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Revista Med
rev.fac.med
ISSN 1909-7700
www.umng.edu.co
Bogotá D.C., Colombia
CONTENS
PRESENTATION
EDITORIAL
PREVALENCE OF ACUTE STRESS DISORDER AND POST-TRAUMATIC STRESS DISORDER IN COLOMBIAN SOLDIERS WOUNDED IN COMBAT
PAULA A. CORZO P., M.D.1* Y ADRIANA P. BOHÓRQUEZ P., M.D.2
1Residente del Programa de Psiquiatría, Universidad Militar de Nueva Granada
2 Profesora Asistente Pontificia Universidad Javeriana, Profesora Asistente Universidad Militar Nueva Granada
Abstract
The objective of this work was to determine the prevalence of acute stress disorder and post-traumatic stress disorder in soldiers wounded in combat admitted to the Military Hospital. For this purpose we proceeded to realize a cross cut, descriptive study in which we applied the CAPS (clinical administered post traumatic stress disorder scale), to a sample of patients admitted due to combat wounds to the Hospital Militar Central de Bogota. We measured prevalence and frequency and did a bivariate analysis of the collected data. We obtained a prevalence of 16,66 % for posttraumatic stress disorder and there were no cases of acute stress disorder, providing clear evidence that the injuries provoked during combat perceived as traumatic, are a factor of significant risk for the development of post-traumatic stress disorder Key words: post-traumatic stress disorder, acute stress disorders
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FREQUENCY OF PSICHIATRIC COMORBIDITIES IN PATIENTS WITH POST- TRAUMATIC STRESS DISSORDER
ADRIANA M. SERRANO C., M.D.1*, DANILO A. ORTIZ J., M.D. 1* Y ADRIANA P. BOHÓRQUEZ P., M.D.2
1Residente tercer nivel, del Programa de Psiquiatría, Universidad Militar Nueva Granada
2 Profesora Asistente Pontificia Universidad Javeriana, Profesora Asistente Universidad Militar Nueva Granada
Abstract
The clinical presentation of the psychiatric co-morbidities associated to the Post-traumatic Stress Disorder (TEPT) is described by means of a descriptive cross section observational study made in patients with a diagnosis of TEPT with antecedent of exhibition to combats, with military rank of professional, sergeant major or official, hospitalized by the Service of Psychiatry of the Central Military Hospital of Bogota between January and June of 2008,. One detected agoraphobia in 45.5% of the subjects, social phobia in 18.2%, specific phobias (according to the type) between 36.4% and 45.5%, a prevalence of 63.3% for depressive upheavals and 10% for distimia, concluding that the affective upheavals, followed by anxiety, were the most frequent co-morbidities, without positive data for consumption of illegal substances. Although this is a pilot study, with a small sample of only eleven patients, it is the first approach to the investigation of co-morbidities in a population of special interest for the Military Health and the National Defense, which in the future and with greater number of patients, will allow to establish and to fortify protocols for its management.
Key words: combat disorders, depressive disorder, post-traumatic stress disorder, dysthymic disorder
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ROLL OF THE PHONOAUDIOLOGIST IN THE AREA OF MENTAL HEALTH: A PROFESSIONAL EXPERIENCE IN THE CENTRAL MILITARY HOSPITAL
SYLVIA A. RAMÍREZ R.1* Y SORAYA COLINA MATIZ2*
1 Fonoaudióloga, Universidad Nacional de Colombia
2 Docente de Práctica Clínica Universidad Nacional de Colombia, Área de Fonoaudiología, Servicio de Medicina Física y Rehabilitación, Hospital Militar Central
Abstract
The objective of the present study was to describe the roll of the phonoaudiologist in the area of mental health, from the professional experience in the Central Military Hospital. The used methodology was of descriptive qualitative type, selecting as variables the knowledge and the abilities and skills, technical procedural as much as interpersonal, which the phonoaudiologist that works in the area of mental health possess. In order to fulfill this objective the expert professional was observed during the second semester of 2008 in the evaluations and interventions of eleven patients, men and women, with cognitive-communicative disorders between the ages of 16 and 88, diagnosed previously with mental disease by the psychiatrist. The profile of the professional of phonoaudiology in the area of mental health was later established, its functions and objectives within a multidisciplinary team, as well as its knowledge, abilities and skills. Also the phonoaudiologic procedures that are made in the area of
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FEATURES AND IMPACT OF AIR FLOW IN BRONCHIECTASIS. AN APPROACH COMPUTERS IN RATS
ALBERTO ENRIQUE D’OTTAVIO, M.D., PH.D.1, MARIO MATTARA, INGENIERO2, RAÚL R. PONSO INGENIERO3, MABEL A. MEDINA, INGENIERA, PH.D.4
1Profesor Titular de Histología y Embriología, Investigador Principal, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, 2 Profesor Titular, Escuela de Ingeniería Mecánica. Facultad de Ciencias Exactas, Ingeniería y Agrimensura, Universidad Nacional de Rosario,
3Profesor Adjunto, Departamento de Matemáticas, Escuela de Ingeniería Mecánica, Facultad de Ciencias Exactas, Ingeniería y Agrimensura, Universidad Nacional de Rosario, 4Profesora Adjunta del Departamento de Matemáticas e Investigadora Principal, Escuela de Formación Básica. Facultad de Ciencias Exactas, Ingeniería y Agrimensura, Universidad Nacional de Rosario.
Abstract
Bronchiectasis, end result of different diseases, not a disease itself. Extending a previous study on congenital bronchiectasis in laboratory rats and given its predominant localization in the post-branching of the bronchial tree, we apply numerical simulation programs the behavior of air flow on murine bronchiectasis, as this location could influence their kinematics and dynamic behavior on the characteristics of the bronchial wall, and impact also on production and development of bronchiectasis. Acrylic molds were obtained in the bronchial tree after injection of a plastic substance in fifteen male Wistar rats aged six months. Under optical microscope (6 to 40 x), using double-pointed compasses and gauges, we measured the length and diameter of the expansion respectively. For smaller elements were used ocular grid. The data of the samples obtained after the respective three-dimensional models and discretization, joined the program Comsol ®, based on the Finite Element Method. The interaction between the eddies detected and the consequent pressures zonal and air stagnant dead zones referred to, would form a vicious circle, which would facilitate the formation and development of bronchiectasis, Which may aggravate any infections that are on dieren.
Keywords: bronchiectasis, air floz
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CHANGES IN THE FUNCTIONAL CAPACITY, QUALITY OF LIFE AND ACTIVITY OF THE DISEASE IN A GROUP OF COLOMBIAN PATIENTS WITH RHEUMATOID ARTHRITIS REFRACTORY TO THE CONVENTIONAL TREATMENTS, WHO WERE TREATED WITH INFLIXIMAB AS RESCUE THERAPY
JOHN LONDOÑO P., M.D.1, DANIEL G. FERNÁNDEZ A., M.D.2*, JUAN C. SALAZAR, M.D.3, DIEGO L. SAIIBI, M.D.4, JOSÉ F. MOLINA, M.D.5, RAFAEL VALLE O., M.D.1, OSCAR RUIZ, M.D. 6, ANTONIO IGLESIAS, M.D. 7, PEDRO SANTOS, M.D.1 Y ELSA REYES S., M.D. 1
1Reumatólogo, Servicio de Reumatología Hospital Militar Central, Bogotá, 2Residente del Programa de Reumatología, Universidad Militar Nueva Granada, Bogotá, 3Reumatólogo de la Fundación Cardio Infantil, Bogotá, 4Reumatólogo de la Clínica Carlos Ardila Lule, Bucaramanga, 5Reumatólogo de la Clínica de las Américas, Medellín, 6Reumatólogo de la Clínica Colombia, Sánitas EPS, Bogotá, 7Reumatólogo, Profesor de la Universidad Nacional de Colombia, Bogotá.
Abstract
Rheumatoid arthritis is a chronic inflammatory process that effects mostly the joints leading to destruction of the joint, deformity, incapacity and deterioration of the quality of life. As a result of technologic advances and the better knowledge of the pathophisiology of the disease, there are new therapeutic options with biologic agents. There are no reports from Colombia about the experience with Infliximab in patients with rheumatoid arthritis. The objective of this study was to quantify the changes in quality of life, functional capacity, signs and symptoms related to the inflammatory activity and the therapeutic efficacy, in a group of Colombian patients with long term rheumatoid arthritis (13+10 years) refractory to conventional treatments. A total of 31 patients, 22 women and 9 men, aged 51+12 years and an average evolution of disease of 13.2+10.4 years, who had active disease in spite of having received Methrotexate or Leflunomide in combination with other agents, such as low doses of glucocorticoids, analgesics and antiinflammatories, received infusions of Infliximab at doses of 3mg/kg during weeks 0, 2, 6, 14, and 22, following the guidelines of the Colombian Rheumatology Association. It was determined that the median functional capacity measured by HAQ-DI went from 1,2±0,54 to 0,29±0.28, that the quality of life measured by Spanish-AIMS improved globally from 48,4±14.4 to 29,4±8.2 in each of its eight components. There was also improvement in the components of SF-12 since the physical health went from 39,9±13,7 to 55,5±24,1 and mental health from 57,0±24,2 to 74,6±17,0. Although 71% of the patients had some type of side effect, they were minor and the medication was not stopped. These findings agree with the international reports that the administration on Infliximab induces a significative improvement in those patients with refractory rheumatoid arthritis. Taking into account the potential side effects and the real risk of tuberculosis in our country, the administration of Infliximab must be carried out in specialized units with well trained personnel and under the strict supervision of a rheumatologist.
Key words: rheumatoid arthritis, quality of life, infliximab
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ANESTHETIC BLOCKING UTILITY IN PATHOLOGY OF COLUMN SPINAL CLINIC AT UNIVERSITY HOSPITAL SAN RAFAEL
JORGE M. PATARROYO M.1, ALVARO H. BERNAL G.1, GERMÁN OCHOA A.2 Y EDUARDO DAZA G.3*
1Residente del Programa de Ortopedia y Traumatología, Universidad Militar Nueva Granada,
2 Ortopedista y Traumatólogo, Especialista en Cirugía de Columna Vertebral, Hospital Universitario Clínica San Rafael, 3Anestesiólogo, Epidemiólogo, Hospital Universitario Clínica San Rafael. Docente Universidad Militar Nueva Granada
Abstract
Epidural and Facet locks have been controversial for its usefulness in the management of pain in patients with spinal pathology, currently used as a last resort. For this work collected between January 2005 and January 2006, at the Hospital Universitario Clínica San Rafael de Bogotá, 50 patients, according to his pathology were divided into three groups. While the first, which included 34 patients with herniated disc and the second, with nine patients with narrow lumbar canal underwent epidural block, the third group, with seven patients with facet disease, facet block was applied. To determine the usefulness of the blocks was assessed improvement of pain, return to the workplace, the use of adjuvant analgesics and the need for some type of surgical procedure according to the pathology presented. The percentage of improvement in pain for the different groups was 71.5% for patients with facet disease, 77.7% for patients with narrow lumbar spinal canal and 65% for patients with lumbar disc herniation. The rate of return to work activity in the three groups was similar, with 85.7% for patients with facet disease, 67% for patients with narrow canallumbar 73.5% for patients with herniated disc. Adjuvant analgesic therapy was required for 42.9% of patients with facet disease, for 55.5% of patients with lumbar canal Strait and the 29.5% of patients with herniated disc. The surgery should have been held to 11% of the group with narrow channel, 14% of the group with disc herniation and is not needed in any facet disease patient. Given the effectiveness of facet block for pain relief in patients with facet and epidural block for patients with narrow lumbar spinal canal and herniated lumbar disc, with improvement in pain over 50% in the three groups, with a rate of return to high employment and a decrease in the need for surgery, it is proposed that these blocks, before
resorting to invasive procedures.
Keywords: back pain, herniated disk, epidural injections
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SOMATIZATION: DIAGNOSTIC CONSIDERATIONS
HAROLD MUÑOZ C., M.D.1*
1Servicio de Psiquiatría, Hospital Militar Central, Bogotá, D.C, Profesor Asociado de la Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, D.C. Colombia.
Abstract
Somatization, the process by which people experience and express emotional distress through physical symptoms, is one of the biggest challenges a physician may face in his daily medical practice because the symptoms have no organic documentable cause. The article reviews and updates the knowledge of somatization and its various disorders, seeking to expand the tools for physicians to perform a more accurate diagnosis and provides some useful recommendations for the management of patients taking into account that the decision whether the etiology of the symptom is psychological and not physical is not easy, and neither it is to accurately diagnose the psychiatric disorder that induces this process.
Key words: somatoform disorders
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NEUROPSYCHIATRIC CONSEQUENCES OF TRAUMATIC BRAIN INJURY
OSCAR BERNAL-PACHECO, M.D.1*, MILENA VEGA-RINCÓN, M.D.2 Y JOSÉ F. HERNÁNDEZ-PRECIADO, M.D.3
1Neurólogo Clínico, Servicio de Neurología, Hospital Militar Central y Hospital Universitario Clínica San Rafael, Docente Universidad Militar Nueva Granada, 2Psiquiatra, Clínica Psiquiátrica Nuestra Señora de La Paz, 3Neurólogo Clínico, Servicio de Neurología, Hospital Universitario Clínica San Rafael
Abstract
Traumatic brain injury (TBI) is one of the main causes of urgent consultations in every hospital in the world, with variability of the severity and consequences, depending on its origins, patients’ characteristics (underlying diseases, age, etc.) and treatment received. The national situation deserves special attention due to the armed conflict which has afflicted us for more than 50 years and which has left physical, psychological and psychiatric sequelae in thousands of patients, their families and their surroundings. In this revision we intend to update the sequelae observed at the neuropsychiatric level and the procedures that demonstrate beneficial to the recovery from TCE. We also note some procedures and pharmaceuticals, which may have theoretical benefit as yet unproven.
Key words: brain injury, craniocerebral trauma, war wounded
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NEUROBIOLOGIC EFFECTS OF PSYCHOTHERAPY
ANGELA M. IRAGORRI, M.D.1,2, LILIANA ROSAS, M.D.2, GABRIEL HERNÁNDEZ, M.D.3 Y LUIS F. OROZCO-CABAL, M.D.1
1Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, 2Clínica La Inmaculada; 3Departamento de Psiquiatría Hospital Militar Central, Docente Facultad de Medicina, Universidad Militar Nueva Granada.
Abstract
Psychotherapy remains a valid treatment option in a variety of psychiatric disorders. Although its effectiveness has been amply demonstrated for over two decades, the biological mechanism by which has an effect on the patient's brain function and behavior, remain unknown. This article reviews the possible mechanisms that mediate its effect on brain function, including cellular and molecular basis of memory, changes in neurotransmitter systems and synaptic plasticity. The review of the evidence accumulated to suggest that psychotherapy has a neurophysiological effect at the same level of drugs with psychotropic action, however, differences in regional specificity and target system may explain the differences observed between these two forms of treatment.
Keywords: psychotherapy, neuronal plasticity, learning, memory
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POSTRAUMÁTIC STRESS DISORDER IN MILITARY PSYCHIATRY
PAULA A. CORZO P., M.D.1*
1Residente del Programa de Psiquiatría, Facultad de Medicina, Universidad Militar de Nueva Granada
Abstract
Post traumatic Stress Disorder is of great relevance In Military Psychiatry, given the situations of internal or external conflict which the members of the Armed Forces frequently must face, which demands to study it and to analyze it with depth. It is clear that emotionally strong experiences transform the human being and that, while there are individuals that after undergoing experiences of that type manage to surpass them without great sequels, others, seem to remain forever in the event. One considers the hypothesis that although post traumatic stress disorder has always existed, is the form to describe it and to perhaps interpret its symptomatology that has been changing, or perhaps, evolving. In order to demonstrate this exhibit and to detect aspects that direct to a better management, we make an analysis of the approach taken to the post traumatic stress disorder in some of the most important armed conflicts at world-wide level, taking into account that the clinical pictures are not presented in similar fashion and that the cruelty of the wars is even greater with time.
Key words: combat disorders, post-traumatic stress disorders, war
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COGNITIVE ALTERATIONS IN SCHIZOPHRENIA
LYDA M. LOZANO C., M.D. 1 Y ROCÍO ACOSTA, M.D. 1*
1Residente tercer nivel, del Programa de Psiquiatría, Universidad Militar Nueva Granada
Abstract
Schizophrenia, a disease that has called the attention of many investigators through time and that affects people who are at the greater productive time of their life, continues presenting a world-wide prevalence of 1%. The marked deterioration and the functional disability that makes the families of the affected ones and society relegate them, or to turn them into one more “obligation”, are the points that have been emphasized more. As far as the cognitive compromise, the findings are supported in neuroanatomic, functional and imaging basis, as well as in studies that utilizing neuropsychological tests, allow demonstrating the compromise of the attention, social cognitive and executive functions. The objective of the present revision is to update the neurological, neuropsychological and psychiatric concepts whereupon the neurocognitive alterations of schizophrenia are handled.
Key words: schizophrenia, cognition, memory, theory of mind
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VIDEO ANALYSIS FOR ESTIMATION OF THE HUMAN MOVEMENT: A REVISION
FABIO MARTÍNEZ, INGENIERO MECATRONICO1, FRANCISCO GÓMEZ, INGENIERO DE SISTEMAS2 Y EDUARDO ROMERO, M.D., PH.D. EN CIENCIAS BIOMÉDICAS3*
1Estudiante Maestría en Ingeniería Biomédica, 2 Candidato a Doctor en Ciencias de la Computación, 3Director Grupo de Investigación Bioingenium, Centro de Telemedicina, Universidad Nacional de Colombia, Bogotá, D.C.
Abstract
The cinematic analysis of the human march is a fundamental tool in rehabilitation medicine, because it facilitates the diagnosis, treatment, follow up and implementation of rehabilitation methods in pathologies associated with the movement. This analysis is based on the description and the quantification of the variability in the displacement of the center mass of the body and the centers of rotation of the joints, information that allows to obtain the various relations that appear to the expert in form of clinical report, or as a tool of virtual visualization, with the purpose of making an observational analysis of the march. In this article the foundations and the sequence of events that constitute a cinematic analysis of the march in medicine are reviewed, as a process that registers processes and quantifies the movement of the patient in a clinical context.
Key words: gait, biomechanics, biomedical engineering
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WARFARIN: CURRENT USE
JAMES YURGAKY1* Y FRANCISCO RODRÍGUEZ2
1Residente del Programa de Medicina Interna, Universidad Militar Nueva Granada,
2Médico Internista del Servicio de Medicina Interna del Hospital Militar Central
Abstract
Warfarine is one of the most prescribed medicines in the world and when it is well indicated, it is documented the benefit in the prevention of thrombotics events and in the reduction of mortality, although aspects related to the security and with a high rate of complications has limited its use in a generalized manner . In this article we review aspects that generate specific doubts in the clinical practiced related to the dose, the indications, the treatment and the prevention of complications of warfarina, in addition to which we promote the search of new drugs with a more favourable security profile. Key words: warfarin, anticoagulants, thrombosis
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UPDATE IN THE CONCEPTUAL FRAMEWORK AND MANAGEMENT OF SEPSIS, SEVERE SEPSIS AND SEPTIC SHOCK
JUAN CARLOS GÓMEZ RODRÍGUEZ, M.D.1*
1Residente del Programa de Cirugía General, Universidad Militar Nueva Granada, Bogotá, D.C
Abstract
Even though sepsis is as old as our immune system, it was not until the XIX century that a causality relation between infectious organisms and the infection per se was identified. Although great advances have taken place after this, it was not until the last 20 years that a process was initiated to try and diminish the mortality, which surpasses 50% in cases of severe sepsis, becoming the tenth most common cause of death in industrialized countries. The epidemiologic sub registry is marred by deficiencies in the standardization and the definitions of the associated terms: sepsis, severe sepsis and septic shock. The understanding of the physiopathologic mechanisms in the last decade has helped to create diagnostic and therapeutic tools that have produced a highly positive impact, with initiatives created to establish uniformity, to publicize them and to standardize the treatment protocols. This is a discussion and review of the management guidelines, which were recently updated, in an attempt to obtain homogenization of the treatment of sepsis from the emergency room to the Intensive Care Unit and to establish data to evaluate sepsis and the real impact of this ominous process. Key words: sepsis, septic shock, infection
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NEOCYTOLYSIS
FERNANDO PALOMINO Q.1*, LEONARDO BAUTISTA T.2 Y MICHEL A. GARCÍA O.2
1Profesor Asistente, División de Fisiología, Facultad de Medicina. Universidad Nacional de Colombia, Bogotá, D.C, Colombia, 2Estudiantes de Medicina de la Universidad Nacional de Colombia, Bogotá, D.C, Colombia
Abstract
The present revision describes Neocytolysis, a process of selective hemolysis of young erythrocytes, demonstrated in patients with chronic renal insufficiency when suspended from treatment with recombinant erythropoietin and documented, also, in astronauts when entering in contact with microgravity and in people acclimated to great altitude, when they descend to sea level. The model postulated until now to demonstrate selective hemolysis “in vivo” is also discussed, which allows to establish the new function of trophic factor for erythropoietin in the plasmatic erythroid maturation and comments are made on the clinical scenarios and the applications towards the future of this process.
Key words: hemolysis, erythropoietin
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ESCAFO-CAPITATE SYNDROME. CASE PRESENTATION
FABIO A. SUÁREZ R., M.D.1, GUILLERMO A. GONZÁLEZ T., M.D.2* Y ÁLVARO J. CAICEDO H., M.D. 2
1Ortopedista, Cirujano de Mano, Servicio de Ortopedia y Traumatología, Hospital Militar Central 2Residente de cuarto nivel, Programa de Ortopedia y Traumatología, Universidad Militar Nueva Granada
Abstract
This is the case of a patient after a fall from a height, who presented with a fracture of the escafoides and the proximal pole pf the capitate bone, with proximal luxation of the distal fragment, very infrequent pathology. There is a review of the literature to support the management of this syndrome. Key words: schapo capitate fracture, navulo capitate sindrome
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URINOTHORAX: CASE REPORT AND LITERATURE REVIEW
JORGE SALINAS P., M.D. 1* Y FRANCISCO RODRÍGUEZ, M.D.2
1 Estudiante de Posgrado del Programa de Medicina Interna, Universidad Militar Nueva Granada, Bogotá, D.C., Colombia, 2Servicio de Medicina Interna, Hospital Militar Central de Bogotá y Profesor de la Facultad de Medicina de la Universidad Militar Nueva Granada, Bogotá, D.C., Colombia.
Abstract
The urinothorax is an uncommon cause of pleural effusion; it involves the presence of urine in the pleural space, generally associated with bilateral obstructive uropathy or trauma of the urinary system. The biochemical characteristics of the effusion are related with to those of urine and they suffer a slight, but substantial modification as it passes into the pleural space where it mixes with the pleural fluid (PF). Characteristically, the PF is a transudate, with a pH < 7,3; however there have been publications where it has been classified as an exudate, associated with high LDH levels. In general, glucose and proteins levels are low (glucose levels < 60 mg/dl), while LDH levels are very high. The accepted biochemical parameter for the diagnosis of urinothorax is a ratio higher than 1 between pleural fluid creatinine and serum creatinine. To date, only few cases have been reported worldwide, probably due to misdiagnosis, to a low index of suspicion and the quick resolution of the pleural effusion with the
Keywords: pleural effusion, creatinine, bladder cancer
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PNEUMONÍA AND OSTEOMYELITIS BY BURKHOLDERIA PSEUDOMALLEI, REPORT OF A CLINICAL CASE
GINA GONZÁLEZ R., M.D.1*, WILLIAM A. MANTILLA D., M.D.1* Y ROBIN RADA E., M.D.
1,21Servicio de Medicina Interna Hospital Militar Central, Bogotá, D.C., Colombia,2 Docente Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, D.C., Colombia
Abstract
Melioidosis, a disease caused by Burkholderia pseudomallei (B. pseudomallei), has been reported verbally in Colombia. In the Asian Southeastern there are reported endemic centers of this infection, associated to the inhalation of aerosols, or contact with water contaminated by the bacteria. It is manifested clinically like septicemia with pulmonary affectation and formation of multiple abscesses. The case of a previously healthy 22 year old soldier is reported, with an acute picture of cough and expectoration, fever and chills and with progressive pain in the right leg. Signs of systemic inflammatory reaction were demonstrated (SIRS), multilobar pneumonia, and arthritis of the right elbow and osteomyelitis of the ipsilateral tibia, with growth of B. pseudomallei in the cultures of the drainage and in the hemocultures. He was treated with Imipenem (500 mg intravenous every 6 hours) and later with trimethoprim Sulfamethoxazole (160/800 mg oral route.
Keywords: melioidosis, Burkholderia pseudomallei, bacterial pneumonia, osteomyelitis, infectious arthritis.
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ENTEROPATHIC ACHRODERMATITIS, A DIAGNOSTIC CHALLENGE. CASE REPORT AND LITERATURE REVIEW
CARLOS F. AVELLANEDA, M.D.1*, CLAUDIA M. CRUZ, M.D.1 Y CAROLINA A. PALACIO, M.D.1
1 Residentes del Programa de Dermatología de la Universidad Militar Nueva Granada, Servicio de Dermatología, Hospital Militar Central, Bogotá, DC, Colombia
Abstract
Enteropathic achrodermatitis is of a low incidence but of a great clinical relevance, which must be recognized quickly and accurately by dermatologists and pediatricians, so that the treatment can be given to control the quick progression of the lesions and the serious systemic changes that may associate with the cutaneous signs characteristic of this disease. Although it was initially described 70 years ago, it as not until 15 years ago that it was established that it was not of an infectious etiology but rather due to a zinc deficiency as a consequence of a genetic alteration of the transport mechanism of the ion. This is the case of a malnourished patient, short stature for his age, delayed psychomotor development and severe skin lesions, who was admitted to the Hospital Militar Central de Bogota after being treated in other institutions with multiple therapies which worsened his symptoms. From the start it was suspected that this was enteropathic achrodermatitis, confirmed by thorough testing, and there was complete resolution of the lesions 3 weeks after the treatment was initiated. Key words: acrodermatitis, zinc, hyperkeratosis
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HANDLING OF PANFACIAL FRACTURE SECONDARY TO HIGH SPEED GUNSHOT WOUND. CASE REPORT
CAMILO FONNEGRA, CIRUJANO ORAL Y MAXILOFACIAL,1, 2 LUZ ADRIANA SABOGAL G., CIRUJANA ORAL Y MAXILOFACIAL1* Y JOSÉ ANTONIO VÉLEZ S.3
1Servicio de Cirugía Oral y Maxilofacial, Hospital Militar Central, Bogotá, Colombia,
2 Docente de Cirugía Oral y Maxilofacial, Universidad Militar Nueva Granada, 3Residente de cuarto nivel del Programa de Cirugía Oral y Maxilofacial, Universidad Militar Nueva Granada, Bogotá, Colombia.
Abstract
Taking into account that the Central Military Hospital of Bogota is one of the most important welfare centers of the country in the handling of war trauma, including facial trauma, we present in this article the case of a 21 year old patient sent to this institution because of pan facial trauma secondary to a gunshot wound, whose treatment consisted of multiple reconstructive surgeries to obtain a suitable functional and aesthetic result. Also described are the types and sites of gunshot wounds in the maxillofacial region, their initial handling, the reconstructive procedures and the results of the given treatments to patients with this type of wounds.
Key words: facial injuries, wounds gunshot
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MORAL THOUGHTS WHILE IN CAPTIVITY
WILLIAM PÉREZ MEDINA
Enfermero Auxiliar del Batallón de Sanidad del Ejército de Colombia
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ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD), THE FORGOTTEN ONES IN THE DIAGNOSIS, REPORT OF CASE
WALTER PONTÓN CORTÉS, M.D.* PSIQUIATRA
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CONSCIENCE. TWO COMMENTARIES 1Médico Interno, Programa de Medicina. Grupo de Neurociencia de Caldas. Facultad de Ciencias para la Salud. Universidad de Caldas. Manizales
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THE GREAT PARADOX OF MEDICINE: MECHANICISM VERSUS HUMANISM
OSCAR L. VACA C.*
Impulsador del Instituto de Prevención e Investigación del Infarto
Médico Tratante, IESS, Quito, Ecuador
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