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San Vicente de Chucurí, Colombia

Gamez-Diaz L.Y.,Group of Primary Immunodeficiencies | Enriquez L.E.,Group of Primary Immunodeficiencies | Matute J.D.,Group of Primary Immunodeficiencies | Velasquez S.,Group of Primary Immunodeficiencies | And 7 more authors.
Academic Emergency Medicine | Year: 2011

Objectives: The objectives were to evaluate the diagnostic accuracy for sepsis in an emergency department (ED) population of the cluster of differentiation-64 (CD64) glycoprotein expression on the surface of neutrophils (nCD64), serum levels of soluble triggering receptor expressed on myeloid cells-1 (s-TREM-1), and high-mobility group box-1 protein (HMGB-1). Methods: Patients with any of the following as admission diagnosis were enrolled: 1) suspected infection, 2) fever, 3) delirium, or 4) acute hypotension of unexplained origin within 24 hours of ED presentation. Levels of nCD64, HMGB-1, and s-TREM-1 were measured within the first 24 hours of the first ED evaluation. Baseline clinical data, Sepsis-related Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, daily clinical and microbiologic information, and 28-day mortality rate were collected. Because there is not a definitive criterion standard for sepsis, the authors used expert consensus based on clinical, microbiologic, laboratory, and radiologic data collected for each patient during the first 7 days of hospitalization. This expert consensus defined the primary outcome of sepsis, and the primary data analysis was based in the comparison of sepsis versus nonsepsis patients. The cut points to define sensitivity and specificity values, as well as positive and negative likelihood ratios (LRs) for the markers related to sepsis diagnosis, were determined using receiver operative characteristics (ROC) curves. The patients in this study were a prespecified nested subsample population of a larger study. Results: Of 631 patients included in the study, 66% (95% confidence interval [CI] = 62% to 67%, n = 416) had sepsis according with the expert consensus diagnosis. Among these sepsis patients, SOFA score defined 67% (95% CI = 62% to 71%, n = 277) in severe sepsis and 1% (95% CI = 0.3% to 3%, n = 6) in septic shock. The sensitivities for sepsis diagnosis were CD64, 65.8% (95% CI = 61.1% to 70.3%); HMGB-1, 57.5% (95% CI = 52.7% to 62.3%); and s-TREM-1, 60% (95% CI = 55.2% to 64.7%). The specificities were CD64, 64.6% (95% CI = 57.8% to 70.8%), HMGB-1, 57.8% (95% CI = 51.1% to 64.3%), and s-TREM-1, 59.2% (95% CI = 52.5% to 65.6%). The positive LR (LR+) for CD64 was 1.85 (95% CI = 1.52 to 2.26) and the negative LR (LR-) was 0.52 (95% CI = 0.44 to 0.62]; for HMGB-1 the LR+ was 1.36 (95% CI = 1.14 to 1.63) and LR- was 0.73 (95% CI = 0.62 to 0.86); and for s-TREM-1 the LR+ was 1.47 (95% CI = 1.22 to 1.76) and the LR- was 0.67 (95% CI = 0.57 to 0.79). Conclusions: In this cohort of patients suspected of having any infection in the ED, the accuracy of nCD64, s-TREM-1, and HMGB-1 was not significantly sensitive or specific for diagnosis of sepsis. © 2011 by the Society for Academic Emergency Medicine.

Pareja R.,Institute Cancerologia Las Americas | Rendon G.J.,Institute Cancerologia Las Americas | Vasquez M.,Hospital Universitario San Vicente Of Paul | Echeverri L.,Institute Cancerologia Las Americas | And 3 more authors.
Gynecologic Oncology | Year: 2015

Radical trachelectomy is the treatment of choice in women with early-stage cervical cancer wishing to preserve fertility. Radical trachelectomy can be performed with a vaginal, abdominal, or laparoscopic/robotic approach. Vaginal radical trachelectomy (VRT) is generally not offered to patients with tumors 2 cm or larger because of a high recurrence rate. There are no conclusive recommendations regarding the safety of abdominal radical trachelectomy (ART) or laparoscopic radical trachelectomy (LRT) in such patients. Several investigators have used neoadjuvant chemotherapy in patients with tumors 2 to 4 cm to reduce tumor size so that fertility preservation may be offered. However, to our knowledge, no published study has compared outcomes between patients with cervical tumors 2 cm or larger who underwent immediate radical trachelectomy and those who underwent neoadjuvant chemotherapy followed by radical trachelectomy. We conducted a literature review to compare outcomes with these 2 approaches. Our main endpoints for evaluation were oncological and obstetrical outcomes. The fertility preservation rate was 82.7%, 85.1%, 89%; and 91.1% for ART (tumors larger than > 2 cm), ART (all sizes), NACT followed by surgery and VRT (all sizes); respectively. The global pregnancy rate was 16.2%, 24% and 30.7% for ART, VRT, and NACT followed by surgery; respectively. The recurrence rate was 3.8%, 4.2%, 6%, 7.6% and 17% for ART (all sizes), VRT (all sizes), ART (tumors > 2 cm), NACT followed by surgery, and VRT (tumors > 2 cm). These outcomes must be considered when offering a fertility sparing technique to patients with a tumor larger than 2 cm. © 2015 Elsevier Inc. All rights reserved.

Herrera J.C.,University of Antioquia | Isaza L.F.,Hospital Universitario San Vicente Of Paul | Ramirez J.L.,University of Antioquia | Vasquez G.,University of Antioquia | Muneton C.M.,University of Antioquia
Biomedica | Year: 2010

Introduction: TP53 is a tumor suppressor gene located on chromosome 17p13.1. This gene is essential for the control of cell cycle and has been found altered in about 50% of all tumor types. Objective: The presence of aneuploidy of chromosome 17 and TP53 gene deletion at 17p13.1 locus was determined in primary solid tumors using the dual-color FISH (fluorescence in situ hybridization). Materials and methods: Thirty-eight samples consisted of several types of primary solid tumors. All samples were mechanically and enzymatically disaggregated with 0.2% collagenase prior to obtaining interphase nuclei. The dual-color FISH was performed using direct fluorescent labeling probes for the chromosome 17 centromere (green signal) and for the TP53 gene locus-specific (orange signal). Results: Characteristic aneuploidy on chromosome 17 was found in 63% (24/38) of the samples. Monosomy occurred most frequently (75%, 18/24), followed by trisomy (17%, 4/24); nullisomy and tetrasomy were less frequent. TP53 gene deletion was found in 89.5% (34/38) of cases. Only four tumors were normal for copy number of chromosome 17 and TP53 gene. The histopathologic study showed that most of the samples were malignant tumors. Conclusions: Aneuploidy of chromosome 17 and deletion at 17p13.1 locus of TP53 gene were genetic alterations found to be very frequent in solid tumors. The dual-color FISH was able to detect both numerical and structural chromosomal abnormalities in interphase nuclei.

Introduction: Burn injuriess affect the quality of life of the injured as a consequence of deformities and loss of bodily function. Objective: Changes in the quality of life related to the health were described in the people who had been affected by burns. Materials and methods: A cross-sectional descriptive study conducted in Medellín, Colombia, enrolled 130 people who suffered burns in the period 2001-2005. A standard quality-of-life survey consisting of 36 questions (the SF-36 scale) was administered. Statistical data were tested with Mann Whitney-U, Student-t, ANOVA, and Kruskal Wallis. Ethical considerations were met within the framework of resolution 8430/93 of the Colombian Ministry of National Health. Results: The number of burns showed an increasing trend each year. Men were most often affected (66.9%) and severe burns were the most common (58%). The main burn sources were the fire flames, targeted attacks and gunpowder burns. The component of change of health upper obtained the average (55.3±19.2) and those of emotional performance (30.2±42.9), and physical performance (31.1±43.6) lowest, finding significant differences in those of physical performance (p=0.039) and general health (p=0.034) according to burn degree. Conclusion: In spite some inconsistency, the most affected quality-of-life components were the physical and emotional performance, with an overall presentation of a low quality-of-life related to health.

Alcoholism was a real problem in Medellín (Colombia) during the first three decades of the XX century. It was focused as a habit that finally dominated people who assumed it. According to the medical knowledge at that time, alcoholism was a social disease with moral, physical, and mental connotations. Therapeutic options for alcoholic patients were limited, and the only mental institution in the city lacked adequate facilities. Consequently, the probability of cure was low, and the prognosis, poor. This article presents the results of a historic investigation about the early diagnosis of alcoholic psychosis in the department of Antioquia (Colombia) between 1900 and 1930. The different clinical approaches to alcoholism and the resources available for treatment are included. We aimed at evaluating the medical knowledge on alcoholism at the beginning or the XX century, and to describe the early steps of the main regional psychiatric center.

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