National Cancer Information System Within the Framework of Health Insurance in Colombia: A Real-World Data Approach to Evaluate Access to Cancer Care.

PURPOSE: The National Cancer Information System (NCIS) has been operating since 2014, including information reported by health care insurers and providers on people with cancer diagnosed and treated within the Colombian health system. Its main purpose is to identify barriers to an effective access to cancer diagnosis and treatment across the country. We aimed to describe the methodology, scope and results in terms of access to health services with real-world data provided by the NCIS. METHODS: Reporting of all cases of cancer by insurers and providers is mandatory by law. Data gathered include demographic and clinical information about new and old cases of cancer who receive health services. Over the years, the reporting process has been automated and it is currently performed in real time. Data quality is ensured through a standardized data-monitoring process. Access to health services is monitored by quality measures defined by consensus. RESULTS: Since 2015, prevalent cases of invasive cancer have increased from 163,776 to 331,021 in 2020 (increment of 102.12%). Regarding quality measures, the proportion of people staged at diagnosis has increased over the years, especially in breast cancer. Meanwhile, early diagnosis is still concerning for breast and prostate cancer. Time to diagnosis and treatment have not consistently reached the expected goals in breast, cervical, and prostate cancer, whereas they have shown a better level of compliance for stomach and colon and rectum tumors, still not reaching the highest performance. CONCLUSION: The real-world information approach provided by the NCIS may be complementary for cancer control planning in Colombia, emphasizing better management processes of health insurers and providers by identifying barriers for timely access to health care.

Factors associated with delays in time to treatment initiation in Colombian women with cervical cancer: A cross-sectional analysis.

Cervical cancer (CC) is one of the leading causes of morbidity in upper-middle income countries such as Colombia. Several studies have reported poor prognosis when treatment is delayed. We aimed to describe the factors associated with delays in time to treatment initiation (TTI) in Colombian women with CC. Cross-sectional analysis including newly diagnosed cases of CC during 2018 and reported to the National Administrative Cancer Registry. TTI was defined as days from diagnosis to the first treatment (chemotherapy, radiation, or surgery). Linear and multinomial logistic regression models were estimated to analyze the association of interest. 1,249 new cases of CC were analyzed (26.98% in-situ and 40.11% locally advanced). The median age was 46 years (IQR: 36-58). Median TTI was 71 days (IQR: 42-105), varying from 70 days (IQR: 43-106) among the surgery group to 76 days (IQR: 41-118) in women under chemotherapy. Only 12.41% were treated within 30 days from diagnosis. TTI was significantly longer in women with state insurance (ß = 18.95 days, 95% CI: 11.77-26.13) compared with those insured by the third payer. Women from the Pacific and Eastern regions also had a significantly longer TTI than those living in the capital of Colombia. Age, health insurance, region of residence, and stage at diagnosis were associated with TTI longer than 45 days in the multinomial model. We concluded that demographic variables (age, region of residence, and health insurance) which are proxies of social disparities and poor access to quality health care services, were associated with delays in TTI.

Dental injuries among children and adolescents aged 1-15 years attending to public hospital in Temuco, Chile.

A cross-sectional study was carried out in children and adolescents of both sexes, aged 1-15 years that sought dental emergency attention to the Regional Hospital between 2004 and 2007 in Temuco, Chile. The purpose of this study was to identify the aetiology, types of traumatic dental injuries in primary and permanent dentitions, sex and age distributions, accident location; and time elapsed before emergency treatment in children and adolescents. The sample consisted of 359 patients with 145 primary teeth and 525 permanent teeth affected by dental trauma. The results showed a 2:1 male:female ratio distribution (242/117) with a mean age of 8.4 years. The 7- to 12-year-old group had the highest frequency of dental injuries (66.6%). Unspecific accidental falls were the main cause of injury to primary and permanent dentition (51.8%), followed by striking teeth against objects (15.6%) and bike accidents (13.9%). In primary dentition the most common diagnosis were subluxation (38.6%) and avulsion (16.6%), whereas in permanent dentition was uncomplicated crown fracture (32.9%). A high proportion of the patients received their first emergency attention 24 h after the accident (32.6%). This study revealed a high frequency (37.9%) in 1-15 aged population that sought emergency attention by dental trauma in the period of time study. A large proportion of children with dental trauma received delayed first emergency care, even 24 h after the accident. Considering the high frequency of traumatic dental injuries in 1-15 aged population and the high percentage of delayed emergency attention is necessary to develop effective educational campaigns in regard to causes, prevention and emergency management of traumatic dental injuries, especially in deprived areas. In conclusion, traumatic dental injury may be considered as a serious dental public health problem especially in children of deprived areas.

Presence of Streptococcus dentisani in the dental plaque of children from different Colombian cities.

Streptococcus dentisani has been identified as an oral cavity probiotic due to its beneficial characteristics. One of its beneficial features is the production of bacteriocins, which inhibit the growth of cariogenic bacteria, and another is its buffering capacity through the production of ammonium from arginine. The purpose of this study was to determine the presence of S. dentisani in the dental plaque of Colombian children and whether the presence of this bacterium is related to oral health and other conditions. Dental plaque and information on diet and oral hygiene habits were collected from children between 6 and 12 years of age from four Colombian cities, divided into caries-free children (International Caries Detection and Assessment System [ICDAS] 0, Decayed Missing Filled Teeth index [DMFT] 0), children with ICDAS 1 and 2, and children with ICDAS >3. Plaque DNA was extracted and quantified, and real-time polymerase chain reaction was performed using specific primers. This bacterium was identified in all samples, with a median of 0.46 cells/ng DNA (interquartile range [IQR] 0.13-1.02), without finding significant differences between the groups (P > 0.05). In caries-free children, a median of 0.45 cells/ng DNA (IQR 0.14-1.23) was found. In children with ICDAS 1 and 2, the median was 0.49 cells/ng DNA (IQR 0.11-0.97), and in children with ICDAS >3, the median was 0.35 cells/ng DNA (IQR 0.12-1.07). However, statistically significant differences were found in the origin of children (P < 0.01), the use of fluoride-containing products (P < 0.01), and the frequency of food intake (P < 0.05). In conclusion, the presence of S. dentisani was quantified in children from four Colombian cities, without finding significant differences in oral health status. Nevertheless, three conditions showed a possible relationship with S. dentisani.

Efectividad de la Remoción Parcial de Caries en Molares Primarios con Lesiones de Caries Profunda. Ensayo Clínico Aleatorizado / Effectiveness of Partial Caries Removal in Primary Molars with Deep Carious Lesions. Randomized Clinical Trial

RESUMEN: Para el tratamiento de lesiones de caries profundas la remoción parcial de caries (RPC) parece presentar ventajas por sobre la remoción completa de caries (RCC). Sin embargo, aún la evidencia es insuficiente para determinar si hay diferencias en relación a signos y síntomas del complejo dentino-pulpar entre ambos tratamientos. El objetivo de este estudio fue determinar la efectividad de la remoción parcial de caries en lesiones de caries dentinarias activas profundas de molares primarios. Se realizó un ensayo clínico controlado aleatorizado de 2 brazos paralelos en 20 participantes entre 4 y 8 años. Los participantes fueron asignado aleatoriamente recibir remoción parcial de la lesión de caries mientras que el grupo control recibió remoción completa de la lesión de caries. La variable de resultado primaria fue éxito del tratamiento medido como la la ausencia de cualquier signo clínico y radiográfico de patología pulpar. Un enfoque de intención de tratar (ITT) se utilizó para el análisis primario y la tasa de supervivencia de cada tratamiento se estimó mediante análisis de Kaplan-Meier. Treinta y ocho dientes fueron incluidos en el estudio. Diecisiete dientes recibieron RPC y 21 RCC. El seguimiento promedio fue de 12,6± DE 5,0 meses para ambos grupos. La tasa de éxito clínico fue de un 94,1 % para la RPC y de 76,2 % para la RCC (p=0,132). La sobrevida estimada a los 18 meses fue de un 92,3 % para RPC y de un 75,9 % para la RCC (p>0,05). En conclusión, a pesar que la terapia RPC presentó menos complicaciones, no mostró ser más efectiva que la RCC en lesiones de caries dentinarias profundas de dientes primarios.

ABSTRACT: For the treatment of deep carious lesions, partial caries removal (PCR) appears to be advantageous over complete caries removal (CCR). However, and in light of insufficient evidence it is difficult to determine if there are differences between both treatments in relation to signs and symptoms of the dentin-pulp complex. The aim of this study was to determine the effectiveness of partial caries removal in deep carious lesions of primary molars. A randomized two-arm parallel controlled trial was performed in 20 participants, 4 to 8 years of age. Participants were randomly assigned to receive partial removal of carious lesions, while the control group was submitted to complete carious lesion removal. The primary outcome variable of treatment success was measured as absence of any clinical and radiographic signs of pulpal pathology. An intention-to-treat (ITT) approach was used for the primary analysis, and the survival rate of each treatment was estimated using Kaplan-Meier analysis. Thirty-eight teeth were included in the study. Seventeen teeth received PCR and 21 CCR. The mean follow-up was 12.6 ± SD 5.0 months for both groups. The clinical success rate was 94.1 % for the PCR and 76.2 % for the CCR (p = 0.132). The estimated survival at 18 months was 92.3 % for PCR and 75.9 % for CCR (p> 0.05). In conclusion and according with this research, PCR did not show to be more effective than the CCR in treatment of deep carious lesions of primary teeth. However, the trend in the results favoring the PCR treatment could justify a future research to confirm or refute our results.

Warfarin initiation and monitoring with clotting factors II, VII, and X.

OBJECTIVE: To report a case of a patient with antiphospholipid antibody syndrome and multiple thromboses who developed heparin-induced thrombocytopenia (HIT) and subsequent international normalized ratio (INR) prolongation possibly due to antiphospholipid antibodies. CASE SUMMARY: A 56-year-old white woman with a history of antiphospholipid antibody syndrome and thrombosis taking chronic warfarin was admitted for gastrointestinal concerns and found to have an INR >14. Warfarin was discontinued, vitamin K was administered, and a heparin infusion was initiated. Over the next 2 days, thrombocytopenia, hypotension, tachycardia, hyponatremia, and progressive abdominal pain developed. Upon transfer to a tertiary care center, HIT was diagnosed, and a lepirudin infusion was initiated. Subsequently, a sudden elevation of the INR occurred (>14) with low prothrombin (factor II) activity. After INR values declined to 2-3, warfarin was reinitiated with dosing adjusted using factor X and II activity levels. Clotting factors II and X activities were measured to monitor long-term warfarin therapy, with no evidence of complications after 7 months. DISCUSSION: Typically, the INR is used to assess the intensity of anticoagulation. The INR value represents the reduction of clotting factors II, VII, and X. In rare circumstances, an independent inhibitor or interfering substance can interfere with the process of measuring the INR. In such situations, an alternative approach can be direct measurement of clotting factor concentrations. CONCLUSIONS: Factor II and/or factor X activity levels provided an alternative means for measuring the anticoagulant effects of warfarin in the presence of a significant inhibitor (antiphospholipid antibodies) that biased the INR measurements.