RESUMO
The evolution of palliative care in Latin America has been slow compared with other parts of the world, especially developed countries. Current data show inequality in the development of palliative care in the region and those differences are also evident within countries between urban and rural populations. Peru is situated in the low-ranking group in terms of palliative care services in Latin America. The main reasons are a lack of education and funding and misconceptions about palliative care. Limited access to the use of opioids and regulatory barriers are also common features. The development of more palliative care units in Peru, as well as in other Latin American countries, is needed to ensure access to adequate and timely treatment for patients receiving palliative care.
Assuntos
Analgésicos Opioides , Cuidados Paliativos , Humanos , América Latina , Peru , Analgésicos Opioides/uso terapêutico , População RuralRESUMO
The lack of breast cancer screening in low and middle-income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50-69 years attending clinics for non-breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated ("usual care"). Women were followed for 2-years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1-9.2), 1.0 (0.3-3.5) and 1.9 (0.9-4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7-2.8) by the end of follow-up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late-stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well-designed opportunistic clinic-based breast cancer screening programs may be useful for early breast cancer detection in LMICs.
Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Exame Ginecológico , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de SaúdeRESUMO
Cancer survival has significantly increased during the past few decades, making survivorship care a key element of cancer control and posing several challenges for long-term care in low- and middle-income countries (LMIC). Most survivorship care guidelines emphasize the potential role of primary care physicians and the need for comprehensive care, with a preference for patient-centered over disease-centered approaches. However, guidelines developed in high-income countries are not always suitable for LMIC, where a shortage of oncology workforce, deficient training in primary care, and low access to comprehensive centers frequently induce undertreatment and a lack of follow-up. Despite universal health insurance coverage, Colombia has fragmented cancer care with deficient survivorship care, given its focus on relapse surveillance without integration of supportive care and comorbidity management, in addition to unequal access for low-income populations and distant regions. Using the breast cancer framework, we describe the development of a guideline for survivorship care on the basis of a risk approach and the proper integration of oncology specialists and family physicians. We used a three-phase process to develop recommendations for disease control (disease-centered review), interventions aimed at improving patients' quality of life (patient-centered review), and care delivery (delivery model review). We deem our proposal suitable for middle-income countries, which represents an input for more standardized survivorship care in these settings.
Assuntos
Neoplasias da Mama , Sobrevivência , Humanos , Feminino , Neoplasias da Mama/terapia , Países em Desenvolvimento , Qualidade de Vida , Colômbia/epidemiologia , Recidiva Local de Neoplasia/terapiaAssuntos
Neoplasias Colorretais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Países em Desenvolvimento , Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Acessibilidade aos Serviços de Saúde , Humanos , América Latina/epidemiologiaRESUMO
Escherichia coli is a rod-shaped bacterium that divides at its midplane, partitioning its cellular material into two roughly equal parts. At the appropriate time, a septum forms, creating the two daughter cells. Septum formation starts with the appearance of a ring of FtsZ proteins on the cell membrane at midplane. This Z-ring causes an invagination in the membrane, which is followed by growth of two new endcaps for the daughter cells. Invagination occurs against a cell overpressure of several atmospheres. A model is presented for the shape of the cell as determined by the tension in the Z-ring. This model allows the calculation of the force required for invagination. Then three possible models to generate the force necessary to achieve invagination are presented and analyzed. These models are based on converting GTP-bound FtsZ polymeric structures to GDP-bound FtsZ structures, which then leave the polymer. Each model is able to generate the force by relating the hydrolyzation to an irreversible molecular binding event, resulting in a net motion of putative anchors for the structures. All three models show that cross-linking the FtsZ protofilaments into a polymer structure allows the removal of GDP-FtsZ without interrupting the structure during force generation, as would happen for a simple polymeric chain.
Assuntos
Escherichia coli/citologia , Modelos Biológicos , Proteínas de Bactérias/metabolismo , Divisão Celular/fisiologia , Membrana Celular/fisiologia , Proteínas do Citoesqueleto/metabolismo , Escherichia coli/metabolismo , Guanosina Difosfato/metabolismo , Guanosina Trifosfato/metabolismo , Análise Numérica Assistida por ComputadorRESUMO
Resumen Colombia tiene un riesgo intermedio a desarrollar cáncer de mama con una tasa de incidencia estandarizada por edad en de 44,1 por 100.000 mujeres. A pesar de que en el país se recomienda la tamización mediante mamografía, en mujeres de 50 a 69 años y examen clínico de mama anual, así como detección temprana para mujeres sintomáticas independientemente de la edad; en Colombia no se ha podido reducir la mortalidad por esta causa. Múltiples causas parecen explicar este problema: baja participación en las actividades de tamización con mamografía por parte de la población objeto; baja calidad de la mamografía, y barreras de acceso para el diagnóstico oportuno y el tratamiento integral. Frente a esta problemática el 3 de octubre fue aprobado en primer debate el proyecto de ley 259 de 2019 Cámara Proyecto de Ley "Por medio de la cual se establecen medidas para la prevención, diagnóstico, tratamiento oportuno, rehabilitación, y cuidados paliativos del cáncer de mama y se dictan otras disposiciones". A fin de revisar el soporte científico del contenido del proyecto de ley y aportar a su adecuada discusión, el Instituto Nacional de Cancerologia (INC) realizó un foro el 9 de diciembre de 2019. El propósito de este artículo es presentar el análisis de los puntos de mayor controversia desde una perspectiva científica, como base para la adecuada toma de decisiones en materia de políticas de salud pública.
Abstract Colombia ranks at an intermediate risk level regarding the development of breast cancer, with an age-standardized incidence rate of 44.1 per 100,000 women. Although mammography screening and annual Clinical Breast Examination for women aged 50 to 69 are recommended in Colombia, as well as early detection for symptomatic women regardless of age, mortality from this cause has not been reduced in Colombia. Multiple causes seem to explain this problem: low participation of the target population in mammography screening activities, poor quality of mammography, and access barriers for timely diagnosis and comprehensive treatment. In view of this problem, the House of Representatives approved in first debate last October 3 Bill No. 259 of 2019 "by means of which measures and other provisions for prevention, diagnosis, timely treatment, rehabilitation, and palliative care of breast cancer are set up". The Colombian National Cancer Institute INC, held a forum on December 9, 2019, aimed at reviewing the scientific support of the content of the bill and contribute to its proper discussion. The purpose of this paper is to present the analysis of the most controversial points from a scientific perspective, as a basis for appropriate decision-making in public health policy.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/terapia , Política Informada por Evidências , Política de Saúde , Qualidade da Assistência à Saúde , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/diagnóstico por imagem , Mamografia , Programas de Rastreamento , Colômbia/epidemiologiaAssuntos
Oncologistas/organização & administração , Colômbia , Humanos , Oncologia , Recursos HumanosRESUMO
Objetivos: Describir los motivos de consulta de los pacientes con enfermedades hemato-oncológicas que asisten al servicio de urgencias de un hospital de cuarto nivel de complejidad. Además se realizó un seguimiento para determinar la causa de egreso del hospital. Métodos: Se realizó un estudio longitudinal descriptivo de los pacientes adultos con antecedente de patología hemato-oncológica que consultaron al servicio de urgencias del Hospital Universitario San Ignacio entre el 1 de noviembre de 2011 y el 29 de febrero de 2012. Resultados: Se identificaron 672 consultas en cuatro meses, con antecedente de tumor sólido en el 84,52% y el resto correspondía a neoplasia hemato-oncológica. El 9,2% de las consultas correspondían a condiciones emergentes, 25,5% a condiciones urgentes y 65,3% a no urgentes. Los motivos de consulta más frecuentes fueron: dolor abdominal (26,3%) y disnea (19,3%). Posterior a la atención inicial, requirieron hospitalización el 56,2%, observación 30,8% y alta el 13% de los pacientes. Conclusión: La mayoría de las consultas al servicio de urgencias corresponden a condiciones no urgentes. Este grupo de pacientes se beneficiaría de la creación de consultas prioritarias para cuidados paliativos en servicios de consulta externa, lo que ayudaría a descongestionar los servicios de urgencias y dar al paciente una atención adecuada ofreciendo calidad de vida, acompañamiento y apoyo.
Objectives: To describe the reasons and outcome of patients with hemato-oncological diseases who were attended at the emergency care service on a quaternary care hospital and determine the most common causes for admission by hemato-oncological diseases. Methods: This was a descriptive longitudinal study of adult patients with a history of hemato-oncological disease who visited the emergency department between 1st November 2011 and 29th February 2012. Results: during the period study, 672 consultations were recorded, with a history of solid tumour in 84.52% and the remainder were hemato-oncological neoplasm; 9.2% of consultations were emergencies, 25.5% were urgencies and 65.3% were not urgent. The most frequent symptoms were abdominal pain (26.3%) and dyspnoea (19.3%). Conclusion: The majority of emergency department visits are non-urgent conditions. This group of patients would benefit with the creation of priority consultations for palliative care in outpatients services. This would help decongest the emergency services and give the patient an adequate quality of life, guidance and support.
Assuntos
Humanos , Cuidados Paliativos , Qualidade de Vida , Adulto , Serviços Médicos de Emergência , Neoplasias , Pacientes Ambulatoriais , Encaminhamento e Consulta , Padrão de CuidadoRESUMO
Breast cancer is increasing in developing countries, and Colombia has a double burden from cervical and breast cancer. Suitable guidelines for breast cancer early detection are needed, and the Breast Health Global Initiative provides a favorable framework for breast cancer control in low resource nations. The Colombian National Cancer Institute developed evidence-based guidelines for breast cancer early detection in which coordinated early detection in symptomatic women and hospital-based screening in women aged 50-69 are recommended. A pilot project to evaluate programmatic approaches (opportunistic screening) was designed, and it is expected that organized hospital-based screening for breast cancer will represent a move towards population-based screening in the near future in accordance with country specific conditions.
RESUMO
El carcinoma córtico-adrenal es una entidad que se presenta raras veces; su evolución es agresiva, con una alta probabilidad de recaída y una supervivencia a 5 años que no supera el 60%. El único tratamiento curativo es la cirugía, siempre y cuando esta sea completa y a los pacientes se los diagnostique en estadios tempranos. Otras intervenciones que se pueden brindar son la radioterapia, la quimioterapia y el control de secreción hormonal en el contexto adyuvante o paliativo. En algunos casos (síndrome de Cushing) el bloqueo hormonal previo a la cirugía es imperativo. En esta revisión se describen la patogénesis, el diagnóstico, los factores pronósticos y el tratamiento del carcinoma córtico-adrenal, con el propósito de guiar el enfoque diagnóstico y el tratamiento.
Adrenal-cortical carcinoma is a rarely occurring entity; it evolves aggressively, has a high probability of relapse and survival at 5 years does not surpass 60%. Surgery provides the only curative treatment, but only when it is complete and carried out on patients with early-stage diagnosis. Additional treatments that may be used include radiotherapy, chemotherapy and control of hormonal secretion in an adjuvant or palliative context. In some cases (Cushing´s syndrome), it is imperative to provide hormonal block before surgery. The pathogenesis, diagnosis, prognostic factors and treatment of adrenal-cortical carcinoma are described in this review in order to sharpen the focus on diagnosis and treatment.
Assuntos
Humanos , Carcinoma Adrenocortical , Síndrome de Cushing , Metástase Neoplásica , Cirurgia Geral/métodosRESUMO
Describir los resultados del tratamiento en pacientes con carcinoma de células no pequeñas avanzado. El 70 % de los pacientes debutan con enfermedad avanzada con supervivencia global de 5 años menor del 13 %. MÉTODOS: Se analizaron variables clínicas de 176 pacientes tratados en Bogotá. RESULTADOS: Promedio de edad 64 años, 64 % hombres 51 % tenía ECOG ≤1. El 90 % tenía compromiso metastásico principalmente a nivel pulmonar y en sistema nervioso central. El 76 % recibió terapia combinada como primera línea; 126 sujetos fueron tratados con (cisplatino 38/21,6 % y carboplatino 88 / 50% más algún agente de tercera generación o etopósido. Treinta y cuatro pacientes recibieron monoterapia, ocho, erlotinib. Se suministraron 3,7 ± 1,7 ciclos por paciente, la tasa de respuesta global fue 29 %, beneficio clínico 39 %, la mediana del tiempo de progresión 3,4 meses. La tercera parte de la población recibió segunda línea; en este grupo tasa de respuesta completa 15,8 %, beneficio clínico 33,8 % la mediana de tiempo libre de progresión 3,1 meses. El 69,3 % había muerto, la mediana de sobrevida global para la población total fue 9,2 meses, la proporción de sujetos vivos a 1 año 26 %. Variables como sexo, estado funcional, historia de tabaquismo, administración de segunda línea, adenocarcinoma, influyeron sobre la supervivencia. CONCLUSIONES: El comportamiento clínico y los objetivos del tratamiento de los pacientes incluidos en este estudio son similares a los reportados en la literatura médica.
Describing results of treatment in patients suffering advanced no small cell according to routine clinical practice. The 70 % of patients suffering debut with advanced disease are determining less than 13 % overall survival in 5 years. METHODS: 176 patients treated in Bogotá. RESULTS: The mean age was 64 years; 64 % were male 51 % had ≤1 ECOG. The 90 % had metastasis, mainly in the lung and in central nervous system. 76 % received combined therapy as the first line of intervention; 126 subjects were treated with a platinum compounds (cisplatin 38/21.6 % carboplatin 88/50 %) plus some third generation agent or etoposide. Thirty-four received monotherapy and eight erlotinib; 3.7 ± 1.7 cycles per patient were supplied on average, overall response rate was 29 %, clinical benefit 39 % and the median time to progression was 3.4 months. Only the third part of the population received a second line intervention; in this group overall response was 15.8 %, clinical benefit 33.8 % and free time progression was 3.1 months. When follow-up finished, 69.3 % had died, median the overall survival was 9.2 months 26 % of the subjects lived for up to one year. Some variables such gender, functional state, history of smoking, administering second line agent and a diagnosis of adenocarcinoma influenced in superlife. CONCLUSIONS: Clinical behaviour and outcomes treatment of patients included in this study were similar to those previously reported in the medical literature.
Assuntos
Humanos , Masculino , Feminino , Metástase Neoplásica/diagnóstico , Neoplasias Pulmonares/terapia , Neoplasias do Sistema Nervoso Central/fisiopatologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Colômbia , Espanha , Oncologia , Tabagismo/imunologiaRESUMO
Objetivos: Obtener una versión en español colombiano de dos instrumentos que miden la calidad de vida relacionada con la salud: EORTC QLQ C-30 (instrumento general) y el EORTC QLQ BR23 (instrumento específico). En estas versiones se busca que el lenguaje y los significados de los contenidos sean consistentes con los diferentes escenarios de aplicación en Colombia. Métodos: Para el proceso de adaptación cultural se siguieron las recomendaciones sugeridas por el grupo de calidad de vida de EORTC relacionadas con las traducciones, los grupos piloto y los procesos de ajuste de escalas de calidad de vida relacionada con la salud. Resultados: Tanto en el proceso de traducción como en el de los grupos piloto, se introdujeron cambios que ajustaron el significado del instrumento para ser usado en el contexto colombiano. Las modificaciones fueron incorporadas en el conjunto de instrumentos del grupo EORTC. Conclusiones: Existe una versión disponible en español colombiano de las escalas EORTC C30 y EORTC BR23.
Objectives: To obtain a Colombian, Spanish language version of two instruments which measure quality of life in relation to health: the EORTC QLQ C30 (general instrument) and the EORTC QLQ BR23 (specific instrument). These local versions seek to establish consistency in content language and meaning applicable to diverse settings in Colombia. Methods: In order to carry out the process of cultural adaptation, the EORTC group´s recommendations were followed on translations, pilot groups and the process of health related quality of life scale adjustments. Results: The translation process, as well as the pilot group section, underwent adjustments that allowed for changes in the instruments´ meanings, thus making them applicable to the Colombian context. These modifications were incorporated into the EORTC group´s body of instruments. Conclusions: Colombian, Spanish language versions of EORTC C30 and EORTC BR23 scales are now available.
Assuntos
Humanos , Adaptação a Desastres , Neoplasias/psicologia , Qualidade de Vida , Coleta de Dados/métodos , ColômbiaRESUMO
El tratamiento neoadyuvante también denominado terapia primaria sistémica o terapia preoperatoria tiene cuatro finalidades en cáncer de mama: disminuir el volumen tumoral para hacer operable lo que antes era inoperable, mejorar las probabilidades para hacer una cirugía conservativa, analizar la quimiosensibilidad in vivo y evaluar el manejo de las micrometástasis. Esta revisión descriptiva toma en cuenta los principales estudios clínicos sobre terapia sistémica neoadyuvante publicados hasta mayo del 2009.
Neoadjuvant treatment also known as primary systemic therapy or preoperative therapy has four objectives when applied to breast cancer: to reduce inoperable tumoral volume to operable size; to enhance the possiblility for conservative surgery; to analyze chemosensitivity in vivo; and, to evaluate the management of micrometastasis. This descriptive review takes into account the major clinical studies on systemic neoadjuvant therapy published as of May, 2009.
Assuntos
Humanos , Feminino , Neoplasias da Mama , Mastectomia Segmentar , Micrometástase de Neoplasia/prevenção & controle , Terapia Neoadjuvante , Taxa de Sobrevida , ColômbiaRESUMO
Objetivo: Determinar la cobertura de examen clínico y mamografía de tamización para cáncer de mama en un grupo de mujeres bogotanas afiliadas a seguros de salud. Métodos: Se realizó una encuesta telefónica a 4.526 mujeres entre 50 y 69 años, residentes en Bogotá y en municipios vecinos, afiliadas a tres compañías de seguros de salud. Se excluyeron las mujeres con antecedente personal de cáncer de mama. La cobertura de tamización se valoró como la proporción de mujeres con antecedente de mamografía y examen clínico de la mama. Se estimó la frecuencia en la vida, en los últimos dos años y en el último año. Se analizaron factores asociados a la práctica de tamización, mediante el cálculo de OR ajustados. Resultados: La frecuencia de vida de uso del examen clínico y mamografía fue de 59,3% y 79,8% respectivamente; el 49,7% y el 65,6% de las mujeres se realizó los exámenes con fines de tamización; el resto, con fines diagnósticos (sintomáticas). El 34,2% tenía examen clínico en el último año, y el 54%, mamografía en los últimos dos años. La educación y el antecedente familiar de cáncer de mama estuvieron asociados a la práctica de tamización. Conclusiones: La cobertura de examen clínico de la mama como método de tamización es baja. Las coberturas de mamografía son superiores a lo exigido por el sistema colombiano, pero inferiores a las coberturas útiles reportadas en países desarrollados.
Objectives: To determine the coverage of clinical breast examination (CBE) and mammography for screening of breast cancer among a group of insured women in Bogotá. Methods: A telephone survey was carried out with 4,526 women between the ages of 50 and 69, residing in Bogotá or its suburbs, who were insured by one of three commercial health plans. Women with a history of breast cancer were excluded. Screening coverage was estimated as the proportion of women who had had a mammography or CBE. Estimates were established for lifetime frequency, two years prior the survey, and one year prior the survey. Factors associated with screening procedures were analyzed with calculations based on adjusted OR. Results: Lifetime frequency of CBE was 59.3% and 79.8% for mammography; and 49.7% and 65.6% of women respectively underwent the tests for screening purposes; the remainder, for diagnostic purposes (breast symptoms). CBE reported a 34.2% one year coverage and mammography reported a 54% two years coverage. Screening was associated to cancer education and family history of breast cancer. Conclusion: Coverage of CBE for screening purposes is low. Mammography coverage is above that required by the Colombian Health Ministry, but below that reported by developed countries.
Assuntos
Humanos , Adulto , Feminino , Neoplasias da Mama , Estudos de Coortes , Programas de Rastreamento/métodos , Cobertura de Serviços de Saúde , Inquéritos Epidemiológicos , ColômbiaRESUMO
Objetivo: Caracterizar las hepatitis crónicas diagnosticadas histológicamente en el HPTU de Medellín en los últimos diez años en su aspecto epidemiológico, clínico y bioquímico, utilizando las historias clínicas de los pacientes que estén incluidos en el estudio. Metodología: Reporte de casos retrospectivo con base en las historias clínicas de los pacientes con diagnóstico histológico de hepatitis crónica en el HPTU en los últimos diez años; de corte transversal, se emplearon medidas de tendencia central y de dispersión. Resultados: Se analizaron 21 pacientes con diagnóstico histológico de hepatitis crónica. Se realizó distribución de frecuencia de las variables sexo, edad, etiología y pruebas diagnósticas. Se describieron los factores asociados al diagnóstico de hepatitis crónica, las complicaciones y frecuencia de estas y por último se analizaron los diferentes motivos de consulta y la prevalencia de los diferentes síntomas. Conclusiones: Se encontró que en la población estudiada hay una alta prevalencia de hepatitis autoinmune (HAI) y hepatitis Idiopática; sin embargo, al analizar los exámenes diagnósticos realizados a los pacientes, faltan estudios que descarten otras etiologías de hepatitis, lo cual es fundamental para llegar a estos diagnósticos.