital with predominantly motor and extrapyramidal neurological signs, with simple brain CT studies showing the classic radiological sign of "Chasing the Dragon" in all five cases. One death was presented, with a mortality of 20% compared to the 25% mortality that has been reported in the scientific literature. CONCLUSIONS: HSLE is usually underdiagnosed since it is often confused with a neuropsychiatric or behavioral disorder associated with the consumption of psychoactive substances (PAS). The diagnosis was made with the typical findings in simple brain CT images. Statistics on heroin use must be considered when approaching a patient with a history of PAS use and neurological signs, to relate them to this etiology and provide comprehensive management to these patients.

High frequency of ocular toxoplasmosis in Quindío, Colombia and risk factors related to the infection.

OBJECTIVES: To determine the frequency of retinochoroidal lesions by ocular toxoplasmosis and their relationships with risk factors, in residents of two districts with high exposure to Toxoplasma, in Armenia-Quindío, Colombia. METHODS: Cross-sectional analyses of fundoscopy screening, serological tests, and questionnaires were performed to determine risk factors associated with ocular toxoplasmosis retinochoroidal lesions. Differences in proportions were analyzed using the chi-squared test. RESULTS: Of 161 individuals examined, 17 (10.5%) exhibited retinochoroidal scars suggestive of old inactive Toxoplasma gondii infection. All 17 individuals were seropositive for T. gondii antibodies. Consumption of bottled water was protective against T. gondii infection among individuals in this study. There were no specific epidemiological risk factors associated with ocular toxoplasmosis retinochoroidal lesions. CONCLUSION: Ocular toxoplasmosis is an important cause of visual impairment in Armenia-Quindío, Colombia. The consumption of boiled or bottled water is a major preventive public health measure to reduce infection by T. gondii and the subsequent onset of OT.

Desregulación emocional y conducta disocial en una muestra de adolescentes en conflicto con la ley / Emotional Dysregulation and Dissocial Behavior in a Sample of Adolescents in Conflict with the Law / Desregulação emocional e conduta dissocial numa mostra de adolescentes em conflito com a lei

Resumen Objetivo. Establecer el grado de relación entre la desregulación emocional y la conducta antisocial y delictiva en adolescentes que se encuentran en conflicto con la ley. Método. Diseño no experimental, enfoque cuantitativo, con alcance descriptivo-correlacional de temporalidad transversal. Participaron 62 adolescentes en conflicto con la ley. Se implementaron la ficha de caracterización MINI KID y la Escala de Desregulación Emocional (DERS-E). Resultados. El 54.8% de los adolescentes reportaron problemas de conducta. Según los hallazgos, la desatención emocional es diferente entre las personas con trastorno disocial y las que no lo presentan (t =4.853, p =0.031). La desatención emocional predice la aparición de trastorno disocial (β =0.030, p= 0.05, Exp(β)= 1.362). Conclusión. Los datos dan cuenta de la importancia de la revisión teórica de la conducta antisocial y de los factores asociados a ella, para establecer mejores modelos de intervención y de comprensión del fenómeno, principalmente la influencia de la regulación emocional en la aparición de la conducta disocial en adolescentes.

Abstract Objective. To establish the degree of relationship between emotional dysregulation and antisocial and criminal behavior in adolescents who conflict with the law. Method. Non-experimental design, quantitative approach, with descriptive scope - correlation of transversal temporality. Sixty-two adolescents in conflict with the law participated. The instruments used were the Characterization Sheet, MINI KID and Emotional Deregulation Scale (DERS-E). Results. 54.8% of adolescents reported behavioral problems. Emotional neglect is different between people with antisocial personality disorder and those who do not have it (t = 4.853, p = 0.031). Emotional neglect predicts the onset of antisocial personality disorder (A = 0.030, p = 0.05; Exp(-) = 1,362). Conclusion. The data showed the importance of the theoretical review of antisocial behavior and the factors associated with it in order to establish better models of intervention and understanding of the phenomenon, mainly the influence of emotional regulation on the onset of dissocial behaviour in adolescents.

Resumo Escopo. Estabelecer o grau de relação entre a desregulação emocional e a conduta antissocial e delitiva em adolescentes que estão em conflito com a lei. Metodologia. Desenho não experimental, enfoque quantitativo, com alcance descritivo-correlacional de temporalidade transversal. Participaram 62 adolescentes em conflito com a lei. Foi implementada a ficha de caracterização MINI KID e a escada de Desregulação Emocional (DERS-E). Resultados. O 54.8% dos adolescentes reportaram problemas de conduta. Segundo os achados, a desatenção emocional é diferente entre as pessoas com transtorno dissocial e as que não a presentam (t= 4.853, p= 0.031). A desatenção emocional prediz a aparição de transtorno dissocial (β = 0.030, p= 0.05, Exp(β) = 1.362). Conclusão. Os dados dão conta da importância da revisão teórica da conduta antissocial e dos fatores associados a ela, para estabelecer melhores modelos de intervenção e de compreensão do fenómeno, principalmente a influencia da regulação emocional na aparição da conduta dissocial em adolescentes.

Microcirculatory blood flow derangements during severe preeclampsia and HELLP syndrome.

OBJECTIVE: To evaluate the microcirculatory blood flow in severe preeclampsia and compare it with healthy pregnant and non-pregnant women controls, using a portable intravital-microscopy technique. METHODS: Using a side-stream dark field (SDF) device, we prospectively evaluated the sublingual microcirculatory blood flow before placental delivery in 40 women with severe preeclampsia (PE-group) complicated (n=8) or not (n=32) with HELLP syndrome, 40 healthy pregnant women (HP-group) matched by gestational and chronological age, and 20 healthy non-pregnant women (NP-group). Microvessels were classified as large or small using a cutoff value of 20µm and those with continuous flow were considered as normal while sluggish, intermittent and stopped flows were considered as abnormal. We computed the proportion of well-perfused small vessels (PPV), and total and functional capillary densities (TCD and FCD) were calculated according to the total number and quantity of well-perfused small vessels per area unit, respectively. RESULTS: Total capillary densities were significantly higher in all pregnant women when compared to non-pregnant controls. The PE-group exhibited, however, significantly lower TCD compared with the HP-group. Meanwhile, significant decreases in PPV and FCD were observed in the PE-group, with deeper alterations in those with coexisting HELLP syndrome. These altered PPVs were significant although incompletely reversed after placental delivery in pregnancies complicated by HELLP syndrome, while capillary densities remained unaltered at least during very early post-delivery period. CONCLUSIONS: Substantial distributive microcirculatory blood flow alterations and restricted capillary densities are observed in preeclampsia, suggesting a key role for microvascular dysfunction in the pathophysiology of this condition.

Effects of dobutamine on intestinal microvascular blood flow heterogeneity and O2 extraction during septic shock.

Derangements of microvascular blood flow distribution might contribute to disturbing O2 extraction by peripheral tissues. We evaluated the dynamic relationships between the mesenteric O2 extraction ratio ([Formula: see text]) and the heterogeneity of microvascular blood flow at the gut and sublingual mucosa during the development and resuscitation of septic shock in a swine model of fecal peritonitis. Jejunal-villi and sublingual microcirculation were evaluated using a portable intravital-microscopy technique. Simultaneously, we obtained arterial, mixed-venous, and mesenteric blood gases, and jejunal-tonometric measurements. During resuscitation, pigs were randomly allocated to a fixed dose of dobutamine (5 µg·kg-1·min-1) or placebo while three sham models with identical monitoring served as controls. At the time of shock, we observed a significant decreased proportion of perfused intestinal-villi (villi-PPV) and sublingual percentage of perfused small vessels (SL-PPV), paralleling an increase in [Formula: see text] in both dobutamine and placebo groups. After starting resuscitation, villi-PPV and SL-PPV significantly increased in the dobutamine group with subsequent improvement of functional capillary density, whereas [Formula: see text] exhibited a corresponding significant decrease (repeated-measures ANOVA, P = 0.02 and P = 0.04 for time × group interactions and intergroup differences for villi-PPV and [Formula: see text], respectively). Variations in villi-PPV were paralleled by variations in [Formula: see text] (R2 = 0.88, P < 0.001) and these, in turn, by mesenteric lactate changes (R2 = 0.86, P < 0.001). There were no significant differences in cardiac output and systemic O2 delivery throughout the experiment. In conclusion, dynamic changes in microvascular blood flow heterogeneity at jejunal mucosa are closely related to the mesenteric O2 extraction ratio, suggesting a crucial role for microvascular blood flow distribution on O2 uptake during development and resuscitation from septic shock.NEW & NOTEWORTHY Our observations suggest that dynamic changes in the heterogeneity of microvascular blood flow at the gut mucosa are closely related to mesenteric O2 extraction, thus supporting the role of decreasing functional capillary density and increased intercapillary distances on alterations of O2 uptake during development and resuscitation from septic shock. Addition of a low-fixed dose of dobutamine might reverse such flow heterogeneity, improving microcirculatory flow distribution and tissue O2 consumption.

Tumors of the coracoid process: clinical evaluation of twenty-one patients.

OBJECTIVE: We present the incidence and management of bone tumors of the coracoid process and discuss the related clinical and imaging findings and treatment. MATERIALS AND METHODS: We present 21 patients (7 males and 14 females; mean age, 39 years) treated for bone tumors of the coracoid process from 1900 to 2010. Mean follow-up was 44 months (range, 12-132 months). Clinical presentation, imaging, surgical treatment, complications, range of shoulder motion, and Musculoskeletal Tumor Society (MSTS) function were evaluated. RESULTS: Bone tumors were benign in 7 (33%) and malignant in 14 (67%). The most common were chondrosarcomas, osteoblastomas, and chondroblastomas. The most common presentation was pain and palpable mass for a mean duration of 11 months. Limb salvage, with or without megaprosthetic reconstruction, was achieved in 20 patients. One patient required forequarter amputation. One patient with chondroblastoma and 2 with chondrosarcoma had local recurrence. The range of shoulder motion varied according to the type of resection: patients with curettage and limited resections without involvement of the abductor mechanism had better shoulder motion, and patients with scapulectomy and proximal humeral resections had significant limitations of motion. The mean MSTS score was 80% (range, 50%-100%). CONCLUSIONS: Chondrosarcomas, osteoblastomas, and chondroblastomas are the most common bone tumors of the coracoid process. Limited resections are associated with nearly normal range of motion and excellent function; however, limited resections are acceptable in only in a small number of patients. In patients with malignant and recurrent lesions, wide resection is required, which is associated with significant limitations of shoulder function.

Depuración mucociliar y macrófagos alveorales en infección pulmonar: el papel modulador de la ciprofloxacina / Alveorales mucociliary clearance and macrophage in lung infection: the role of ciprofloxacin modulator

La depuración mucuciliar es uno de los principales mecanismos operantes de los pulmones para la limpieza del material inhalado que se deposita en ellos y para los detritus biológicos localmente producidos. Este proceso de depuración se deprime durante las infecciones respiratorias agudas, como resultado de los cambios en la viscosidad del mucus, la disminución en la frecuencia del movimiento ciliar, el daño epitelial, y la liberación de elastasa leucocitaria humana. Con una gama de antibioticos se han notado efectos adversos en la actividad ciliar, que van desde leves hasta los mas severos. Sin embargo, los resultados preliminares con la ciprofloxacina, sugieren que este agente antimicrobiano no afecta el movimiento ni la coordinación de las cilias en los explantes bronquiales humanos in vitro. Se están realizando estudios in vivo. Los macrófagos alveolares facilitan las respuestas inmunes protectoras contra los patógenos micribianos en el pulmón; pueden activarse específicamente contra bacterias particulares. La ciprofloxacina ha mostrado que se concentra en la mucosa bronquial y en los macrófagos, este es un hallazgo que es particularmente importante a la luz de los descubrimientos porque algunos patógenos intracelulares proliferan dentro de los macrófagos. La ciprofloxacina ha demostrado poseer actividad bactericida intramacrofagica contra una variedad de organismos, y además puede modificar las bacterias de tal manera que facilita su fagocitación, por los leucocitos polimorfonucleares. Se concluye que los efectos de la ciprofloxacina sobre la función ciliar y los macrófagos, son de importancia clínica, y ofrecen apoyo al uso de este antibiótico contra una amplia gama de patógenos broncopulmonares...