Clinico-pathological conference (CPC): Patient with congenital heart malformation and infective endocarditis

RESUMEN: Se presenta el caso de un hombre de 17 años, sin antecedentes de importancia, quien consultó por deterioro de su clase funcional, fatigabilidad y disnea, de un mes de evolución, además de fiebre y síndrome de respuesta inflamatoria sistémica (SIRS), en quien se documentaron una malformación congénita de novo tipo situs inversus con levocardia y una comunicación interventricular (CIV), asociadas a transposición de grandes vasos; durante la hospitalización recibió varios tratamientos con antibióticos sin aislamiento microbiológico ni identificación de la causa de su descompensación hemodinámica. En el examen posmortem se identificó endocarditis por Aspergillus spp., con embolia a diferentes órganos.ABSTRACT: We present the case of a 17 year-old-man, with no remarkable past medical history, who had a one month history of worsening functional class, fatigability and dyspnea, in addition to fever and systemic inflammatory response syndrome (SIRS); a de-novo congenital heart malformation, situs inversus type, with levocardia and a ventricular septal defect (VSD) associated with transposition of great vessels were documented. During hospitalization he received several antibiotic treatments without microbiological isolation or identification of the cause of hemodynamic decompensation. An Aspergillus endocarditis with emboli to different organs was identified in the post-mortem examination

Clinico-pathological conference (CPC) : a previously healthy patient with respiratory insuficiency due to intersticial pneumonia

ABSTRACT: We present the case of a 40-year-old woman, with no remarkable past medical history, who was admitted to San Vicente Foundation University Hospital, in Medellín, Colombia; she complained of respiratory symptoms lasting 20 days. Interstitial pneumonia associated with AIDS was diagnosed, which progressed to respiratory failure that did not respond to therapy directed against the opportunistic infections that were identified. She finally developed multiorgan failure that caused death.RESUMEN: Se presenta y discute el caso de una mujer de 40 años, sin antecedentes relevantes, quien ingresó al hospital Universitario San Vicente Fundación, por presentar síntomas respiratorios durante 20 días. Se diagnosticó sida de novo y neumonía intersticial asociada, todo lo cual progresó hasta la falla ventilatoria, que fue refractaria al tratamiento dirigido hacia los oportunistas identificados, debido a lo cual se produjo una falla orgánica múltiple que causó la muerte

Comparison of frictional resistance between passive self-ligating brackets and slide-type low-friction ligature brackets during the alignment and leveling stage

To compare the frictional resistance between passive self-ligating brackets and conventional brackets with low-friction ligature under bracket/archwire and root/bone interface during dental alignment and leveling. A tridimensional model of the maxilla and teeth of a patient treated with conventional brackets, and slide ligatures was generated employing the SolidWorks modeling software. SmartClip self-ligating brackets and Logic Line conventional brackets were assembled with slide low-friction ligatures, utilizing archwires with different diameters and alloys used for the alignment and leveling stage. Friction caused during the bracket/archwire interface and stress during the bone/root interface were compared through a finite element model. SmartClip and Logic Line brackets with slide elastomeric low-friction elastomeric ligature showed similar frictional stress values of 0.50 MPa and 0.64 MPa, respectively. Passive self-ligating brackets transmitted a lower load along the periodontal ligament, compared to conventional brackets with a low-friction ligature. Slide low-friction elastomeric ligatures showed frictional forces during the bracket/archwire interface similar to those of the SmartClip brackets, while the distribution of stresses and deformations during the root/bone interface were lower in the passive self-ligating brackets

Avaliação do componente bucal. : Projeto “Escolas Saudáveis” da Fundação Las Golondrinas, Medellín, 2006-2011

Introduction: We aim to assess a health education strategy for schools, regarding the oral component, through oral hygiene and oral health indexes, using the knowledge and practices for oral health of school kids, parents and/or significant adults. Methods: We conducted an evaluation using elements from a quantitative and descriptive study in two periods, 2006 and 2011. We carried out a review of dental records and clinical examinations using oral hygiene (IHOs) and oral health (DMFT and deft) indexes. A survey was conducted in school kids, parents and/or significant adults about knowledge and practices relevant to oral health. Results: We found an improvement of the knowledge and practices relating to oral health in the participants of the study. Parents and adults noticed a positive change in the oral health of children. A positive change in the oral hygiene was found in 56% of females, 54% of children under 11 and 53% of the high school students. 60% of the children were healthy relative to cavities at the time of examination and 44% had no caries experience. Conclusions: The observed indicators allowed us to positively evaluate the results of the project and invited to strengthening community strategies for health education within institutional plans.Introducción: se pretende evaluar una estrategia de escuela saludable en su componente bucal a través de indicadores de higiene bucal, salud bucal y conocimientos y prácticas de diversos actores (escolares y padres o adultos significativos). Métodos: estudio evaluativo a través de elementos de un estudio cuantitativo y descriptivo con datos de dos momentos del tiempo (2006 y 2011). Se revisaron historias clínicas y se realizaron exámenes clínicos para indicadores de higiene bucal (iho) y salud bucal (cop-d, ceo-d). Encuesta a padres o adultos significativos, y a escolares, sobre conocimientos y prácticas en salud bucal. Resultados: existe mejoría en los conocimientos y prácticas de los escolares partícipes del desarrollo del proyecto, haciéndose visible para los adultos que notan un cambio positivo en la salud bucal de los niños. Se presentó un cambio positivo en la higiene bucal del 56% de las mujeres, del 54% de los niños y niñas menores de 11 años y del 53% de los estudiantes de secundaria. Se encontró para el 2011 que el 60% estaba sano en el momento del examen y un 44% no tenía experiencia de caries. Conclusiones: los indicadores observados permitieron evaluar positivamente los resultados del proyecto, y se invita al fortalecimiento de estrategias comunitarias desde la educación para la salud en los planes educativos institucionales.Introdução: pretende-se avaliar uma estratégia de escola saudável em seu componente bucal por meio de indicadores de higiene bucal, saúde bucal e conhecimentos e práticas de diversos autores (escolares e pais ou adultos significativos). Métodos: estudo avaliativo mediante elementos de um estudo quantitativo e descritivo com dados de dois momentos: 2006 e 2011. Revisaram-se histórias clínicas e realizaram-se exames clínicos para indicadores de higiene bucal (IHOS) e saúde bucal (cop-d, ceo-d). Enquete a pais ou adultos significativos e a escolares sobre conhecimentos e práticas em saúde bucal. Resultados: existe uma melhoria nos conhecimentos e práticas dos escolares participantes do desenvolvimento do projeto, fazendo-se visível para os adultos que notam uma mudança positiva na saúde bucal das crianças. Apresentou-se uma mudança positiva na higiene bucal de 56% das mulheres, de 54% das crianças menores de 11 anos e de 53% dos estudantes do ensino fundamental (a partir da sexta série). Constatou-se para 2011 que 60% estavam saudáveis no momento do exame e 44% não tinham experiência de cáries. Conclusões: os indicadores observados permitiram avaliar positivamente os resultados do projeto, e convida ao fortalecimento de estratégias comunitárias a partir da educação para a saúde nos planos educativos institucionais

Predictores de riesgo en una cohorte española con cardiolaminopatías. Registro REDLAMINA

[Abstract] Introduction and objectives. According to sudden cardiac death guidelines, an implantable cardioverter-defibrillator (ICD) should be considered in patients with LMNA-related dilated cardiomyopathy (DCM) and ≥ 2 risk factors: male sex, left ventricular ejection fraction (LVEF) < 45%, nonsustained ventricular tachycardia (NSVT), and nonmissense genetic variants. In this study we aimed to describe the clinical characteristics of carriers of LMNA genetic variants among individuals from a Spanish cardiac-laminopathies cohort (REDLAMINA registry) and to assess previously reported risk criteria. Methods. The relationship between risk factors and cardiovascular events was evaluated in a cohort of 140 carriers (age ≥ 16 years) of pathogenic LMNA variants (54 probands, 86 relatives). We considered: a) major arrhythmic events (MAE) if there was appropriate ICD discharge or sudden cardiac death; b) heart failure death if there was heart transplant or death due to heart failure. Results. We identified 11 novel and 21 previously reported LMNA-related DCM variants. LVEF < 45% (P = .001) and NSVT (P < .001) were related to MAE, but not sex or type of genetic variant. The only factor independently related to heart failure death was LVEF < 45% (P < .001). Conclusions. In the REDLAMINA registry cohort, the only predictors independently associated with MAE were NSVT and LVEF < 45%. Therefore, female carriers of missense variants with either NSVT or LVEF < 45% should not be considered a low-risk group. It is important to individualize risk stratification in carriers of LMNA missense variants, because not all have the same prognosis.[Resumen] Introducción y objetivos. Según las guías de muerte súbita, se debe considerar un desfibrilador automático implantable (DAI) para los pacientes con miocardiopatía dilatada debida a variantes en el gen de la lamina (LMNA) con al menos 2 factores: varones, fracción de eyección del ventrículo izquierdo (FEVI) < 45%, taquicardia ventricular no sostenida (TVNS) y variantes no missense. Nuestro objetivo es describir las características clínicas de una cohorte española de pacientes con cardiolaminopatías (registro REDLAMINA) y evaluar los criterios de riesgo vigentes. Métodos. Se evaluó la relación entre factores de riesgo y eventos cardiovasculares en una cohorte de 140 portadores de variantes en LMNA (54 probandos, 86 familiares, edad ≥ 16 años). Se consideró: a) evento arrítmico mayor (EAM) si hubo descarga apropiada del DAI o muerte súbita, y b) muerte por insuficiencia cardiaca, incluidos los trasplantes. Resultados. Se identificaron 11 variantes nuevas y 21 previamente publicadas. La FEVI < 45% (p = 0,001) y la TVNS (p < 0,001) se relacionaron con los EAM, pero no el sexo o el tipo de variante (missense frente a no missense). La FEVI < 45% (p < 0,001) fue el único factor relacionado con la muerte por insuficiencia cardiaca. Conclusiones. En el registro REDLAMINA, los únicos 2 predictores asociados con EAM fueron la TVNS y la FEVI < 45%. No se debería considerar grupo de bajo riesgo a las portadoras de variantes missense con TVNS o FEVI < 45%. Es importante individualizar la estratificación del riesgo de los portadores de variantes missense en LMNA, porque no todas tienen el mismo pronóstico.This study received a grant from the Proyecto de investigación de la Sección de Insuficiencia Cardiaca 2017 from the Spanish Society of Cardiology and grants from the Instituto de Salud Carlos III (ISCIII) [PI14/0967, PI15/01551, AC16/0014] and ERA-CVD Joint Transnational Call 2016 (Genprovic). Grants from the ISCIII and the Ministerio de Economía y Competitividad de España (Spanish Department of Economy and Competitiveness) are supported by the Plan Estatal de I+D+i 2013-2016: Fondo Europeo de Desarrollo Regional (FEDER) “Una forma de hacer Europa”

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Experiencias en el aula: cuarto encuentro de prácticas pedagógicas innovadoras.

Cuarto encuentro de prácticas pedagógicas innovadoras, evento que se llevo a cabo los días 7 y 8 de Octubre de 2019

Experiencias en el aula: cuarto encuentro de prácticas pedagógicas innovadoras.

Cuarto encuentro de prácticas pedagógicas innovadoras, evento que se llevo a cabo los días 7 y 8 de Octubre de 2019

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Congreso Internacional de Responsabilidad Social Apuestas para el desarrollo regional.

Congreso Internacional de Responsabilidad Social: apuestas para el desarrollo regional [Edición 1 / Nov. 6 - 7: 2019 Bogotá D.C.]El Congreso Internacional de Responsabilidad Social “Apuestas para el Desarrollo Regional”, se llevó a cabo los días 6 y 7 de noviembre de 2019 en la ciudad de Bogotá D.C. como un evento académico e investigativo liderado por la Corporación Universitaria Minuto de Dios -UNIMINUTO – Rectoría Cundinamarca cuya pretensión fue el fomento de nuevos paradigmas, la divulgación de conocimiento renovado en torno a la Responsabilidad Social; finalidad adoptada institucionalmente como postura ética y política que impacta la docencia, la investigación y la proyección social, y cuyo propósito central es la promoción de una “sensibilización consciente y crítica ante las situaciones problemáticas, tanto de las comunidades como del país, al igual que la adquisición de unas competencias orientadas a la promoción y al compromiso con el desarrollo humano y social integral”. (UNIMINUTO, 2014). Dicha postura, de conciencia crítica y sensibilización social, sumada a la experiencia adquirida mediante el trabajo articulado con otras instituciones de índole académico y de forma directa con las comunidades, permitió establecer como objetivo central del evento la reflexión de los diferentes grupos de interés, la gestión de sus impactos como elementos puntuales que contribuyeron en la audiencia a la toma de conciencia frente al papel que se debe asumir a favor de la responsabilidad social como aporte seguro al desarrollo regional y a su vez al fortalecimiento de los Objetivos de Desarrollo Sostenible