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RevistaMed Vol.16 No. 2 - 2008

Revista Med

rev.fac.med

ISSN 1909-7700

www.umng.edu.co
Bogotá D.C., Colombia





AUTHORS INDEX



CONTENTS

LAPAROSCOPIC APPENDECTOMY, OUTCOME OF 91 CASES

HÉCTOR RENÉ HAZBÓN N. M.D.1*

1 Unidad de Invasión Mínima, Hospital de Yopal (Casanare), Docente adjunto Universidad Nacional de Colombia., Bogotá D.C., Colombia

Abstract

Appendectomy has different surgical approaches at this moment and there is no consensus as to whether the traditional or the minimally invasive is more efficient and safer. Different groups defend their approaches and there are studies of diverse tendencies that can help us make decisions on how to approach this common pathology, reinforcing the formal training in our specialty. 91 cases of appendicitis in their different presentations were accumulated in this study to analyze their surgical handling, evolution and complications, with the variable common epidemiologies of the group. The non-complicated appendectomies had an average surgical time of 32 minutes, whereas in the ones with generalized peritonitis it was 79.3 minutes. The hospital stay of the non-complicated appendectomy patients was 0.79 days, whereas in the cases of generalized peritonitis it was 7 days. There was no mortality and the morbidity of medical reason was due to comorbidity unrelated to the appendicular inflammatory phenomenon; whereas the surgical morbidity was the appearance of intraabdominal abscesses in 2 patients, sepsis and extension to a right hemicolectomy in another patient, persistent vomiting in another patient and pointing out the absence of infection of the operative bed in the studied cases. Based on these findings we propose that the laparoscopic approach of the non-complicated appendix is feasible with equal or inferior morbidity to the one obtained in the conventional approach. The difficulty in obtaining good results obeys to the non-standardization of the procedure and the diverse training of the groups that perform these approaches.

Key words: appendicitis, laparoscopy, peritonitis, abscess

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HEADACHE AS A SYMPTOM OF CAFFEINE ABSTINENCE: A POPULATION- BASED STUDY

ADALBERTO CAMPO-ARIAS1* Y EDWIN HERAZO1

1 Grupo de Investigación del Comportamiento Humano, Instituto de Investigación del Comportamiento Humano, Bogotá, Colombia

Abstract

Headache is a common symptom among the general population. However, in Colombia this symptom has not been investigated during abstinence to caffeine. The objective of this study was to find out the frequency of headache as a symptom of caffeine abstinence and its associated variables, according to gender, among adults between 18 and 65 years of age in Bucaramanga, Colombia. A cross-sectional study was designed with a sample of adult daily coffee drinkers during the last month. Logistical regression was used to adjust the variables associated with headache a symptom of caffeine abstinence, according to gender. A total of 1.119 people reported daily coffee intake. The mean age was 41.0 years, and mean level of education 8.4 years. 69.0% were females; 60.1% were married or free union, 49.9% had a remunerated employment, 66.0% were in a high or middle socioeconomic status and 28.7% referred headache related to caffeine abstinence. Among women, variables associated with headache were drinking three o more cups of coffee per day (OR=3.51, 95%CI 2.54-4.86), low education levels (OR=2.34, 95%CI 1.38-3.97), low socioeconomic status (OR=2.07, 95%CI 1.48-2.89), and age older than 45 years old (OR=1.43, 95%CI 1.03-2.00). Among men, the variables related to headache were common mental disorders (OR=3.46, 95%CI 1.62-7.37), and drinking three o more cups of coffee per day (OR=2.09, 95%CI 1.14-3.82). In conclusion, at least a third of adults report headache as a symptom of caffeine withdrawal. Headache was strongly associated with three o more cups of coffee per day in both women and men.

Key words: headache, caffeine, substance withdrawal syndrome

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CLINICAL AND PARACLINICAL ASSOCIATED FACTORS RELATED TO THE ADMISSION OF PATIENTS WITH A DIAGNOSIS OF MALARIA TO THE INTENSIVE CARE UNIT OF THE HOSPITAL MILITAR CENTRAL

WILSON A BAUTISTA M. M.D.1, SANDRA L PARRA C. M.D.1, ALIRIO R. BASTIDAS G. M.D.2, HENRY OLIVEROS M.D.3

1Residente Medicina Interna, Universidad Militar Nueva Granada, Bogotá D.C., Colombia.2 Residente de Neumología, Universidad Militar Nueva Granada, Bogotá D.C., Colombia. 3Anestesiólogo, Epidemiólogo Hospital Militar Central, Bogotá D.C., Colombia 4

Abstract

An analytic observational study of retrospective cohorts was carried out during the period comprised between January first 2002 and January 31, 2008 to determine the clinical and paraclinical factors associated with the patients admitted to the Intensive Care Unit (ICU) of the Hospital Militar Central with the diagnosis of malaria. The sample size was calculated using the program TAMAMU ® and 298 clinical histories were selected of which 278 fulfilled the inclusion criteria. Of the 278 patients, only 7,91% were admitted to ICU. Variables associated with admission to ICU were dyspnea (P <0.001), parasitemia greater than 50.000/µL (P = 0.001), use of antibiotics (P=0.001), platelet count of <83.000/mm3 (P = 0.01), and use of antimalarics in the first eight hours of admission to the hospital (P = 0.001). In conclusion, the presence of dyspnea, trombocytopaenia, parasitemia greater than 50.000/µL were related with the admission to ICU in patients with the diagnosis of malaria, use of antimalarics in the first eight hours of admission to the hospital is a protector factor but further clinical trials are needed in order to clarify the association with the use of use antibiotics.

Key words: Malaria, parasitemia, thrombocytopaenia

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TRIPLE NEGATIVE BREAST CANCER

JULIO PEGUERO SÁNCHEZ-NAVARRO M.D.1 AND ANA MARÍA GONZÁLEZ-ANGULO M.D., M.Sc.2*

1Department of Internal Medicine, Brackenridge Hospital, The University of Texas Medical Branch, Austin TX. 2Departments of Breast Medical Oncology and Systems Biology, The University of Texas, M.D. Anderson Cancer Center, Houston TX

Abstract

Triple negative breast cancer is a subtype of malignancy that does not express receptors for estrogen, progesterone or HER2NEU. The majority of these tumors form part of the “basal” genetic profile, but the terms are not synonymous or interchangeable. Because of their aggressive biology, they require a multidisciplinary approach. The relation between the BRCA gene and these tumors is still undefined and the subject of growing research. Premenopausal african americans have been identified in the United States as one of the ethnic groups at risk for this type of tumor. This neoplasm is sensitive to conventional chemotherapy but it remains at a high risk of recurrence. Some of the molecular targets include the epithelial growth factor receptors (EGFR), vascular endothelial growth factor (VGEF) and the poliadenosin-diphosphate-polimerase (PARP).

Keywords: breast neoplasm, receptors, estrogen, receptors, progesterone

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GERM CELL TUMOUR

YOVANY RODRÍGUEZ P. 1* Y JAVIER I. GODOY M.D. 2

Abstract

Germ Cell Tumours are malignancies derived from primordial germ cells. They are classified as seminomatous and non seminomatous, the latter divided based on the cellular differentiation as Embrionary germ cell, Choriocarcinomas, Yolk salk tumors and mature and inmature teratoma. They are the most frequent tumors in men between the ages of 20 and 35 and correspond to 90% of testicular tumors found as non-symptomatic hard painless testicular masses. Their embryologic origin as well as their migration from the primordial gut toward the seminiferous tubules explains the emergence of GCT in the mediastinum and retroperitoneum. In this review there is a description about embryologic, clinical and pathologic characteristics of the disease, as well as staging and treatment.

Keywords: neoplasms germ cell and embryonal , carcinoma embryonal, choriocarcinoma, teratoma, testicular neoplasms

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THE ROLE OF NITRIC OXIDE (NO) IN THE NORMAL PHYSIOLOGY OF THE AIRWAY AND ITS IMPLICATIONS ON THE PATHOPHYSIOLOGY OF PULMONARY HYPERTENSION

ManuelChinchilla , MD1, Fabio Bolivar 2, Carlos Luengas, MD1, Melvin Rincón MD1, Isabel Bolivar., MD1 y Patricio López-Jaramillo, MD, PhD1, 3.

1 Grupo VILANO, Fundación Cardiovascular de Colombia, Floridablanca, Colombia, 2 Facultad de Salud, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia, 3 Facultad de Medicina Universidad de Santander (UDES), Bucaramanga, Colombia.

Abstract

Pulmonary hypertension is a disease of the pulmonary microvasculature characterized by vasoconstriction, smooth muscle and endothelial proliferation, and thrombosis. Many molecules have been implicated in the etiology, demonstrating an increased production of vasoconstrictor agents as well as mitogenic, prothrombotic and inflammatory mediators such as tromboxano A2, endothelin (ET), and the inhibitor of the plasminogen activator, together with a low production of vasodilator substances such as prostacyclin (PGI2) and nitric oxide (NO), which in physiological conditions, acts as a modulator of the basal tones of the pulmonary vessels, an inflammatory mediator, and an immunomodulator. The histopathology of the injuries in pulmonary hypertension, triggered by the alteration in the production or activity of NO, which is caused by an accumulation of free radicals that leads to lower bioavailability of NO, suggests that the damage in the endothelium and the proliferative stimulus are fundamental processes for their development. This article reviews the role played by NO in the normal physiology of the airway and its implications on the pathophysiology of pulmonary hypertension.

Key words: Hypertension pulmonary, nitric oxide, endothelin, epoprostenol, vascular endothelial.

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SYSTEMIC COMPROMISE FROM LARGE CELL INTRAVASCULAR LYMPHOMA

JOSÉ J. ARIAS A. M.D.1* , LAURA ESCOBAR M.D. 1 Y MARÍA HELENA ASTORQUIZA, M.D.1

1Servicio de Patología, Hospital Militar Central, Bogotá, D.C., Colombia, Universidad Militar Nueva Granada, Bogotá D.C., Colombia

Abstract

This is the first case of intravascular large cell lymphoma diagnosed at the Hospital Militar de Bogota, in an adult female who presented with chronic fever, weight loss, constitutional symptoms and progressive motor deterioration for the previous 20 days to the point of paraplegia. A work up was carried out to rule out neoplastic diseases, infections or autoimmune diseases, but she died on the fourteen hospital day. The autopsy, performed 5 hours post mortem, showed an intravascular large cell malignancy, limited to the vascular spaces of multiple organs. The lymphomatous origin was confirmed posteriorly by immunochemical tests.

Key words: Lymphoma large B-cell diffuse, lymphoma B-cell

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BART’S SYNDROME, A CASE REPORT

JOHANNA PRADA, M.D.1 Y LIDA ROJAS, M.D. 2*

1 Residente de Dermatología, Universidad Militar Nueva Granada, Bogotá D.C., Colombia.

2 Médico Pediatra, Servicio de Pediatría, Hospital Naval de Cartagena, Cartagena, Colombia.

Abstract

Bart’s Syndrome is a rare congenital disorder, characterized by the association of bullous epidermolysis, congenital absence of areas of skin and ungueal abnormalities. This is the report of a newborn male referred to the Hospital Militar Central in Bogotá, for evaluation of extensive cutaneous lesions present a birth, who was diagnoses with Bart’s syndrome and who improved with treatment, showing a gradual resolution with time, in agreement with what is seen in the literature.

Key word: Bart syndrome, epidermolysis bullosa

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NEGATIVE PRESSURE THERAPY OVER SKIN GRAFTS: A CASE REPORT

MAURICIO ALFREDO BOLIVAR L., M.D.1*Y LUIS EDUARDO NIETO R. M.D2

1Residente de Cirugía Plástica, Universidad Militar Nueva Granada, Bogotá D.C., Colombia

2 Cirujano Plástico, Servicio Integrado de Cirugía Plástica, Hospital Militar Central, Hospital San José, Bogotá D.C., Colombia.

Abstract

Case report of a 79 year old male, with multiple soft tissue injuries in both lower limbs and with associated comorbidities like diabetes and heart disease that made difficult their management. We decided to put partial thickness skin grafts, and in the postoperative process we used VAC® therapy to accelerate the graft integration process, obtaining complete healing and coverage of the exposed areas. We made a review of the literature and we can corroborate that this new technique is effective in the management of diabetic and cardiovascular patients.

Key Words: VAC® Therapy, skin transplantation

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BRAIN ABSCESS FROM Escherichia coli: A SIMPLE DIARRHEA, DOCTOR?

ANDRÉS FELIPE OROZCO, M.D.1, GUILLERMO A. MONSALVE D. M.D. 2*

1 Residente de Neurocirugía, Universidad Militar Nueva Granada, Bogotá D.C., Colombia.

2 Neurocirujano, Servicio de Neurocirugía, Hospital Militar Central, Bogotá D.C., Colombia.

Abstract

A case of a 20 year-old soldier, who developed a brain abscess from Escherichia coli after a 7 day episode of diarrhea, is presented. The clinical course of the disease, its treatment and the different aetiologies of brain abscesses are discussed, emphasizing the importance of the follow up of diarrheic diseases no matter how simple they may look.

Key words: brain abscess, Escherichia coli, diarrhea

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AEROSPACE MEDICINE AND HUMAN FACTORS IN AVIATION.

THE IMPORTANCE OF A TRANSDISCIPLINARY APPROACH TO HEALTH

CR. MÉDICO LINA MARÍA SÁNCHEZ R. M.D. 1*

1 Centro de Medicina Aerospacial, Fuerza Aérea Colombiana, Bogotá D.C., Colombia,

Programa de Doctorado Interfacultades en Salud Pública, Universidad Nacional de Colombia, Bogotá D.C.,Colombia

Abstract

The study of the human factor in aviation accidents constitutes a challenge in aerospace medicine and aviation safety for the millennium. In spite of the efforts to develop models of interpretation from different approaches and disciplines, research continues to provide fragmented information emphasizing pilot error, making it difficult to identify structural problems leading to focalised intervention measures. Aerospace medicine research requires the integration of diverse disciplines and the participation of the different social actors of the aeronautic industry, in order to contribute to the solution of such complex problems as those presented by human factors and to propose actions for pilots’ health promotion and accident prevention.

Keywords: aviation, accidents aviation, health promotion

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MEDICINE AND WARS, AN INTRODUCTION

HUGO ARMANDO SOTOMAYOR TRIBÍN, M.D.1*

1Profesor Asociado, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, D.C., Colombia.

Abstract

In this and in the next article, we will be show a brief history of the evolution of modern medicine, an anthropological consideration about war and the evolution of war, starting in late 18th century and early 19th century, until our days.

Keywords: medicine, war, biological warfare, chemical warfare

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RevistaMed Vol.17 No.1 - 2009

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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Ultima actualización:  Marzo 11 de 2010