Aicardi syndrome is an X-linked-dominant genetic condition that is present almost exclusively in females. To diagnose Aicardi syndrome, the classic triad of agenesis of the corpus callosum, infantile spasms, and chorioretinal lacunae must be present. Here, we described a case of a female newborn baby delivered at 36 weeks of gestation that arrived at the emergency department with stiffening of arms and legs; therefore, an electroencephalogram was performed, showing generalized polypots confirming infantile spasms. Moreover, magnetic resonance was performed, showing complete agenesis of the corpus callosum. The patient was then transferred for an ophthalmoscopic examination, which evidenced multiple hypopigmented chorioretinal lesions corresponding to chorioretinal lacunae. Based on the clinical and radiological findings, the diagnosis of Aicardi syndrome was established, and treatment with anticonvulsive therapy and physiotherapy was initiated. This case report highlights the main characteristics that clinicians should consider to suspect this rare genetic condition, emphasizing the imaging and electroencephalographic findings.
The COVID‐19 pandemic impacted people's lives all over the world, requiring health and safety measures intended to stop the virus from spreading. This study explores whether an unintended consequence of these measures is a new form of ageism. We explore, using qualitative methods, the experiences of older adults living through the pandemic in the United Kingdom and Colombia. Although there were some small differences between countries, for the most part, the experiences were similar. We found that older adults reported that they were seen as a homogenous group and experienced both benevolent and hostile ageism and a loss of autonomy as a consequence of COVID‐19 protection measures. Participants from both countries expressed anger and frustration, and increased anxiety, and felt that their individuality was ignored. We recommend that policy‐makers, the media, and wider society consider the impact of such health and safety measures on older adults in preparing for future pandemics and health challenges.
Se trata de un paciente masculino con antecedente de artritis reumatoidea, síndrome de ojo seco y trasplante de córnea, hace 3 años. El paciente informa disminución de la agudeza visual en el ojo derecho. En el examen físico, se detecta una línea de rechazo en el meridiano a las 6 en la córnea e hiperemia conjuntival temporal. Un mes después refiere secreción excesiva y disminución de la agudeza visual (cuenta dedos a 3 metros). El examen reveló vascularización corneal de 360° y una perforación aséptica de la córnea central. La primera medida terapéutica fue cianoacrilato y lentes de contacto blandos, colirio de moxifloxacino al 0,5 % cada 4 horas, y colirio de hialuronato de sodio al 0,1 %. Quince días después no refirió mejoría, y su agudeza visual se redujo a cuenta dedos a 2 metros. Al examen, la neovascularización en cuatro cuadrantes y la prueba Seidel fueron positivas. Al día siguiente, se realizó un injerto conjuntival que mejoró el cuadro clínico; finalmente, se realizó un segundo trasplante tectónico de córnea. El abordaje terapéutico y quirúrgico de una perforación corneal depende del tamaño, forma, ubicación y causa de la lesión, siendo útiles los adhesivos tisulares de cianoacrilato en lesiones pequeñas.
IntroductionUncontrolled asthma significantly impairs health-related quality of life and work productivity. Some add-on therapies, such as vitamin D supplements, safely reduce the rate of asthma exacerbation. The purpose of this study was to assess the cost-utility of vitamin D supplementation in adults with mild to moderate persistent asthma in Colombia.MethodsA Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYs of two therapy strategies, vitamin D supplementation plus ICS versus ICS alone, were calculated over a one-year time horizon. Deterministic and probability sensitivity analyses were conducted, and cost-effectiveness was evaluated at a willingness-to-pay value of $5,180 per QALY gained.ResultsThe base-case analysis showed that compared with no supplementation, vitamin D supplementation was associated with higher costs and higher QALYs. The expected annual cost per patient with vitamin D supplementation was US$1338 and without this supplementation it was US$1095. The QALYs per person estimated with vitamin D supplementation was 0,80, and without this supplementation it was 0,63. The estimated incremental cost-effectiveness ratio (ICER) was US$1583 per QALY.Conclusion Add-on vitamin D supplement was cost-effective when added to the usual care in patients with mild to moderate persistent asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines.
Trauma registries play an important role in building capacity for trauma systems. Regularly, trauma registries exist in high-income countries (HICs) but not in Low- and Middle-Income Countries (LMICs). Neurotrauma includes common conditions, like traumatic brain injuries (TBI) and spinal cord injuries (SCI). The development of organized neurotrauma care is crucial for improving the quality of care in less-resourced areas. The recent article published in the IJHPM by Barthelemy et al, entitled "Neurotrauma Surveillance in National Registries of Low-and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries" adds an important body of literature to improve understanding of the importance of these types of efforts bypromoting organized neurotrauma care systems in LMICs. Here, we provide a short commentary based on our experience with the LATINO neurotrauma registry in the LATAM region.
The assortment of periodontal and implant‐related treatments has been continuously improved over the last 50 years. Once the decision‐making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision‐making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri‐implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the “net benefit ratio” between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.
The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) “gold standard” periodontal/implant‐related treatment options, and on the overall decision‐making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment‐related risks and complications.
Background: The vertical increase of the alveolar ridge dimension using allograft or xenograft mixed with autogenous bone graft and covered by a nonabsorbable high-density polytetrafluoroethylene (d-PTFE) membrane is well documented in the literature. Purpose: The aim of this study was to assess vital mineralized tissue formation in vertical ridge augmentation (VRA) procedures using autogenous bone chips mixed either with an allograft or a xenograft. Methods: This prospective clinical trial recruited 16 partially edentulous patients to undergo vertical ridge augmentation in one or more sites, making up a total of 24 samples for histological evaluation. Patients were sequentially stratified into Group A (treated with a freeze-dried bone allograft [FDBA] mixed with autogenous bone) or to Group B (treated with a bovine xenograft mixed with autogenous bone). Histological samples were analyzed according to the biomaterial used for VRA. Histological samples were obtained on the same day of membrane removal and implant placement. Results: Thirty-three implants were placed in 16 sites of regenerated bone via VRA, 13 patients with ridge augmentation in the posterior mandible, and 3 patients with VRA in the anterior maxilla. Group A (FDBA + autogenous) and Group B (xenograft + autogenous) showed a percent vital mineralized tissue (VMT) area of 67.64 ± 16.84 and 60.93 ± 18.25, respectively. A significant difference between the two biomaterials was not observed. Conclusion: When mixed with autogenous bone, either allografts or xenografts may provide a successful augmentation. Either mixture could serve as reliable alternative in VRA for obtaining a high percentage of VMT.
An asymptomatic 26-year-old woman underwent confocal microscopy as part of a control population for a research study. Images revealed reduced sub-basal corneal nerve density and multiple activated dendritic cells. Three years later, she presented with a self-limited cutaneous vasculitis in her lower extremities which prompted an evaluation for autoimmune diseases. Laboratory testing revealed positive antinuclear antibodies (1:320, thick granular pattern), and anti-SSA/SSB (SSA, 53.6 U/mL, moderately positive; SSB, 142.7 U/mL, strongly positive). Two weeks later, she presented with ocular pain and an ophthalmologic examination revealed ocular surface staining. An ocular ultrasound was consistent with posterior scleritis. Based on this picture, a diagnosis of Sjögren syndrome (SS) was made. SS is a chronic autoimmune disease that can present with symptoms that diminish the patient's quality of life. Confocal microscopy might be a valuable tool for the early diagnosis of disease.
Ernesto Bustamante Zuleta (1922–2021) was an impactful Colombian neurosurgeon whose legacy is inextricably linked with the development of the neurosurgery specialty in Colombia. His detail-oriented approach to treatment complemented his reputation for mastery of the neurosciences. Never simply confined to the operating theater, this calm and considerate physician felt compelled to teach during his entire career. The result of his teaching made a lasting imprint on an entire generation of neurosurgeons who subsequently established a high standard of neurosurgical care in Colombia. A true pioneer, Bustamante comprehensively engaged in his field, from founding the country’s first residency program in neurosurgery to successfully implementing technology in his procedures, performing many of Colombia’s first neurosurgical interventions, and publishing extensively across various categories of medical science. This historical reflection highlights his enduring contributions to the field and considers his legacy through the witness testimony of many of his students and collaborators. The hope is that his contributions may be acknowledged in full, as he was a reserved person who never boasted of his own accomplishments. The authors also hope that those who did not have the opportunity to know him would be informed by the historical context of the development of Colombian neurosurgery and inspired by his conviction and altruism.
The history of Colombian neurosurgery is a collective legacy of neurosurgeon-scientists, scholars, teachers, innovators, and researchers. Anchored in the country's foundational values of self-determination and adaptability, these pioneers emerged from the Spanish colonial medical tradition and forged surgical alliances abroad. From the time of Colombian independence until the end of World War I, exchanges with the French medical tradition produced an emphasis on anatomical and systematic approaches to the emerging field of neurosurgery. The onset of American neurosurgical expertise in the 1930s led to a new period of exchange, wherein technological innovations were added to the Colombian neurosurgical repertoire. This diversity of influences culminated in the 1950s with the establishment of Colombia's first in-country neurosurgery residency program. A select group of avant-garde neurosurgeons from this period expanded the domestic opportunities for patients and practitioners alike. Today, the system counts 10 recognized neurosurgery residency programs and over 500 neurosurgeons within Colombia. Although the successes of specific individuals and innovations were considered, the primary purpose of this historical survey was to glean relevant lessons from the past that can inform present challenges, inspire new opportunities, and identify professional and societal goals for the future of neurosurgical practice and specialization.
Background RT-PCR testing is the standard for diagnosis of COVID-19, although it has its suboptimal sensitivity. Chest computed tomography (CT) has been proposed as an additional tool with diagnostic value, and several reports from primary and secondary studies that assessed its diagnostic accuracy are already available. To inform recommendations and practice regarding the use of chest CT in the in the trauma setting, we sought to identify, appraise, and summarize the available evidence on the diagnostic accuracy of chest CT for diagnosis of COVID-19, and its application in emergency trauma surgery patients; overcoming limitations of previous reports regarding chest CT accuracy and discussing important considerations regarding its role in this setting. Methods We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. The review was conducted following the JBI methodology for systematic reviews. The Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267). Results Thirty studies that fulfilled selection criteria were included; 19 primary studies provided estimates of sensitivity (0.91, 95%CI = [0.88–0.93]) and specificity (0.73, 95%CI = [0.61; 0.82]) of chest CT for COVID-19. No correlation was found between sensitivities and specificities (ρ = 0.22, IC95% [–0.33; 0.66]). Diagnostic odds ratio was estimated at: DOR = 27.5, 95%CI (14.7; 48.5). Evidence for sensitivity estimates was graded as MODERATE, and for specificity estimates it was graded as LOW. Conclusion The value of chest CT appears to be that of an additional screening tool that can easily detect PCR false negatives, which are reportedly highly frequent. Upon the absence of PCR testing and impossibility to perform RT-PCR in trauma patients, chest CT can serve as a substitute with increased value and easy implementation. Systematic Review Registration [ www.crd.york.ac.uk/prospero ], identifier [CRD42020198267].
Background: The considerable increase in labiaplasty, demands plastic surgeons to be acquainted with the surgical techniques, their respective complications and satisfaction rates. This is a systematic review of the available evidence on labia minoraplasty looking at surgical techniques, clinical outcomes and patient satisfaction. Methods: A comprehensive search across PubMed, Web of Science, SCOPUS and Cochrane CENTRAL was executed through October 2020. A random-effect model meta-analysis was performed to assess the satisfaction and complications rates. Results: Forty-six studies including 3804 patients fulfilled the inclusion criteria. The pooled satisfaction rate following labia minoraplasty was 99% (95%CI: 97%-99%). Substantial heterogeneity was present across studies (I2 = 63.09%, p < 0.001). The highest pooled incidence of dehiscence was reported for laser-assisted labiaplasty (5%, 95%CI: 2%-8%) and wedge resection (3%, 95%CI: 1%-5%). The highest pooled incidence of hematoma formation (8%, 95%CI: <1%-23%) and postoperative bleeding (2%, 95%CI: <1%-15%) was reported for W-shape resection. The highest pooled incidence of transient pain or discomfort was reported for deepithelialization (2%, 95%CI: <1%-23%) and W-shape resection (2%, 95%CI: <1%-15%). Three flap necrosis were reported, two occurred using wedge resection labia minoraplasty and one was not specified. The most common causes for revision surgery (n=169) were dehiscence and aesthetic concerns. Conclusion: Overall, labia minoraplasty is a very safe procedure. However, serious complications requiring surgical management have been reported. In this sense, an experienced surgeon, proper knowledge of female genital anatomy, and a thorough technique selection in accordance with the patient characteristics is mandatory.
The objective of this article is to propose a technique for mandibular reconstructions of up to 17 cm, in order to obtain anterior iliac crest grafts smaller than those required, and then lengthen them using corticotomies. This technique has been performed in 5 patients with an indication for reconstruction after partial mandibulectomy due to pathology. Reconstruction of the body of the mandible, including the angle in some cases, was performed using nonvascularized anterior iliac crest grafts. These were elongated using corticotomies and fixed to cover the defect using reconstruction plates and screws (2.4 system). The wedge spaces that were formed by lengthening the bone block were grafted with autologous medullary bone and platelet-rich plasma. There was no loss of any of the grafts and there was no need for second surgical times to place more grafts. All cases were able to be rehabilitated with removable prostheses or dental implants. This method optimizes the amount of graft obtained, favors revascularization of the graft, reduces hypoxia times and allows the placement of osteoconductive and/or osteoinductive grafts directly on the exposed medullary areas, with the aim of promoting integration and reducing the resorption rate in large grafts.
Misinformation can have a detrimental impact on our beliefs, and it is therefore necessary to understand the cognitive mechanism by which false information is integrated or can be changed. In two experiments, we worked with fake psychic demonstrations, because observers easily adopt the experience as reflecting a « true » psychic event. We manipulated the availability of alternative explanations by providing a general warning that the performer is a magician with no psychic abilities (Experiment 1), or disclosing afterwards how the fake demonstration had been staged (Experiment 2). In experiment 1, witnessing the psychic demonstration significantly increased participants’ psychic beliefs, even though they had been warned. However, providing the alternative explanation about the deceptive method mitigated this effect. In experiment 2, the realization of deception significantly reduced participants’ psychic beliefs directly after the performance, and remained reduced at the one week later.
Tumors of the abdominal wall are rare, divided into benign and malignant lesions that are composed of primary tumors and by the parietal invasion of intra-abdominal tumors and metastatic parietal implants. In the case of metastases in the abdominal wall, the most frequent are metastases from neoplasms of colonic origin. The case described below is that of a 68-year-old patient with a history of stage IIA left lung adenocarcinoma who received partial response radiotherapy with an indication for chemotherapy, which she refused and lost follow-up.
Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The standard management for localized GIST is the complete surgical resection. For this procedure, laparoendoscopic cooperative surgery (LECS) has been proposed as a safe and effective alternative. We want to show our experience with LECS technique for the management of GIST and a literature review. Materials and methods: A retrospective, cross-sectional study was carried out, which included patients with a diagnosis of localized GIST treated with LECS technique between January 2011 and December 2018. Results: During the period of the study, 21 patients were managed by LECS technique, with a male-female rate 3:1. Average surgical time was 98.5 min, 100% negative borders in all patients. Intraoperative bleeding was 30.7 cc and all patients had orally tolerance in the first 24 h. None of them required ICU management, no mortality was reported. Conclusions: The LECS technique has demonstrated to be a viable, safe, and effective technique for the management of gastric GIST's, showing superiority in organ function preservation and in the range of oncological margins. Prospective studies are necessary to obtain knowledge about the outcome of patients managed through LECS technique.
Objectives To compare the rate disparity between outcomes (overall survival (OS), progression-free survival (PFS), and safety) of concurrent chemoradiation (cCRT) followed by durvalumab in two patient cohorts with locally advanced (LA) stage III non-small cell lung cancer (NSCLC), one non-Hispanic White (NHW), and the other Latin-American.MethodsA multicenter retrospective study was performed, including 80 Hispanic and 45 NHW LA stage III NSCLC patients treated with cCRT followed by durvalumab. Both cohorts were analyzed in terms of main outcomes (OS, PFS, and safety) and compared between them and with the PACIFIC trial population outcomes. The efficacy-effectiveness gap was assessed using an efficacy-effectiveness (EE) factor that was calculated by dividing each cohort median overall survival by the corresponding reference OS from the PACIFIC trial. In both cohorts, results of PD-L1 testing were recorded, and the main outcomes were compared according to PD-1 expression levels (≥50%, 1–49%, and <1%).ResultsFor the entire population (N=125), the overall response rate (ORR) was 57.6% (N=72), and 18.4% (N=25) achieved stable disease. OS was 26.3 months (95%CI 23.9-28.6), and PFS was 20.5 months (95%CI 18.0-23.0). PFS assessed by ethnicity showed a median for the Hispanic population of 19.4 months (95%CI 16.4-22.5) and 21.2 months (95%CI 17.2-23.3; p=0.76) for the NHW group. OS by race showed a significant difference in favor of the NHW group, with a median OS of 27.7 months (95%CI 24.6-30.9) vs. 20.0 months (95%CI 16.4-23.5) for Hispanics. (P=0.032). Unadjusted 12-month and 24-month OS was 86.6% (95%CI 79.9–88.0) and 46.6% (95%CI 40.2–48.3) for NHW compared to 82.5% (95%CI 77.1–84.2) and 17.5% (95%CI 15.6-24.5) in Hispanics. NHW had an EE factor of 0.78 and Hispanics had 0.58, showing a reduction in survival versus NHW and PACIFIC of 20% and 42%, respectively. HR for the OS among NHWs and Hispanics was 1.53 (95%CI 1.12-1.71; P=0.052) and 2.31 (95%CI 1.76-2.49; P=0.004). Fifty-six patients (44.8%) had some degree of pneumonitis due to cCRT plus durvalumab. There was no difference in the proportion of pneumonitis according to race (P=0.95), and the severity of pneumonitis was not significantly different between Hispanics and NHWs (P=0.41).Conclusions Among patients with LA stage III NSCLC, NHW had better survival outcomes when compared to Hispanics, with an OS that seems to favor the NHW population and with an EE factor that shows a shorter survival in Hispanics compared with NHW and with the PACIFIC trial group.
Since the early seventies with the work of Akira Fujishima on photocatalytic and super-hydrophilic properties of titanium dioxide (TiO2), also known as the Honda-Fujishima effect, pho-tocatalysis has been investigated and progressively implemented in cement-based materials towards the development of self-cleaning, air-purifying and antiseptic materials, buildings and infrastructure. Although important achievements have been obtained at the laboratory scale, their real scale application has had some limitations mainly due to the low efficiencies obtained during adverse environmental conditions. Therefore, this article presents the challenges and opportunities of using of titanium dioxide in cement-based materials towards the development of truly efficient sustainable building materials. First, TiO2 photocatalysis and its incorporation in cementitious materials are presented. Second, self-cleaning, air-purifying and antimicrobial properties are discussed in terms of the lab and pilot project results. Third, conclusions regarding the different multifunctional properties are given towards the real application of TiO2 photocatalysis. Particularly, complementary technologies and strategies are presented in order to increase the above-mentioned multifunc-tional properties.
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