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Resumen Introducción y objetivos: El trauma cardiaco en países subdesarrollados es de predominio penetrante, con altas tasas de mortalidad extrahospitalaria, pero con mortalidad intrahospitalaria que dependerá en parte de si el paciente se encuentra taponado o no. Las técnicas mínimamente invasivas para practicar la ventana pericárdica y la nueva interpretación del resultado positivo, han hecho variar paradigmas previamente establecido, lo cual ha llevado a realizar un cambio en el abordaje inicial de los pacientes con trauma precordial penetrante estables hemodinámicamente. Por lo cual, queremos mostrar nuestra experiencia en el manejo mínimamente invasivo de pacientes estables hemodinámicamente llevados a ventana pericárdica por trauma precordial. Materiales: En un periodo entre el 2018 y el 2019, se evaluaron 5 pacientes con herida penetrante precordial al servicio de trauma Hospital Universitario del Valle Evaristo García lo cuales fueron manejados por cirugía mínimamente invasiva. Resultados: Pacientes con e-FAST(tomado de las siglas en inglés, Extended Focused Assessment with Sonography in Trauma) positivo subxifoideo; llevados a ventana pericárdica por toracoscopia y laparoscopia, todas positivas con identificación de lesiones en pericardio, aurícula derecha , ventrículo izquierdo y auricula izquierda no sangrante, manejadas con lavado con SSN 500 cc hasta obtener líquido claro, aspiración de coágulos. Drenaje de hemotórax y Toracostomía cerrada para abordaje torácico. 72 horas retiro de tubo de tórax y egresó sin complicaciones documentadas. Conclusiones: La cirugía mínimamente invasiva en trauma resulta ser efectiva y segura para el manejo del trauma penetrante precordial en el paciente estable hemodinámicamente. Evitando toracotomías y esternotomías innecesarias.

Objective To assess the diagnostic performance of high-sensitivity troponin T (hs-TnT) in patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS); confirm whether it shortens the time to diagnosis; and analyze the clinical consequences derived from its use. Method A prospective, longitudinal observational study was carried out in 5 emergency care departments. Patients seen for chest pain with suspected of NSTE-ACS were consecutively included. Patient care followed the internal protocols of the center, based on the consensus guidelines of the European Society of Cardiology. Serial conventional cardiac troponin (cTn) and hs-TnT determinations were made. Results A total of 351 patients were included in the study. A final diagnosis of acute myocardial infarction (AMI) was established in 77 patients, with unstable angina in 102, and no acute coronary syndrome in 172 patients. The hs-TnT values were above percentile 99% in a large number of patients without AMI. In the initial determination, the diagnostic sensitivity of the hs-TnT was significantly greater than that of cTn (87.0% vs. 42.9%), which led to a negative predictive value of 95.1%. Conclusions High-sensitivity troponin T improves diagnostic performance compared with conventional troponin assay, shortens the time to diagnosis, and identifies a larger number of patients with smaller myocardial infarctions.

Resumen Los autores presentan un caso de hematoma subcapsular roto y del cuarto segmento del hígado en una mujer de 26 años, en la semana 36 del embarazo, complicada por preeclampsia. Los signos clínicos de preeclampsia se asociaron con dolor en el hipocondrio derecho y hallazgos de laboratorio compatibles con un verdadero síndrome HELLP. Se realizó una laparotomía de emergencia con rotura hepática y hemoperitoneo. Se realizó una cirugía de control de daños, con drenaje de hemoperitoneo, packing hepático y uso de una bolsa de Bogotá. El desempaque se realizó a las 24 horas y la colocación de la terapia de VAC asociada con la malla con el posterior cierre de la fascia dentro de los 10 días. Se presentan diferentes opciones terapéuticas que incluyen intervenciones médicas, quirúrgicas y radiológicas. No se puede definir una estrategia única. El enfoque multidisciplinario parece obligatorio. La cirugía debe permanecer lo menos agresiva posible.

Las alteraciones morfológicas de la próstata, por las que se realiza cribado son la hiperplasiaprostática benigna (HPB) y el cáncer de próstata (CaP). La HPB es el tumor benigno más frecuenteen varones mayores de 50 años, se caracteriza por el aumento del volumen de la glándula y usualmente acompañado de síntomas urinarios. El CaP es la segunda causa de muerte relacionada con cáncer en Estados Unidos y Europa en mayores de 70 años, su incidencia por debajo de los 50 es rara. El cribado o pruebas de detección, tiene como meta el hallar el cáncer antes de la aparición de síntomas, el cribado no se realiza en pacientes por sospechar que tienen cáncer, sino como un método de pesquisa. El objetivo de este artículo, es efectuar una revisión a los referentes teóricos, y proponer un nuevo algoritmo diagnóstico de alteraciones morfológicas de la próstata, basado en la evidencia.

In the late years, the use of acellular dermal matrix (ADM) has extended rapidly in the field of breast reconstruction. However, with the follow-up visits, we discovered some deformities on the lateral part of the lower pole, due to the folding of the ADM. The aim of this letter is to share some tricks developed in our clinical practice that would permit the surgeon to avoid getting these irregularities in the aesthetic result of breast reconstruction with ADM. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Measurement of total activity or insoenzyme 2 (CKMB) of creatin kinase (CK) are most widely used biological markers used with muscular injury. However, atliletes present increases in tliese enzymes wich look like myocardial disorders. Measurement of tlie mass concentration of CKMM and its relation to total CK helps to distinguisii between myocardial and muscular-skeletal problems. In the case of the isoforms of the CKMM insoenzyme it has been shown that the relation between the tissue isoform and the modified mass of the plasma (CKMM/CKMMI) is a good early indicator of muscular injury. After physical exercise, increased can be detected even without parallel increases in CK. The combined measurement of mass CKMM and the CKMM isoforms allows recent muscular injuries ( 24 hours), something impossible to detect using normal biological markers. Resumen Las medidas de la actividad total o de la isoenzima 2 (CKMM) de la creatina cinasa (CK) constituyen los marcadores biologicos mas empleados de lesion muscular. Pero, en los atletas se pueden encontrar aumentos de estas enzimas que simulan alteraciones miocardicas. La medida de la concentracion masica de CKMM y su razon sobre el CK total ayudan a distinguir entre alteraciones de origen miocardico o musculo-esqueletico. En el caso de las isoformas de la isoenzima CKMM se ha demostrado que la razon entre la isoforma del tejido y la masa modificada del plasma (CKMM/CKMM I) es un indicador muy precoz de lesion muscular y, despues de practicar ejercicio fisico, se pueden detectar aumentos incluso sin aumentos paralelos de CK. La medida combinada de CKMM masica y las isoformas CKMM permite distinguir lesiones musculares recientes ( 24 h), indetectables para los marcadores biologicos habituales.

Background This research forms part of a cross-country comparison study that seeks to understand the role of ethnicity in framing childhood obesity as a public health problem. In our modern multi-ethnic world the need and opportunity for international comparisons using the concept of race and ethnicity are both becoming increasingly important. However, definitions of ethnicity vary according to socio-political circumstances. In preparation for conducting the major study, we have examined this concept in Colombia, Brazil, Mexico, Canada and the United Kingdom. Our research questions were: 1) How are ethnicity and race defined and measured? 2) What are the concepts that underpin race and ethnicity in each of the countries? 3) Are these measures, categories and concepts sufficiently similar to allow cross-country comparisons in the field of childhood obesity? Methods We conducted a scoping review according to Leva et al . (2012). We searched published and unpublished literature, census questionnaires, and health and nutritional surveys, without restriction of language and reported from 2005. Starting from 2005 allowed us to include the latest Colombian census and the recent censuses and surveys from the other countries. We searched web pages from Ministries of Health and statistical agencies, electronic databases (CINAHL, Medline, EMBASE, Global Health Library and LILACS). We manually searched bibliographies of relevant books on ethnicity and health. Results We reviewed 13 questionnaires, 4 constitutional acts, 8 official reports and their related documents. We found that all of the reviewed countries use self-identification to determine ethnicity. However, each country collects their data differently, using either a single concept of ethnicity or a combination of concepts. Colombia is focused on ethnic minority populations. Mexico, Canada and the UK use a combination of country of origin, geographical origin and skin colour. Brazil establishes ethnicity on skin colour alone. Canada has one White and Black categories while the UK evaluates a wider set of subcategories. England and Wales separate Irish from British and Scotland separates Scottish from British and Irish. Black categories in the UK also include African and Caribbean origin separately. Conclusion As a result of this scoping review we identified different approaches to ethnicity which do not allow direct quantitative comparison. Therefore, our cross-country comparison study will be focused on understanding childhood obesity within each country, comparing qualitatively. Brazil is no longer considered a useful comparison given its singular approach. This kind of conceptual analysis is necessary for cross-country studies, and could lead to more international harmonisation of exposure variables such as ethnicity and race.