Fundacion Valle del Lili

Valle del Guamuez, Colombia

Fundacion Valle del Lili

Valle del Guamuez, Colombia
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Martinez-Rondanelli A.,ICESI University | Escobar-Gonzalez S.S.,Fundacion Valle del Lili | Henao-Alzate A.,Fundacion Valle del Lili | Martinez-Cano J.P.,ICESI University
International Orthopaedics | Year: 2017

Purpose: A four-column classification system offers a different way of evaluating tibial plateau fractures. The aim of this study is to compare the intra-observer and inter-observer reliability between four-column and classic classifications. Methods: This is a reliability study, which included patients presenting with tibial plateau fractures between January 2013 and September 2015 in a level-1 trauma centre. Four orthopaedic surgeons blindly classified each fracture according to four different classifications: AO, Schatzker, Duparc and four-column. Kappa, intra-observer and inter-observer concordance were calculated for the reliability analysis. Results: Forty-nine patients were included. The mean age was 39 ± 14.2 years, with no gender predominance (men: 51%; women: 49%), and 67% of the fractures included at least one of the posterior columns. The intra-observer and inter-observer concordance were calculated for each classification: four-column (84%/79%), Schatzker (60%/71%), AO (50%/59%) and Duparc (48%/58%), with a statistically significant difference among them (p = 0.001/p = 0.003). Kappa coefficient for intr-aobserver and inter-observer evaluations: Schatzker 0.48/0.39, four-column 0.61/0.34, Duparc 0.37/0.23, and AO 0.34/0.11. Conclusions: The proposed four-column classification showed the highest intra and inter-observer agreement. When taking into account the agreement that occurs by chance, Schatzker classification showed the highest inter-observer kappa, but again the four-column had the highest intra-observer kappa value. The proposed classification is a more inclusive classification for the posteromedial and posterolateral fractures. We suggest, therefore, that it be used in addition to one of the classic classifications in order to better understand the fracture pattern, as it allows more attention to be paid to the posterior columns, it improves the surgical planning and allows the surgical approach to be chosen more accurately. © 2017 SICOT aisbl


Pazlozada J.,Fundacion Valle del Lili
Medical Physics | Year: 2013

Purpose: To examine the logic of the current use of high level control (HLC) mode as set up on many fluoroscopic systems. Methods: Use of HLC requires special means of activation and a continuous audible alarm and implies a higher dose rate of fluoroscopy. To examine if this implication is true in practice, we performed a survey of the entrance air kerma to an abdomen phantom as well as the maximum air kerma for a number of fluoroscopic machines operated under automatic exposure‐rate control using standard (non‐HLC) fluoroscopy and HLC fluoroscopy modes. Measurements were made using the abdomen phantom of the ACR Radiography / Fluoroscopy Accreditation Program with the ionization chamber placed either 15 cm from isocenter or at the FDA compliance point. For the maximum dose rate determination a 3 mm thick sheet of lead was placed over the phantom. The results presented are for 7 different mobile and fixed c‐arm units operated in available protocol and magnification modes. Results: For the abdomen phantom, the machines showed widely different entrance air kerma rates and response to changes in exposure mode and protocols. Our survey found: c‐arm units which gave a lower dose rate under HLC fluoroscopy than standard fluoroscopy when used with the abdomen phantom; units for which the HLC dose rate for some protocols was less than for standard fluoroscopy with other protocols; and units which did not exceed 88 mGy/min for some protocols even with lead in the beam when operating under HLC. In all cases, the audible alarm signaled HLC fluoroscopy with the implication of high dose rate. Conclusion: The audible alarm activated by HLC can be misleading and counterproductive since dose rates under HLC can be lower than standard fluoroscopy on the same machine. HLC does not always mean high doserate fluoroscopy. JP was supported by the Fulbright Scholar Program. © 2013, American Association of Physicists in Medicine. All rights reserved.


Maiti A.K.,Oklahoma Medical Research Foundation | Kim-Howard X.,Oklahoma Medical Research Foundation | Viswanathan P.,Oklahoma Medical Research Foundation | Guillen L.,University of Buenos Aires | And 10 more authors.
Arthritis and Rheumatism | Year: 2010

Objective. Autoimmune diseases often have susceptibility genes in common, indicating similar molecular mechanisms. Increasing evidence suggests that rs6822844 at the IL2-IL21 region is strongly associated with multiple autoimmune diseases in individuals of European descent. This study was undertaken to attempt to replicate the association between rs6822844 and 6 different immune-mediated diseases in non-European populations, and to perform disease-specific and overall meta-analyses using data from previously published studies. Methods. We evaluated case-control associations between rs6822844 and celiac disease (CD) in subjects from Argentina; rheumatoid arthritis (RA), type 1 diabetes mellitus (DM), primary Sjögren's syndrome (SS), and systemic lupus erythematosus (SLE) in subjects from Colombia; and Behçet's disease (BD) in subjects from Turkey. Allele and gene distributions were compared between cases and controls. Meta-analyses were performed using data from the present study and previous studies. Results. We detected significant associations of rs6822844 with SLE (P = 0.008), type 1 DM(P = 0.014), RA (P = 0.019), and primary SS (P = 0.033) but not with BD (P = 0.34) or CD (P = 0.98). We identified little evidence of population differentiation (FST = 0.01) within cases and controls from Argentina and Colombia, suggesting that association was not influenced by population substructure. Disease-specific meta-analysis indicated significant association for RA (Pmeta = 3.61 × 10-6), inflammatory bowel disease (IBD; Crohn's disease and ulcerative colitis) (Pmeta = 3.48 × 10-12), type 1 DM (Pmeta = 5.33 × 10-5), and CD (Pmeta = 5.30 × 10-3). Overall meta-analysis across all autoimmune diseases reinforced association with rs6822844 (23 data sets; Pmeta = 2.61 × 10-25, odds ratio 0.73 [95% confidence interval 0.69-0.78]). Conclusion. Our results indicate that there is an association between rs6822844 and multiple autoimmune diseases in non-European populations. Metaanalysis results strongly reinforce this robust association across multiple autoimmune diseases in both European-derived and non-European populations. © 2010, American College of Rheumatology.


Ruiz S.J.,International Center for Medical Research and Training | Montealegre M.C.,International Center for Medical Research and Training | Ruiz-Garbajosa P.,CIBER ISCIII | Correa A.,International Center for Medical Research and Training | And 7 more authors.
Journal of Clinical Microbiology | Year: 2011

CTX-M-15-producing Escherichia coli has emerged worldwide as an important pathogen associated with community-onset infections, but in South America reports are scarce. We document the presence of CTX-M-15-producing E. coli of the international ST131 and ST405 clones in Colombia and present the first molecular characterization of these isolates in South America. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


PubMed | Center for Clinical Research, Fundacion Valle del Lili and ICESI University
Type: Journal Article | Journal: Journal of pediatric surgery | Year: 2016

Trauma is an important cause of morbidity and mortality in children. Blunt trauma is the most common type and falls and road traffic injuries (RTI) are the most frequent mechanisms.Secondary analysis of institutional data included within the Panamerican Society of Trauma Registry (STP-ITSDP). A total of 581 trauma patients younger than 18years, hospitalized between 2012 and 2014, were included.Blunt trauma (BT) (68%) was the most common type, and falls (42.5%) the most common mechanism. Median age was: 14years for penetrating trauma (PT), 8years for BT, and 5.5years for other types of trauma (OT). Of all patients, 8.1% had a Glasgow score<8, 9% had a Glasgow score of 8-13 and 81.1% had a Glasgow score higher than 14. Death occurred in 5.2% of patients: 83.3% as inpatients and 16.7% during initial management in the emergency room (ER). Patients dying in the ER were mostly PT victims, with higher ISS and lower Glasgow scores.Trauma is an important cause of morbidity and mortality in our pediatric population. Fundacin Valle de Lili (FVL), a referral hospital, receives a high number of trauma patients from southwestern Colombia. Detailed knowledge of epidemiological data will help us to develop rapid response strategies for patients with trauma and to develop prevention and promotion programs.


Arias R.H.,Surgeon Obesity Clinic | Mesa L.,Fundacion Valle del Lili | Posada J.G.,Fundacion Valle del Lili | Velez J.P.,Surgeon Obesity Clinic
Obesity Surgery | Year: 2010

The database of patients who underwent laparoscopic gastric bypass at our institution from 2002 to 2008 was reviewed. Five patients with kidney transplants were found. The impact of the laparoscopic gastric bypass on their comorbidities and the grafts and patients' survival were studied. The five patients of the group are between 36 and 66 years old, three men and two women. Preoperative body mass index ranged between 35 and 42 kg/m 2. The first patient was operated on 4 years ago and presented an anastomotic leak at the gastrojejunal anastomosis that healed with medical treatment. The remaining four patients id not present postoperative complications. At the moment of analysis, the five patients were healthy and enjoying a good quality of life. All the patients had dyslipidemia which reached normal levels after surgery. Three of the atients had diabetes and achieved good control after the surgery. Most importantly, the absorption of immune suppressors was not altered; while some of the patients were even able to reduce their doses. Patients with renal terminal renal diseases and those with renal transplants with severe or morbid obesity are a group that can particularly enefit from a gastric bypass. The laparoscopic gastric bypass is feasible in severely or morbidly obese patients with kidney transplantation. The absorption of the immunesuppressive medication is not altered after a gastric bypass. © Springer Science+Business Media, LLC 2010.


Quintero I.F.,Fundacion Valle del Lili | Candamil A.,Residente de Anestesiologia | Mantilla J.H.M.,CES University | Medina H.,University of Valle | Cadena F.A.,CES University
Revista Colombiana de Anestesiologia | Year: 2013

The intracranial hypotension syndrome (IHS) is a disorder caused by brain descent due to a CSF leak resulting from diagnostic, therapeutic or spontaneous lesions. The pathophysiology, the clinical and the therapeutic approach are similar as in post dural puncture headache, the latter being considered a mild form of IHS. This paper describes two patients with orthostatic headache and severe neurological involvement after epidural and spinal anesthesia, diagnosed and treated as post dural puncture headache, but who required additional care because of their abnormal course. IHS is a serious complication that may result in clinical decline and death; consequently, it requires a comprehensive approach to the various triggering factors, the clinical picture, diagnostic methods, pathophysiology and management. © 2012 Sociedad Colombiana de Anestesiología y Reanimación.


Canas C.A.,Fundacion Valle Del Lili | Canas F.,University of Valle | Bonilla-Abadia F.,Fundacion Valle Del Lili | Ospina F.E.,Fundacion Valle Del Lili | Tobon G.J.,Fundacion Valle Del Lili
Autoimmunity | Year: 2016

Autoimmune diseases (AIDs) are chronic conditions initiated by the loss of immunological tolerance to self-antigens and represent a heterogeneous group of disorders that affect specific target organs or multiple organs in different systems. While the pathogenesis of AID remains unclear, its aetiology is multifunctional and includes a combination of genetic, epigenetic, immunological and environmental factors. In AIDs, several epigenetic mechanisms are defective including DNA demethylation, abnormal chromatin positioning associated with autoantibody production and abnormalities in the expression of RNA interference (RNAi). It is known that environmental factors may interfere with DNA methylation and histone modifications, however, little is known about epigenetic changes derived of regulation of RNAi. An approach to the known environmental factors and the mechanisms that alter the epigenetic regulation in AIDs (with emphasis in systemic lupus erythematosus, the prototype of systemic AID) are showed in this review. © 2015 Taylor & Francis.


Betancur J.F.,Fundacion Valle Del Lili | Betancur J.F.,CES University | Bonilla-Abadia F.,ICESI University | Hormaza A.A.,ICESI University | And 3 more authors.
Lupus | Year: 2016

Aim The aim of this study was to describe a case series of patients with primary or secondary antiphospholipid syndrome (APS) treated with direct oral anticoagulants (DOACs). Patients and methods Clinical charts of eight patients with thrombotic primary or secondary APS treated with direct oral anticoagulants (DOACs) between January 2012 and May 2015 were reviewed. Results The mean age was 45 ± 14.36 (range 27-69 years). Four patients had secondary APS (50%). All patients were initially treated with warfarin by a mean time of 70.87 ± 57.32 months (range 17-153 months). Changes in anticoagulation were defined by recurring thrombosis in five patients (62.5%) and life-threatening bleeding in the other three cases. Seven patients (87.5%) received rivaroxaban treatment and one patient (12.5%) apixaban. The mean follow-up period with DOACs was 19 ± 10.06 months (range 2-36 months). There was no recurrence of thrombosis by the time of data collection. Conclusions Despite not being the standard treatment in APS, we propose DOACs as a rational alternative for the management of patients with this diagnosis. Further interventional clinical studies are necessary for possible standardization of this therapy in APS patients. © SAGE Publications.


PubMed | Fundacion Valle del Lili, ICESI University and University of Valle
Type: Journal Article | Journal: Journal of medical case reports | Year: 2016

Pulmonary surfactant is a complex mixture of lipids and proteins. Mutations in surfactant protein-C, surfactant protein-D, and adenosine triphosphate-binding cassette subfamily A member 3 have been related to surfactant dysfunction and neonatal respiratory failure in full-term babies. Adenosine triphosphate-binding cassette subfamily A member 3 facilitates the transfer of lipids to lamellar bodies. We report the case of patient with a homozygous intronic ABCA3 mutation.We describe a newborn full-term Colombian baby boy who was the son of non-consanguineous parents of mixed race ancestry (Mestizo), who was delivered with severe respiratory depression. Invasive treatment was unsuccessful and diagnosis was uncertain. Exons 4 and 5 of the SP-C gene showed heterozygous Thr138Asn polymorphism and homozygous Asn186Asn polymorphism respectively. At intron 25 at position -98 from exon 26 a homozygous C>T transition mutation was detected in ABCA3 gene.The clinical presentation and the histopathological findings of this case are consistent with a case of neonatal respiratory failure due to surfactant deficiency. Analysis of the five coding SP-C exons does not support surfactant deficiency. An analysis of the mutation IVS25-98 T was performed and a homozygous mutation responsible for our cases neonatal respiratory failure was detected. The findings suggest an autosomic recessive pattern of inheritance. Genetic counseling was provided and the relatives are now informed of the recurrence risks and treatment options.

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