Colombia Medica最新文献

Background: Guidelines in medicine are essential tools to provide quality and standardised medical care. We analysed the quality of aesthetic medicine guidelines.

Methods: A systematic review with a prospective registration protocol (https://osf.io/8pdyv) of databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR), web pages of scientific societies and grey literature was done from inception to February 2023 and without language restrictions. Quality was evaluated using AGREE II (% of the maximum score), RIGHT (% of the total 35 items) and a shared decision making (SDM) quality assessment tool (31 items score) individually and in duplicate, respectively.

Results: Six (86%) guidelines were classified as not recommended; one (14%) was recommended with modifications, and all were classified as poorly reported (7/7; 100%). The median overall quality was 27% (IQR: 26-43) and 26% (IQR 15-36) for AGREE II and RIGHT, respectively. No document used these tools for its development. SDM appeared superfluity in almost all of the guidelines explored.

Conclusions: Aesthetic medicine and surgical guidelines had low quality and must be improved. There is a wide range of improvement, especially in applicability, reporting of evidence, recommendations, conflict of interest, quality control and SDM. These guidelines require a rigorous methodology based on systematic reviews to ensure quality evidence-based recommendations.

Background: Morphological properties such as length and tortuosity of the large intestine segments play important roles, especially in interventional procedures like colonoscopy.

Objective: Using computed tomography (CT) colonoscopy images, this study aimed to examine the morphological features of the colon's anatomical sections and investigate the relationship of these sections with each other or with age groups. The shapes of the transverse colon were analyzed using artificial intelligence.

Methods: The study was conducted as a two- and three-dimensional examination of CT colonography images of people between 40 and 80 years old, which were obtained retrospectively. An artificial intelligence algorithm (YOLOv8) was used for shape detection on 3D colon images.

Results: 160 people with a mean age of 89 men and 71 women included in the study were 57.79±8.55 and 56.55±6.60, respectively, and there was no statistically significant difference (p= 0.24). The total colon length was 166.11±25.07 cm for men and 158.73±21.92 cm for women, with no significant difference between groups (p=0.12). As a result of the training of the model Precision, Recall, and Mean Average Precision (mAP) were found to be 0.8578, 0.7940, and 0.9142, respectively.

Conclusion: The study highlights the importance of understanding the type and morphology of the large intestine for accurate interpretation of CT colonography results and effective clinical management of patients with suspected large intestine abnormalities. Furthermore, this study showed that 88.57% of the images in the test data set were detected correctly and that AI can play an important role in colon typing.

Case description: Four cases of patients aged 41, 33, 43 and 68 years who presented periapical lesions and needed periodontal surgery for pre-prosthetic purposes.

Clinical findings: The first case presented an intra-radicular retainer that was difficult to remove and likely to generate a root fracture. In addition, asymmetry of the gingival zenith was observed. The second case presented a complete crown at 16 with mesial marginal mismatch and subgingival margins distally. The third case presented a vestibular fistula with inflammation at the cervical level. The fourth case presented a vestibular fistula in the upper right lateral incisor. All patients showed apical lesions.

Treatment and outcome: The first three cases received coronal lengthening and apical surgery in the same surgical procedure. In the fourth case, apical surgery was performed, and placement of implants 13 and 15 with a pontic of 14. During the clinical control and radiographs performed after the surgical procedures, bone filling of the lesion was found.

Clinical relevance: Considering the results obtained, performing the periodontal and endodontic surgery procedures in a single surgical act is suggested. This reduces costs, travel, number of appointments, medication intake and post-surgical complications.

Background: The association of fragmented QRS (fQRS) with many cardiac pathologies such as cardiac fibrosis has been described previously. Paraaortic adipose tissue (PAT) is thought to be associated with many cardiac diseases and there is only one publication on its echocardiographic evaluation.

Aims: To describe the possible relationship between fQRS and PAT.

Methods: Patients presenting to the cardiology outpatient clinic were evaluated for inclusion in the study. Presence of additional R' wave or notching/splitting of S wave in two contiguous ECG leads was defined as fragmented QRS (fQRS) and patients were divided into two groups according to fQRS status on ECG. The hypoechoic space in front of the ascending aorta was considered as PAT in the parasternal long-axis view. The medical history and routine laboratory parameters of the participants were recorded. Univariate and multivariate binary regression analysis was used to determine the relationship between PAT and fQRS.

Results: A total of 221 patients were enrolled and divided into two groups according to fQRS status. PAT was significantly higher in the fQRS group: 9.2 mm (7.1/12.3) vs 6.8 mm (1.2/10.9), p=0.001. Univariate analysis showed significant association between fragmented QRS and PAT size (OR 1.122, p= 0.001). Binary regression analysis revealed an independent and strong association between aortic size (OR 1.4, CI95% 1.012-1.938, p=0.042), paraaortic adipose tissue (OR 1.483, CI95% 1.084-2.029, p=0.014) and fragmented QRS.

Conclusions: The presence of fQRS is associated with PAT, a newly defined parameter in echocardiography.

Background: Managing foreign bodies in otorhinolaryngology requires appropriate treatment based on case severity.

Objective: To analyze the clinical characteristics associated with complicated cases of foreign bodies.

Methods: This study categorized patients with diagnosed foreign bodies into complicated and uncomplicated cases. Complicated cases were defined as complications from foreign bodies requiring an operating room procedure, hospitalization, or tracheal foreign body. Otherwise, they were considered uncomplicated. Clinical data and disease variables were recorded. Univariate and multivariate regression analyses were performed to evaluate the significance of different clinical features between the groups (p-value <0.05).

Results: Of the 751 cases studied, most cases involving foreign bodies were treated outpatient and typically presented without complications, while 20.1% (n=151) were confirmed as complicated. There were 119 cases present with complications from foreign bodies, 58 requiring removals in an operating room, 57 needing hospitalization, and two tracheal foreign bodies. Multivariate analysis revealed that male gender (p-value 0.043, OR (95%CI) = 1.554 (1.015-2.378)), positive presenting symptoms (p-value <0.0001, OR (95%CI)= 4.081 (2.299-7.248)), foreign body in the hypopharyngeal area (p-value <0.0001, OR (95%CI) = 65.615 (6.907-623.336)), and foreign body in the laryngeal area (p-value 0.006, OR (95%CI) = 27.787 (2.568-300.673)) were significantly associated with complicated foreign bodies cases.

Conclusion: Complicated foreign body cases should be addressed in male patients complaining of symptoms and foreign bodies in the hypopharyngeal and laryngotracheal locations. Due to the complexity of their condition, effective management of these patients requires a multidisciplinary approach.

Background: Differences in asthma prevalence between urban and rural areas have been observed worldwide. Epidemiological studies in middle- and low-income countries suggest that internal migration processes may partly explain these disparities.

Objective: To investigate the association between internal migration and asthma in children living in transitional areas of Ecuador.

Methods: A cross-sectional study was conducted using data from a birth cohort of children living in a tropical coastal region in northwestern Ecuador. Asthma indicators included wheezing in the past 12 months, ever wheezing, and asthma diagnosis by a doctor. Internal migration was defined as a change of residence between geographical units: cantonal, parish, and census tract. The relationship between asthma and migration was analyzed using binary logistic regression.

Results: Of 2,404 participants, 1,818 children met the inclusion criteria. Among them, 2.8% experienced cantonal migration, 11.9% parish migration, and 24.6% census tract migration. The prevalence of wheezing in the past 12 months, ever wheezing, and asthma diagnosis by a doctor was 13.1%, 33.3%, and 7%, respectively. Children with a history of cantonal migration were more likely to have experienced wheezing compared to those who did not migrate (OR: 1.56; 95%CI: 0.87-2.79).

Conclusions: Changes in residence between smaller or adjacent geographic units appeared not to be associated with asthma prevalence. However, cantonal migration may play a role in respiratory health outcomes.

Introduction: Intestinal parasites particularly affect vulnerable populations, making their management crucial in endemic areas.

Objective: To evaluate the relationship between intestinal parasites, socioeconomic characteristics, and anthropometric nutritional status.

Methods: This is an observational, cross-sectional study conducted on children aged 1 to 15 years in Tartagal, Argentina, for a year. Intestinal parasitic infections were determined through fecal analysis using sedimentation techniques (Teleman), Kato-Katz, and the Baerman method. Demographic and socioeconomic data were collected using a standardized survey. Height, weight, and mid-upper arm and head circumference were measured in the participants.

Results: Of the 588 participants who provided fecal samples, 55.4% had intestinal parasites, with G. lamblia and H. nana being the most prevalent species. Additionally, 31.9% of participants were found to have malnutrition due to excess weight. Risk factors for intestinal parasite presence included age, overcrowding, and walking barefoot, while owning a refrigerator, having an animal corral, adequate water storage, and belonging to the Guaraní ethnic group were protective factors. High vulnerability areas were observed regarding housing conditions and access to public services.

Conclusions: An association between socioeconomic conditions and the risk of intestinal parasite presence was observed. However, no association was found between anthropometric nutritional status and the presence of intestinal parasites.

Description of the cases: A series of 6 cases with a probable diagnosis of sporadic CJD, treated in a Peruvian national reference hospital, are presented.

Clinical findings: The relevant clinical signs were rapidly progressive dementia and myoclonus, followed by akinetic mutism and pyramidal signs.

Treatment and results: Of the cases presented, 80% were men, with an average age of presentation of 65 years and duration from diagnosis to death of 6.5 months. Laboratory tests, images (Brain Resonance) and protein dosage 14.3.3 were performed to support the clinical suspicion. There is no effective treatment at the moment for said pathology.

Clinical relevance: Creutzfeldt-Jakob disease (CJD) is a progressive, fatal, neurodegenerative disease of low prevalence and incidence. Great clinical suspicion and the exclusion of other etiologies are required. Currently there is no treatment for this entity and there is a high probability of death before one year.

Introduction: TRUS-guided prostate biopsy is a current method used to obtain the histopathological material necessary to make a definitive diagnosis of prostate cancer.

Objective: To investigate patient-related variables affecting the level of pain felt during prostate biopsy to determine what can be done to minimize pain.

Methods: The study included 241 patients scheduled for prostate biopsy. Four patients who did not meet the criteria were excluded. Local anesthesia was administered intrarectally 10 minutes before the biopsy to 237 patients, and a conventional 12-core biopsy was performed. The level of pain felt by all patients during the biopsy was measured using the Visual Analog Scale (VAS) score. Pain scores were compared by forming groups according to the selected parameters.

Results: The mean age of the 237 included patients was 66.0±7.8 years, the mean serum PSA level was 33.7±197.5 ng/dL, and the mean prostate volume was 33.7±197.5 ml. The mean VAS score was 4.3±1.9. The pain score was higher in patients with positive digital rectal examination findings and lower in patients using 5-alpha reductase inhibitors(5-ARİ). At the same time, no significant difference was found in patients with positive tumor pathology, perineural invasion, alpha-blockers, or combination therapy.

Conclusion: Some patient parameters may affect the level of pain felt during TRUS-guided prostate biopsy.