BackgroundTrauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management.MethodsThis is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed.ResultsThe study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120).ConclusionsThe study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.

Asphaltene adsorption from a toluene solution on a glass surface was studied as a function of concentration, at ambient temperature and atmospheric pressure. The thickness of the asphaltene film measured by ellipsometry was found to be in the 20−298 nm range. The film thickness was found to increase by 38−70 nm after 24 h. Solutions containing asphaltene mixtures from different crude oils result in significant variations in film thickness when compared with single asphaltene cases. For CN-Ceuta and DM153-Ceuta mixtures, a diminution was observed, whereas an increase was found with the DM153-Furrial mixture. Finally, the results attained with asphaltenes in which low molecular weight compounds have been removed suggest a film swelling effect due to the alkyl-type resins which are found to modify the colloidal properties of the aggregated asphaltenes in agreement with the literature.

Introducción. Dado el aumento de la incidencia y la mortalidad por dengue, su diagnóstico es relevante para los países endémicos. Las clasificaciones clínicas y las pruebas de laboratorio existentes tienen un desempeño variable en la práctica clínica, pues su sensibilidad fluctúa entre 45 y 98 %, y su especificidad, entre 4 y 98 %, lo cual se debe, en parte, a la diversidad de contextos en los que se utilizan.Objetivo. Desarrollar algoritmos clínicos para el diagnóstico del dengue en el contexto colombiano.Materiales y métodos. Se hizo un estudio transversal a partir de fuentes secundarias. Se construyeron algoritmos clínicos de diagnóstico del dengue con base en métodos bayesianos que combinaron síntomas, signos y parámetros del hemograma, y se comparó su exactitud diagnóstica con la de las pruebas de referencia. Se hizo una validación externa del algoritmo de mayor exactitud y sensibilidad, comparándolo con la clasificación clínica de la Organización Mundial de la Salud de 1997 y la del 2009, con la guía colombiana del 2010 y con la escala diagnóstica propuesta por el Ministerio de Salud y Protección Social de Colombia en el 2013.Resultados. Se generaron cuatro algoritmos, dos de signos y síntomas y dos que incluyeron el conteo de leucocitos (≤4.500/mm3) o de plaquetas (≤60.000/mm3). El algoritmo de mayor exactitud incluyó los parámetros del hemograma, con una sensibilidad de 76,5 % (IC95% 71,9-80,5) y una especificidad de 46,0 % (IC95% 37,6-54,7). En la validación externa, la sensibilidad fue de 11,1 % (IC95% 4,9-20,7) y la especificidad fue de 91,9 % (IC95% 87,5-93,9). La escala del Ministerio tuvo una sensibilidad de 76,4 % (IC95% 64,9-85,6) y una especificidad de 38,0 % (IC95% 32,8-43,4).Conclusión. La inclusión de los parámetros del hemograma mejoró la sensibilidad de los algoritmos de diagnóstico basados en los signos y los síntomas. Sin embargo, el diagnóstico clínico del dengue sigue siendo un reto para la investigación en salud.

ResumenIntroducción: La inactividad física es el cuarto factor de riesgo para desarrollar una enfermedad no transmisible. La asesoría brindada por el médico depende de sus propios hábitos de vida. Objetivo: Describir los niveles de actividad física y los factores relacionados con la consejería en estudiantes de primero y quinto año de la facultad de medicina de una Universidad privada en Bogotá, Colombia. Materiales y métodos: Estudio descriptivo con 61 estudiantes de primer año y 62 de quinto año de medicina con edades comprendidas entre 18 y 29 años. Se analizaron los datos de un subconjunto de registros, que hacen parte de un archivo mayor de datos obtenido en un estudio de corte transversal, en el que se aplicó la versión en español del cuestionario Healthy Doctor = Healthy Patient. Resultados: Se evaluaron 123 estudiantes de primero y quinto año de medicina. En primer año el 39,3% y en quinto año el 48,8% cumplieron con las recomendaciones de actividad física. Ser inactivo lo reportaron el 21,3% y el 8,1% respectivamente. La falta de tiempo fue la principal barrera para realizar actividad física. La actitud positiva hacia la consejería fue del 100% en el último año. Se observó más sobrepeso en el grupo de quinto año (23,8% hombres y 9.8% mujeres). Conclusión: La proporción de estudiantes de medicina que realizan actividad física es inferior a la observada en la población general y en poblaciones similares de estudiantes de medicina. El análisis de las barreras sugiere que en futuras intervenciones se debe pensar en la adjudicación de un tiempo para su práctica dentro del currículo. Se debe repensar la forma en que las facultades de medicina están abordando el tema de la actividad física, como pilar fundamental de la promoción de la salud.AbstractIntroduction: Physical inactivity is the fourth risk factor for developing a Non transmissible Chronic Disease (NCD). The advice given by the physician depends on people’s own lifestyle. Objective: To describe the levels of physical activity (PA) and factors associated with counseling in students from the first and fifth year of the faculty of medicine at a private university in Bogotá, Colombia. Materials and methods: A descriptive study was made with 61 first-year students and 62 from fifth year of medicine between 18 and 29 years old. The data from a subset of records was analyzed, which are part of a database obtained in a cross-sectional study, in which the Spanish version of the questionnaire Healthy Doctor = Healthy patient was applied. Results: 123 first and fifth year of medicine students were evaluated. In first year 39.3% and in fifth year 48.8% met the recommendations of PA. 21.3% and 8.1 % respectively reported to be inactive. Lack of time was the main barrier to physical activity. Positive attitude toward counseling was 100% in the last year. More overweight was observed in the group of fifth year (23.8% men and 9.8% women). Conclusion: The proportion of medical students who perform PA is lower than those observed in the general population and in similar populations of medicine students. The analysis of the barriers suggests that future interventions should consider the allocation of time to practice it within the curriculum. The way how medical schools are addressing the issue of physical activity must be reviewed as a fundamental pillar of health promotion.

Diagnosing dengue in endemic areas remains problematic because of the low specificity of the symptoms and lack of accurate diagnostic tests. This study aimed to develop and prospectively validate, under routine care, dengue diagnostic clinical algorithms. The study was carried out in two phases. First, diagnostic algorithms were developed using a database of 1,130 dengue and 918 non-dengue patients, expert opinion, and literature review. Algorithms with > 70% sensitivity were prospectively validated in a single-group quasi-experimental trial with an adaptive Bayesian design. In the first phase, the algorithms that were developed with the continuous Bayes formula and included leukocytes and platelet counts, in addition to selected signs and symptoms, showed the highest sensitivities (> 80%). In the second phase, the algorithms were applied on admission to 1,039 consecutive febrile subjects in three endemic areas in Colombia of whom 25 were laboratory-confirmed dengue, 307 non-dengue, 514 probable dengue, and 193 undetermined. Including parameters of the hemogram consistently improved specificity without affecting sensitivity. In the final analysis, considering only confirmed dengue and non-dengue cases, an algorithm with a sensitivity and specificity of 65.4% (95% credibility interval 50-83) and 40.1% (34.7-45.7) was identified. All tested algorithms had likelihood ratios close to 1, and hence, they are not useful to confirm or rule out dengue in endemic areas. The findings support the use of hemograms to aid dengue diagnosis and highlight the challenges of clinical diagnosis of dengue.