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Background: Patients with sleep apnea (SA) and coronary artery disease (CAD) are at higher risk of atrial fibrillation (AF) than the general population. Our objectives were: to evaluate the role of CAD and SA in determining AF risk through cluster and survival analysis, and to develop a risk model for predicting AF. Methods: Electronic medical record (EMR) database from 22,302 individuals including 10,202 individuals with AF, CAD, and SA, and 12,100 individuals without these diseases were analyzed using K-means clustering technique; k-nearest neighbor (kNN) algorithm and survival analysis. Age, sex, and diseases developed for each individual during 9 years were used for cluster and survival analysis. Results: The risk models for AF, CAD, and SA were identified with high accuracy and sensitivity (0.98). Cluster analysis showed that CAD and high blood pressure (HBP) are the most prevalent diseases in the AF group, HBP is the most prevalent disease in CAD; and HBP and CAD are the most prevalent diseases in the SA group. Survival analysis demonstrated that individuals with HBP, CAD, and SA had a 1.5-fold increased risk of developing AF [hazard ratio (HR): 1.49, 95% CI: 1.18-1.87, p = 0.0041; HR: 1.46, 95% CI: 1.09-1.96, p = 0.01; HR: 1.54, 95% CI: 1.22-1.94, p = 0.0039, respectively] and individuals with chronic kidney disease (CKD) developed AF approximately 50% earlier than patients without these comorbidities in a period of 7 years (HR: 3.36, 95% CI: 1.46-7.73, p = 0.0023). Comorbidities that contributed to develop AF earlier in females compared to males in the group of 50-64 years were HBP (HR: 3.75 95% CI: 1.08-13, p = 0.04) CAD and SA in the group of 60-75 years were (HR: 2.4 95% CI: 1.18-4.86, p = 0.02; HR: 2.51, 95% CI: 1.14-5.52, p = 0.02, respectively). Conclusion: Machine learning based algorithms demonstrated that CAD, SA, HBP, and CKD are significant risk factors for developing AF in a Latin-American population.

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Scorpions of the Neotropical genus Tityus are responsible for most severe envenomations in the Caribbean, South America, and Lower Central America (LCA). Although Tityus is taxonomically complex, contains high toxin polymorphism, and produces variable clinical manifestations, treatment is limited to antivenoms produced against species with restricted distributions. In this study, we explored the compositional and antigenic diversity of Tityus venoms to provide improved guidelines for the use of available antivenoms at a broader geographic scale. We used immunoblotting, competitive ELISA, and in vivo studies to compare reactivity against commercial antivenoms from Brazil, Venezuela, and Mexico, as well as MALDI-TOF mass spectrometry, cDNA sequencing, and phylogenetic analyses to assess venom sodium channel-active toxin (NaTx) content from medically important Tityus populations inhabiting Brazil, Colombia, Costa Rica, Ecuador, Panama, Trinidad and Tobago, and Venezuela. Additionally, we raised rabbit antibodies against Tityus venoms from LCA to test for cross-reactivity with congeneric species. The results suggest that Tityus spp. possess high venom antigenic diversity, underlying the existence of four toxinological regions in Tropical America, based on venom composition and immunochemical criteria: LCA/Colombia/Amazonia (Region I), Venezuela (Region II), southeast South America (Region III), and a fourth region encompassing species related to toxinologically divergent Tityus cerroazul. Importantly, our molecular and cross-reactivity results highlight the need for new antivenoms against species inhabiting Region I, where scorpions may produce venoms that are not significantly reactive against available antivenoms.

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El infarto del omento es una enfermedad poco frecuente que se manifiesta como causa de dolor abdominal. Se requiere un diagnóstico adecuado, basado en las características por imagen, puesto que su reconocimiento orienta el manejo que en la mayoría de los casos es conservador. Sin embargo, en algunos casos puede ser necesario el manejo quirúrgico. Dentro de las modalidades de imagen utilizadas para el estudio del dolor abdominal agudo, la tomografía computarizada multidetector (TCM) es la modalidad de imagen con mayor precisión para realizar diagnóstico de infarto del omento. Se presenta el caso de un paciente con torsión e infarto del omento mayor en el lado derecho, que requirió cirugía. Se realiza una revisión de la literatura sobre el infarto del omento mayor enfatizando los hallazgos por imágenes, los diagnósticos diferenciales más frecuentes y el tratamiento de esta entidad.

Omental infarction is a rare disease that occurs as a cause of abdominal pain. It requires an adequate diagnosis based on the image characteristics, since its recognition guides the management that in the majority of the cases is conservative. However, surgical management may be necessary in some cases. Among the imaging modalities used for the study of abdominal pain, multidetector computed tomography (MCT) is the most accurate imaging modality for the diagnosis of omental infarction. We present a case of a patient with torsion and infarct of the mayor omentum in the right side that required surgery. We make a literature review of omental infarction, emphasizing in the imaging findings, the most common differential diagnosis and treatment of the pathology.

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El linfoma de células del manto hace parte del subgrupo de linfomas no Hodgkin (LNH). Este se manifiesta con adenopatías, esplenomegalia, síntomas B y compromiso cutáneo asociado a enfermedad diseminada. El compromiso esplénico se presenta como: Esplenomegalia sin lesión focal; lesiones sólidas únicas o múltiples e infiltración del bazo sin cambios morfológicos ni lesiones focales. La aparición de linfoma con lesiones quísticas es extremadamente rara, se encuentran solo unos cuantos casos en la literatura, ninguno de ellos en el bazo. Se expone el caso de una paciente de 59 años de edad, quien consultó por dolor abdominal intermitente. En los estudios diagnósticos se observó esplenomegalia con lesiones sólidas y quísticas. Se realizó esplenectomía con estudio histopatológico que confirmó compromiso por linfoma de células del manto.

Mantle cell lymphoma is a Non-Hodgkin Lymphoma (NHL). In cases of disseminated disease, lymphadenopathy, splenomegaly, B-symptoms and skin disease are present. Lymphoma affecting the spleen has several radiologic presentations, ranging from normal appearance, to splenomegaly or multiples focal solid lesions. Cystic presentation of lymphoma is rare and few cases have been reported, none of them involving the spleen. We report a case of a 59-year old female patient with cystic spleen lesions that after splenectomy were diagnosed as Mantle cell lymphoma.

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Snakebites inflicted by the arboreal viperid snake Bothriechis schlegelii in humans are characterized by pain, edema, and ecchymosis at the site of the bite, rarely with blisters, local necrosis, or defibrination. Herein, a comparative study of Bothriechis schlegelii snake venoms from Colombia (BsCo) and Costa Rica (BsCR) was carried out in order to compare their main activities and to verify the efficacy of Bothrops antivenom produced in Brazil to neutralize them. Biochemical (SDS-PAGE and zymography) and biological parameters (edematogenic, lethal, hemorrhagic, nociceptive, and phospholipase A2 activities) induced by BsCo and BsCR snake venoms were evaluated. The presence of antibodies in Bothrops antivenom that recognize BsCo and BsCR snake venoms by enzyme-linked immunosorbent assay and Western blotting, as well as the ability of this antivenom to neutralize the toxic activities were also verified. SDS-PAGE showed differences between venoms. Distinctive caseinolytic and hyaluronidase patterns were detected by zymography. BsCo and BsCR showed similar phospholipase A2 activity. Strong cross-reactivity between BsCo and BsCR was detected using Bothrops antivenom with many components located between 150 and 35 kDa. BsCR was more edematogenic and almost fourfold more hemorrhagic than BsCo, and both venoms induced nociception. BsCR (LD50 5.60 mg/kg) was more lethal to mice than BsCo (LD50 9.24 mg/kg). Bothrops antivenom was effective in the neutralization of lethal and hemorrhagic activities of BsCo and BsCR and was partially effective in the neutralization of edematogenic and nociceptive activities. In conclusion, geographic distribution influences the composition and activities of Bothriechis schlegelii venoms. Bothrops antivenom cross-reacted with these venoms and was partially effective in neutralizing some toxic activities of BsCo and BsCR.

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La polimialgia reumática es una enfermedad que generalmente afecta a los individuos mayores de 50 años. Desde 1963 se ha modificado su denominación y clasificación; en la actualidad, para su diagnóstico se cuentan con criterios clínicos e imagenológicos. Entre los criterios imagenológicos se considera especialmente el ultrasonido; sin embargo, la resonancia magnética permite descartar diagnósticos diferenciales y considerar en forma oportuna el diagnóstico de la polimialgia reumática. Esto se destaca en el presente artículo que describe el caso de una paciente de 56 años con antecedentes de perioniquia secundaria a pedicura y, como complicación, una espondilodiscitis. Posteriormente aparece dolor articular simétrico, matutino, en caderas y hombros; por medio de resonancia magnética se establece el diagnóstico del proceso infeccioso inicial y se descarta el compromiso infeccioso articular, lo cual se asocia a criterios clínicos y se diagnostica y trata la polimialgia reumática.

Polymyalgia rheumatica is a disease that usually affects people over 50 years old. Since 1963, its name and classification have been modified; at present, there are clinical and imaging data criteria for its diagnosis. Among the imaging criteria, ultrasound plays a pivotal role; however, magnetic resonance helps to rule out different diagnoses, as well as to clarify the diagnosis of polymyalgia rheumatica. This paper highlights this fact by presenting the case of a 56-year old female patient with a history of paronychia secondary to pedicure, and spondylodiscitis as a complication. Later, she reports symmetrical joint pain in hips and shoulders in the morning; magnetic resonance is used to establish the initial infective process, while infective joint involvement is discarded; it is associated with clinical criteria in order to establish the diagnosis and treatment of polymyalgia rheumatic.

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El sarcoma de Ewing representa el segundo tumor primario de hueso más común en niños y adolescentes (3 % de todos los tumores óseos pediátricos), solo excedido en prevalencia por el osteosarcoma. Respecto al sitio de compromiso, el sarcoma de Ewing afecta la pelvis, las extremidades y las costillas en el 86 % de los casos, seguido por la escápula (de 4 a 5 %). Este artículo presenta un caso de sarcoma de Ewing en la escápula; se describen sus características clínicas e imaginológicas, así como su tratamiento.

Ewing´s sarcoma is the second most common primary bone tumor in children and adolescents (3% of all pediatric bone tumors), its prevalence is only exceeded by osteosarcoma. Regarding the site of involvement, Ewing's sarcoma involves pelvis, limbs and the ribs in 86% of cases, followed by the scapula (4-5%). This article presents a case of Ewing's sarcoma in the scapula; clinical and imaging characteristics are described, as well as treatment.

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INTRODUCTION: Scorpion stings are a public health problem in many countries. However, in Colombia, very few epidemiological, clinical or toxicological studies have been undertaken. OBJECTIVE: Ecological and epidemiological aspects were related to the prevalence of scorpion stings by Tityus asthenes. The clinical features of envenomization were described in patients and in an experimental animal model. MATERIALS AND METHODS: The study was conducted in four localities of Mutatá and Urabá Counties in the province of Antioquia, Colombia. The sample consisted of 1,593 (929 urban, 664 rural) of the 5,305 exposed people, inhabitating 324 households (188 urban (58%); 136 rural (42%) of 1,448 houses total in the study area. An interview survey was performed in every selected family for a more realistic estimate of sting prevalence. Additionally, a prospective study was directed toward patients presenting scorpion stings at care at the local hospital over an 18-month period. RESULTS: The probability was 12.9 times greater of finding T. asthenes inside or around houses in places near to forest and high agrarian plantations (odds ratio = 13). Eighty scorpion stings were reported in the retrospective study (4.1% prevalence [95% CI 3.3-4.8%] ), but only 14 of the patients (17.5%) sought care in the local hospital (an 82.5% underreportage). Seventy percent of the stings occurred in rural places; 50% occurred in the locality of Caucheras, with an attack rate of 10.6%. The overall household infestation rate was 269% (95% CI 22.9-30.8%) and an area dispersion ratio of 100%. Signs of systemic envenomization occurred mainly in children (67%). The 50% lethal dose of T. asthenes venom was 121.6 µg for 18-20 g Swiss Webster rats (95% CI 103.7-139.6). Immunodetection of T. asthenes and Centruroides gracilis/C.margantatus venoms in the experimental animals was possible when were tested by Western blot against Alacramyn (Instituto Bioclón, México) and Soro antiaracnídico (Instituto Butantan, Brasil) antivenoms. Scorpion interspecific differences were noted. CONCLUSIONS: The prevalence of stings by T. asthenes were common and their presence was associated with tropical rainforests. Envenomization at low density can be neutralized efficiently by anti-scorpion antivenoms produced in México and Brazil but with differing specificities for the venom of each scorpion species.

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Introducción. El escorpionismo afecta a países tropicales como Colombia.Objetivo. Determinar los indicadores ecológicos y epidemiológicos de las picaduras por Tityus asthenes en cuatro localidades de Mutatá, Colombia, y las características clínicas del envenenamiento y toxinológicas del veneno. Materiales y métodos. Es un estudio prospectivo/retrospectivo descriptivo y experimental; se visitaron aleatoriamente 324 de las 1.448 viviendas del municipio: 188 urbanas (58,0%) y 136 rurales (42,0%), con 1.593 habitantes. En 18 meses se estudiaron prospectivamente los pacientes picados por T. asthenes que ingresaron al hospital local y, retrospectivamente en encuestas domiciliarias, se determinó el subregistro. Se recolectaron escorpiones vivos y se realizaron experimentos con el veneno. Resultados. Hubo 12,9 más probabilidades de hallar ejemplares de T. asthenes en el área rural (OR=6,5; IC95% 3,9-10,8), en el intradomicilio y peridomicilio cercano a bosques y plantaciones agrarias altas (OR=13,0; IC95% 7,5-23,0). Se reportaron 80 picaduras ocurridas en los dos últimos años (prevalencia de 4,1%; IC95% 4,8-3,3); sólo 14 personas (17,5%) consultaron al hospital (subregistro de 82,5%). La prevalencia ponderada de infestación por escorpiones en las viviendas encuestadas fue de 26,9% (112 casas) (IC95% 30,8-22,9). El 50% de los accidentes ocurrió en la localidad de Caucheras: 10,6% de proporción de ataque. El envenenamiento sistémico fue más frecuente en niños (67%). La dosis letal 50 del veneno en ratones de 18 a 20 g, fue 121,6 μg (IC95% 103,7-139,6). Hubo reactividad inmunológica por Western blot de los antivenenos del Instituto Bioclón, México (Alacramyn®) y del Instituto Butantan, Brasil (Soro antiaracnídico®)...

Introduction. Scorpion stings are a public health problem in many countries. However, in Colombia, very few epidemiological, clinical or toxicological studies have been undertaken. Objective. Ecological and epidemiological aspects were related to the prevalence of scorpion stings by Tityus asthenes. The clinical features of envenomization were described in patients and in an experimental animal model. Materials and methods. The study was conducted in four localities of Mutatá and Urabá Counties in the province of Antioquia, Colombia. The sample consisted of 1,593 (929 urban, 664 rural) of the 5,305 exposed people, inhabitating 324 households (188 urban (58%); 136 rural (42%) of 1,448 houses total in the study area. An interview survey was performed in every selected family for a more realistic estimate of sting prevalence. Additionally, a prospective study was directed toward patients presenting scorpion stings at care at the local hospital over an 18-month period. Results. The probability was 12.9 times greater of finding T. asthenes inside or around houses in places near to forest and high agrarian plantations (odds ratio=13). Eighty scorpion stings were reported in the retrospective study (4.1% prevalence [95% CI 3.3-4.8%] ), but only 14 of the patients (17.5%) sought care in the local hospital (an 82.5% underreportage). Seventy percent of the stings occurred in rural places; 50% occurred in the locality of Caucheras, with an attack rate of 10.6%. The overall household infestation rate was 269% (95% CI 22.9-30.8%) and an area dispersion ratio of 100%. Signs of systemic envenomization occurred mainly in children (67%). The 50% lethal dose of T. asthenes venom was 121.6 μg for 18-20 g Swiss Webster rats (95% CI 103.7-139.6). Immunodetection of T. asthenes and Centruroides gracilis/C.margantatus venoms in the experimental animals was possible when were tested by Western blot against Alacramyn® (Instituto Bioclón, México) and Soro antiaracnídico®...

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