BackgroundDysmenorrhea is a frequent and misdiagnosed symptom affecting the quality of life in young women. A working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) score was designed to diagnose dysmenorrhea and to predict medical leave.MethodsThis cross-sectional design included young medical students, who completed a self-administered questionnaire that contained the verbal rating score (VRS; pain and drug subscales) and WaLIDD scales. The correlation between scales was established through Spearman test. The area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio (LR +/−) were evaluated to diagnose students availing medical leave due to dysmenorrhea; moreover, to predict medical leave in students with dysmenorrhea, a binary logistic regression was performed.ResultsIn all, 585 students, with a mean age of 21 years and menarche at 12 years, participated. Most of them had regular cycles, 5 days of menstrual blood flow and 1–2 days of lower abdominal pain. The WaLIDD scale presented an adequate internal consistency and strong correlation with VRS subscales. With a cutoff of >6 for WaLIDD and 2 for VRS subscales (drug subscale and pain subscale) to identify students with dysmenorrhea, these scales presented an area under the curve (AUC) ROC of 0.82, 0.62, and 0.67, respectively. To identify students taking medical leave due to dysmenorrhea, WaLIDD (cutoff >9) and VRS subscales (cutoff >2) presented an AUC ROC of 0.97, 0.68, and 0.81; moreover, the WaLIDD scale showed a good LR +14.2 (95% CI, 13.5–14.9), LR −0.00 (95% CI, undefined), and predictive risk (OR 5.38; 95% CI, 1.78–16.2).ConclusionThis research allowed a comparison between two multidimensional scales regarding their capabilities, one previously validated and a new one, to discriminate among the general population of medical students, among those with dysmenorrhea or those availing medical leave secondary to dysmenorrhea. WaLIDD score showed a larger effect size than the pain and drug score in the students. In addition, this study demonstrated the ability to predict this combination of events.

In the present study concentration of heavy metals [HMs], such as Cu, As, Pb, Cr, Zn, Co, Cd and Ni, present in vegetables included in the typical Colombian diet were measured. The study was conducted as follows: samples of parsley, artichoke and carrots produced in a location near the Muña dam were collected, where the Bogot a River water is treated for use as a water resource. To determine food safety, national and international [HMs] established limits were compared with quantified [HMs] in samples of different vegetable parts and of the surrounding soil. Fresh samples were separated in their respective parts for cold acid digestion with HCl and HNO 3 (1:1) for 15 days. Heavy metal mean AE standard error (SE) were as follows (mg/kg) As 2.36 AE 0.185, Cd 0.16 AE 0.009, Co 0.43 AE 0.019, Cr 12.1 AE 0.453, Cu 13.1 AE 1.68, Ni 0.00, Pb 7.07 AE 0.482 and Zn 3.976 AE 0.332. Cd, Cr, As, Co and Ni showed high transfer factor in Cynara scolymus. Moreover, high Pb, Cu and Zn transfer factor were present in Petroselinum crispum. Except for Daucus carota roots, there was a high metal transfer specifically in Petroselinum crispum leaves and other different plant parts, with high transfer factor for Cr, As, Co, Pb, Cu and Zn.

BackgroundThe calcium intake on the diet below normal daily requirements is related with low levels of vitamin D. The available scientific evidence supports a key role of calcium and vitamin D in skeletal health. We analyzed this relationship in healthy colombian population and describe this association.ObjectivesThe main objetive is to Assess the prevalence of hypovitaminosis D and the relationship with the daily calcium intake in a healthy Colombian population. Furthermore it is crucial to estimate the impact of key mineral elements such as Calcium and Vitamin D in bone health.MethodsIn a prospective cohort of general population we measure the prevalence of hypovitaminosis D and the calcium intake, (mg/dl) following demographic, antropomethric, biochemical characteristics and sun exposure of the population evaluated. We used a model of multiple regresion to predict the levels of vitamin D regarding the factors analysed. We excluded patients with secondary conditions that affect the absorption of calcium and vitamin D.ResultsWe included 97 patients, average age 23 yrs, 61% women, average weight 65 kg, Height 165 cm, average BMI 22.8. The calcium intake was 393,7 mg/d, levels of vitamin D were 23.71. We identified hypovitaminosis D in 87% of the patients, 24.7% had vitamin D defficiency and 63% had insufficiency (Figure 1, Levels of Vitamin D in the population study).The concentration of Vitamin D was calculated in quadratic function, for the relationship between sex, sun exposure and habitual calcium intake. (R:>90%).ConclusionsWe found a strong relationship between low calcium intake and hypovitaminosis D in the study group. In a healthy colombian population we saw an important low intake of calcium on the diet and high prevalence of Hypovitaminosis D. These findings have enormous impact on public health policy in our country. Effective and imperative strategies are required to prevent future complications such as Osteoporosis and secondary fractures.ReferencesCatharine-Ross A., et al. The 2011 report on dietary references intake for calcium and vitamin D from the Institute of Medicine. What clinicians need to know. JCEM 2011;96:53–58Disclosure of InterestNone declared

BackgroundVitamin D is a steroid hormone with pleiotropic effects on physiological processes. Among others, immune system regulation and their analogues prevent symptom development of autoimmune diseases such as SLE. A previous research in a colombian clinic found a prevalence of hipovitaminosis D of 87% in healthy population, but hypovitaminosis D is higher in SLE patients than healthy controls.ObjectivesTo establish the prevalence of hypovitaminosis D in patients with SLE and relationship with SLEDAI – 2K.MethodsA cross sectional study was carried out. 80 medical records with a diagnoses of SLE o CIE-10 M30-M36 were identified and we included patients>18 years of age who meet at least 4 of the 11 criteria to diagnoses of SLE for medical record. The analysis included means, DS and Kruskall Wallis with p-value<0.05.ResultsThe majority of patients are women (94%), with an average age of 39.9 years, married (41%), with secondary education (56.7%) and different occupations. It was found that the patients with higher activity, had lower vitamin D levels. Additionally, if the patient had lupus nephritis, vitamin D levels decreased even more.Abstract AB0618 – Figure 1ConclusionsPatients with active systemic lupus Erythematosus, (SLE) have hypovitaminosis D more frequently and we noticed that patients with renal involvement have the lowest levels of vitamin D, which justifies a later analysis.References[1] American College of Rheumatology. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum. 1999Sep;42(9):1785–96.[2] Simioni J, Heimovski F, Skare T. On lupus, vitamin D and leukopenia. 2016;56(3):206–211.[3] Guzman R.A, Piñeros L.G, Theran A, Flechas J, Mejía M. AB0795 Hypovitaminosis D and Calcium Intake of Adult Population in Bogota (DICAVITD). Ann Rheum Dis2016;75:1175–1176.[4] Alele J., et al. Autoimmun Rev2010;9:137–39.[5] Dall, era M., et al. in Kelley&Firestein,s Textbook of Rheumatology. 10th Ed, Elsevier; Philadelphia 2017; 1368–89.Disclosure of InterestNone declared

The flavonoid izalpinin was isolated from the aerial parts of Chromolaena leivensis. Its structural determination was carried out using MS and NMR spectroscopic techniques (1H, 13C). This compound was evaluated for its anti-inflammatory effect in a rat model on λ-carrageenan-induced plantar edema. Paw inflammation was measured at one-hour intervals for seven hours following the administration of λ-carrageenan. Serum creatine kinase (CK) levels were evaluated, obtaining statistically significant results with the treatments at doses of 10 mg/kg (* p < 0.01) and 20 mg/kg (** p < 0.005). The anti-inflammatory effect of the compound was evaluated by using plethysmography, and the results showed significant differences at the three concentrations (10 mg/kg, 20 mg/kg, 40 mg/kg) in the first and third hours after treatment. * p < 0.05; ** p < 0.001; **** p < 0.0001 vs. the negative control group treated with vehicle (DMSO). Lastly, molecular docking analyses reveal that izalpinin has a strong binding affinity with five target proteins involved in the inflammatory process. The analysis using molecular dynamics allowed demonstrating that the ligand–protein complexes present acceptable stability, with RMSD values within the allowed range.

Desde hace muchos años, (1915-23),  el Dr Cabot en el Massachussets General Hospital, (MGH) implemento la publicacion en la Revista New England Journal Of Medicine, (NEJM), de casos clinicos vistos en el Hospital y se convirtieron en Conferencias clinicas patologicas que se han sedimentado a través del tiempo y constituyen lectura obligada de miles de Médicos en el mundo por el abordaje de los casos, el interés que suscita y las enseñanzas que deja. (1-3).  Otras revista Medicas, no menos importantes, presentan igualmente reportes de casos pero ninguna ha tenido la identificacion plena que caracteriza al NEJM por esta seccion.   Con el avance en medios diagnósticos, particularmente pruebas de laboratorio como biomarcadores, genética y el avance en imagenología se ha enriquecido el camino para diagnosticar con mayor precisión patologías de probable presentación misteriosa y que conllevan a dificutades diagnósticas. Igualmente en el campo de la Patología las coloraciones especiales de Inmunohistoquímica, el procesamiento de los tejidos y pruebas especiales han contribuido a clasificar mejor diversas patologías. (4-6).   El papel de la anatomía patológica ha sido preponderante en estas discusiones y los ccordinadores de esta sesion en la revista han sido en su mayoria connotados patòlogos. La relevancia de esta historia es su aplicación en nuestra clínica y en particular en el Departamento de Medicina Interna de la Institución, donde hemos propéndido porque nuestros estudiantes, Internos y residentes adquiera cada dia con mayor profundidad elementos vitales en la recoleccion de la historia clínica, en la pericia de un buen examen físico y en la correcta solicitud de estudios que conlleven a un Diagnosticoclinico acertado. Se rescata la Filosofía de “Continuar aprendiendo del Paciente”. Se Implemento en la clínica la Gran Reunión de Medicina Interna, una vez a la semana donde se discuten los casos díficiles y se invitan diferentes servicios de acuerdo a la patología del paciente. Por esto, en este nímero damos la bienvenida al CCC, (Casos Clínicos de la Corpas), que presentará en cada número de la revista algunos de los casos más interesantes vistos en nuestra institución y que son discutidos por reconocidos expertos de la entidad y pretende aportar un grano de arena al conocimiento, que sea de gran utilidad para los diferentes colegas y estudiantes y que se genere expectativa en cada numero que se publique para actualizarse con los nuevos casos presentados como de indiscutible manera ocurre con los Case Records del NEJM para los diferentes clínicos del mundo. Se escogen casos que dejen enseñanzas, que planteen dificultades en el diagnóstico con amplias posibilidades de diagnosticos  diferenciales, que estimulen discusion para diversas alternativas terapéuticas, que experimentados Médicos puedan discutir  las nuevas tecnologías y su aplicabilidad en la pr´ctica y que logren un impacto en la formación y entrenamiento de los diferentes estudiantes y colegas alrededor del mundo.   Hoy se revisan dos caso de interés, vistos en el Servicio, en pacientes con Síndrome Antifosfolípido Primario, uno que genero grandes discusiones por la necesidad de anticoagular plenamente a pesar de tener severa trombocitopenia y otro como manifestación inicial de Infarto agudo del Miocardio, que adquiera gran relevancia por el denominado síndrome MINOCA tan en boga hoy en día en los ambitos de Cardiología y UCI. (7-13). La Dra Pedraza et al hacen unas presentaciones interesantes que aportan información útil para la evaluación y manejo de pacientes con esta fascinante patología.   En Hora Buena es recibida, esta interesante Sección de la revista que esperamos ayude de manera práctica a nuestros colegas en la evaluación y manejo de sus pacientes.

Background:Vitamin D (25OHD) has immunomodulatory properties that can play a major role in patients with active lupus or lupus nephritis. His immunomodulatory function could be influenced by demographic factors, comorbidities (Charlson score), bone supplements, and other features.Objectives:We explored the association between the best 25OHD cut-off points and specific clinical features that were present in patients with active lupus or lupus nephritis.Methods:A retrospective descriptive research using clinical registers of patients diagnosed with systemic erythematosus lupus, attended in two rheumatology clinics was performed. A decisions tree model was used to identify the best cut-off points of 25OHD [ng/mL] and clinical features associated with active lupus (SLEDAI-2k >6) or lupus nephritis.Results:We identified 81 patients, median age 41 years, women 91.3%. Active lupus and lupus nephritis were present in 69.1% and 29.6%, respectively. Median 25OHD was 26.49, without a difference at comparing with active lupus patients 24.85, but lower in lupus nephritis patients 21.50 (p: 0.015). Lupus nephritis was absent in patients with 25OHD cut-off points >38.8 (alone) or ≤38.8 if they were older than >57 years. Active lupus was always present in patients ≤44 years with 1. High comorbidity or 2. Low comorbidity plus cut-off point 25OHD >35; in >44 years, both a euthyroid state and the absence of bone supplements were present in patients with active lupus.Conclusion:Exist a strong relationship between vitamin D levels and LES activity.References[1] American College of Rheumatology. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum. 1999 Sep;42(9):1785-96[2] Simioni J, Heimovski F, Skare T. On lupus, vitamin D and leukopenia. 2016;56(3):206-211.[3] Guzman R.A, Piñeros L.G, Theran A, Flechas J, Mejía M. AB0795 Hypovitaminosis D and Calcium Intake of Adult Population in Bogota (DICAVITD). Ann Rheum Dis 2016;75:1175-. 1176.Acknowledgement:To Fundación Universitaria Juan N. CorpasDisclosure of Interests:None declared

Introduction: Conventional homeopathy recommends giving 10 strokes (succussions) to prescription bottle, before taking it. To scientifically support such activity, it must be based on studies on the physicochemical aspects of the memory of water and agitated water chains, supplemented with spectrometry. Objective: To analyze spectrometric profiles of homeopathic high dilutions, comparing additionally agitated and non-agitated dilutions, and to define differences according to each dilution´s kingdom. Methodology: Homeopathic dilutions were prepared using a ratio of 1:100 obtaining dilutions from 1cH to 15cH. Measurements of absorbance of 15cH dilutions were performed at 340 nm and 200 nm, with and without additional agitation. Results: Statistically significant differences were found between agitated and non-agitated dilutions (p