Enhancing rural community engagement through palliative care networks: A scoping review.

Palliative care is a crucial discipline that alleviates suffering and enhances the quality of life for patients with life-limiting illnesses and their families. However, there is gap globally between the need for and availability of these services. Integrated health service networks offer a promising solution to address this gap in rural areas, by coordinating care across different levels and sectors. This scoping review aimed at identifying the key characteristics of palliative care networks in rural communities. A broad search without time limits was conducted in four databases. Analysis and synthesis were conducted using Latent Dirichlet Allocation topic modeling. Sixteen studies were included, revealing four key themes regarding the development of palliative care networks in rural areas: community engagement is essential to secure the reach of rural networks, tailored approaches acknowledging diversity enrich these networks, team-centric efforts involving stakeholder coordination ensure successful implementation, and a multifaceted approach-empowering non-traditional stakeholders and incorporating technology resources into primary health services-dynamizes palliative care delivery in rural areas. These findings underscore the potential of collaborative and innovative approaches to enhance the accessibility and effectiveness of palliative care in underserved rural communities. Further cost-effectiveness studies are warranted to better understand the impact these strategies can have on health systems.

Palliative care national plan implementation through stakeholder analysis.

BACKGROUND: National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the implementation of public health initiatives, as recommended by the World Health Organisation. However, utilising stakeholder analysis is a strategy underused in public palliative care. OBJECTIVE: To conduct a stakeholder analysis characterising a diverse group of stakeholders involved in implementing a national palliative care plan in three rural regions of an upper-middle-income country. METHODS: A descriptive cross-sectional study design, complemented by a quantitative stakeholder analysis approach, was executed through a survey designed to gauge stakeholders' levels of interest and capability in relation to five fundamental dimensions of public palliative care: provision of services, accessibility of essential medicines, palliative care education, financial support, and palliative care vitality. Stakeholders were categorised as promoters (high-power, high-interest), latent (high-power, low-interest), advocates (low-power, high-interest), and indifferent (low-power and low-interest). Stakeholder self-perceived category and knowledge level were also assessed. RESULTS: Among the 65 surveyed stakeholders, 19 were categorised as promoters, 34 as advocates, 9 as latent, and 3 as indifferent. Stakeholders' self-perception of their category did not align with the results of the quantitative analysis. When evaluated by region and palliative care dimensions the distribution of stakeholders was nonuniform. Palliative care funding was the dimension with the highest number of stakeholders categorised as indifferent, and the lowest percentage of promoters. Stakeholders categorised as promoters consistently reported a low level of knowledge, regardless of the dimension, region, or their level of interest. CONCLUSIONS: Assessing the capability, interest, and knowledge of stakeholders is a crucial step when implementing public health initiatives in palliative care. It allows for a data-driven decision-making process on how to delegate responsibilities, administer financial resources, and establish governance boards that remain engaged and work efficiently.

Increasing Annual Cancer Incidence in Patients Age 20-49 Years: A Real-Data Study.

PURPOSE: Data from population-based studies have shown an increased incidence of certain types of neoplasms in patients younger than 50 years (early-onset cancer [EOC]); however, little information is derived from other real-world data sources. In a nonpopulation registry, we analyzed changes in the incidence of several neoplasms in successive generations. METHODS: This cross-sectional study included all patients with a cancer diagnosis registered in one university hospital in Málaga, Spain, between 1998 and 2021, and 18 neoplasms were analyzed. For each neoplasm, the proportion of patients younger than 50 years and age 50 years and older (late-onset cancer [LOC]) of the total number of patients diagnosed each year was determined. In addition, the age limit was lowered to 45-40 years. Changes in these proportions between each year and the following year were assessed by calculating the annual percentage change (APC), and a final assessment of these changes was performed by determining the average APC (AAPC). RESULTS: Of the 24,596 patients, 5,466 (22.2%) had EOC, and 19,130 (77.8%) had LOC. The incidence of all tumors increased throughout the study period in both age groups. The AAPC increase was higher in patients with EOC than in those with LOC for the following neoplasms: head and neck (6.1% v 4.6%), colon (11.0% v 8.2%), testicular (16.3% v -13.1%), non-Hodgkin lymphoma (8.4% v 5.9%), rectum (16.1% v 6.8%), kidney (27.8% v 20.1%), and sarcoma (43.4% v 28.6%). This increase was confirmed in patients younger than 45 years and 40 years. CONCLUSION: Our results are consistent with the data published for most tumor sites analyzed. This global public health problem requires the utmost attention to decrease excess cancer in young patients.

Treatment of intertrochanteric fractures using cephalomedullary nail: One or two cephalic screws?

OBJECTIVES: To determine the incidence of cut-out, cut-in, cut-through, Z-effect, and reverse Z-effect in two cephalomedullary nail (CMN) systems: one with single cephalic screw fixation and the other with dual-screw fixation using a lag screw and an anti-rotation screw. METHODS: A retrospective study from a cohort of patients was conducted between January 2017 and August 2019 in patients with intertrochanteric fractures treated with osteosynthesis using CMN. RESULTS: One hundred ninety-six patients with intertrochanteric fractures who met the inclusion criteria were recruited. The median age was 81 years [interquartile range (IQR) 12]. Seventy-six percent had fractures classified as Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 31A2. Twenty-one mechanical complications occurred, 8.7% (17) was cut-out with a single cephalic screw CMN and 2% (4) was Z-effect with a dual-screw CMN non-integrated. The median tip-apex distance (TAD) was 19.4 mm (IQR 10.8) in patients who experienced cut-out and 19 mm (IQR 10) in those who experienced Z-effect. The median time to cut-out occurrence was 39,5 days (IQR 47,5), while the median time to Z-effect was 90 days (IQR 86). CONCLUSIONS: The incidence of osteosynthesis failure using CMN is more frequent in patients treated with a single cephalic screw CMN. LEVEL OF EVIDENCE: Therapeutic, Level III.

Guía colombiana de práctica clínica para el diagnóstico y tratamiento del incidentaloma adrenal / Colombian clinical practice guideline for diagnostic and treatment of adrenal incidentaloma

Objetivo: Brindar recomendaciones actualizadas a urólogos y profesionales de la salud involucrados en el diagnóstico y manejo del incidentaloma adrenal. Métodos: Mediante la adopción de la guía para manejo de incidentaloma adrenal de la Sociedad Europea de Endocrinología (AGREE-II y AGREE-REX) y búsqueda complementaria de literatura basada en la mejor evidencia científica disponible en definición, diagnóstico, manejo quirúrgico y seguimiento. Adicionalmente, esta guía aborda pacientes con incidentalomas bilaterales y embarazadas. Resultados: Incidentaloma adrenal se define como una lesión mayor de 1 cm localizado en la suprarrenal, detectada mediante una imagen realizada por una razón diferente a cualquier sospecha de patología adrenal. La gran mayoría son adenomas no funcionantes, que no representan riesgo y no requieren manejo adicional. Sin embargo, existen lesiones tumorales como el carcinoma adrenocortical, el feocromocitoma, adenomas productores de hormonas o metástasis. Conclusiones: Los incidentalomas adrenales son masas predominantemente benignas que no requieren adrenalectomía, no obstante se requiere estudiarlas para descartar patologías que requieran manejo específico. Enfáticamente, la intervención quirúrgica debe guiarse por la probabilidad de malignidad, grado de secreción hormonal, edad, estado de salud y preferencia del paciente.

Objective: To provide updated recommendations to urologists and health-care providers faced to diagnosis and treatment of adrenal incidentaloma. Methods: Through adoption of the adrenal incidentaloma guideline from European Endocrinology Society (AGREE-II and AGREE-REX), and complementary search of literature based on available high-quality scientific evidence for definition, diagnosis, surgical management and follow-up. Additionally, this guideline covers bilateral adrenal incidentalomas and pregnant women. Results: Adrenal incidentaloma is defined as a lesion greater than 1 cm localized in adrenal gland, detected by imaging studies which are requested for another different reason than an adrenal pathology suspicion. A great majority are non-functional adenomas, without life-threatening risk nor additional treatment necessity. However, there are tumoral lesions that demand appropriate management like adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastasis. Conclusions: Adrenal incidentalomas predominantly are benign masses that do not require adrenalectomy (specially in asymptomatic, unilateral, non-functioning adrenal mass), nevertheless, must be exclude other harmful pathologies. Emphatically, surgical treatment must be indicated by malignant probability, hormonal-secreting status, age, health condition, and patient's preference.

Guía colombiana de tuberculosis genitourinaria / Colombian clinical practice guideline for urogenital tuberculosis

Objetivo: Brindar recomendaciones actualizadas en el diagnóstico, así como en el tratamiento médico y quirúrgico, para urólogos y profesionales de la salud atendiendo pacientes con tuberculosis genitourinaria. Método: Revisión sistemática de la literatura sobre tuberculosis urogenital definiendo preguntas de trabajo con esquema PICO para temas como epidemiología, fisiopatología, diagnóstico, manejo médico y quirúrgico de la enfermedad, y secuelas. Resultados: La tuberculosis genitourinaria presenta una incidencia aproximada del 20%, aunque se estima que hay subregistro importante. En Colombia, la tuberculosis es endémica, pero no hay guías para el diagnóstico y el manejo de este compromiso urogenital, por lo que son una necesidad. La tuberculosis genitourinaria debe sospecharse en pacientes con cuadros inflamatorios o infecciosos urinarios recurrentes, con o sin alteración estructural del tracto genitourinario, sin respuesta al tratamiento farmacológico convencional, sin causa clara o con nexo y factor de riesgo epidemiológico identificado. Puede diagnosticarse por medio de pruebas bacteriológicas, serológicas, moleculares o histopatológicas. En cada caso se requiere una evaluación imagenológica adecuada para determinar el compromiso orgánico o las secuelas, así como la estrategia para el manejo quirúrgico. Conclusiones: La tuberculosis genitourinaria es una condición infectocontagiosa, problema de salud pública, que concierne con gran interés a Colombia. Puede afectar cualquier órgano del tracto genitourinario femenino y masculino. El tratamiento médico oportuno tiene los mejores resultados y las menores tasas de necesidad quirúrgica y de secuelas. El abordaje diagnóstico y terapéutico estandarizado busca mejorar los resultados clínicos, la calidad de vida y la oportunidad del paciente con sospecha de esta enfermedad.

Objective: To provide updated recommendations in diagnosis, as well as for medical and surgical treatment focused on urologists and health-care professionals participating actively in care for urogenital tuberculosis. Method: Systematic review of literature on urogenital tuberculosis, previously defining working clinical questions with PICO scheme for topics such as epidemiology, pathophysiology, diagnosis, medical and surgical therapeutics for the disease. Results: Genitourinary tuberculosis has an incidence of approximately 20%, although a significant underreporting is estimated. In Colombia, tuberculosis infection is endemic, but there are no guidelines focused on this urogenital involvement, so there is a necessity. Urogenital tuberculosis should be suspected in patients with recurrent urinary inflammatory or infectious conditions, with or without structural alterations of genitourinary tract, who do not respond to conventional pharmacological treatment, with no apparent cause or have identified epidemiological link and risk factors. Diagnosis can be made by serological, bacteriological, molecular tests or histopathology. In each case, adequate imaging evaluation is mandatory to determine organ involvement, sequelae, and as strategy for surgical treatment. Conclusions: Genitourinary tuberculosis is an infectious disease, a public health issue, which concerns Colombia. It can affects any female and male urogenital tract organic tissue. Timely pharmacological management offers and has the best clinical results and lowest rates of surgical need or sequelae. The standardized diagnostic and therapeutic approach seeks to improve clinical outcomes, quality of life and opportunity for patients with suspected disease.

Results of a survey on the treatment of adolescents and young adult (AYA) sarcoma patients in Spain at present time.

INTRODUCTION: We aimed to analyse health care services for adolescents and young adults (AYA) with sarcomas in Spain. METHODS: A survey was sent to all Spanish cancer centres, including questions about demographic, facilities, and treatment strategies for AYAs with sarcomas in the last 2 years. RESULTS: Thirty-five units participated in the survey, 17 paediatric and 15 adult units. There were three specialized AYA units. First line regimen varied depending on whether the treating unit was paediatric or not, for osteosarcomas, rhabdomyosarcomas, and non-rhabdomyosarcomas. By contrast, 91.4% of Ewing sarcomas were treated according to EE2012. In the relapse setting, differences between units were higher in all tumours. Additionally, 48% of the units reported not having trials for this population. CONCLUSION: There are major differences in the treatment of AYAs with sarcomas between adult and paediatric units. Enormous efforts are needed to homogenize treatments and increase the access to innovation.

Design and implementation of a standard care programme of therapeutic exercise and education for breast cancer survivors.

BACKGROUND: Breast cancer survivors (BCS) face several symptoms and are at higher risk of weight gain following diagnosis. Current literature shows that both exercise and diet play a key role in recovery of BCS. However, there is a gap between current guidelines and the real-world context. The aim of this article is to describe the process behind a free, not-for-profit community-based therapeutic exercise and education programme (TEEP) for BCS in the clinical setting. METHODS: The "Onco-Health Club" (OHC) consists of therapeutic exercise (TE) intervention aimed at ameliorating cancer-related fatigue (CRF) and improving QoL and physical function. TE is supplemented with nutritional education, providing information about the Mediterranean diet. To this end, patients are recruited from an oncologist and are referred to a physiotherapist and a nutritionist for baseline assessment. TEEP consists of a 3-month intervention, delivered twice a week in a group format with 1 h of TE and 30 min of nutritional education. BCS then have a final assessment and are advised to continue with a healthy lifestyle. Data about referral, compliance and assessment were collected. RESULTS: From May 2017 to February of 2020, a total of 158 patients were recruited from 8 cohorts and 142 initially started the OHC. From 119 that joined the program, 96 patients were considered to have finished it with good adherence (assistance > 80%). BCS significantly improved their QoL, as well as upper and lower limb's function, and increased their level of physical activity. CRF tended to decrease (p = 0.005). CONCLUSIONS: This study obtained data on recruitment, compliance, and possible limitations of these kinds of programmes in a real-world context. Further research is needed in order to optimize patient engagement and compliance, as well as to determine the transferability of these programmes in the clinical setting. TRIAL REGISTRATION: NCT03879096, Registered 18th March 2019. Retrospectively registered.

Incidencia de displasia del desarrollo de cadera. Estandarizando la radiografía con un dispositivo anti rotatorio «Orthohip¼ / Incidence of developmental dysplasia of the hip. Standardizing radiography with an "Orthohip" anti-rotation device

Introducción: La displasia del desarrollo de cadera es una patología que ocasiona secuelas funcionales si es omitida o mal diagnosticada. La radiografía AP de pelvis es el método más usado como tamizaje, sin embargo, múltiples variables alteran el resultado; posicionamiento, ambiente, paciente etc. El objetivo fue determinar la incidencia de displasia del desarrollo de cadera usando un dispositivo anti rotatorio y evaluando la concordancia entre observadores con parámetros cuantitativos y cualitativos en la radiografía para el diagnóstico. Materiales y métodos: Estudio observacional retrospectivo de cohorte histórico incluyendo pacientes entre 4 y 9 meses de edad con radiografía AP de pelvis, usando el dispositivo anti rotatorio evaluando solo la displasia simple. Para la medición se utilizó el programa CareStream y el análisis de concordancia con el programa Stata 15. Resultados: Se incluyeron 181 radiografías de pacientes, encontrando una incidencia de displasia del desarrollo de cadera de 9.4% (IC 95%: 5.5 - 14.6), donde 29.4% fueron bilateral, 35.3% de cadera derecha y 35.3% de cadera izquierda, teniendo en cuenta 3 o más parámetros cualitativos como la esclerosis acetabular lateral, configuración acetabular plana, línea en metáfisis externa y un borde irregular. Se encontró un buen grado de acuerdo (kappa mayor a 0.6) en la esclerosis acetabular, línea acetabular izquierda y en el diagnóstico final (kappa 0.8). Discusión: La estandarización de la toma de radiografía con el uso de un dispositivo anti rotatorio «Orthohip¼ y parámetros cualitativos adicional al índice acetabular facilita un ad

Introduction: Hip developmental dysplasia is a pathology that causes functional sequelae if it is missed or misdiagnosed. AP pelvis radiography is the most used method for screening, however, multiple variables alter the result; positioning, environment, patient etc. The objective was to determine the incidence of hip developmental dysplasia using an anti-rotation device and evaluating interobserver agreement with quantitative and qualitative parameters on radiography for diagnosis. Materials and methods: Retrospective observational study of historical cohort including patients between 4 and 9 months of age with AP pelvic radiography, using the anti-rotation device evaluating only simple dysplasia. For the measurement, the CareStream program was used and the agreement analysis was carried out with the Stata 15 program. Results: 181 patient radiographs were included, finding an incidence of hip developmental dysplasia of 9.4% (95% CI: 5.5 - 14.6), where 29.4% were bilateral, 35.3% of the right hip and 35.3% of the left hip, having It takes into account 3 or more qualitative parameters such as lateral acetabular sclerosis, flat acetabular configuration, line in the external metaphysis and an irregular edge. A good degree of agreement was found (kappa greater than 0.6) in acetabular sclerosis, left acetabular line and in the final diagnosis (kappa 0.8). Discussion: The standardization of radiography taking with the use of an anti-rotation device "Orthohip" and additional qualitative parameters to the acetabular index facilitates an ad

Significant Decrease in Annual Cancer Diagnoses in Spain during the COVID-19 Pandemic: A Real-Data Study.

The COVID-19 pandemic has caused a profound change in health organizations at both the primary and hospital care levels. This cross-sectional study aims to investigate the impact of the COVID-19 pandemic in the annual rate of new cancer diagnosis in two university-affiliated hospitals. This study includes all the patients with a pathological diagnosis of cancer attended in two hospitals in Málaga (Spain) during the first year of pandemic. This study population was compared with the patients diagnosed during the previous year 2019. To analyze whether the possible differences in the annual rate of diagnoses were due to the pandemic or to other causes, the patients diagnosed during 2018 and 2017 were also compared. There were 2340 new cancer diagnosis compared to 2825 patients in 2019 which represented a decrease of -17.2% (p = 0.0001). Differences in the number of cancer patients diagnosed between 2018 and 2019 (2840 new cases; 0.5% increase) or 2017 and 2019 (2909 new cases; 3% increase) were not statistically significant. The highest number of patients lost from diagnosis in 2020 was in breast cancer (-26.1%), colorectal neoplasms (-16.9%), and head and neck tumors (-19.8%). The study of incidence rates throughout the first year of the COVID-19 pandemic shows that the diagnosis of new cancer patients has been significantly impaired. Health systems must take the necessary measures to restore pre-pandemic diagnostic procedures and to recover lost patients who have not been diagnosed.

Experience of clinical screening for COVID-19 among patients undergoing elective orthopedic surgeries: an alternative proposal.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing. METHODS: This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients' scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation. RESULTS: A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19. CONCLUSION: Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic. LEVEL OF EVIDENCE: IV.

Machine learning and natural language processing (NLP) approach to predict early progression to first-line treatment in real-world hormone receptor-positive (HR+)/HER2-negative advanced breast cancer patients.

BACKGROUND: CDK4/6 inhibitors plus endocrine therapies are the current standard of care in the first-line treatment of HR+/HER2-negative metastatic breast cancer, but there are no well-established clinical or molecular predictive factors for patient response. In the era of personalised oncology, new approaches for developing predictive models of response are needed. MATERIALS AND METHODS: Data derived from the electronic health records (EHRs) of real-world patients with HR+/HER2-negative advanced breast cancer were used to develop predictive models for early and late progression to first-line treatment. Two machine learning approaches were used: a classic approach using a data set of manually extracted features from reviewed (EHR) patients, and a second approach using natural language processing (NLP) of free-text clinical notes recorded during medical visits. RESULTS: Of the 610 patients included, there were 473 (77.5%) progressions to first-line treatment, of which 126 (20.6%) occurred within the first 6 months. There were 152 patients (24.9%) who showed no disease progression before 28 months from the onset of first-line treatment. The best predictive model for early progression using the manually extracted dataset achieved an area under the curve (AUC) of 0.734 (95% CI 0.687-0.782). Using the NLP free-text processing approach, the best model obtained an AUC of 0.758 (95% CI 0.714-0.800). The best model to predict long responders using manually extracted data obtained an AUC of 0.669 (95% CI 0.608-0.730). With NLP free-text processing, the best model attained an AUC of 0.752 (95% CI 0.705-0.799). CONCLUSIONS: Using machine learning methods, we developed predictive models for early and late progression to first-line treatment of HR+/HER2-negative metastatic breast cancer, also finding that NLP-based machine learning models are slightly better than predictive models based on manually obtained data.

Resultados imagenológicos y funcionales en pacientes con luxación acromioclavicular manejados con técnica de estabilidad bidimensional con supersuturas / Functional and imaging outcomes of acromioclavicular dislocation with two-dimensional stability surgical technique with supersutures

Introducción: las luxaciones acromioclaviculares son frecuentes en los servicios de urgencias de ortopedia, en su gran mayoría reciben un tratamiento conservador, sin embargo, para aquellas que requieren de manejo quirúrgico no existe una técnica estándar con adecuados resultados a largo plazo. El objetivo fue describir el abordaje quirúrgico con la técnica de estabilidad bidimensional con supersuturas en luxaciones acromioclaviculares agudas y reportar los desenlaces funcionales, radiológicos y complicaciones en el postoperatorio utilizando esta técnica. Materiales y métodos: se trata de un estudio descriptivo de series de casos, realizado en dieciocho pacientes con diagnóstico de luxación acromioclavicular aguda (menor de dos semanas) entre enero de 2015 a noviembre de 2019 en dos instituciones de Bogotá, Colombia. Evaluando la funcionalidad con el cuestionario DASH, se realizó un análisis radiológico tomando radiografías comparativas de la articulación acromioclavicular teniendo en cuenta la distancia acromioclavicular y coracoclavicular en el postoperatorio inmediato, al mes y después de los seis meses. Resultados: como resultados posteriores a la intervención quirúrgica se encontraron puntajes óptimos con resultados satisfactorios en el cuestionario de evaluación funcional (95% con puntajes por debajo de 15 puntos a los seis meses de evaluación con una mediana de 3.7 en escala de 0-100) y hallazgos imagenológicos postoperatorios con esta técnica quirúrgica con baja incidencia de complicaciones (dos pacientes con dolor y uno con hiperestesia de la zona intervenida). Conclusión: en conclusión, la técnica quirúrgica de estabilidad bidimensional con supersuturas presenta resultados satisfactorios de funcionalidad con baja frecuencia de complicaciones siendo de gran valor para el manejo de lesiones acromioclaviculares agudas

Introduction: acromioclavicular dislocations are frequent in orthopedic emergency services, the vast majority receive conservative treatment, however, in those that require surgical management there is no standard technique with adequate long-term results. The objective was to describe the surgical approach with the two-dimensional stability technique with supersutures in acute acromioclavicular dislocations and to report the functional and radiological outcomes and complications in the postoperative period using this technique. Materials and methods: this is a descriptive study of case series, carried out in eighteen patients with a diagnosis of acute acromioclavicular dislocation (less than two weeks) between January 2015 and November 2019 in two institutions in Bogotá, Colombia. Evaluating the functionality with the DASH questionnaire, a radiological evaluation was carried out taking comparative radiographs of the acromioclavicular joint, considering the acromioclavicular and coracoclavicular distance, in the immediate postoperative period, at one month and after six months postoperatively. Results: after the surgical intervention, optimal scores were found with satisfactory results in the functional evaluation questionnaire (95% with scores below 15 points at six months of evaluation with a median of 3.7 on a scale of 0-100) and findings postoperative imaging with this surgical technique with a low incidence of complications (two patients with pain and one with hyperesthesia of the intervened area). Conclusion: the two-dimensional stability surgical technique with supersutures presents satisfactory results of functionality with a low frequency of complications, being of great value for the management of acute acromioclavicular injuries

Treatment with type-i collagen scaffolds in patients with venous ulcers. case report

ABSTRACT Introduction: Chronic venous insufficiency affects about 5% of the global adult population. Venous leg ulcers are one of the most frequent complications of this pathology, with a global prevalence of 2%. This disease affects both the quality of life of patients and, due to the high cost of the treatment, the health system. Compressive therapy and moist wound healing have been the gold standard treatment. However, when complications occur, they may not be effective. Case report: This is the case of a 66-year-old female patient with venous ulcers on her lower limbs and symptoms of fever and local pain that did not respond to conventional therapies. The patient was treated with a new dermal substitute made of an acellular type-I collagen membrane, which promotes the closure of the ulcer by stimulating the replacement of injured tissue with tissue similar to the healthy one. The condition of the patient improved at 16 weeks, and after 8 months of treatment there was no recurrence of the lesions. Conclusions: Acellular type-I collagen membrane developed by the Tissue Engineering Working Group of the Department of Pharmacy of the Universidad Nacional de Colombia is effective in treating venous ulcers of the lower limbs. Its low cost facilitates the access of the whole population to therapies based on its application.

RESUMEN Introducción. La insuficiencia venosa crónica afecta alrededor del 5% de la población adulta en el mundo; una de sus mayores complicaciones son las úlceras en miembros inferiores, las cuales tienen una prevalencia mundial del 2%. Las úlceras afectan la calidad de vida de los pacientes e impactan al sistema de salud debido a los altos costos de atención que genera. El tratamiento de referencia es la terapia compresiva y la cura húmeda de las heridas, sin embargo estas intervenciones pueden no ser efectivas cuando las lesiones se complican. Presentación del caso. Paciente femenina de 66 años con úlceras venosas en miembros inferiores acompañadas de fiebre y dolor local que no respondían a las terapias convencionales. La paciente fue tratada con un nuevo sustituto dérmico basado en una membrana acelular de colágeno tipo I que contribuye al cierre de la úlcera al estimular el remplazo del tejido lesionado por tejido similar al sano, con lo cual tuvo mejoría a las 16 semanas; después de 8 meses de terminado el tratamiento no se presentó recurrencia de las lesiones. Conclusiones. La membrana acelular de colágeno tipo I desarrollada por el Grupo de Trabajo en Ingeniería de Tejidos del Departamento de Farmacia de la Universidad Nacional de Colombia es efectiva en el tratamiento de úlceras venosas en miembros inferiores y su bajo costo facilita el acceso de toda la población a terapias basadas en su aplicación.

Energy System Assessment in Survivors of Breast Cancer.

BACKGROUND: Survivors of breast cancer commonly report functional limitations, including cancer-related fatigue (CRF) and decreased aerobic capacity. One key gap is addressing the 3 energy systems (aerobic, anaerobic lactic, and alactic), requiring assessment to establish a baseline exercise intensity and duration. OBJECTIVE: This study examined the feasibility of energy system-based assessment, also providing descriptive values for assessment performance in this population. DESIGN: This was a cross-sectional study. METHODS: Seventy-two posttreatment survivors of breast cancer were recruited. Following a baseline musculoskeletal assessment, women attempted 3 energy system assessments: submaximal aerobic (multistage treadmill), anaerobic alactic (30-second sit-to-stand [30-STS]), and anaerobic lactic (adapted burpees). Heart rate (HR) and rating of perceived exertion (RPE) were recorded. Secondary outcomes included body composition, CRF, and upper- and lower-limb functionality. RESULTS: Seventy of 72 participants performed the 30-STS and 30 completed the adapted burpees task. HR and RPE specific to each task were correlated, reflecting increased intensity. Women reported low-moderate levels of CRF scores (3% [2.1]) and moderate-high functionality levels (upper-limb: 65.8% [23.3]; lower-limb: 63.7% [34.7]). LIMITATIONS: All survivors of breast cancer had relatively low levels of CRF and moderate functioning. Additionally, on average, participants were classified as "overweight" based on BMI. CONCLUSION: This study is the first to our knowledge to demonstrate feasibility of energy system assessment in survivors of breast cancer. Using a combination of HR and RPE, as well as baseline assessment of each energy system, clinicians may improve ability to prescribe personalized exercise and give patients greater ability to self-monitor intensity and progress.

Characteristics of hyperglycemic crises in an adult population in a teaching hospital in Colombia.

BACKGROUND: Hyperglycemic crisis are the most serious forms of acute decompensation of diabetes mellitus and require urgent medical attention. The epidemiological data of these conditions in Latin America are scarce and in Colombia unknown, that is why we decided to describe the clinical characteristics and factors associated with the mortality of adults who presented with hyperglycemic crises in a teaching hospital in Colombia. MATERIALS AND METHODS: Retrospective cohort study of all episodes of hyperglycemic crisis treated in Pablo Tobón Uribe Hospital in a three-year period. RESULTS: The records of 2233 hospitalization episodes related to diabetes mellitus were review, the prevalence of hyperglycemic crises was 2%, half of the events were diabetic ketoacidosis and 57% of the events occurred in people with type 2 diabetes mellitus, 32% of the events were precipitated by an infection and 27% by and inadequate therapy. The average hospital length of stay was 14 ± 3 days and the mortality rate 2.27%. CONCLUSIONS: In a teaching hospital in Latin America hyperglycemic crises are common, with diabetic ketoacidosis being the most frequent, and in a significant number of cases may be preventable. The hospital length of stay in our population is longer than reported in the literature.

Tuberculosis miliar con diseminación renal y genitourinaria: reporte de un caso / Miliary tuberculosis, with renal and genitourinary disemination; Case Report

Antecedentes: A pesar de los grandes avances en la medicina contemporánea; la Tuberculosis continúa siendo un reto diagnóstico, en especial al presentarse con características clínicas poco usuales. Caso clínico: Paciente masculino de 48 años, agri-cultor, de escasos recursos económicos, sin comorbilidades previas, el cual presenta sintomatología constitucional, pérdida de peso, iebre y dolor lumbar irradiado a ambos lancos de la región abdominal, de características poco especíicas, de un mes de evolución; acompañado de disuria y oliguria, y niega síntomas respiratorios. Al examen físico luce crónicamente enfermo, en mal estado nutricio-nal, sin deterioro de la conciencia, no se evidencia adenopatías cervicales ni inguinales; sin presencia de signos pulmonares, con leve dolor con la puño percusión renal bilateral, en el área genital, se identiica una masa de borde regular, móvil sobre el polo superior del testículo derecho. En el examen hematológico con presencia de Bicitopenia anemia microcitica hipocromica y trombocitopenia leve, en gases arteriales acidosis metabólica con Anión Gap elevado, además con hiperazoemia e hiperkalemia en la bioquímica sanguínea refractaria al tratamiento, razón por la cual fue sometido a Hemodiálisis aguda. Al evaluar radiografía de tórax se observa patrón micro-nodular difuso, no se realiza baciloscopias por falta de expectoración ni por lavado gástrico, en el ultrasonido renal y de vías urinarias se visualizó nefromegalia y la presencia de masa heterogénea de aspecto granulomatoso en testículo derecho; por lo que se solicitó tomografía toracoabdominal, en donde se observa patrón micronodular múltiple a nivel pulmonar, con afectación renal, ganglionar y testicular, se solicita BAAR de sedimento urinario seriado con resultados positivos, y la tinción Ziehl Neelsen en orina con resultado positivo; con ello se inicia terapia antiimica. Discusión: La Tuberculosis renal no tiene un cuadro clínico clásico; generalmente se presenta con manifestaciones atípicas; como en nuestro caso con sintomatología urinaria, hiperazoemia que culmino en terapia de restitución renal de emergencia, con posterior recuperación de la función renal.