{"title":"Inequities in the emergence, manifestations and consequences of COVID19","authors":"F. Paz","doi":"10.25100/CM.V52I1.4778","DOIUrl":"https://doi.org/10.25100/CM.V52I1.4778","url":null,"abstract":"","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76696129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Franklin R Aguilar-Gamboa, Dennis Cubas-Alarcon, Miguel Villegas-Chiroque, Virgilio E Failoc-Rojas
Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions.
Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris.
Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems.
Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.
{"title":"Pityriasis rubra pilaris post-infection due COVID-19: case report.","authors":"Franklin R Aguilar-Gamboa, Dennis Cubas-Alarcon, Miguel Villegas-Chiroque, Virgilio E Failoc-Rojas","doi":"10.25100/cm.v52i1.4577","DOIUrl":"https://doi.org/10.25100/cm.v52i1.4577","url":null,"abstract":"<p><strong>Case description: </strong>32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions.</p><p><strong>Clinical findings: </strong>Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris.</p><p><strong>Treatment and outcome: </strong>rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems.</p><p><strong>Clinical relevance: </strong>We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/77/1657-9534-cm-52-01-e7014577.PMC8054706.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38917990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Inequality Virus is the name given to SARS-COV2 by an OXFAM publication, highlighting that during the pandemic, the ten richest men on the planet have earned 540 billion dollars, a figure that would serve to finance a universal vaccine for COVID19. This fact is an exemplary demonstration of the inequities of the pandemic, analyzed below in three different dimensions: 1) The origins of the pandemic, in the context of inequitable socio-ecological systems where the relationship amongst humans and between humans and nature has been broken; 2) Its manifestations, in conditions of social inequity, with its patterns of occurrence and a painful trace of disease and death; and 3) The consequences, in a vicious circle with the complex systems that gave rise to it, causing a profound situation of inequity, in other words, the pandemic as a source of more unjust differences.
{"title":"Inequities in the emergence, manifestations and consequences of COVID19.","authors":"Fabian Mendez","doi":"10.25100/cm.v51i4.4778","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4778","url":null,"abstract":"The Inequality Virus is the name given to SARS-COV2 by an OXFAM publication, highlighting that during the pandemic, the ten richest men on the planet have earned 540 billion dollars, a figure that would serve to finance a universal vaccine for COVID19. This fact is an exemplary demonstration of the inequities of the pandemic, analyzed below in three different dimensions: 1) The origins of the pandemic, in the context of inequitable socio-ecological systems where the relationship amongst humans and between humans and nature has been broken; 2) Its manifestations, in conditions of social inequity, with its patterns of occurrence and a painful trace of disease and death; and 3) The consequences, in a vicious circle with the complex systems that gave rise to it, causing a profound situation of inequity, in other words, the pandemic as a source of more unjust differences.","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/50/1657-9534-cm-52-01-e1014778.PMC8054711.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38916946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claudia Perez, José Rico, Carlos Guerrero, Orlando Acosta
Background: Viruses are being used as alternative and complementary tools for treating cancers. Oncolytic viruses exhibit tumor tropism, ability to enhance anti-tumor immunity and ability to be used in combination with conventional chemotherapy and radiotherapy. We have recently selected some rotavirus isolates which are adapted to efficiently infect and kill tumor cell lines.
Aim: We tested five tumor cell-adapted rotavirus isolates for their ability to infect the human adenocarcinoma cell line MCF-7.
Methods: Cell surface membrane-associated proteins mediating virus particle attachment were characterized using ELISA, immunoprecipitation, FACS analysis, and antibody blocking.
Results: It was found that heat shock proteins (HSPs) such as Hsp90, Hsp70, Hsp60, and Hsp40 are expressed on the cell surface forming complexes with protein disulfide isomerase (PDI), integrin β3, and heat shock cognate protein 70 (Hsc70) in lipid raft microdomains. Interaction of rotavirus isolates with these cellular proteins was further confirmed by a competition assay and an inhibition assay involving the HSPs tested.
Conclusion: Our findings suggest that the tumor cell-adapted rotavirus isolates studied here offer a promising tool for killing tumor cells, thus encouraging further research into this topic, including animal models.
{"title":"Role of heat-shock proteins in infection of human adenocarcinoma cell line MCF-7 by tumor-adapted rotavirus isolates.","authors":"Claudia Perez, José Rico, Carlos Guerrero, Orlando Acosta","doi":"10.25100/cm.v51i4.4196","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4196","url":null,"abstract":"<p><strong>Background: </strong>Viruses are being used as alternative and complementary tools for treating cancers. Oncolytic viruses exhibit tumor tropism, ability to enhance anti-tumor immunity and ability to be used in combination with conventional chemotherapy and radiotherapy. We have recently selected some rotavirus isolates which are adapted to efficiently infect and kill tumor cell lines.</p><p><strong>Aim: </strong>We tested five tumor cell-adapted rotavirus isolates for their ability to infect the human adenocarcinoma cell line MCF-7.</p><p><strong>Methods: </strong>Cell surface membrane-associated proteins mediating virus particle attachment were characterized using ELISA, immunoprecipitation, FACS analysis, and antibody blocking.</p><p><strong>Results: </strong>It was found that heat shock proteins (HSPs) such as Hsp90, Hsp70, Hsp60, and Hsp40 are expressed on the cell surface forming complexes with protein disulfide isomerase (PDI), integrin β3, and heat shock cognate protein 70 (Hsc70) in lipid raft microdomains. Interaction of rotavirus isolates with these cellular proteins was further confirmed by a competition assay and an inhibition assay involving the HSPs tested.</p><p><strong>Conclusion: </strong>Our findings suggest that the tumor cell-adapted rotavirus isolates studied here offer a promising tool for killing tumor cells, thus encouraging further research into this topic, including animal models.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/a4/1657-9534-cm-52-01-e2024196.PMC8054709.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38916947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
José Pacheco-Romero, Oscar Acosta, Doris Huerta, Santiago Cabrera, Marlene Vargas, Pedro Mascaro, Moisés Huamán, José Sandoval, Rudy López, Julio Mateus, Enrique Gil, Enrique Guevara, Nitza Butrica, Diana Catari, David Bellido, Gina Custodio, Andrea Naranjo
Background: Preeclampsia is a multiorgan disorder associated with maternal and perinatal morbi-mortality. In Peru, incidence is 10% and accounts for 22% of maternal deaths. Genome and genetic epidemiological studies have found an association between preeclampsia and genetic polymorphisms.
Objective: To determine the association of the vascular endothelial growth factor (VEGF) +936 C/T and +405 G/C, interleukine-6 (IL-6) -174 G/C, IL-1β-511 C/T, Apo A-1-75 G/A, Apo B-100 2488 C/T (Xbal) polymorphisms with preeclampsia in pregnant Peruvian women.
Methods: Were included preeclamptic and healthy (control) pregnant women. Maternal blood samples were subjected to DNA extraction, and molecular genetic analysis was conducted using the PCR-RFLP technique and following a specific protocol for each gene. Allele and genotypic frequencies in the cases and controls were compared.
Results: No association was found between the VEGF+936C/T and VEGF+405 polymorphisms and preeclampsia. The frequencies of the GG genotypes and the G allele of the -174 G/C polymorphism in the IL6 gene in preeclamptic and controls showed significant differences, with higher frequencies in cases. For the -511 C/T polymorphism of the IL-1β gene, no significant differences were found in the frequencies of TT genotypes compared with CT+CC. The genotypes and alleles of the Apo-A1-75 G/A and Apo-B100 Xbal variants showed no significant differences between cases and controls.
Conclusion: No association was found between the studied genetic markers and preeclampsia. However, in the -174G/C polymorphism of the IL-6 gene, significant differences were found mainly in the GG genotype and G allele.
{"title":"Genetic markers for preeclampsia in Peruvian women.","authors":"José Pacheco-Romero, Oscar Acosta, Doris Huerta, Santiago Cabrera, Marlene Vargas, Pedro Mascaro, Moisés Huamán, José Sandoval, Rudy López, Julio Mateus, Enrique Gil, Enrique Guevara, Nitza Butrica, Diana Catari, David Bellido, Gina Custodio, Andrea Naranjo","doi":"10.25100/cm.v52i1.4437","DOIUrl":"10.25100/cm.v52i1.4437","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is a multiorgan disorder associated with maternal and perinatal morbi-mortality. In Peru, incidence is 10% and accounts for 22% of maternal deaths. Genome and genetic epidemiological studies have found an association between preeclampsia and genetic polymorphisms.</p><p><strong>Objective: </strong>To determine the association of the vascular endothelial growth factor (VEGF) +936 C/T and +405 G/C, interleukine-6 (IL-6) -174 G/C, IL-1β-511 C/T, Apo A-1-75 G/A, Apo B-100 2488 C/T (Xbal) polymorphisms with preeclampsia in pregnant Peruvian women.</p><p><strong>Methods: </strong>Were included preeclamptic and healthy (control) pregnant women. Maternal blood samples were subjected to DNA extraction, and molecular genetic analysis was conducted using the PCR-RFLP technique and following a specific protocol for each gene. Allele and genotypic frequencies in the cases and controls were compared.</p><p><strong>Results: </strong>No association was found between the VEGF+936C/T and VEGF+405 polymorphisms and preeclampsia. The frequencies of the GG genotypes and the G allele of the -174 G/C polymorphism in the IL6 gene in preeclamptic and controls showed significant differences, with higher frequencies in cases. For the -511 C/T polymorphism of the IL-1β gene, no significant differences were found in the frequencies of TT genotypes compared with CT+CC. The genotypes and alleles of the Apo-A1-75 G/A and Apo-B100 Xbal variants showed no significant differences between cases and controls.</p><p><strong>Conclusion: </strong>No association was found between the studied genetic markers and preeclampsia. However, in the -174G/C polymorphism of the <i>IL-6</i> gene, significant differences were found mainly in the GG genotype and G allele.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/6f/1657-9534-cm-52-01-e2014437.PMC8054708.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38917988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adriana Linares Ballesteros, Roy Sanguino Lobo, Juan Camilo Villada Valencia, Oscar Arévalo Leal, Diana Constanza Plazas Hernández, Nelson Aponte Barrios, Iván Perdomo Ramírez
Abstract Background: Acute leukemias are the most frequent malignancies in children. Advances in treatment have improved the overall survival to 80%. Almost 10% of children with cancer develop clinical cardiac toxicity. Total anthracycline cumulative dose is a risk factor for early-onset cardiotoxicity. Objective: To describe the incidence of early-onset cardiotoxicity in children with acute leukemia treated with chemotherapy. Methods: A prospective descriptive study of patients >1 y and <18 years diagnosed with acute leukemia. Assessed with electrocardiograma, echocardiography, and blood biomarkers at diagnosis and during the follow-up. Results: 94 patients with acute lymphoblastic leukemia and 18 with acute myeloid leukemia were included. 20 patients (17.9%) developed early-onset cardiotoxicity. Statistically significant data was seen after anthracycline dose >150 mg/m2, between the first echocardiographic evaluation and posterior analyses in the left ventricular fraction ejection with Teicholz p 0.05, Simpson p 0.018 and GLS p 0.004. In this study, there was no relation between blood biomarkers and cardiotoxicity. Conclusions: Cancer therapeutic-related cardiac dysfunction is related to anthracycline cumulative dose. In this study, echocardiographic follow-up was useful to predict risk factors for early cardiac dysfunction.
背景:急性白血病是儿童最常见的恶性肿瘤。治疗的进步使总生存率提高到80%。几乎10%的儿童癌症患者会出现临床心脏毒性。蒽环类药物总累积剂量是早发性心脏毒性的危险因素。目的:了解急性白血病患儿化疗后早发性心脏毒性的发生率。方法:对年龄>1岁的患者进行前瞻性描述性研究。结果:94例急性淋巴细胞白血病患者和18例急性髓性白血病患者纳入研究。20例(17.9%)出现早发性心脏毒性。蒽环类药物剂量>150 mg/m2后,首次超声心动图评价与后验分析左室射血分数的差异有统计学意义(Teicholz p 0.05, Simpson p 0.018, GLS p 0.004)。在这项研究中,血液生物标志物与心脏毒性之间没有关系。结论:蒽环类药物累积剂量与肿瘤治疗相关性心功能障碍有关。在本研究中,超声心动图随访有助于预测早期心功能障碍的危险因素。
{"title":"Early-onset Cardiotoxicity assessment related to anthracycline in children with leukemia. A Prospective Study.","authors":"Adriana Linares Ballesteros, Roy Sanguino Lobo, Juan Camilo Villada Valencia, Oscar Arévalo Leal, Diana Constanza Plazas Hernández, Nelson Aponte Barrios, Iván Perdomo Ramírez","doi":"10.25100/cm.v52i1.4542","DOIUrl":"https://doi.org/10.25100/cm.v52i1.4542","url":null,"abstract":"Abstract Background: Acute leukemias are the most frequent malignancies in children. Advances in treatment have improved the overall survival to 80%. Almost 10% of children with cancer develop clinical cardiac toxicity. Total anthracycline cumulative dose is a risk factor for early-onset cardiotoxicity. Objective: To describe the incidence of early-onset cardiotoxicity in children with acute leukemia treated with chemotherapy. Methods: A prospective descriptive study of patients >1 y and <18 years diagnosed with acute leukemia. Assessed with electrocardiograma, echocardiography, and blood biomarkers at diagnosis and during the follow-up. Results: 94 patients with acute lymphoblastic leukemia and 18 with acute myeloid leukemia were included. 20 patients (17.9%) developed early-onset cardiotoxicity. Statistically significant data was seen after anthracycline dose >150 mg/m2, between the first echocardiographic evaluation and posterior analyses in the left ventricular fraction ejection with Teicholz p 0.05, Simpson p 0.018 and GLS p 0.004. In this study, there was no relation between blood biomarkers and cardiotoxicity. Conclusions: Cancer therapeutic-related cardiac dysfunction is related to anthracycline cumulative dose. In this study, echocardiographic follow-up was useful to predict risk factors for early cardiac dysfunction.","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/6c/1657-9534-cm-52-01-e2034542.PMC8054707.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38917987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Through the culture of thinness, increasingly promoted in our society as a beauty canon, it is not surprising that the number of people affected by eating disorders is increasing.
Objective: This research aims to study the relationship between non-suicidal self-injuries and nuclear aspects of eating disorders specified along with this article.
Methods: The sample consisted of 60 women diagnosed with anorexia and bulimia. Questionnaires assessing impulsivity, body satisfaction, alexithymia, body attitude and self-esteem were administered. Participants with non-suicidal self-harm were compared with those without it, and participants with anorexia with and without self-harm and participants with bulimia with and without self-harm were compared.
Results: Differences were found in body dissatisfaction= 5.71; p ≤0.01), body attitudes= 4.80; p ≤0.02), self-esteem= 14.09; p ≤0.00) and impulsivity (t= 3.39; p ≤0.01) between participants with and without non-suicidal self-harm.
Conclusions: These are key factors for the clinical area in the treatment of eating disorders to prevent the presence of self-harm, as it allows focusing the treatment target on those aspects such as dissatisfaction and impulsivity, which are key in the development of self-harm.
{"title":"Non-suicidal self-injury in patients with eating disorders: nuclear aspects.","authors":"Álvaro Rodríguez-López, Erika Rodríguez-Ortiz, Borja Romero-Gonzalez","doi":"10.25100/cm.v51i4.4342","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4342","url":null,"abstract":"<p><strong>Background: </strong>Through the culture of thinness, increasingly promoted in our society as a beauty canon, it is not surprising that the number of people affected by eating disorders is increasing.</p><p><strong>Objective: </strong>This research aims to study the relationship between non-suicidal self-injuries and nuclear aspects of eating disorders specified along with this article.</p><p><strong>Methods: </strong>The sample consisted of 60 women diagnosed with anorexia and bulimia. Questionnaires assessing impulsivity, body satisfaction, alexithymia, body attitude and self-esteem were administered. Participants with non-suicidal self-harm were compared with those without it, and participants with anorexia with and without self-harm and participants with bulimia with and without self-harm were compared.</p><p><strong>Results: </strong>Differences were found in body dissatisfaction= 5.71; <i>p</i> ≤0.01), body attitudes= 4.80; <i>p</i> ≤0.02), self-esteem= 14.09; <i>p</i> ≤0.00) and impulsivity (t= 3.39; <i>p</i> ≤0.01) between participants with and without non-suicidal self-harm.</p><p><strong>Conclusions: </strong>These are key factors for the clinical area in the treatment of eating disorders to prevent the presence of self-harm, as it allows focusing the treatment target on those aspects such as dissatisfaction and impulsivity, which are key in the development of self-harm.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/e4/1657-9534-cm-52-01-e2044342.PMC8054705.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38917989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-30DOI: 10.25100/cm.v51i4.4422.4506
Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Fernando Rodríguez-Holguín, José Julián Serna, Alexander Salcedo, Alberto García, Claudia Orlas, Luis Fernando Pino, Ana Milena Del Valle, David Mejia, Juan Carlos Salamea-Molina, Megan Brenner, Tal Hörer
Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.
{"title":"REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients.","authors":"Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Fernando Rodríguez-Holguín, José Julián Serna, Alexander Salcedo, Alberto García, Claudia Orlas, Luis Fernando Pino, Ana Milena Del Valle, David Mejia, Juan Carlos Salamea-Molina, Megan Brenner, Tal Hörer","doi":"10.25100/cm.v51i4.4422.4506","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4422.4506","url":null,"abstract":"<p><p>Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the <b>R</b>esuscitative <b>E</b>ndovascular <b>B</b>alloon <b>O</b>cclusion of the <b>A</b>orta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/88/1657-9534-cm-51-04-e4064506.PMC7968426.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-30DOI: 10.25100/cm.v51i4.4422.4599
Mario Alain Herrera, Luis Fernando Tintinago, William Victoria Morales, Carlos A Ordoñez, Michael W Parra, Mateo Betancourt-Cajiao, Yaset Caicedo, Mónica Guzmán-Rodríguez, Linda M Gallego, Adolfo González Hadad, Luis Fernando Pino, José Julián Serna, Alberto García, Carlos Serna, Fabian Hernández-Medina
Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.
{"title":"Damage control of laryngotracheal trauma: the golden day.","authors":"Mario Alain Herrera, Luis Fernando Tintinago, William Victoria Morales, Carlos A Ordoñez, Michael W Parra, Mateo Betancourt-Cajiao, Yaset Caicedo, Mónica Guzmán-Rodríguez, Linda M Gallego, Adolfo González Hadad, Luis Fernando Pino, José Julián Serna, Alberto García, Carlos Serna, Fabian Hernández-Medina","doi":"10.25100/cm.v51i4.4422.4599","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4422.4599","url":null,"abstract":"<p><p>Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/67/1657-9534-cm-51-04-e4124599.PMC7968428.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan Carlos Salamea-Molina, Amber Nicole Himmler, Laura Isabel Valencia-Angel, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Mónica Guzmán-Rodríguez, Claudia Orlas, Marcela Granados, Carmenza Macia, Alberto García, José Julián Serna, Marisol Badiel, Juan Carlos Puyana
Hemorrhagic shock and its complications are a major cause of death among trauma patients. The management of hemorrhagic shock using a damage control resuscitation strategy has been shown to decrease mortality and improve patient outcomes. One of the components of damage control resuscitation is hemostatic resuscitation, which involves the replacement of lost blood volume with components such as packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets in a 1:1:1:1 ratio. However, this is a strategy that is not applicable in many parts of Latin America and other low-and-middle-income countries throughout the world, where there is a lack of well-equipped blood banks and an insufficient availability of blood products. To overcome these barriers, we propose the use of cold fresh whole blood for hemostatic resuscitation in exsanguinating patients. Over 6 years of experience in Ecuador has shown that resuscitation with cold fresh whole blood has similar outcomes and a similar safety profile compared to resuscitation with hemocomponents. Whole blood confers many advantages over component therapy including, but not limited to the transfusion of blood with a physiologic ratio of components, ease of transport and transfusion, less volume of anticoagulants and additives transfused to the patient, and exposure to fewer donors. Whole blood is a tool with reemerging potential that can be implemented in civilian trauma centers with optimal results and less technical demand.
{"title":"Whole blood for blood loss: hemostatic resuscitation in damage control.","authors":"Juan Carlos Salamea-Molina, Amber Nicole Himmler, Laura Isabel Valencia-Angel, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Mónica Guzmán-Rodríguez, Claudia Orlas, Marcela Granados, Carmenza Macia, Alberto García, José Julián Serna, Marisol Badiel, Juan Carlos Puyana","doi":"10.25100/cm.v51i4.4511","DOIUrl":"10.25100/cm.v51i4.4511","url":null,"abstract":"<p><p>Hemorrhagic shock and its complications are a major cause of death among trauma patients. The management of hemorrhagic shock using a damage control resuscitation strategy has been shown to decrease mortality and improve patient outcomes. One of the components of damage control resuscitation is hemostatic resuscitation, which involves the replacement of lost blood volume with components such as packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets in a 1:1:1:1 ratio. However, this is a strategy that is not applicable in many parts of Latin America and other low-and-middle-income countries throughout the world, where there is a lack of well-equipped blood banks and an insufficient availability of blood products. To overcome these barriers, we propose the use of cold fresh whole blood for hemostatic resuscitation in exsanguinating patients. Over 6 years of experience in Ecuador has shown that resuscitation with cold fresh whole blood has similar outcomes and a similar safety profile compared to resuscitation with hemocomponents. Whole blood confers many advantages over component therapy including, but not limited to the transfusion of blood with a physiologic ratio of components, ease of transport and transfusion, less volume of anticoagulants and additives transfused to the patient, and exposure to fewer donors. Whole blood is a tool with reemerging potential that can be implemented in civilian trauma centers with optimal results and less technical demand.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/15/1657-9534-cm-51-04-e4044511.PMC7968429.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}