Translumbar catheter placement. Six years’ experience at Hospital Universitario San Ignacio

Introducción: La implantación de catéteres translumbares es un tipo de abordaje venoso que constituye una de las últimas opciones en pacientes sin disponibilidad de accesos venosos centrales convencionales. Objetivos: Revisar la literatura, describir la técnica y comunicar la experiencia de seis años en la realización de este procedimiento. Métodos: Se realizó una búsqueda de la literatura disponible sobre la implantación de catéteres translumbares en MedLine, Ovid y Liliacs; asimismo, se obtuvo una base de datos sobre los pacientes en quienes se implantó un catéter translumbar en el Hospital Universitario San Ignacio en el periodo entre 2008 y 2013. Finalmente, se ejecutó un estudio retrospectivo descriptivo. Resultados: Se realizaron 98 procedimientos en 66 pacientes (41 hombres y 25 mujeres). Se observó la incidencia de complicaciones hasta 72 horas posprocedimiento y se identificaron solo tres complicaciones (4,6 %) Conclusiones: El implante de catéteres translumbares constituye una alternativa eficaz y segura en pacientes que necesitan hemodiálisis y han agotado otros accesos venosos convencionales. Los resultados se hallan dentro de los indicadores publicados en la literatura.Artículo original4062-4066Introduction: In recent years the Hospital Universitario San Ignacio has become a local and national reference center for translumbar catheter placement. This procedure is one of the last options to achieve effective central venous access in patients without other possible alternatives. Objectives: To review the literature, describe the technique and report the experience of six years in the making of this procedure. Methods: Search of the available literature about translumbar catheter placement was performed in MEDLINE, OVID and LILIACS. Additionally, it was obtained a database on patients with translumbar catheter placement at Hospital Universitario San Ignacio in the 2008-2013 period. Finally a retrospective study was made. Results: 98 Procedures were performed in 66 patients (41 men and 25 women). The incidence of complications up to 72 hours post-procedure was observed, identifying only 3 complications (4.6%) Conclusions: Translumbar catheter placement is an effective and safe alternative in patients requiring hemodialysis and have exhausted other conventional venous accesses. Our results are according to those reported in the available literature

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm

Q1Q1Jóvenes adultosAim: The protective effects of Kangaroo mother care (KMC) on the neurodevelop-ment of preterm infants are well established, but we do not know whether the ben-efits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. Method: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. Results: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct rela-tionship between brain volumes and duration of KMC, after controlling for potential confounders. Conclusion: Our findings suggest that the neuroprotective effects of KMC for pre-term infants persisted beyond childhood and improved their lifetime functionality and quality of life.https://orcid.org/0000-0001-6697-5837https://orcid.org/0000-0002-1923-3934https://orcid.org/0000-0001-5464-2701Revista Internacional - IndexadaA1N

Association between periodontal disease and endothelial dysfunction in smoking patients

Q329-35Over the past two decades, there has been increasing interest in the impact of oral health on cardiovascular disease, particularly regarding the effects of chronic infections such as periodontitis on the endothelium. The aim of this study was to evaluate in healthy smokers whether there are any significant differences in the frequency of endothelial dysfunction between subjects with chronic moderate to severe periodontal disease and periodontally healthy subjects. An observational cross-sectional study was conducted. The target population was adults older than 40 years of age. Blood tests were performed to determine values of CBC, glycaemia, total cholesterol, HDL-C, and LDLC. Periodontal examinations and probing were conducted with a Florida Probe®, and standardized procedures were used to measure flow-mediated dilation. Out of 150 subjects [69 male (46%) and 81 female (54%)], 75 (50%) had chronic periodontitis. The mean value for baseline flow-mediated dilation was 4.04% and the mean value for final flow-mediated dilation was 4.66%, with a 0.62% mean difference showing a statistically significant increase (p<0.001).This study found no significant difference in the flow-mediated dilation values between periodontally healthy subjects and those with periodontitis, in contrast to the literature, which suggests a negative impact of periodontal disease on endothelial function

Desempeño diagnóstico de la radiografía de tórax digital en decúbito para la detección de derrame pleural

Objetivo: Calcular las características operativas de la radiografía de tórax en decúbito supino comparada con la escanografía de tórax como patrón de oro, para determinar la presencia de derrame pleural. Metodología: Se realizó un estudio de evaluación de prueba diagnóstica. Se tomó una muestra de 484 pacientes procedentes de servicios de urgencias, hospitalización, cirugía y Unidad de cuidados intensivos o intermedios del Hospital Universitario San Ignacio, a quienes se les hubiera realizado escanografía de tórax y radiografía de tórax en decúbito supino a partir de Diciembre de 2012 y que cumplieran los criterios de inclusión. Resultados:La sensibilidad de la radiografía de tórax para diagnóstico de escaso derrame pleural es de 9.7%, con especifi cidad de 86%, en moderado derrame pleural la sensibilidad es de 33.7%, con especifi cidad de 87.2%, cuando es abundante, la sensibilidad de la radiografía de tórax aumenta a 80.3% y la especifi cidad es de 78.1%. Conclusiones: La radiografía de tórax en decúbito supino continúa siendo un estudio imaginológico vigente en casos seleccionados, útil para la detección de derrame pleural.Artículo de investigación51-60Objective: To calculate the operating characteristics of the supine chest radiograph compared with computed tomography of the chest as the gold standard for determining the presence of pleural effusion. Methodology: an evaluation study of diagnostic test was performed. A sample of 484 patients from emergency services, hospitalization, surgery and intensive or intermediate care at Hospital Universitario San Ignacio, who had chest CT and supine chest radiography from December 2012 and that met the inclusion criteria. Results: The sensitivity of chest radiography for diagnosis of small pleural effusion is 9,7%, with specifi city of 86%, in moderate pleural effusion sensitivity is 33,7% and specifi city of 87,2%, when it is abundant the sensitivity of chest radio-graphy increases to 80,3% and specifi city to 78,1%. Conclusions: The supine chest radiograph remains a current imaging study in selected cases, useful for the detection of pleural effusion

Post Infection Constrictive Bronchiolitis in an Infant after SARS-CoV-2

La bronquiolitis obliterante se caracteriza por ser una enfermedad respiratoria obstructiva crónica con cambios histológicos irreversibles y de presentación inusual en la población pediátrica por lo cual usualmente es sub diagnosticada, sin embargo, en episodios broncoobstructivos de evolución atípica o severa debe ser considerada como probable diagnóstico. La bronquiolitis obliterante se considera una enfermedad crónica inflamatoria de los bronquiolos que puede presentarse de dos formas histopatológicas ya sea por afectación peribronquiolar desde el epitelio hacia la luz de forma concéntrica (constrictiva) o por ocupación del lumen del bronquiolo dado por proliferación del tejido endoluminal (proliferativa). El diagnóstico se realiza según criterios clínicos y criterios radiológicos (TC de tórax), un puntaje mayor de 7 predice con alta precisión el diagnóstico de bronquiolitis obliterante. Dado que se trata de una enfermedad inflamatoria crónica mediada por la respuesta inmune, el tratamiento esta dirigido a suprimir la respuesta inflamatoria para evitar el daño pulmonar por cambios irreversibles sin embargo, una vez instaurada la enfermedad el tratamiento será sintomático, de soporte y seguimiento de la función pulmonar. A continuación, se presenta el caso de un lactante de 2 meses de edad con antecedente en su periodo neonatal de infección respiratoria por SARS-CoV-2 (COVID-19) en quien se evidenció cambios radiológicos y clínicos compatibles con bronquiolitis constrictiva post infecciosa en su evolución clínica.Q4Neonatos con Bronquiolitis constrictivaBronchiolitis obliterans is a chronic and irreversiblepulmonary disease that leads to obstruction andobliteration of the small airways and that can present by peribronchiolar involvement, from the epitheliumtowards the lumen in a concentric (constrictive), orby occupation of the lumen of the bronchiole, given by proliferation of the endoluminal tissue (proliferative). The lesion at the level of the small airway can occurafter lung or bone marrow transplantation, infections, inhalation of toxic substances, connective tissue diseasesor secondary to drugs. In the pediatric population, the constrictive form secondary to severe respiratory tractinfections, and known as post-infectious bronchiolitisobliterans (PIBO), is the most common and its clinicalpresentation can be highly variable from mild to severe airway obstruction that does not respond to treatmentwith bronchodilators, in addition to hypoxemia, cough andtachypnea. Diagnosis is difficult given the previous need for a lung biopsy, the current absence of biomarkers, andsince its pathophysiology is not clearly understood. The CT as well as a clinical score predict with high precisionthe diagnosis of obliterative bronchiolitis. Treatment isaimed at suppressing the inflammatory response to preventlung damage. We report a case of a 2-month-old infant with a history of respiratory infection due to SARS-CoV-2(COVID-19) in his neonatal period is presented, in whomradiological and clinical changes compatible with PIBO were evidenced.https://orcid.org/0000-0002-5917-8212https://orcid.org/0000-0002-3037-9715https://orcid.org/0000-0003-1627-7971https://orcid.org/0000-0003-3870-4102https://orcid.org/0000-0002-1923-3934Revista Nacional - IndexadaS

Cystic Lymphangioma in the Small Intestine : A Case Report

En este artículo se describe el raro caso de una niña de 7 años de edad en quien se realizó un diagnóstico histopatológico final de linfangioma quístico en el intestino delgado. Los linfangiomas son lesiones benignas de origen vascular que muestran diferenciación linfática y pueden ocurrir en muchas regiones anatómicas, pero los del tubo digestivo son poco frecuentes. Dada la localización atípica y los hallazgos radiológicos, se ilustra este caso documentado, seguido por una revisión de la literatura.Reporte de caso3556-3560In this article, we report a rare case of a 7-year old female patient with a final histopathological diagnosis of cystic lymphangioma in the small intestine. Lymphangiomas are benign lesions of a vascular origin that show lymphatic differentiation. They may occur in many anatomic regions, but the gastrointestinal tract lymphangioma is a very rare entity. Due to this uncommon location and radiologic findings, we report this case, which documented in our institution, followed by a review of the literature

Pericardial Mesothelioma : case report

En el siguiente artículo se describe el caso de un paciente de 48 años de edad, quien consultó a urgencias por un cuadro clínico de un mes de evolución de dolor retroesternal, asociado con disnea y deterioro de la clase funcional. El angio-TAC de tórax mostró derrame pericárdico, engrosamiento de las capas de pericardio y adenomegalias mediastinales. El paciente fue llevado a biopsia ganglionar y pericárdica con hallazgo histopatológico de mesotelioma pericárdico. El mesotelioma pericárdico es una enfermedad primaria maligna poco común, de etiología desconocida y con pocos casos descritos en Colombia, en el cual las células mesoteliales pericárdicas, que conforman una de las dos capas que constituyen el pericardio, sufren una transformación neoplásica. Las modalidades diagnósticas que mejor caracterizan este tipo de lesiones son la ecografía, la tomografía axial computarizada y la resonancia magnética.Reporte de caso3709-3712The following article describes the case of a 48 year old male patient, who was admitted emergency care due to 1 month of retrosternal pain, associated with dyspnea and functional class deterioration. The CT angiogram of the chest revealed pericardial effusion, thickened pericardial layers and mediastinal lymphadenopathy. The patient underwent pericardial and lymph node biopsy with pericardial mesothelioma histopathological findings. Pericardial mesothelioma is a rare primary neoplastic disease, of unknown etiology, where pericardial mesothelial cells which make up one of the two layers that constitute the pericardium, undergo a neoplastic transformation. Only few cases are reported in Colombia. Diagnostic methods that best characterize this type of disease are echocardiography, computed axial tomography and magnetic resonance imaging

Correlation between cholangiopancreatography by magnetic resonance and the endoscopic retrograde colangio pancreatography in hospitalized by biliary lithiasis in the University Hospital San Ignacio (Bogota-Colombia) between 2005 to 2011

Objetivo: Determinar el grado de acuerdo entre la colangiopancreatografía por resonancia magnética (CPRM) y los hallazgos por colangiopancreatografía endoscópica retrograda (CPRE) en pacientes hospitalizados por enfermedad biliar litiásica en un periodo de tiempo en un hospital de referencia. Material y métodos: Tipo de estudio evaluación de prueba diagnóstica retrospectivo, tipo de muestra no probabilístico por conveniencia, el cálculo de tamaño de muestra fue calculado a partir de los datos obtenidos de la prueba piloto y fue de 320 pacientes. Se recolectaron 354 pacientes los cuales se sometieron a ambos estudios (CPRM y CPRE), para evaluar la correlación entre estas 2 pruebas se realizó mediante la variante nominal Kappa. Resultados: cumplieron con criterios de inclusión 354 pacientes, 226 mujeres (63,8%), hombres 128 (36,2%), edad mediana 48 años. Se observó dilatación del colédoco por CRMN en el 60%, sensibilidad del 96,7%, especificidad del 40%, índice de Kappa 0,406 (IC 95%: 0,32-0,50) que indica una concordancia moderada. Para la presencia de cálculo coledociano en CPRM fue 54%, con Sensibilidad del 72,6%, especificidad del 68,3%, índice de Kappa 0,409 (IC 95%: 0,31-0,51) concordancia moderada. Para cálculos en vesícula índice Kappa 0,246 débil. Se identificó 27% de falsos negativos de CRMN para detección de cálculo coledociano. Conclusiones: La CPRM y la CPRE tuvieron una correlación moderada según índice Kappa en la detección de dilatación y cálculos coledocianos en nuestra cohorte de pacientes con probabilidad intermedia. El número de pacientes falsos negativos para coledolitiasis mediante CPRM, plantea la necesidad de búsqueda de otros estudios prospectivos aleatorizados como la ultrasonografía endoscópica biliopancreática que comparen características operativas con CPRM en pacientes de probabilidad intermedia para coledocolitiasis.Q4Artículo original226-230Objetive: Determine the grade of agreement between the colangiopancreatography by magnetic resonance (CPRM) and the endoscopic retrograde colangio pancreatography (ERCP) in hospitalized patients by biliary lithiasis in a period of time in a ref-erence hospital. Material and methods: Type of study, retrospective evaluation of diagnostic tool, the size of the sample was calculated from the pilot simple and was 320 patients. We recolected 354 patients that urderwent both studies (CPRM and ERCP), to evaluate the correlation between both procedures we used Kappa variation. Results: 354 pacients were included, 226 women (63.8%), men 128 (36.2%), with mean age of 48 years. There was dilatation of the choledocus by CRMN in 60%, sensibility of 96, 7%, especificity of 40%, Kappa index 0,406 (IC 95%: 0, 32-0, 50) that indicates a moderate agreement. For the presence of choledocus calculi with CPRM was 54%, with sensibility of 72.6%, specificity of 68.3%, Kappa index 0.409 (IC 95%: 0.31-0.51), moderate agreement. For caculi in the gallbladder the kappa index was 0.246 weak. We identify 27% de false negatives for CRMN in detecting choledocusd lithiasis. Conclusions: The CPRM and ERCP had a moderate correlation according to the Kappa index detecting dilatation and choledocus calculi in our patients. The number of false negatives for cho-ledocolithiasis by CPRM leads us to seek in other prospective aleatory studies like endoscopic biliiopancreatic ultrasonopgraphy to compare the CPRM in patients with intermediate probability for choledoco-lithiasis

Prevalence of sleep complaints in Colombia at different altitudes

AbstractStudy objectivesTo determine the prevalence of sleep complaints in adults in Colombia at different altitudes.DesignCross-sectional, population-based and observational study.SettingUrban areas in three cities (Bogotá, Bucaramanga, Santa Marta) located between 15 and 2640 masl. Subjects Over 18 years old.InterventionsEpworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Berlin questionnaire, STOP-Bang questionnaire and diagnostic criteria for restless leg syndrome (IRLSSG).Measurements and resultsThe overall prevalence of sleep complaints was 59.6% (CI 95%: 57.3; 61.8%). According to the Pittsburgh scale, 45.3% (CI 95%: 43.0; 47.5) required medical assistance. The Berlin questionnaire indicated that 19.0% (CI 95%: 17.3; 20.8%) had a high risk of sleep apnea (OSA) compared to 26.9% (CI 95%: 24.9; 29.0%) according to STOP-Bang. Among the subjects, 13.7% (CI 95%: 12.3; 15.3%) had excessive daytime sleepiness and 37.7% (CI 95%: 35.5; 39.8%) had a restless leg syndrome. When comparing cities, significant differences in the overall frequency of subjects requiring care were found between Santa Marta (higher frequency) and the other two cities. Differences in sleep problem frequency (Pittsburgh) were observed between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (higher frequency) and the other two cities. The high risk of OSA (STOP-Bang) was different between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (high frequency) and Bucaramanga.ConclusionsWe observed a high prevalence of sleep complaints with significant differences among the cities, indicating a need to pay a greater attention to these problems

Prognosis value of the PESI Scale and of Angiography Through Computerized Axial Tomography (angioCAT) in patients with diagnosis of PE (Pulmonary Embolism) in the Hospital Universitario San Ignacio, years 2010 – 2013

Objetivo: Determinar el valor predictivo de la combinación de índice de severidad de tromboembolismo pulmonar (PESI), disfunción ventricular derecha (RVD) evaluada en angiografía por escanografía, dímero D, troponina I cardíaca (cTnI) y péptido natriurético tipo B BNP, comparados con su uso por separado para estratificar el riesgo en pacientes normotensos con diagnóstico de tromboembolismo pulmonar (TEP). Métodos: Se seleccionaron pacientes >18 años que estuvieron hospitalizados en el Hospital Universitario San Ignacio entre 2010 y 2013 con diagnostico confirmado de TEP; mediante historias clínicas se recolectaron las variables de la escala PESI, los valores de troponina, el BNP y el dímero D, y se revisaron las imágenes de escanografía para medir la relación ventrículo derecho-ventrículo izquierdo, la morfología del tabique interventricular, el diámetro de la arteria pulmonar principal y el reflujo de la vena cava inferior. Resultados: 128 pacientes incluidos, de los cuales 7 (5,4 %) murieron. El ecocardiograma, el dímero D y la troponina se obtuvieron en 124 (96 %), y el BNP, en 101 (79 %). El PESI de alto riesgo se relacionó con todas las causas de mortalidad (p=0,049). Las combinaciones de PESI de alto riesgo con RV/LV >0,9 (p=0,04) y BNP >100 ng/ml con RV/LV >0,9 (p=0,007) fueron relacionadas de forma significativa con el desenlace primario. Otras combinaciones no mostraron relación con todas las causas de mortalidad. Conclusiones: La combinación de PESI con la relaciones RV/LV medida por escanografía de tórax mejora las características de predicción de la escanografía para detectar un desenlace combinado de muerte, hospitalización en UCI y requerimiento inotrópico.Artículo original4481-4485Pacientes con diagnóstico de TEPObjective: To determine the predictive value of the combination of the Severity Index of Pulmonary Embolism (PESI), Right Ventricular Dysfunction (RVD-evaluated by Computed angiography), D-dimer, troponin and BnP, compared with its separate use in order to stratify the risk in normotensive patients with a diagnosis of Pulmonary Embolism (PE). Methods: Patients > the age of 18 were selected, who were hospitalized in the Hospital Universitario San Ignacio, between the years of 2010-2013, with confirmed diagnosis of PE. The PESI variables, as well as troponin, BNP, and D-dimer values were calculated through clinical histories, and the CT angiograms were reviewed in order to assess the RV/LV ratio, the morphology of interventricular septum, the diameter of right pulmonary artery and the inferior vena cava reflux. Results: 128 patients were included. 7 of these patients died (5.4%). An echocardiogram, D-dimer, and troponin were obtained in 124 patients (96%), and BNP was additionally obtained in 101 patients (79%). A high-risk PESI was associated to all-cause mortality (p=0.049). The combinations of high risk PESI with RV/LV > 0.9 (p=0.04) and BNP > 100 ng/ml with RV/LV Z 0.9 (p0.007) were significantly related with the primary conclusion. Other combinations did not show a relationship with all causes of mortality. Conclusions: The combination of PESI with RV/LV index as measured by CT chest angiogram improves the predictive capability of CT chest angiogram to detect the combined outcome of mortality, ICU admission and requiring inotropic support