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Introduction: Millions of snake bites occur worldwide each year. Clinical practice guidelines generally do not recommend the use of prophylactic antibiotics. Objective: To determine the sociodemographic, clinical, and pharmacological variables and the use of antibiotics in a group of patients with snake bites in Colombia. Methods: A retrospective cross-sectional study was carried out. Patients affiliated with a Colombian health insurer who presented with snake bites between 2015 and 2022 were included. The cases were identified from the National Public Health Surveillance System. Sociodemographic, clinical and pharmacological variables were identified. Descriptive and bivariate analyses were performed. Results: A total of 643 patients were analyzed, with a median age of 30.8 years, and 74.7% were men. The most frequently identified genus of snake was Bothrops (88.8%), and most incidents were classified as mild ophidian accidents (61.6%). A total of 59.7% of patients received snake antivenom. A total of 13.8% and 2.2% of the patients had cellulitis or abscesses, respectively. A total of 63.5% received antibiotics (50.6% for prophylaxis and 12.9% for treatment), especially cephalexin (25.9%), and most of the antibiotic management was considered inappropriate (91.7%). Conclusion: Most patients with snake bites received antibiotics, especially for prophylactic purposes, a clinical behavior that goes against current evidence. The use of antibiotics with an unsuitable spectrum for the microorganisms that are usually found in the wounds of these patients is frequent. The development of local clinical practice guidelines is required to help reduce the overprescription of antibiotics, as the excessive use of antimicrobials is the main determinant of antimicrobial resistance.

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PURPOSE: To describe the demographic clinical characteristics and to identify the risk factors of patients diagnosed with fungemia and secondary intraocular involvement. METHODS: Retrospective cohort of 97 patients diagnosed with fungemia and with or without involvement of the posterior segment. Demographic, clinical and ophthalmological variables were identified to establish the risk of retinal seeding. RESULTS: An incidence of ocular involvement of 22.68% was obtained and no clear risk factor was found for subsequent showings in patients with fungemia. A risk trend was only found in patients with diabetes with an OR: 2.85; CI 95%: (0.80-10.12) and history of HIV with an OR: 2.29 CI95%: (0.85-6.12). CONCLUSIONS: In this first cohort carried out in Colombia according to our search, findings were obtained that agree with those of other authors worldwide, where there is no evidence of a decrease in incidence compared with older studies and the absence of risk factors for the compromise of the posterior pole in patients with fungemia.KEY MESSAGESSystematic fundus evaluation by an ophthalmologist in patients with candidaemia is a recommended practice based on low-quality evidence.The identification of real risk factors for retinal compromise in fungemia would allow us to be more selective with the population to be evaluated.Fungemia generally occurs in critically ill patients, where access and availability of ophthalmology evaluation are a resource that is not always available.

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Abstract Introduction: Cutting is a nonsuicidal self-injurious behavior. Although this behavior is increasingly frequent in children under the age of 15, studies on its prevalence in the Colombian pediatric population have not yet been conducted. Objective: To describe the risk factors and the sociodemographic and clinical characteristics of children under the age of 15 diagnosed with cutting and treated at the emergency service of a quaternary care hospital located in Bogotá D.C., Colombia. Materials and methods: Descriptive, observational, and cross-sectional study. The medical records of patients under 15 years of age with Z91.5, F32, F33, F99, F19, F41, F43, T742 and X60 ICD-10-CM medical diagnosis codes treated between 2011 and 2017 were reviewed to identify cases meeting the diagnosis criteria for cutting (nonsuicidal self-injury). Results: In total, 85 medical records of children aged 10-14 were included. Cutting prevalence in the sample was 0.15%, but in the psychiatric disorders subgroup it was 26.7%. A 3:1 female-to-male ratio was found. Out of the 85 children, 62% did not have a nuclear family (i.e., did not live with both parents), 30.6% showed a poor school performance, and 80% injured their forearms. Concerning their mental health, 22.3% reported their anxiety was reduced after injuring themselves, and 72.9% did not have suicidal thoughts. The most frequent risk factors were having a history of mental disorder (52.9%), having experienced psychological violence (25.8%), and, in the case of boys, using psychoactive substances (22.7%). Conclusions: The prevalence of cutting found here is lower than what has been reported for this population in other countries. Likewise, cutting was three times more common in girls, and having a history of mental disorders might increase the risk of developing this behavior. Although the characteristics described here will allow identifying easily this condition in Colombian children, it is necessary to conduct further studies to determine the effectiveness of therapies aimed at this population.

Resumen Introducción. El cutting es un comportamiento de autolesión no suicida cada vez más frecuente en menores de 15 años; sin embargo, en Colombia aún no se han realizado estudios que reporten la prevalencia de esta conducta en población pediátrica. Objetivo. Describir las características sociodemográficas y clínicas, y los factores de riesgo de la población pediátrica (0 a 14 años) con diagnóstico de cutting atendida en el servicio de urgencias de una clínica de cuarto nivel en Bogotá D.C., Colombia. Materiales y métodos. Estudio observacional descriptivo de corte transversal en el que se revisaron las historias clínicas de los pacientes menores de 15 años atendidos entre los años 2011 y 2017 con los códigos diagnósticos CIE 10 Z91.5, F32, F33, F99, F19, F41, F43, T742 y X60, con el fin de identificar aquellos casos que cumplieran con los criterios diagnósticos de cutting. Resultados. Se incluyeron 85 historias clínicas de niños entre 10 y 14 años. La prevalencia de cutting fue de 0.15% en el total de la muestra y de 26.7% en el subgrupo con antecedentes de trastorno psiquiátrico. Se encontró una relación mujer a hombre de 3:1. El 62% no tenía un núcleo familiar unificado, el 30.6% presentó un rendimiento escolar bajo y el 80% se lesionó el antebrazo. Respecto a su salud mental, el 22.3% reportó reducción de ansiedad con la lesión y el 72.9% no presentó ideas suicidas. Los factores de riesgo más frecuentes fueron presentar antecedente de enfermedad mental (52.9%), ser víctima de violencia psicológica (25.8%) y, en el caso de los varones, consumir sustancias psicoactivas (22.7%). Conclusiones. La prevalencia de cutting fue inferior en comparación con lo reportado en otros países. Este comportamiento fue tres veces más frecuente en niñas y el antecedente personal psiquiátrico podría aumentar el riesgo de presentarlo. A pesar de que las características aquí descritas permitirán identificar fácilmente esta condición en población pediátrica colombiana, es necesario realizar nuevos estudios que determinen la efectividad de medidas terapéuticas dirigidas a esta población.

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A 43-year-old woman underwent radiofrequency pulmonary vein ablation for symptomatic paroxysmal atrial fibrillation. At 3 months, she developed worsening dyspnea and exercise intolerance; tests revealed severe stenosis in her right pulmonary veins at the venoatrial junction and an abnormally small left atrium.

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Resumen La leishmaniosis cutánea es una enfermedad causada por un parásito pro tozoo intracelular; el glucantime es una opción terapéutica, aunque está asociado con alteraciones cardiovasculares, siendo la más frecuente la prolongación del intervalo QTc que se presenta entre el 17,8 % y 19 % de los pacientes. Si este efecto no es detectado a tiempo puede causar una arritmia fatal por torsade de pointes. Se presenta el caso de una paciente de 77 años quien se encontraba en tratamiento con glucantime intramus cular como tratamiento de leishmaniosis cutánea e ingresó por un cuadro clínico de hipocalemia severa refractaria y episodios de torsade de pointes; posteriormente, presentó fibrilación ventricular que no respondió a des fibrilación y reanimación. Las alteraciones en la repolarización cardiaca producidas por este medicamento se consideran secundarias a la acu mulación de compuestos pentavalentes y trivalentes en el miocardio. No existe tratamiento específico para esta situación, pero siempre se debe realizar manejo de soporte, evitar fármacos que prolonguen el intervalo QT, normalizar los niveles de potasio y de magnesio, elevar la frecuencia cardiaca con isoproterenol e implantar marcapaso transvenoso para lograr sobre-estimulación y reducción de los periodos refractarios.

Abstract Cutaneous leishmaniasis is a disease caused by an intracellular protozoan parasite; Glucantime is a therapeutic option, although it is associated with cardiovascular alterations, the most frequent being the prolongation of the QTc interval, that occurs between 17.8% and 19% of patients. If this effect is not early recognized, it can cause a fatal arrhythmia due to torsade de pointes. The case of a 77-year-old patient who was receiving intramuscu lar glucantime as treatment for cutaneous leishmaniasis is presented, the patient was admitted with severe refractory hypokalemia and episodes of torsade de pointes; subsequently, presented ventricular fibrillation that did not respond to defibrillation and resuscitation. The alterations in cardiac repolarization produced by this medicine are considered secondary to the accumulation of pentavalent and trivalent compounds in the myocardium. There is no specific treatment for this situation, but supportive manage ment should always be performed, avoid drugs that prolong the QT inter val, normalize potassium and magnesium levels, raise the heart rate with isoproterenol and implant transvenous pacemaker to achieve over-stimulation and reduction of refractory periods.

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Resumen La intususcepción intestinal consiste en la introducción o invaginación de un segmento del intestino dentro de la luz del segmento adyacente. Una parte del intestino se pliega como un telescopio y penetra dentro de otra. La ma yoría de los casos se producen durante los primeros cinco años de vida y la mitad de estos durante el primer año. En los niños mayores y en los adultos frecuentemente es el resultado de lesiones tumorales intraluminales como lipomas, carcinoma, pólipos fibroides inflamatorios o linfoma maligno. Se presenta el caso clínico de una paciente de 45 años con cuadro de dolor ab dominal originado por intususcepción ileotransversa causada por un lipoma intraluminal, el cual fue resuelto exitosamente mediante cirugía.

Abstract Intussusception involves the introduction or invagination of a segment of the intestine within the lumen of the adjacent segment. A part of the intes tine folds like a telescope and penetrates into another. Most cases occur during the first five years of life and half of these during the first year. In older children and adults are the result of intraluminal tumor lesions such as lipomas, carcinoma, inflammatory fibroid polyps or malignant lymphoma. We present the clinical case of a 45-year-old patient with abdominal pain caused by ileotransverse intussusception caused by an intraluminal lipoma, which was successfully resolved by surgery.

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Resumen Introducción: el bostezo se presenta con frecuencia en los pacientes sometidos a prueba de mesa basculante. Estudios previos han demostrado que el bostezo estimula el sistema nervioso simpático con sus consecuentes cambios hemodinámicos, principalmente en la frecuencia cardíaca y la presión arterial. Objetivo: describir los efectos hemodinámicos y sobre el sistema nervioso autónomo del bostezo, así como establecer el bostezo como mecanismo protector de síncope o predictor de respuesta hemodinámica positiva. Métodos: estudio observacional de fuente secundaria, realizado a partir de una base de datos de pacientes que fueron sometidos a prueba de mesa basculante entre agosto de 2010 hasta diciembre de 2015 y presentaron al menos un bostezo durante la prueba. Se realizaron análisis estadísticos y pruebas pareadas para determinar correlaciones. Resultados: se incluyeron 156 pacientes, la mayoría mujeres, edad promedio 40 años. 43 pacientes presentaron síncope, 113 (72,4%) bostezo sin síncope, y de éstos, 50 (44,2%) tuvieron bostezo y prueba de mesa basculante con respuesta positiva. Se observó un aumento en la mayoría de variables hemodinámicas, sin embargo, hubo una disminución significativa de la frecuencia cardíaca. En 67 pacientes se observó bostezo como protector de síncope mientras que en 61 pacientes como predictor de respuesta hemodinámica positiva. Conclusión: el bostezo se asoció con activación del sistema nervioso simpático, con efectos hemodinámicos y sobre el sistema nervioso autónomo. Puede plantearse como un signo predictor de respuesta hemodinámica positiva de tipo mixto o vasodepresora y en otros casos como un mecanismo protector frente a la aparición de síncope.

Abstract Introduction: Yawning is often present in patients subjected to a tilt table test. Previous studies have demonstrated that yawning stimulates the sympathetic nervous system, with its subsequent haemodynamic changes, mainly heart rate and blood pressure. Objective: To describe the haemodynamic effects of yawning on the autonomic nervous system, as well as to establish yawning as a protective mechanism of syncope, or a predictor of a positive haemodynamic response. Methods: A secondary source observational study conducted using a database of patients that were subjected to the tilt table test between August 2010 and December 2015, and yawned at least once during the test. Statistical analyses and paired tests were performed to determine correlations. Results: A total of 156 patients were included, the majority women, and a mean age of 40 years. Syncope was presented in 43 patients. The remaining 113 (72.4%) yawned with no syncope, and of these, 50 (44.2%) had yawned and had a positive response to the tilt-table test. Although there was an increase in the majority of haemodynamic variables, a significant decrease was observed in the heart rate. Yawning was observed as a protector of syncope in 67 patients, whilst it was a predictor of a positive haemodynamic response in 61 patients. Conclusion: Yawning is associated with activation of the sympathetic nervous system, with haemodynamic effects and on the autonomic nervous system. It could be established as a predictive sign of a mixed type or vasodepressor positive haemodynamic response, and in other cases as a protective mechanism against the appearance of a syncope.

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Resumen El dolor abdominal es una causa frecuente de consulta para el médico general. Corresponde al 1% de la consulta externa ubicándose como la novena causa externa y la segunda en los servicios de urgencias en Colombia. Cuando éste es crónico, rara vez es tributario de manejo quirúrgico, pero impacta negativamente en la calidad de vida de los pacientes. Un enfoque anatómico y fisiopatológico permiten un adecuado diagnóstico y tratamiento por parte del médico. Siendo así, este trabajo tiene como objetivo revisar los elementos base para el enfoque del dolor abdominal crónico y proponer un algoritmo diagnóstico para estos casos. MÉD.UIS. 2018;31(1):47-55.

Abstract Abdominal pain is a frequent chief complaint for primary care physician. It explains 1% of outpatient visits ranking 9th in the office and 2nd in the emergency room. Chronic pain, rarely needs surgical management but declines quality of life. An anatomic and physiophatologic approach result in a correct diagnosis and treatment by the physician. This work aims to review the major elements for the study of chronic abdominal pain and to propose a clinical diagnostic algorithm in these cases. MÉD.UIS. 2018;31(1):47-55.

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Abstract: Introduction: Atrial fibrillation is the most prevalent arrhythmia in clinical practice. Evidence has recently shown a relationship between epicardial adipose tissue and atrial fibrillation, which may be stronger than that for traditional obesity markers. Objective: To analyse the available evidence associating adipose epicardial tissue with incidence, severity and recurrences of atrial fibrillation. Methods: A systematic search in PubMed, EBSCO, Cochrane, SciELO and LILACS databases for observational studies published in the last 10 years, evaluating the association between atrial fibrillation and epicardial adipose tissue was undertaken. All articles were evaluated by two authors and differences were solved by consensus. Results: After having screened and evaluated articles for quality, 15 were selected for the qualitative synthesis. All studies reported a statistically significant association between total fat and periatrial epicardial adipose tissue and the presence of atrial fibrillation, which persisted after adjustment of covariates. The evidence was not uniform regarding arrhythmia severity. Periatrial epicardial fat was significantly higher in patients who had a recurrent disease. Conclusion: the presence of epicardial adipose tissue (total and periatrial) is significantly associated with atrial fibrillation and arrhythmia recurrence.(AU)

Resumen: Introducción: La fibrilación auricular es la arritmia más prevalente en la práctica clínica. Recientemente se ha demostrado una relación entre el tejido adiposo epicárdico y la fibrilación auricular, que puede ser más fuerte que la de los marcadores de obesidad tradicionales. Objetivo: Analizar las pruebas disponibles que asocian el tejido epicárdico adiposo con la incidencia, gravedad y recurrencia de la fibrilación auricular. Métodos: Se realizó una búsqueda sistemática en las bases de datos PubMed, EBSCO, Cochrane, SciELO y LILACS de estudios observacionales publicados en los últimos 10 años, evaluando la asociación entre la fibrilación auricular y el tejido adiposo epicárdico. Dos autores evaluaron todos los artículos y las diferencias se resolvieron por consenso. Resultados: Después de haber examinado y evaluado la calidad de los artículos, se seleccionaron 15 para la síntesis cualitativa. Todos los estudios informaron una asociación estadísticamente significativa entre la grasa total y el tejido adiposo epicárdico periatrial y la presencia de fibrilación auricular, que persistió después del ajuste de las covariables. Las evidencias no fueron uniformes con respecto a la gravedad de la arritmia. La grasa epicárdica periatrial fue significativamente mayor en los pacientes que tuvieron una enfermedad recurrente. Conclusión: La presencia de tejido adiposo epicárdico (total y periatrial) se asocia significativamente con fibrilación auricular y recurrencia de arritmia.(AU)

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Abstract: The transvenous implantable cardiac defibrillator (T-ICD) is currently considered the standard of care for prevention of sudden cardiac death in patients with structural cardiac disease or channelopathies. However, the use of these devices is associated with a significant increase of short and long-term complications, mostly related to intravascular leads. The subcutaneous implantable cardiac defibrillator (S-ICD) is a novel alternative for high-risk patients susceptible to intravascular lead complications, with a similar efficacy as T-ICD. Multiple ongoing clinical trials involving the S-ICD are expected to provide additional information about safety, use and benefits in the clinical setting.

Resumen: El desfibrilador cardiaco implantable transvenoso (DCI-T) se considera actualmente el tratamiento estándar para la prevención de la muerte súbita cardiaca en pacientes con enfermedad cardiaca estructural o canalopatías. Sin embargo, el uso de estos dispositivos se asocia con un aumento significativo de complicaciones a corto y largo plazo, principalmente relacionadas con derivaciones intravasculares. El desfibrilador cardiaco implantable subcutáneo (DCI-S) es una alternativa novedosa para pacientes de alto riesgo susceptibles a complicaciones intravasculares, con una eficacia similar al DCI-T. Se espera que varios ensayos clínicos en curso que involucran al DCI-S brinden información adicional sobre seguridad, uso y beneficios en el entorno clínico.