Resumen El divertículo de Meckel (DM) corresponde a la involución aberrante del canal onfalo-mesentérico o conducto vitelino, el cual se ubica a nivel del borde antimesentérico del íleon terminal. Es la anomalía estructural más común del tracto gastrointestinal, casi siempre es asintomático y su diagnóstico por lo general es incidental, sin embargo, la complica ción con diverticulitis es una condición poco usual. Describimos el caso de un hombre de 65 años, que ingresó referido de otra institución con diagnóstico de abdomen agudo, al examen físico presentó signos de irritación peritoneal con evidencia de leucocitosis y neutrofilia en hemograma de ingreso. Se realizó tomografía computarizada de abdomen con contraste endovenoso, la cual se interpretó como diverticulitis de Meckel complicada, siendo corroborado durante el acto quirúrgico y confirmado mediante anatomía patológica. La diverticulitis de Meckel es una entidad rara, sin embargo, es importante reconocerla dentro de los diagnósticos diferenciales de abdomen agudo, lo cual permitirá una pronta intervención y un favorable desenlace.

Abstract Meckel’s diverticulum corresponds to the aberrant invo lution of the omphalo-mesenteric canal or vitelline duct, which is located at the level of the antimesenteric border of the terminal ileum. It is the most common structural anomaly of the gastrointestinal tract, it is almost always asymptomatic and its diagnosis is usually incidental, how ever the complication with diverticulitis is an unusual con dition. We describe the case of a 65-year-oldman, who was admitted from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computerized tomography of the abdomen with intra venous contrast was performed, which was interpreted as complicated Meckel’s diverticulitis, being corroborated during the surgical act and confirmed by pathological anatomy. Meckel’s diverticulitis is a rare entity, however it is important to recognize it within the differential diagnoses of acute abdomen, which will allow prompt intervention and a favorable outcome.

RESUMEN Introducción: La sarcopenia es un factor de riesgo para morbilidad, mortalidad y discapacidad en adultos mayores, por lo que su manejo es prioridad en geriatría. El objetivo de este artículo, consiste en caracterizar una población de adultos mayores de dos hogares geriátricos y establecer la prevalencia de sarcopenia y el grado de dependencia. Métodos: Estudio de corte transversal desarrollado en la ciudad de Pereira-Colombia. Se incluyó a una población de 72 adultos desde los 65 hasta los 98 años, usando muestreo probabilístico. Se determinó la sarcopenia por medio de los Criterios del Consenso Europeo sobre Definición y Diagnóstico de Sarcopenia; evaluándose la fuerza de prensión, índice de masa muscular esquelética, en caso de presentarse sarcopenia, la severidad de esta junto a la velocidad de marcha, y el grado de dependencia según la escala de Barthel. Resultados: Participaron finalmente 57 personas. El 68,4% (n=39) eran mujeres. La mediana de la edad fue de 83 años. El 2% no presentó sarcopenia, 9% presentaban sospecha de sarcopenia, 28% tenían sarcopenia confirmada y 61% sarcopenia grave. Según la escala de Barthel, el 31,5% eran independientes, 45,6% tenían dependencia leve, 15,8% moderada, 5,3% severa y 1,8% total. Conclusiones: La prevalencia de sarcopenia en los hogares geriátricos de Pereira es elevada, incluso mayor a la reportada en la literatura. Del mismo modo, encontrarse en un hogar geriátrico privado no garantiza una mejor condición física y/o calidad de vida.

ABSTRACT Introduction: Sarcopenia is a risk factor for morbidity, mortality and disability in older adults, so its management is a priority in geriatrics. The aim of this article is to characterize a population of older adults from two geriatric homes and to establish the prevalence of sarcopenia and the degree of dependence. Methods: Cross-sectional study developed in the city of Pereira-Colombia. A population of 72 adults from 65 to 98 years of age was included, using probability sampling. Sarcopenia was determined by means of the Criteria of the European Consensus on Definition and Diagnosis of Sarcopenia, evaluating grip strength, skeletal muscle mass index, in case of sarcopenia, the severity of sarcopenia together with walking speed, and the degree of dependence according to the Barthel scale. Results: 57 people participated. A total of 68.4% (n=39) were women. The median age was 83 years. Two percent had no sarcopenia, 9% had suspected sarcopenia, 28% had confirmed sarcopenia and 61% had severe sarcopenia. According to the Barthel scale, 31.5% were independent, 45.6% had mild, 15.8% moderate, 5.3% severe and 1.8% total dependence. Conclusions: The prevalence of sarcopenia in geriatric homes in Pereira is high, even higher than that reported in the literature. Similarly, being in a private nursing home does not guarantee a better physical condition and/or quality of life.

ABSTRACT Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard for diagnosis and treatment of choledocholithiasis. The American Society for Gastrointestinal Endoscopy (ASGE) in 2010 proposed stratifying patients into 3 risk levels; however, studies have found controversial results about the predictive parameters of these diagnostic criteria. The objective of this study is to determine the performance of the high-risk predictive criteria of the ASGE 2010 in the diagnosis of choledocholithiasis in a Colombian Caribbean population. Methods: Retrospective cross-sectional study, which included patients with suspected choledocholithiasis, and who were taken for evaluation by ERCP, meeting the criteria proposed by the ASGE of high probability. The result obtained was compared with the presence of choledocholithiasis on ERCP, from which values and 95% confidence intervals were estimated for sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio. Results: A total of 118 patient data were included in this study. The median age of the patients was 46 years (IQR= 31; 17- 89); 78% (n= 92) were female. 65.3% (n= 77) were older than 55 years. The ERCP result was positive in 81.4% (n= 96) of the patients. The presence of an altered liver profile (90%) was found to be the most sensitive test, clinical cholangitis (86%) the most specific, the presence of duct lithiasis by US (85%) was the test with the highest positive predictive value, and the presence of duct lithiasis by US (35%) was the test with the highest negative predictive value. Conclusions: The predictive parameters of the ASGE 2010 criteria for the diagnosis of choledocholithiasis show variability with respect to the performance proposed in the guidelines.

RESUMEN Introducción: La colangiopancreatografía retrógrada endoscópica (CPRE) se ha convertido en el estándar de oro para el diagnóstico y tratamiento de la coledocolitiasis. La Sociedad Americana de Endoscopia Gastrointestinal (ASGE) propuso en 2010 estratificar a los pacientes en 3 niveles de riesgo; sin embargo, los estudios han encontrado resultados controvertidos sobre los parámetros predictivos de estos criterios diagnósticos. El objetivo de este estudio consiste en determinar el desempeño de los criterios predictivos de alto riesgo de la ASGE 2010 en el diagnóstico de coledocolitiasis en una población del Caribe colombiano. Métodos: Estudio transversal retrospectivo, en el que se incluyeron pacientes con sospecha de coledocolitiasis, y que fueron llevados a evaluación por CPRE, cumpliendo los criterios propuestos por la ASGE de alta probabilidad. El resultado obtenido se comparó con la presencia de coledocolitiasis en la CPRE, a partir de la cual se estimaron los valores y los intervalos de confianza del 95% para la sensibilidad, la especificidad, el valor predictivo positivo y negativo, y la razón de probabilidad positiva y negativa. Resultados: En este estudio se incluyeron los datos de 118 pacientes. La edad media de los pacientes era de 46 años (RIQ= 31; 17- 89); el 78% (n= 92) eran mujeres. El 65,3% (n= 77) eran mayores de 55 años. El resultado de la CPRE fue positivo en el 81,4% (n= 96) de los pacientes. La presencia de un perfil hepático alterado (90%) resultó ser la prueba más sensible, la colangitis clínica (86%) la más específica, la presencia de litiasis ductal por US (85%) fue la prueba con mayor valor predictivo positivo, y la presencia de litiasis ductal por US (35%) fue la prueba con mayor valor predictivo negativo. Conclusiones: : Los parámetros predictivos de los criterios de la ASGE 2010 para el diagnóstico de coledocolitiasis muestran variabilidad con respecto al rendimiento propuesto en las guías.

ABSTRACT The prolonged use of synthetic chemical fertilizers produces negative effects on the fertility of the soil. As an alternative, the use of microorganisms in agriculture has been proposed in recent years. The objective of this trial was to evaluate the agronomic efficiency of isolates of microorganisms from different soils with native Andean crops in the germination and growth of tomato and lettuce plants. To do this, free-living nitrogen-fixing bacteria were isolated and selected using Ashby medium in soils and rhizosphere of amaranth (Amaranthus quitensis Kunth), blackberry (Rubus glaucus Bentham), white carrot (Arracacia xanthorriza Bancr.) And mashua (Tropaeolum tuberosum Ruiz & Pav.). Subsequently, physiological and biochemical tests were carried out to select bacteria that resembled the genus Azotobacter sp., and were inoculated in greenhouse crops of lettuce and tomato, from February to April 2018, where the days to germination, plant height, and number of leaves were measured, and an analysis of variance and Tukey’s test were performed to assess whether there were statistical differences between the treatments. In the inoculation of 3 strains in the tomato crop, a significant advance in the germination time of 3-4 days was observed. In 9 of the treatments, a significant increase in the height of both tomato and lettuce plants was observed, and the number of leaves significantly increased in 6 lettuce and 3 tomato treatments. The bacterial strain that obtained the best results was isolated in the rhizosphere of the blackberry crop.

RESUMEN El uso prolongado de fertilizantes químicos sintéticos produce efectos negativos en la fertilidad del suelo. Como alternativa, en los últimos años se ha propuesto la utilización de microorganismos en la agricultura. El objetivo de este ensayo fue evaluar la eficiencia agronómica de aislados de microorganismos de diferentes suelos con cultivos nativos andinos, en la germinación y el crecimiento de plántulas de tomate y lechuga. Para ello se aislaron y seleccionaron bacterias fijadoras de nitrógeno de vida libre utilizando medio Ashby en suelos y rizosfera de cultivos de amaranto (Amaranthus quitensis Kunth), mora (Rubus glaucus Bentham), zanahoria blanca (Arracacia xanthorriza Bancr.) y mashua (Tropaeolum tuberosum Ruiz & Pav.). Posteriormente se realizaron pruebas fisiológicas y bioquímicas para seleccionar las bacterias que se asemejaban al género Azotobacter sp., y se inocularon en cultivos en invernadero de lechuga y tomate, de febrero a abril de 2018, donde se midieron los días a la germinación, altura de la planta, número de hojas, y se realizó un análisis de varianza y test de Tukey para evaluar si existían diferencias estadísticas entre los tratamientos. En la inoculación de 3 cepas en el cultivo del tomate se observó un adelanto significativo en el tiempo de germinación de 3-4 días. En 9 de los tratamientos se constató un aumento significativo en la altura de la planta tanto de tomate como de lechuga y el número de hojas aumentó significativamente en 6 tratamientos de lechuga y 3 de tomate. La cepa bacteriana que mejores resultados obtuvo fue aislada en la rizosfera del cultivo de mora.

Resumen Introducción: El delírium es un síndrome neuropsiquiátrico de etiología multifactorial que se presenta de forma frecuente en el adulto mayor hospitalizado. En Santander no hay estudios que describan su incidencia y factores epidemiológicos asociados. Objetivo: Evaluar la incidencia de delírium, características clínicas según el tipo, mortalidad a 30 días de hospitalización y complicaciones asociadas al delírium, en pacientes adultos mayores de 65 años hospitalizados en un departamento del nororiente colombiano. Materiales y métodos: Se incluyeron pacientes ≥ 65 años hospitalizados en sala general de la Clínica FOSCAL. Se excluyeron pacientes con delírium al ingreso, hospitalizados en unidad de cuidado crítico, intubación orotraqueal, Glasgow <8/15 y con limitación para evaluar el delírium de forma adecuada. Resultados: De 492 pacientes hospitalizados con edad promedio de 75 años, la incidencia acumulada fue de 9,3%; con mayor porcentaje en mujeres (63%) y en ≥ 85 años (31,5%). Se evidenció una asociación con mayor estancia hospitalaria (11.0 vs 7.1 días, p <0.05), un mayor deterioro funcional evaluado por escala Barthel y riesgo de mortalidad (HR:2.9 IC95%: 2.1-3.4). El sexo masculino, el estado cognitivo normal, índice de Barthel ≥ 60 y estado nutricional normal fueron factores protectores. Conclusiones: La incidencia de delirium en la población del oriente colombiano tuvo una incidencia similar que a nivel mundial. Se asoció con mayor estancia hospitalaria, declinación funcional y mortalidad. Aplicando escalas de tamizado cognitivo, funcional y nutricional se podrían identificar los pacientes con mayor vulnerabilidad para desarrollo de delirium. MÉD.UIS.2021;34(1):9-17.

Abstract Introduction: Delirium is a neuropsychiatric syndrome of multifactorial etiology that occurs frequently in hospitalized older adults. There are no studies describing the incidence of delirium in Santander and its associated epidemiological factors. Objective: To assess the incidence of delirium, clinical characteristics according to type, mortality after 30 days of hospitalization and complications associated with delirium, in adult patients over 65 years hospitalized in a department in Colombian northeast. Materials and Methods: We included all hospitalized patients ≥ 65 years. We excluded patients with delirium on admission, those hospitalized in intensive care unit, with orotracheal intubation, Glasgow < 8/15, or with factors limiting the ability to assess delirium. Results: 492 hospitalized patients with an average age of 75 years were analyzed. The cumulative incidence of delirium was 9.3%. Of these patients there was a higher percentage of women (63%) and adults ≥ 85 years (31.5%). The greatest association was related to longer hospital stay (11.0 vs 7.1 days, p <0.05), functional impairment evaluated by Barthel scale, and increased risk of mortality (HR:2.9 IC95%: 2.1-3.4). Male sex, normal cognitive status, Barthel index ≥ 60 and normal nutritional status were protective factors. Conclusions: The incidence of delirium in the population of eastern Colombia was similar to the incidence worldwide. Delirium was associated with longer hospital stay, functional decline, and mortality. Applying cognitive, functional, and nutritional screening scales, it would be possible to identify patients with greater vulnerability to delirium development. MÉD.UIS.2021;34(1):9-17.

ABSTRACT Background: COVID-19 pandemic has generated changes regarding the management of patients with all kind of pathologies. Here we show the experience concerning the surgical treatment of acute appendicitis (AA) in a teaching hospital in the city of Buenos Aires during the lockdown, and its comparison with the same period of 2019 in order to assess the differences between the timing for consultation, intraoperative findings and the treatment outcome. Material and methods: A prospective database was retrospectively analyzed. We compared patients undergoing surgical treatment for AA in March-July of 2019 v. March-July 2020, taking into account the preoperative period and comparing the outcome regarding the surgical intervention and the impact in the postoperative period between the two groups. Results: 127 patients were included, 46 treated during the pandemic. Patients undergoing surgical treatment during the pandemic had a higher incidence of peritonitis (61.7% vs. 76.1%; p = 0.09) and higher requirement of abdominal drainage (9.9% vs. 23.9%; p = 0.03). There was an increase in the incidence of complications (10.9 vs. 4.9%; p: 0.21), reoperations (8.7 vs. 1.23%, p: 0.03), readmissions (6.5 vs. 0%, p: 0.02) and need for out-patient intravenous antibiotics (6.5 vs. 0%; p: 0.02). The average hospital length was of 1.89 (SD 2.04) and 3.24 (SD 7.31) for the groups operated before and during pandemic, respectively. Conclusions: During the COVID-19 pandemic, the number of patients undergoing surgical intervention because of AA decreased compared to the previous year, with increased complications in the postoperative period, higher compromise of the appendix, and longer hospital stay.

RESUMEN Antecedentes: la pandemia por COVID-19 generó cambios en el manejo de pacientes con todo tipo de patologías. Mostramos la experiencia respecto de los pacientes con apendicitis aguda (AA) operados en un hospital universitario de la Ciudad Autónoma de Buenos Aires durante los meses de confina miento y su comparación con el mismo período del año 2019 a fin de evaluar las diferencias. Material y métodos: se analizó en forma retrospectiva una base confeccionada de forma prospectiva. Se compararon pacientes operados de AA, consignando los datos respecto del período preoperatorio, comparando datos inherentes a la cirugía y sus resultados en los períodos marzo-julio de 2019 y 2020. Resultados: fueron incluidos 127 pacientes, 46 de ellos operados durante la pandemia. Los pacientes operados durante la pandemia presentaron mayor incidencia de peritonitis (61,7% vs. 76,1%; p: 0,09) y mayor requerimiento de drenaje abdominal (9,9% vs. 23,9%; p: 0,03). También tuvieron mayor in cidencia de complicaciones (10,9 vs. 4,9%; p: 0,21), reoperaciones (8,7 vs. 1,23%, p: 0,03), reinterna ciones (6,5 vs. 0%, p: 0,02) y requerimiento de antibioticoterapia endovenosa prolongada (6,5 vs. 0%; p: 0,02). La estadía hospitalaria fue mayor para la cohorte operada durante la pandemia: 3,24 días (Desvío estándar [D.E.]: 7,31) vs. 1,89 días (D.E: 2,04). Conclusiones: durante la pandemia por COVID-19, el número de pacientes operados por AA disminuyó con respecto al año 2019; se observaron estadios más avanzados de la enfermedad, mayores compli caciones en el posoperatorio y mayor estadía hospitalaria.

Resumo Neste artigo exploramos o potencial teórico e metodológico da teoria da Aprendizagem Expansiva com o objetivo de analisar as aprendizagens que ocorrem em sala de aula de Matemática. A análise incide sobre um conjunto de observações de práticas em sala de aula, que envolveram o uso de um procedimento escolar, a regra de três, e os seus desdobramentos quando esse procedimento foi confrontado com situações do cotidiano dos alunos. A pesquisa de campo em duas turmas do 8º ano do Ensino Fundamental de uma escola pública revelou uma série de aprendizagens não previstas no planejamento inicial da professora, relacionadas à expansão de significado de um procedimento escolar (regra de três) e às formas de resolver um problema quando situações do cotidiano são introduzidas por meio de um artefato cultural (conta de água). Mostrou também como a pesquisa em Educação Matemática pode influenciar a própria aprendizagem dos sujeitos envolvidos na atividade.

Abstract In this article we examine the theoretical and methodological possibilities offered by Expansive Learning theory to analyze learning resulting from a problem solving classroom activity. This activity involved the use of a school procedure, rule of three, and its subsequent unfolding when students' everyday situations were confronted with a school procedure. The field research, in two 8th-grade classes from a public school, revealed a range of learning instances not anticipated by the teacher related with the meaning expansion of a school procedure (rule of three) and with the different ways of solving a problem when everyday situations are introduced by means of a cultural artifact (water bill). It also showed how research in mathematics education may influence the subjects' learning.

Desenvolve uma análise do processo de formação matemática na licenciatura, confrontando o conhecimento matemático veiculado nesse processo com algumas das questões que se colocam para o professor na sua prática docente na escola básica. O estudo focaliza os números naturais e toma como referência o curso diurno de licenciatura em matemática da Universidade Federal de Minas Gerais (UFMG). As fontes utilizadas são livros didáticos escolares e universitários, documentos curriculares referentes ao curso de licenciatura da UFMG e, de modo especial, a literatura de pesquisa no campo da educação matemática. O estudo, ao mesmo tempo em que descreve uma parte dos conhecimentos matemáticos envolvidos nas questões da prática profissional docente na escola básica, explicita formas concretas com que se expressa a dicotomia formação/prática - reiteradamente apontada nos estudos sobre as licenciaturas, mas quase sempre num plano genérico e, muitas vezes, superficial.

This article, analyse the process of formation for mathematics' teachers at undergraduate level, confronting the mathematical knowledge transmitted in this process with some of the issues the teacher is faced with at school. The study focuses on the natural number system and refers to the undergraduate degree in mathematics at the Federal University of Minas Gerais (UFMG), in Brazil. The sources used include textbooks on numbers (at school and university levels), syllabus specifications for the referred course and the research literature on mathematics education. We describe part of the mathematical knowledge (about natural numbers) involved in professional teaching practice at elementary school. We also point out some concrete forms taken on by the formation/teaching practice dichotomy, thus contributing to a better understanding of this important and much debated issue.

Apresenta-se um caso de homem com 61 anos de idade, portador de carcinoma do terço médio do esôfago. Foi submetido a ressecção gastro-esofágica radical através de laparotomia mediana toracotomia direita. O exame histopatológico mostrou carcinoma de células escamosas nitidamente originado da camada epitelial de cisti esofágico duplicado. Mostrou-se mediante imunohistoquímica células tumorais coradas para p53. Em 11 meses de evolução o paciente permanece assimtomático.

The authors present the case report of a 61-year-old man, admitted with middle third squamous cell esophageal carcinoma. He was submitted to a curative gastroesophageal resection via a medium laparotomy and a right thoracotomy. An intrathoracic esophagogastric anastomosis was performed. The pathological analysis of the surgical specimen revealed a squamous cell carcinoma clearly originating from the epithelial lining of an esophageal duplication cyst. Immunohistochemitry showed p 53 staining of the tumor cells. The patient at 11 month follow up was asymptomatic.