The Caldera. No. 21

Las huellas que deja el tiempo… Los años siempre dejan su huella… El inexorable paso del tiempo… Son algunas de las expresiones que utilizamos, popularmente, para referirnos a cómo cada almanaque vivido, cómo cada instante que pasa deja sus marcas, sus rastros, sus huellas. En el período Barroco, el hombre cayó en un estado de pesadez existencial, no sólo a nivel económico, político y social, sino que se constituyó en una época que lo sumergió en una crisis existencial; el hombre barroco, descubrió y escribió con horror, sobre la efímera condición de la especie humana. Pero no sólo el hombre del Barroco se ha inquietado con el finito y definitivo paso del hombre por la tierra, también civilizaciones como la Griega, la Romana, la Egipcia, y más cercanas a nosotros, los Incas, los Mayas y los Aztecas, le han rendido culto al paso del tiempo, incluso, crearon sus propias maneras de registrarlo, sus propios calendarios y llevaban un registro de lo que iban viviendo. Yo me atrevo a decir que la dificultad no radica en las marcas físicas que deja el ineludible, el inevitable paso del tiempo; me atrevo a afirmar que el problema es el no dejar huellas positivas, en no dejar ningún rastro loable, ni marca agradable “ninguna estela en el mar”, en palabras de Machado, en nada, ni en nadie.Una obra para la posteridad; Por Matías Gómez Buitrago…06 Dr. Jorge Reynolds Pombo: Orgullo Colombiano; Por Carlos Rodríguez Blanco…10 Ética y moral: Fundamentos de un CALDISTA; Por Andrés David Rojas…14 Nuestra RECTORA; Por Valentina Manrique y Luisa Navarro…18 Líderes Caldistas 2017…24 Lectura: PROCESO FUNDAMENTAL En el Instituto Caldas…36 Instituto CALDAS: 65 AÑOS; Por Carlos Alirio Castillo y Saula Nayibe Figueroa…42 Eventos Conmemoración: 65 años…58 Interclases 2017…62 Nuevos laboratorios…66 Expresiones Caldistas…68 Galería de Imágenes…96 Nuestros MAESTROS…104The traces that time leaves ... The years always leave their mark ... The inexorable passage of time ... These are some of the expressions that we use, popularly, to refer to how each lived almanac, how each passing moment leaves its marks, its traces, her footprints. In the Baroque period, man fell into a state of existential heaviness, not only at the economic, political and social level, but was constituted at a time that plunged him into an existential crisis; the baroque man, discovered and wrote with horror, on the ephemeral condition of the human species. But not only the man of the Baroque has been concerned with the finite and definitive passage of man on earth, also civilizations such as the Greek, the Roman, the Egyptian, and closer to us, the Incas, the Mayas and the Aztecs, They have worshiped the passage of time, even created their own ways of recording it, their own calendars and kept a record of what they were living. I dare say that the difficulty does not lie in the physical marks left by the inescapable, the inevitable passage of time; I dare to affirm that the problem is not to leave positive traces, in not leaving any praiseworthy trace, nor a pleasant mark "no wake in the sea", in the words of Machado, on anything, or on anyone

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

Estado nutricional en niños menores de 13 años con diagnóstico oncológico de primera vez del Hospital Universitario del Valle "Evaristo García" de Cali, Colombia

La valoración del estado nutricional de niños con diagnóstico oncológico de primera vez permite proponer un adecuado y oportuno plan de recuperación nutricional. Objetivo: Determinar el estado nutricional por medio del índice de masa corporal (IMC) y de la talla para la edad (T/E) en niños < 13 años con diagnóstico oncológico de primera vez del Hospital Universitario del Valle (HUV) “Evaristo García” de Cali, Colombia, y establecer posibles asociaciones. Metodología: Estudio de prevalencia en 38 niños con cáncer. Fueron consideradas variables clínicas, paraclínicas y sociodemográficas. El análisis estadístico incluyó estimación de la proporción de niños con infección y su correspondiente intervalo de confianza al 95%; estimación de porcentajes, percentiles, promedios, medianas y las demás medidas descriptivas con sus correspondientes desviaciones estándar y rangos; análisis univariado; posible ocurrencia de asociación entre las variables (ORs con sus respectivos intervalos de confianza al 95%); prueba exacta de Fisher con un valor de p <0.05, a dos colas, significativo, y análisis de regresión logística múltiple. Resultados: Hubo una prevalencia del 36,8% para malnutrición y retraso en la talla, respectivamente, con una edad promedio de 70±49 meses. Hubo predominio del género femenino. Hubo mayor oportunidad de presentar malnutrición y retraso en la talla, respectivamente, en el género femenino, presentar tumor sólido y anemia. Los factores asociados a malnutrición fueron: sexo, edad y tipo de tumor; y a retraso en la talla: anemia. Conclusión: El estado nutricional estuvo comprometido en el 36.8%, con posibles factores de riesgo para malnutrición, el sexo, la edad y el tipo de tumor; y para retraso en la talla, la anemia

PREVALENCIA DE ENTEROPARÁSITOS EN NIÑOS CON CÁNCER DE UN HOSPITAL UNIVERSITARIO DE TERCER NIVEL DE ATENCIÓN DE CALI, COLOMBIA Y POSIBLES FACTORES DE RIESGO

Introducción. Por medio de la alteración de la respuesta inmune, el parasitismo intestinal (PI) en cáncer y la desnutrición, favorece su establecimiento. Objetivo: Determinar la prevalencia de enteroparásitos (EP), en niño

ESTADO NUTRICIONAL EN NIÑOS CON DREPANOCITOSIS DE UN HOSPITAL UNIVERSITARIO DE TERCER NIVEL DE ATENCIÓN DE CALI, COLOMBIA Y POSIBLES FACTORES DE RIESGO SOCIODEMOGRÁFICOS

Introducción: El estado nutricional (EN) de los niños con enfermedades crónicas hematológicas, permite proponer un oportuno y adecuado plan de recuperación nutricional y evitar su morbimortalidad. Objetivo: Determinar la prevalencia del EN de niños con anemia de células falciformes (ACF) por medio de las tablas de la OMS de un hospital universitario de tercer nivel de atención de Cali, Colombia y posibles factores de riesgo. Metodología: Estudio descriptivo observacional no experimental de tipo prevalencia en 80 niños con ACF. Fueron incluidas variables sociodemográficas (edad y género), clínicas (peso y talla) y nutricionales (índice de masa corporal IMC y talla para la edad TE). Fueron clasificados en malnutridos (MNT) o con talla alterada (TA). Resultados: Se analizaron 80 niños de 6.1±3.8 años (5 meses-14 años); 51,2% del género masculino; con promedio de peso = 21.6±9.9 kg (7.2-64.6) y talla = 114.1±22.4 cm (67-167). Hubo una prevalencia para MNT del 42,5%: y para TA del 42,9%. Hubo > oportunidad de presentar MNT en el grupo de escolares y de TA en el género femenino; siendo posibles factores de riesgo asociados a MNT la edad y a TA el género (

Yellow fever reemergence in Venezuela – Implications for international travelers and Latin American countries during the COVID-19 pandemic

In the last few years, Venezuela has been the epicentre for multiple concurrent epidemics (syndemics) of emerging and reemerging infectious and tropical diseases. These events have severe implications for public health control efforts in Latin American and other regions due to the latent threat of case importation. At the top of the list, the resurgence of vector-borne diseases (VBD), such as malaria and dengue pose substantial challenges for the region [5]. On the other hand, the reemergence of vaccine-preventable diseases (VPD) due to low immunization coverage has led to new and multiple outbreaks of measles, diphtheria and other vaccine-preventable infections that are once again affecting many populations.http://scienti.colciencias.gov.co:8081/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000153095https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000451070https://orcid.org/0000-0002-1447-1458https://orcid.org/0000-0002-9429-0058https://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000000695Marlen.martinezg@[email protected]://scholar.google.com/citations?user=o3Y7mZwAAAAJ&hl=eshttps://scholar.google.es/citations?user=flSrsSIAAAAJ&hl=e

Biología de los anfibios y reptiles en el bosque seco tropical del norte de Colombia.

Los anfibios y reptiles son animales asombrosos y su biología es mucho más Fascinante y variada de lo que originalmente se consideraba. Esta afirmación se soporta fácilmente en múltiples aspectos, entre los cuales sobresale, su reproducción (Duellman &amp; Trueb 1994; Wells 2007; Balshine 2012; Gómez-Mestre et al. 2012; Vitt &amp; Caldwell 2014; Pough et al. 2016). En los anfibios, por ejemplo, muchas especies no dejan sus huevos en charcas y lagunas, como tradicionalmente ha creído el común de las personas, sino que las hembras los depositan en ambientes terrestres, tales como la superficie de hojas o en ambientes húmedos que se dan a nivel del suelo entre hojarasca y bajo troncos caídos, piedras o raíces de árboles (Duellman &amp; Trueb 1994; Crump 2015). Más aún, hay especies cuya reproducción es tan especializada que los padres o madres transportan a los renacuajos en diferentes partes de su cuerpo , ya sea, por pocas horas o días, mientras los depositan en ambientes específicos, o hasta que las crías terminan su ciclo de metamorfosis y se desarrollen como un adulto, pero en miniatura  (Noble 1927; Mendelson et al. 2000; Castroviejo-Fisher et al. 2015). Con respecto a los reptiles, hay ejemplos de especies, donde, - las hembras no requieren que un gameto masculino fertilice sus óvulos para producir crías, o especies, donde el sexo de la progenie no está determinado genéticamente, sino por la temperatura ambiental, lo cual, permiten la incubación de huevos (Tinkle &amp; Gibbons 1977; Shine 1995; Vitt &amp; Caldwell 2014). Los factores o procesos asociados a la evolución de este último aspecto en la reproducción de reptiles, es todo un enigma para los científicos (BlacNburn 2006; Shine 2015). Estos y muchos más ejemplos, que se encuentran a lo largo de este libro, contradicen la imagen que durante décadas se tuvo de los anfibios y reptiles, incluso, por científicos y naturalistas tan prestigiosos como, Carlos Linneo, quien afirmó que estos vertebrados eran animales repulsivos, en los cuales el creador no había ejercido toda su sabiduría y poder (Halliday &amp; Adler 1986)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care