Anemia de Células Falciformes: Una revisión

La anemia hemolítica más frecuente en la población mundial es la anemia de células falciformes, con una incidencia de 1/600 recién nacidos en Estados Unidos y en España algunas regiones con incidencia de 1/5000 neonatos; en Colombia no hay registros con respecto a la incidencia y prevalencia.La transmisión de la ACF es autosómica dominante. Los  homocigotos (SS),  no sintetizan Hb A y poseen eritrocitos con un 90% de Hb S. El  portador o heterocigoto (AS) tiene hematíes con Hb A mayor al 50% y Hb S de 20 – 40% y son usualmente asintomáticos.La Hb S se debe a una mutación en el gen de la cadena beta de globina, lo que conlleva a la polimerización de la Hb en condiciones de baja oxigenación, originándose un cambio en la morfología del eritrocito adquiriendo la forma falciforme.La sintomatología es secundaria a la anemia hemolítica crónica, la vaso–oclusión en los diferentes órganos y la asplenia funcional la cual predispone a la infección. Otras manifestaciones asociadas son el secuestro esplénico, la aplasia eritroide y las complicaciones órgano – especificas, que disminuyen la calidad de vida y predisponen a mayor mortalidad.Su manejo debe realizarse en centros de referencia donde haya un manejo integral incluyendo el recurso humano y físico, ya que el manejo inadecuado y sus complicaciones disminuyen la sobrevida la cual no es superior a los 45 años según reportes

Apreciaciones sobre el uso y aplicación de la estadística en las ciencias de la salud

The statistics applied to health sciences should be a tool and not the object of study, so you want is that you get professional training in basic skills and can apply it to his scientific work. But often the researcher, usually one that ignores the particular theoretical statistical method incurs called statistical simplicity, which leads to inadequate, deficient or misleading analysis of the results obtained, thereby losing the ability to deliver conclusions relevant researchLa Estadística aplicada a las ciencias de la salud debe ser una herramienta y no el objeto de estudio, lo que se desea es que el profesional en formación obtenga las competencias básicas en ella y pueda aplicarlas a su trabajo científico. Pero es frecuente que el investigador, usualmente aquel que ignora las particularidades teóricas del método estadístico, incurra en el denominado simplismo estadístico, lo que conduce a un inadecuado, deficitario o equívoco análisis de los resultados obtenidos, perdiéndose de esa forma la posibilidad de entregar conclusiones relevantes de la investigación realizada.(DUAZARY 2013 No. 1, 62 - 66

Apreciaciones sobre el uso y aplicación de la estadística en las ciencias de la salud

The statistics applied to health sciences should be a tool and not the object of study, so you want is that you get professional training in basic skills and can apply it to his scientific work. But often the researcher, usually one that ignores the particular theoretical statistical method incurs called statistical simplicity, which leads to inadequate, deficient or misleading analysis of the results obtained, thereby losing the ability to deliver conclusions relevant researchLa Estadística aplicada a las ciencias de la salud debe ser una herramienta y no el objeto de estudio, lo que se desea es que el profesional en formación obtenga las competencias básicas en ella y pueda aplicarlas a su trabajo científico. Pero es frecuente que el investigador, usualmente aquel que ignora las particularidades teóricas del método estadístico, incurra en el denominado simplismo estadístico, lo que conduce a un inadecuado, deficitario o equívoco análisis de los resultados obtenidos, perdiéndose de esa forma la posibilidad de entregar conclusiones relevantes de la investigación realizada.(DUAZARY 2013 No. 1, 62 - 66

Glomerulonefritis primarias en niños que asisten a un Centro de Referencia en la Región Caribe colombiana

Introduction: Primary glomerulonephritis are diseases that affect the structure and function of the glomerulus. For proliferative glomerulopathies, it has been observed that for IgA and IgM mesangial GN, they are the ones that mostly evolve to end-stage renal failure, followed by membranous-proliferative or mesangiocapillar GN. The clinical manifestation of GN is the result of the combination of hematuria, proteinuria and the presence of acute or chronic renal failure.Material and methods: Medical records were reviewed. They were collected in a database of all biopsies performed from 2008 to 2014. An ?² was used to establish associations between variables (? = 95%). For the differences among proportions Student’s t or U-Mann-Whitney were used.Results: 146 (88%) patients who had complete data were selected. The mean age was 8 ± 4 years old for both sexes. No significant difference was found between gender by age (p? 0.05), nor was there an association between gender and age (p? 0.05). The predominant NGs with the highest prevalence were Proliferative Mesangial and IgA Nephropathy. NGs by Thin Basal Membrane, Nephropathy by C3 and Cq were not present in male patients. The most prevalent syndromic picture was the Nephrotic Syndrome (58%).Conclusions: The existence of this registry of renal biopsies is the basis for the creation of the Registry of Glomerulopathies in children in Colombia, whose data are necessary to establish programs for the treatment and prevention of glomerular diseases in our country in order to decrease its progression.Introducción:Las glomerulonefritis (GN) primarias son enfermedades que afectan a la estructura y función del glomérulo. Dentro de las glomerulopatías proliferativas se ha observado que la GN mesangial por IgA e IgM, son las que evolucionan con mayor frecuencia a la insuficiencia renal permanente; seguida de la GN membrano-proliferativa o mesangiocapilar. La presentación clínica de la GN incluye hematuria, proteinuria e insuficiencia renal aguda o crónica.Material y métodos: Se revisaron las historias clínicas y se acopiaron en una base de datos todas las biopsias realizadas entre los años 2008 a 2014. Se realizó un ?², para establecer las asociaciones entre variables (? = 95%) y para las diferencias entre proporciones se utilizó t de Studentó U- Mann-Whitney.Resultados: Se seleccionaron 146 pacientes (88% del total analizado) que tenían los datos completos. La edad promedio fue de 8±4 años para ambos sexos. No se encontraron diferencias significativasni asociaciones entre el sexo y la edad (p? 0,05). Las GN predominantes fueron las proliferativa mesangial y la nefropatía por IgA. Las GN por membrana basal delgada, nefropatía por C3 y C4 q no se presentaron en varones. La presentación clínica más frecuente fue el Síndrome Nefrótico (58%).Conclusiones: Los hallazgos de éste registro de biopsias renales podrían ser la base para la creación de un Registro de Glomerulopatías en niños en Colombia, instrumento necesario para establecer programas de tratamiento y prevención de las enfermedades glomerulares en nuestro país a fin de disminuir su progresión

Asociación de obesidad con la Enfermedad Renal Crónica de pacientes atendidos en la Clínica de la Costa. 2005-2014

Introduction: Obesity is a risk factor for the development and the progression of the Chronic Kidney Disease (CKD). In Latin America there are few studies where the stages of CKD and the degrees of obesity are related.Objective:The objective of the study is to evaluate the association of obesity with the chronic renal disease in patients seen in the extern consult of the department of Nephrology at the Clinic of the Coast in Barran-quilla, Colombia.Materials and Methods: A descriptive case series study was conducted. The sample consisted of 300 pa-tients collected in NefroRed©. Measurements of central tendency Y and X2were conducted to establish the association between degrees of obesity with CKD stages. Statistical analyseswere performed in R-CRAN. When the test was realized an association between degrees of obesity and the different stages of CKD was found [x2: 48.62; p-value <0.01].Conclusion: No statistical evidence of association was found between waist circumference and the stages of CKD [x2: 8.82; p-value ? 0.05]. There is an association between levels of obesity and the different stages of CKD. No relationship between waist circumference and the stages of CKD was found.Introducción: La obesidad es un factor de riesgo de desarrollo y progresión de enfermedad renal crónica (ERC). En Latinoamérica existen pocos estudios donde se relacionen los estadios de ERC y grados de obesidad.Objetivo: El objetivo de estudio es evaluar la asociación de obesidad con la enfermedad renal crónica de pacientes atendidos en la consulta externa del departamento de Nefrología en la Clínica de la Costa en Barranquilla, Colombia.Materiales y métodos: Se realizó un estudio observacional descriptivo tipo serie de casos. La muestra estuvo compuesta por 300 pacientes acopiados en NefroRed©. Se realizaron medidas de tendencia central y un ?² para establecer la asociación entre los grados de obesidad con los estadios de la ERC. Los análisis estadísticos se realizaron en R-CRAN. Al realizar la prueba, se encontró una asociación entre los grados de obesidad y los diferentes estadios de la ERC [?²: 48,62; p-valor < 0,01].Conclusión: No se encontró evidencia estadística de asociación entre el Perímetro Abdominal y los estadios de ERC [?²: 8,82; p-valor ? 0,05]. Existe asociación entre los grados de obesidad y los diferentes estadios de la ERC. No se encontró la relación entre perímetro abdominal y los estadios de ERC

Health Tourism Cluster: Global Context of this Model

Objetivo: Identificar información actualizada y amplia sobre los clústeres de turismo en salud, contemplando variables asociadas a estos complejos productivos. Metodología: Revisión bibliográfica en diversas bases de datos utilizando los términos: Health Cluster, Health Tourism Cluster, Tourism Cluster, Health Tourism, Medical Tourism, Health and Medical Tourism, Clúster de Turismo en Salud, Clúster de Turismo Medico, Clúster de Turismo, Clúster de Salud, Turismo en Salud, Turismo Médico. Se seleccionaron artículos y libros considerados como relevantes, con información sobre el área de la salud y bienestar y sobre los clústeres como complejos productivos a nivel mundial. Resultado: Se seleccionaron 35 referencias relevantes, asociadas a los clústeres de turismo médico/de salud. Y se organizaron en los capítulos Salud, Clúster, Turismo Médico y Turismo en Salud, Clúster de Turismo en Salud, Clústeres de Turismo en Salud alrededor del mundo, Ventajas y Desventajas, Aporte a la sociedad y economía e Innovación. Conclusiones: Los clústeres se perfilan cada día más como alternativa de crecimiento en los entornos económicos, específicamente el regional, puesto que este se mueve en zonas geográficas concéntricas, por lo que potencializar la estrategia, apostarle a la innovación, enfocarse en una estructura adecuada, poseer una visión futurista, y el trabajo mancomunado de los actores que intervienen en especial la triada academia estado empresa, hacen de este tipo de aglomeraciones una apuesta interesante que hace frente a los desafíos económicos.Objective: To identify the updates on information about health tourism clusters, contemplating variables associated with these productive complexes. Methodology: Bibliographic review in various data bases using the terms: Health Cluster, Health Tourism Cluster, Tourism Cluster, Health Tourism, Medical Tourism, Health and medical tourism, Clúster de Turismo en Salud, Clúster de Turismo Medico, Clúster de Turismo, Cluster de Salud, Turismo en Salud, Turismo Medico. Articles and books considered relevant were selected, and which contained information on the area of health and well-being and on clusters as productive complexes worldwide. Results: 35 relevant references were selected, associated with medical/health tourism clusters. They were organized in the chapters Health, Cluster, Medical Tourism and Health Tourism, Health Tourism Cluster, Health Tourism Clusters around the world, Advantages and Disadvantages, Contribution to society and Economy and Innovation. Conclusions: Clusters are emerging more as an alternative for development in economic environments, specifically the regional one, since it moves in concentric geographical areas. Strengthen the strategy, to bet on innovation, focus on an adequate structure, possessing a futuristic vision, and joint work of the actors that intervene especially the trio academia-state-company, make this type of agglomerations an interesting bet that faces economic challenges

Impact on the bacterial resistance of the previous revision of the prescription of antibiotics by the pharmaceutical service in hospitals of Atlántico (Colombia)

Objetivo: Determinar el impacto sobre la resistencia bacteriana de la revisión previa de la prescripción de antibióticos por parte del servicio farmacéutico en hospitales de mediana y alta complejidad del departamento del Atlántico (Colombia). Metodología: Se analizaron los valores de resistencia de bacterias Gram positivas, Enterobacterias y Gram negativos no fermentadores reportados en cinco institutos prestadores de salud (IPS) del departamento del Atlántico, en dos periodos (preintervención e intervención), de 12 meses cada uno, entre junio de 2015 y mayo de 2017. Resultados: Durante los dos periodos de estudio se identificaron 68 microorganismos en 8590 aislamientos microbiológicos provenientes de muestras de orina (40,3 %), sangre (21,7 %), tejidos (8,5 %) y otras (29,5 %). Los microorganismos aislados más frecuentemente fueron Escherichia coli (28,9 %), Staphylococcus coagulasa negativo (12,1%), Klebsiella pneumoniae (12,0 %), Pseudomonas aeruginosa (11,1 %) y Staphylococcus aureus (7,2 %). Durante los dos periodos la resistencia global osciló entre 27 y 40 %. Durante la Preintervención la resistencia osciló entre el 33 y el 39 %, mientras que durante la Intervención estuvo entre el 27 y 40 %. Al comparar los periodos de estudio solo hubo disminución significativa de la resistencia en los primeros nueve meses del periodo de intervención (p < 0.05). Conclusiones: Los valores de resistencia bacteriana reportados en el periodo de intervención fueron menores que en el periodo de preintervención. Se evidenció que la revisión previa de la prescripción por parte del servicio farmacéutico en las instituciones participantes influye en una disminución significativa de la resistencia bacteriana, pero que esta debe ser tanto continua como incremental.Objective: To determine the impact on bacterial resistance of the previous review of the prescription of antibiotics by the pharmaceutical service in medium and high complexity hospitals of the Department of Atlántico (Colombia). Methodology: Resistance values were analyzed for Gram-positive bacteria, Enterobacterial and non-fermenting Gram-negative bacteria reported in five health care institutions (IPS) of the Atlántico Department, in two periods (pre-intervention and intervention), of 12 months each between the months of June 2015 and May 2017. Results: During the two study periods, 68 microorganisms were identified in 8,590 microbiological isolates from urine samples (40.3 %), blood samples (21.7 %), tissues (8.5%) and others (29.5 %). The most frequently isolated microorganisms were Escherichia coli (28.9 %), Coagulase Negative Staphylococcus (12.1 %), Klebsiella pneumoniae (12.0 %), Pseudomonas aeruginosa (11.1 %) and S. aureus (7.2 %). During both periods the global resistance ranged between 27 and 40 %. During the Pre-intervention the resistance ranged between 33 and 39 %, while during the Intervention it was between 27 and 40 %. When comparing study periods, there was only significant decrease in resistance in the first nine months of the intervention period (p <0.05). Conclusions: the bacterial resistance values reported during the intervention period were lower than in the pre-intervention period. It was evidenced that the previous revision of the prescription by the pharmaceutical service in the participating institutions influences a significant decrease of the bacterial resistance; but that this must be both continuous and incremental

Optimizing dialysis dose in the context of frailty: an exploratory study

Introduction Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function, which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the degree of frailty in a population of adult patients on HD. Materials and methods A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina) was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility, physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman’s correlation and a logistic regression. Results CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional tests. However, a significant and inverse correlation between physical activity and CFS was documented (score − 1.41 (CI − 2.1 to − 0.7). Conclusion No significant correlation was documented between Kt/V value and different parameters of the frailty status, but this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients was significantly higher in older individuals, although young individuals were not exempt from it

Incidence and management of inguinodynia after inguinal plasty

Background: Hernia is defined as a defect of fascial and muscle-aponeurotic structures, allowing the protrusion of elements. The most frequent is inguinal region, prevailing in men 3:1 vs female. The most frequent complications are persistent chronic pain.Methods: A descriptive, prospective and cross-sectional study was performed in postoperative inguinal plasty patients, using a laparoscopic approach and open approach, the presence or absence of inguinodynia was studied using the visual analogue pain scale (VAS) and the Semmes-Weinstein monofilament, in addition to a systematic investigation in the following PubMed, Medline, Clinical Key and Index Medicus databases, with articles from July 2019 to April 2020.Results: Inguinodynia was present in laparoscopic surgery and open approach, 58 patients had inguinodynia at two weeks associated with the inflammatory response of the tissues and the presence of a foreign body (mesh), 77% of the patients with persistence of pain at 3 months reported mild pain (VAS 1-4), 21% moderate pain that did not limit their daily activities (VAS 5-8) and 2% of the patients reported severe pain which limited physical activity and effort   (VAS 9-10).Conclusions: Inguinodynia has an impact on hospital costs and quality life, we consider it is essential to domain the anatomical variants of the region. We propose an extensive follow-up of this group of patients, to make a comparison of diagnostic methods, as well as conservative management vs. modern techniques for pain control

Accurate masses and radii of normal stars: modern results and applications

This paper presents and discusses a critical compilation of accurate, fundamental determinations of stellar masses and radii. We have identified 95 detached binary systems containing 190 stars (94 eclipsing systems, and alpha Centauri) that satisfy our criterion that the mass and radius of both stars be known to 3% or better. To these we add interstellar reddening, effective temperature, metal abundance, rotational velocity and apsidal motion determinations when available, and we compute a number of other physical parameters, notably luminosity and distance. We discuss the use of this information for testing models of stellar evolution. The amount and quality of the data also allow us to analyse the tidal evolution of the systems in considerable depth, testing prescriptions of rotational synchronisation and orbital circularisation in greater detail than possible before. The new data also enable us to derive empirical calibrations of M and R for single (post-) main-sequence stars above 0.6 M(Sun). Simple, polynomial functions of T(eff), log g and [Fe/H] yield M and R with errors of 6% and 3%, respectively. Excellent agreement is found with independent determinations for host stars of transiting extrasolar planets, and good agreement with determinations of M and R from stellar models as constrained by trigonometric parallaxes and spectroscopic values of T(eff) and [Fe/H]. Finally, we list a set of 23 interferometric binaries with masses known to better than 3%, but without fundamental radius determinations (except alpha Aur). We discuss the prospects for improving these and other stellar parameters in the near future.Comment: 56 pages including figures and tables. To appear in The Astronomy and Astrophysics Review. Ascii versions of the tables will appear in the online version of the articl