Osteomalacia tumoral. Reporte de un caso y revisión de la literatura

Introducción La osteomalacia tumoral (OT) es un síndrome paraneoplásico poco frecuente caracterizado por una alteración en la tasa de reabsorción del fósforo a nivel renal, causado por la producción tumoral de la proteína fosfatúrica, llamada factor de crecimiento fibroblástico 23 (FGF-23). Las manifestaciones clínicas son consecuencia de los niveles bajos de fósforo sérico que llevan a dolor musculoesquelético y fracturas por fragilidad ósea. Usualmente se trata de un tumor de origen mesenquimal de pequeño tamaño que puede ser difícil de localizar, pero en los casos en los que se logra realizar la extirpación quirúrgica del mismo, los síntomas y las anomalías bioquímicas revierten rápidamente(1). Presentamos un caso de un paciente con un tumor de gran tamaño y una enfermedad de larga evolución, que tuvo un desenlace exitoso luego de la cirugía

Contribución al desarrollo social a través de la extensión universitaria

La Universidad Tecnológica de Pereira (UTP), a través de la Vicerrectoría de Investigaciones Innovación y Extensión, busca promover la extensión universitaria como una estrategia que permite el intercambio, la aplicación y la integración del conocimiento científico, tecnológico, artístico y cultural; al igual que la vinculación con la realidad social, cultural, económica y productiva de la región y del país, al darle valor a las capacidades institucionales y al generar una articulación e integración entre la docencia y la investigación, la cual permita la identificación de problemáticas y la propuesta de alternativas de solución; además de las oportunidades en el sector externo para realizar intervenciones y alianzas que conduzcan a fortalecer y aportar al desarrollo económico, cultural y el bienestar de la comunidad en general. En este sentido, para el año 2018 se ofertó, a los miembros de la comunidad universitaria, la «Convocatoria interna para la financiación de proyectos de extensión social, cultural y artístico» cuya ejecución se realizaría en el año 2019 y cuyo objetivo era fomentar el desarrollo de proyectos de carácter social, cultural, artístico, los cuales permitieran la solución y transformación de problemáticas que involucraran o beneficiaran sectores de diferentes comunidades. En esta convocatoria fueron financiados catorce proyectos que involucran a diferentes estamentos de la sociedad civil en torno al planteamiento y a la discusión de problemáticas, conflictos y sus posibles soluciones, así como a la identificación de oportunidades de progresos tecnológicos, ambientales, educativos o de creación artística, los cuales involucren o beneficien sectores de diferentes comunidades

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Características clínicas de pacientes con Virus de Inmunodeficiencia Humana. Hospital General Docente “Enrique Cabrera”

Introduction: The care of patients with Human Immunodeficiency Virus is currently carried out in a decentralized way in Cuba. The number of patients with HIV admitted to general hospitals is increasing.Objective: To determine the clinical characteristics of patients with HIV admitted to Enrique Cabrera General Teaching Hospital.Material and Methods: A descriptive retrospective study was carried out in patients with HIV admitted to Enrique Cabrera General Teaching Hospital from January 1st, 2007 to December 31st, 2013. The sample consisted of 86 cases. Results: The number of patients increased per year, male cases constituted 79 %, the most frequent age groups were from 21 to 30 years and from 41 to 50 years. Generalized adenopathies were the most frequent findings on physical examination. CD4 T- cell counts below 200 cells/mm3 predominated in the study. Respiratory pathologies constituted 25 % of the causes of admission. Hospital diagnosis was carried out in 36 % of the cases, 77 % of which had late diagnoses of HIV.Conclusions: HIV patients constitute a young population that is admitted more and more to secondary level hospitals.  They present own characteristics of the disease and pathologies that put their lives at risk.Keywords: HIV, AIDS, generalized adenopathies, CD4 T-cell count, hospital diagnoses, late diagnosis, AIDS case.Introducción: La atención de pacientes con VIH se realiza actualmente en Cuba de forma descentralizada; cada vez es mayor el número de casos ingresados en hospitales generales.Objetivo: Determinar características clínicas de pacientes con VIH ingresados en el Hospital General Docente “Enrique Cabrera”.Material y Métodos: Se realizó una investigación descriptiva retrospectiva de pacientes con VIH ingresados en el Hospital General Docente “Enrique Cabrera” en el período comprendido del 1RO de enero de 2007 hasta 31 de diciembre de 2013. La muestra estuvo constituida por 86 casos.Resultados: El número de pacientes se incrementó por años, los casos masculinos constituyeron 79%, los grupos de edad más frecuentes 21 a 30 y 41 a 50 años. Las adenopatías generalizadas fue el hallazgo al examen físico más frecuente. Predominó el conteo de T CD4 menor de 200 células/mm3. Las patologías respiratorias constituyeron 25% de las causas de ingreso. Se realizó el diagnostico hospitalario en 36% de los casos de los cuales el 77% eran diagnósticos tardíos de la enfermedad.Conclusiones: Los pacientes con VIH constituyen una población joven que ingresa cada vez más a nivel secundario hospitalario, con características propias de esta enfermedad y patologías que ponen en riesgo su vida.Palabras claves: VIH, SIDA, adenopatías generalizadas, conteo de T CD4, diagnóstico hospitalario, diagnóstico tardío, caso SIDA

Características clínico-epidemiológicas de los pacientes con el Virus de Inmunodeficiencia Humana. Boyeros. 2013

Introduction: Infection by AIDS has being a world and national health problem. Decentralization process of the attention of these patients make possible that every day more patients assist to secondary level hospitals to be treated. Objective: To characterize patients with AIDS infection in Boyeros municipality. Material and Methods: We were carried out a descriptive, cross-sectional study, of people with AIDS residents in Boyeros municipality up to December 31 2013. Demographic variables analyzed, were age, sex, occupation, AIDS markers illnesses, time of diagnosis, CD4 count and antiretroviral treatment. Results: The biggest number of cases are of masculine sex. Most affected age groups are 20 to 39 years old and of pre-university educational level. There are 30% of cases are unemployed persons. 80% of the cases have less than 10 years of been diagnosed, 76% were classified as AIDS with CD4 low count. More frequent AIDS illness was neurotoxoplasmosis. Zidovudina-Lamivudina-Nevirapina is the most antiretroviral treatment utilized. Conclusions: AIDS population in Boyeros is by majority masculine and young people. There is an important group of unemployed persons. The CD4 cells count is above 200 cells/mm3 and more than a half of cases have a suitable ARVT.  Keywords: Decentralization, HIV, AIDS, ARVT, CD4 count, Viral Load, Neurotoxoplasmosis.Introducción: La infección por el VIH continúa siendo un problema de salud mundial y nacional. El proceso de descentralización de la atención de estos pacientes hace que cada día sean más los que se atienden en hospitales de nivel secundario. Objetivo: Caracterizar los pacientes con infección por VIH en el municipio Boyeros. Material y Métodos: Se realizó un estudio descriptivo de corte transversal, de las personas con VIH residentes en el municipio Boyeros hasta el 31 de diciembre de 2013. Se analizaron variables demográficas como edad, sexo, escolaridad, ocupación, enfermedades marcadoras de sida, tiempo de diagnóstico, conteo de CD 4 y tratamiento antirretroviral. Resultados: El mayor número de casos son del sexo masculino, el grupo de edad más afectado es 20 a 39 años y predomina el nivel escolar preuniversitario (50 %). Existe 30 % de casos desocupados. El 80 % de los casos tienen menos de 10 años de diagnóstico, 76 % de los casos se clasificaron sida por conteo bajo de CD 4 y fue la neurotoxoplasmosis la enfermedad marcadora de sida más frecuente. El esquema Zidovudina- Lamivudina- Nevirapina  es el más utilizado. Conclusiones: La población VIH es mayoritaria masculina y joven con escolaridad preuniversitaria y un grupo importante sin vinculo laboral. Predomina tiempo de diagnóstico menor de 10 años, los casos con CD 4 por encima de 200 células/mm3 y más de la mitad de los casos tienen indicado TARV.Palabras clave: descentralización, VIH, sida, TARV, conteo de CD4, carga viral, neurotoxoplasmosis, Linfocitos

ENGIU: Encuentro Nacional de Grupos de Investigación de UNIMINUTO.

El desarrollo del prototipo para el sistema de detección de Mina Antipersona (MAP), inicia desde el semillero ADSSOF perteneciente al programa de Administración en Seguridad y Salud en el trabajo de la UNIMINUTO, se realiza a partir de un detector de metales que emite una señal audible, que el usuario puede interpretar como aviso de presencia de un objeto metálico, en este caso una MAP. La señal audible se interpreta como un dato, como ese dato no es perceptible a 5 metros de distancia, se implementa el transmisor de Frecuencia Modulada FM por la facilidad de modulación y la escogencia de frecuencia de transmisión de acuerdo con las normas y resolución del Ministerio de Comunicaciones; de manera que esta sea la plataforma base para enviar los datos obtenidos a una frecuencia establecida. La idea es que el ser humano no explore zonas peligrosas y buscar la forma de crear un sistema que permita eliminar ese riesgo, por otro lado, buscar la facilidad de uso de elementos ya disponibles en el mercado

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted