Leishmaniasis is a zoonosis produced by the transmission of the protozoan leishmania caused by the bite of sand-flies from the Lutzomya specie. Several clinical manifestations present themselves, depending on the infecting strain and the host's immune response; the most frequent variety is localised cutaneous leishmaniasis. Atypical forms sometimes develop, such as the diffuse variety, in which the number of ulcers is greater than 10, thereby affecting several body areas requiring special considerations in its diagnosis and management. This article reports two cases of patients from endemic areas of Santander suffering from diffuse cutaneous leishmaniasis produced by the L. panamensis strain. Protocols for the active search of this type of case in endemic areas throughout Colombia should be implemented.

La insuficiencia cardiaca congestiva constituye una de las principales causas de hospitalización, morbilidad y mortalidad en los países occidentales. Aunque en Colombia no se conocen con exactitud su incidencia y prevalencia, recientemente se ha planteado que está adquiriendo proporciones epidémicas. Diversos estudios demuestran que los pacientes con esta condición presentan alteraciones cognitivas tales como pérdida de la memoria y déficit de atención, las cuales se relacionan con un peor pronóstico clínico. Los síntomas cognitivos no sólo indican una enfermedad cardiaca más avanzada, sino que también se asocian con pobre adherencia al tratamiento y menor calidad de vida. A pesar de su importancia, los mecanismos fisiopatológicos de esta relación no son claros. Se sugiere que las alteraciones hemodinámicas cerebrales derivadas de la disminución en el gasto cardiaco, así como de la presencia de múltiples microinfartos cerebrales secundarios a microembolismos, podrían relacionarse con alteraciones cognitivas en dichos pacientes. Sin embargo, hasta el momento no existen suficientes datos que permitan confirmar esta hipótesis.Congestive heart failure is a leading cause of hospitalization, morbidity and mortality in the Western countries. Although its incidence and prevalence in Colombia is not fully established, it seems to be acquiring epidemic proportions. Several studies have shown that patients with congestive heart failure present cognitive impairments such as memory loss and attention deficit, which are associated with a worse clinical prognosis. The cognitive symptoms are not only indicative of a more advanced heart disease but are also associated with poor adherence to treatment and lower quality of life. Despite their importance, the pathophysiological mechanisms of this relationship have not been clearly defined. It has been suggested that the cerebral hemodynamic changes resulting from a decrease in cardiac output and from the presence of multiple brain microinfarctions secondary to microembolisms could be related to cognitive impairment in patients with congestive heart failure. However, until now no sufficient data are available to confirm this hypothesis.

Antecedentes: la obesidad es un factor de riesgo para un primer infarto agudo del miocardio. La enfermedad coronaria prematura genera gran impacto socioeconómico por los años productivos perdidos, lo que hace importante su prevención y tratamiento. Objetivo: evaluar el impacto de la obesidad y otros factores de riesgo convencionales en la presentación de un primer evento coronario agudo en sujetos menores de 50 años. Métodos: estudio transversal que incluyó pacientes con diagnóstico de síndrome coronario agudo que ingresaron a la institución entre febrero de 2002 y febrero de 2007. La población se dividió en: sujetos menores y mayores de 50 años, estos últimos seleccionados de manera aleatoria en relación 1:1. La información demográfica, la historia cardiovascular y los factores de riesgo se identificaron en la historia clínica electrónica de la institución y y se corroboraron por vía telefónica. Se empleó la prueba t de student o Wilcoxon rank-sum, según la distribución de las variables. Se realizó un análisis multivariado para determinar los factores de riesgo independientes. Un valor de p < 0,05 se consideró significativo. Resultados: en el período de estudio ingresaron 942 sujetos con diagnóstico de síndrome coronario agudo. 16,1% (152) correspondió a sujetos menores de 50 años y 90,79% (132) presentaban un primer evento. El promedio de edad en el grupo joven fue 44,3 ± 5,1 y en el grupo mayor (n=132) fue 65,6 ± 8,3 años. El sobrepeso (OR 1.095; IC 1,01-1,18 p=0,019) y el recuento leucocitario (OR 1,00; IC 1.001-1.005 p=0,001) fueron los dos criterios independientes que predijeron el síndrome coronario agudo en adultos menores de 50 años, luego de realizar el análisis multivariado no condicional. Los otros factores de riesgo convencionales no mostraron diferencia significativa. Conclusión: el sobrepeso y la inflamación estimada por el conteo leucocitario, fueron los factores de riesgo independientes para la presentación de un primer episodio de síndrome coronario agudo en adultos colombianos menores de 50 años. Estos resultados confirman la importancia del sobrepeso y la inflamación en los mecanismos fisiopatológicos de la enfermedad cardiovascular en nuestra población.Background: obesity is a risk factor for developing a first myocardial infarct. Premature coronary disease generates a big socioeconomical impact due to productive years loss, which makes important its prevention and treatment. Objective: evaluate the impact of obesity and other conventional risk factors in the presentation of a first acute coronary event in subjects < 50 years. Methods: transversal study that included patients with diagnosis of acute coronary syndrome admitted to the institution between February 2002 and February 2007. The population was divided in subjects younger and older than 50 years, these last ones selected at random in a 1:1 relation. Demographic information, cardiovascular history and risk factors were identified in the institution’s electronic clinical history and were corroborated by telephone. The t student or Wilcoxon rank-sum test was used, according to the variables distribution. A multivariated study for determining the independent risk factors was performed. A p < 0,05 value was considered significant. Results: during the study period 942 subjects with acute coronary syndrome diagnosis were admitted. 16.1% (152) were subjects younger than 50 years and 90.79% (132) had a first event. Mean age in the young group was 44.3 ± 5,1 and in the older group (n = 132) was 65,6 ± 8,3 years. Overweight (OR 1.095; IC 1,01-1,18 p=0,019) and leucocyte count (OR 1,00; IC 1.001-1.005 p=0,001) were the two independent factors that predicted acute coronary syndrome in younger than 50 years adults, after realizing a multivariate non conditional analysis. Other conventional risk factors did not show significant difference. Conclusion: overweight and inflammation estimated by leucocyte count were the independent risk factors for the presentation of a first episode of acute coronary syndrome in Colombian adults younger than 50 years. These results confirm the importance of overweight and inflammation in the physiopathological mechanisms of cardiovascular disease in our population.

Background: obesity is a risk factor for developing a first myocardial infarct. Premature coronary disease generates a big socioeconomical impact due to productive years loss, which makes important its prevention and treatment. Objective: evaluate the impact of obesity and other conventional risk factors in the presentation of a first acute coronary event in subjects < 50 years. Methods: transversal study that included patients with diagnosis of acute coronary syndrome admitted to the institution between February 2002 and February 2007. The population was divided in subjects younger and older than 50 years, these last ones selected at random in a 1:1 relation. Demographic information, cardiovascular history and risk factors were identified in the institution’s electronic clinical history and were corroborated by telephone. The t student or Wilcoxon rank-sum test was used, according to the variables distribution. A multivariated study for determining the independent risk factors was performed. A p < 0,05 value was considered significant. Results: during the study period 942 subjects with acute coronary syndrome diagnosis were admitted. 16.1% (152) were subjects younger than 50 years and 90.79% (132) had a first event. Mean age in the young group was 44.3 ± 5,1 and in the older group (n = 132) was 65,6 ± 8,3 years. Overweight (OR 1.095; IC 1,01-1,18 p=0,019) and leucocyte count (OR 1,00; IC 1.001-1.005 p=0,001) were the two independent factors that predicted acute coronary syndrome in younger than 50 years adults, after realizing a multivariate non conditional analysis. Other conventional risk factors did not show significant difference. Conclusion: overweight and inflammation estimated by leucocyte count were the independent risk factors for the presentation of a first episode of acute coronary syndrome in Colombian adults younger than 50 years. These results confirm the importance of overweight and inflammation in the physiopathological mechanisms of cardiovascular disease in our population.

MÉTODOS: estudio transversal que incluyó pacientes con diagnóstico de síndrome coronario agudo que ingresaron a la institución entre febrero de 2002 y febrero de 2007. La población se dividió en: sujetos menores y mayores de 50 años, estos últimos seleccionados de manera aleatoria en relación 1:1. La información demográfica, la historia cardiovascular y los factores de riesgo se identificaron en la historia clínica electrónica de la institución y y se corroboraron por vía telefónica. Se empleó la prueba t de student o Wilcoxon rank-sum, según la distribución de las variables. Se realizó un análisis multivariado para determinar los factores de riesgo independientes. Un valor de p ≤ 0,05 se consideró significativo.

The Physical Model of the Cardiovascular System «Dynasim» claims to simulate several aspects of the cardiovascular system. Certain parameters of the device are controlled by a computer. Pressure data from different points are acquired with electronic sensors , which are processed and analyzed via software. An interphase that communicates the hardware and software components with the simulation device was developed for this purpose. The model is hydraulically operated and works with a pneumatic bombing system. Its materials are transparent, which permits the phenomena visualization. The prin- cipal objectives are teaching and research, due to its capability to simulate different physiologic and pathologic situations.