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Introduction: Hyperkalemia is a prevalent electrolyte disorder related to elevated serum potassium levels, resulting in diverse abnormal electrocardiographic findings and associated clinical signs and symptoms, often necessitating specific treatment. However, in some patients, these abnormal findings may not be present on the electrocardiogram even in elevated serum potassium levels. This study aims to identify electrocardiographic abnormalities related to the severity of hyperkalemia and the clinical outcomes in an emergency department in southwestern Colombia. Methodology: This is a retrospective cross-sectional descriptive study. We described the electrocardiographic findings, clinical characteristics, treatment, and outcomes related to the degrees of hyperkalemia. The potential association between the severity of hyperkalemia and electrocardiographic findings was evaluated. Results: A total of 494 patients were included. The median of the potassium level was 6.6 mEq/L. Abnormal electrocardiographic findings were reported in 61.5% of the cases. Mild and severe hyperkalemia groups reported abnormalities in 59.9% and 61.2%, respectively. The most common electrocardiography abnormalities were the peaked T wave 36.2%, followed by wide QRS 83 (16.8%). Only 1.4% of patients had adverse outcomes. The abnormal findings were registered in 61.5%. Mortality was 11.9%. The peaked T wave was the most common finding across different levels of hyperkalemia severity. Conclusion: High serum potassium levels are related with abnormal ECG. However, patients with different degrees of hyperkalemia could not describe abnormal ECG findings. In a high proportion of patients with renal chronic disease and hyperkalemia, the abnormalities in the ECG could be minimal or absent.

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To assess the cost-effectiveness of the robotic-assisted laparoscopic radical prostatectomy (RALRP) compared to open radical prostatectomy (ORP) for localized prostate cancer from a healthcare perspective in Colombia. A systematic review was conducted in Embase, Scopus, Web of Science, PubMed, and Cochrane CENTRAL databases, to identify relevant publications up to January 2020 to summarize clinical outcomes related to effectiveness of robot-assisted and open radical prostatectomy. A tree decision model was designed given the clinical outcomes and possibilities of complication and success. Outcomes were defined as complications according to Clavien - Dindo classification and success measured as urethral stricture rate. Cost was divided into two categories: surgical procedure and complications. Incremental cost-effectiveness ratio (ICER) was calculated and a deterministic sensitivity analysis was performed to evaluate the impact of the uncertainty on the conclusions of the model. A 90-day horizon was defined. Direct medical costs associated with RALRP were $6.511 ($ 5.127- $8.138), and for ORP were $4.476 ($2.170-$ 6.511). The average cost for complication management was rated at $ 327 for RALRP and $ 382 for ORP, based on an augmented risk of post-operative urethral stricture in the ORP group (2.4% vs 10.8%). ICER was calculated in USD $18.987. The cost of RALRP has to be reduced to around USD 5.345 to achieve an ICER under 1 GDP making the intervention feasible. Using a 3 GDP per capita threshold, the implementation of RALRP could be cost-effective for the treatment of localized prostate cancer in emerging economies. Bolder measures including the use of one needle carrier, three robotic arms, and a shorten hospitalization program of 24 h, can save around $1000 for each patient, achieving the goal cost of $5345 needed for a favorable ICER.

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Introducción. La enfermedad de Erdheim Chester es un trastorno infrecuente, de etiología no clara y edad de presentación variable, que se caracteriza por la proliferación anormal de histiocitos no Langerhans. Puede presentarse de forma asintomática, con manifestaciones locales o como complicaciones sistémicas. El diagnóstico se basa en las condiciones clínicas del paciente, estudios imagenológicos y el estudio anatomopatológico, mediante el cual se confirma la enfermedad. Caso clínico. Paciente masculino con una lesión lítica en el séptimo arco costal, inicialmente asintomático y posteriormente con dolor torácico persistente. Se realizó resección y reconstrucción de la pared torácica, con resolución de la sintomatología y adecuada evolución posoperatoria. El resultado de la patología confirmó el diagnóstico de enfermedad de Erdheim Chester. Discusión. Se presenta el caso de un paciente con compromiso costal y fractura patológica como localización y manifestación inusual de la enfermedad de Erdheim Chester, tratado quirúrgicamente de forma adecuada, y sin aparición de recidiva. Debido a la diversidad de síntomas que pueden presentar y a la afectación de múltiples órganos, además de los estudios imagenológicos, la clínica debe orientar los exámenes complementarios, como electro o ecocardiograma, resonancia nuclear magnética, o angioTAC. En los pacientes asintomáticos se ha recomendado un manejo expectante y en los sintomáticos el tratamiento médico con glucocorticoides, inhibidores de BRAF e interferón alfa. El papel de la cirugía no ha sido estudiado a profundidad

Introduction. Erdheim Chester disease is a rare disorder of unclear etiology and variable age of presentation, characterized by abnormal proliferation of non-Langerhans histiocytes. It can present asymptomatic, with local manifestations or as systemic complications. The diagnosis is based on the clinical conditions of the patient, imaging studies, and the pathological study, through which the disease is confirmed.Clinical case. A male patient with a lytic lesion in the seventh costal arch, initially asymptomatic and later with persistent chest pain, underwent resection and reconstruction of the chest wall, with resolution of the symptoms and adequate postoperative evolution. The pathology report confirmed the diagnosis of Erdheim Chester's disease.Discussion. The case of a patient with rib involvement and pathological fracture is presented as an unusual location and manifestation of Erdheim Chester's disease, treated surgically appropriately, and without recurrence. Due to the diversity of symptoms that they can present and the involvement of multiple organs, in addition to imaging studies, the clinic should direct complementary tests such as electrocardiogram or echocardiogram, magnetic resonance imaging, or CT angiography. Expectant management has been recommended in asymptomatic patients, and medical treatment with glucocorticoids, BRAF inhibitors, and interferon alfa in symptomatic patients. The role of surgery has not been studied in depth

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La agenesia esternal es una rara malformación del desarrollo embrionario del esternón, que puede estar o no relacionado con otras anomalías congénitas. Se presenta el caso de un paciente de 4 años de edad con agenesia esternal total, que fue llevado a reconstrucción de la pared torácica anterior con material protésico absorbible y pericardio bovino, logrando la adecuada estabilidad de la pared torácica y la corrección de la función de la misma, con una evolución satisfactoria después de dos años de seguimiento

Sternal cleft is a rare malformation of the embryonic development of the sternum, which may or may not be related to other congenital anomalies. We present the case of a 4-year-old patient with total sternal cleft, who underwent reconstruction of the anterior chest wall with absorbable prosthetic material and bovine pericardium, achieving adequate stability and correction of the function of the chest wall, with a satisfactory evolution after two years of follow-up

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Introducción. El manejo quirúrgico de las lesiones de la pared costal con resección y reconstrucción con material protésico ha venido en aumento, debido al avance en las técnicas quirúrgicas y en la experiencia del cirujano, así como en la innovación y las características de los materiales protésicos, que permiten realizar resecciones amplias de la pared garantizando una mayor estabilidad esquelética, una menor alteración de la mecánica respiratoria y mejores los resultados estéticos. Métodos. Se presenta la experiencia en la clínica CardioVID, Medellín, Colombia, entre los años 2015 y 2019, mediante una revisión retrospectiva de 8 casos sometidos a resección de lesiones benignas de la pared torácica y reconstrucción con material protésico. Resultados. Se encontró una adecuada evolución de los pacientes, con un buen resultado estético y funcional, con adecuado control de la enfermedad, sin reportes de complicaciones ni de recidiva en el seguimiento. Discusión. Una técnica adecuada permite la reconstrucción de estos defectos con complicaciones mínimas y bajas tasas de extracción de prótesis, finalizando con excelentes resultados funcionales y cosméticos. Con nuestra experiencia podemos concluir que la elección adecuada de los pacientes candidatos a manejo quirúrgico, una buena técnica quirúrgica y un personal con experiencia son cruciales para lograr buenos resultados en cuanto a función pulmonar y estética. Además de lograr una sobrevida bajo los parámetros establecidos posterior a lograr una resección R0

Introduction. Surgical management of chest wall lesions with resection and reconstruction with prosthetic material has been increasing, due to advances in surgical techniques and surgeon's experience, as well as innovation and characteristics of prosthetic materials. They allow wide resections of the wall, guaranteeing greater skeletal stability, less alteration of respiratory mechanics, and better aesthetic results.Methods. The experience in the CardioVID clinic, Medellín, Colombia, between the years 2015 and 2019, is presented through a retrospective review of eight cases that underwent resection of benign lesions of the chest wall and reconstruction with prosthetic material.Results. An adequate evolution of the patients was found, with a good aesthetic and functional result, with adequate control of the disease, without reports of complications or recurrence in follow-up.Discussion. An adequate technique allows the reconstruction of these defects with minimal complications and low prosthesis extraction rates, ending with excellent functional and cosmetic results. With our experience, we can conclude that the proper choice of patients who are good candidates for surgical management, a good surgical technique, and an experienced staff are crucial to achieve good results in terms of lung function and aesthetics results, in addition to obtain survival under the established parameters after achieving an R0 resection

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Green waste (GW) management is a key issue due to its high production rate and its variety of physical properties and chemical composition. Composting is a promising alternative for GW treatment and valorization. However, the presence of recalcitrant components such as lignin and cellulose increase the processing time. Strategies such as addition of co-substrates and operative modifications have improved the processing time and compost quality. Therefore, in this study, three strategies have been implemented (i) addition of unprocessed food (UF) and processed foods (PF) as co-substrates for GW to improve the nutrients composition of the substrates at the beginning of the process, (ii) addition of phosphate rock (PR) to improve product quality, and (iii) the use of two-stage composting (TSC) to accelerate the degradation. For this purpose, three treatments with the same mixture (48% GW + 21% UF + 18% PF + 13% sawdust (SW)) were conducted: (i) TA (TSC + 15% PR), (ii) TB (traditional composting +15% PR), and (iii) TC (traditional composting). TSC did not show significant differences compared with TC regarding the process and compost quality, while the addition of PR increased the phosphorus content of the product. However, TC produced the compost with the highest quality according to the Colombian legislation for soil amendment.

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Introduction Prediction of lymph node involvement (LNI) is of paramount importance for patients with prostate cancer (PCa) undergoing radical prostatectomy (RP). Multiple statistical models predicting LNI have been developed to support clinical decision-making regarding the need of extended pelvic lymph node dissection (ePLND). Our aim is to evaluate the prediction ability of the best-performing prediction tools for LNI in PCa in a Latin-American population. Methods Clinicopathological data of 830 patients with PCa who underwent RP and ePLND between 2007 and 2018 was obtained. Only data from patients who had ≥ 10 lymph nodes (LNs) harvested were included (n = 576 patients). Four prediction models were validated using this cohort: The Memorial Sloan Kettering Cancer Center (MSKCC) web calculator, Briganti v.2017, Yale formula and Partin tables v.2016. The performance of the prediction tools was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results The median age was 61 years old (interquartile range [IQR] 56­66), the median Prostate specific antigen (PSA) was 6,81 ng/mL (IQR 4,8­10,1) and the median of LNs harvested was 17 (IQR 13­23), and LNI was identified in 53 patients (9.3%). Predictions from the 2017 Briganti nomogram AUC (0.85) and the Yale formula AUC (0.85) were the most accurate; MSKCC and 2016 Partin tables AUC were both 0,84. Conclusion There was no significant difference in the performance of the four validated prediction tools in a Latin-American population compared with the European or North American patients in whom these tools have been validated. Among the 4 models, the Briganti v.2017 and Yale formula yielded the best results, but the AUC overlapped with the other validated models.

Introducción La predicción del compromiso ganglionar es de suma importancia en pacientes con cáncer de próstata (CaP) que se van a someter a prostatectomía radical (PR). Múltiples modelos estadísticos se han desarrollado para predecir el riesgo de compromiso ganglionar y facilitar las decisiones clínicas de realizar o no linfadenectomía pélvica ampliada (LPA). Nuestro objetivo es evaluar la habilidad de predicción de las mejores herramientas de predicción de compromiso ganglionar en CaP en una población latinoamericana. Métodos Se evaluaron los datos clínico-patológicos de 830 pacientes con CaP sometidos a PR y LPA entre el 2007­2018. Solo se analizaron os pacientes con 10 o más ganglios extraídos (n = 576). Cuatro modelos de predicción fueron validados en esta cohorte: el modelo de la calculadora online del Memorial Sloan Kettering Cancer Center (MSKCC), el Briganti v.2017, la fórmula de Yale, y tablas de Partin v.2016. Se evaluó el desempeño de los modelos con curvas de características operativas del receptor (COR) y el área bajo la curva (ABC). Resultados La mediana de edad fue 61 años (rango intercuartílico [RI]: 56­66), mediana de Prostate specific antigen (PSA) 6,81 ng/mL (RI: 4,8­10,1), y mediana de ganglios extraídos 17 (RI: 13­23); se documentó compromiso ganglionar en 53 pacientes (9.3%). La habilidad de predicción del nomograma de Briganti v.2017 ABC (0,85) y la fórmula de Yale ABC (0,85) fueron las más precisas. El modelo del MSKCC y las tablas de Partin v.2016 mostraron AUC de 0,84 ambos. Conclusiones No encontramos diferencia estadisticamente significativa en el desempeño de los cuatro modelos de predicción validados en esta población latinoamericana comparada con pacientes norteamericanos o europeos en los que estas herramientas fueron desarrolladas. Entre los 4 modelos, el nomograma de Briganti v.2017 y la fórmula de Yale mostraron los mejores resultados; sin embargo, el AUC se sobrepone con los otros modelos validados.

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ABSTRACT Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). Materials and Methods: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. Results: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.

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Resumen El secuestro pulmonar es una enfermedad congénita infrecuente caracterizada por la presencia de una porción de parénquima pulmonar que recibe vascularización independiente de la circulación sistémica. Se presentan tres casos de secuestro pulmonar intralobares, de presentación tardía, uno de ellos asociado a una malformación adenomatosa quística y en los cuales el manejo se completó por videotoracoscopia: dos de ellos con lobectomía total y uno con lobectomía sublobar. Se trata de una enfermedad de presentación clínica variable y cuyo tratamiento es, en la mayoría de los casos, quirúrgico, requiriéndose usualmente resecciones lobares, las cuales pueden llevarse a cabo de manera eficaz y segura por videotoracoscopia.

Abstract Pulmonary sequestration is an infrequent congenital disease characterized by the presence of a portion of pulmonary parenchyma that receives vascularization independent of the systemic circulation. We present three cases of intralobar pulmonary sequestration of late presentation, one of them associated with a cystic adenomatous malformation and in which the management was completed by videothoracoscopy: two of them with total lobectomy and the other with sublobar lobectomy. It is a disease of variable clinical presentation and whose treatment is, in most cases, surgical, usually requiring lobar resections, which can be carried out effectively and safely by video-assisted thoracoscopy.