Safety of surgery: quality assessment of meta-analyses on the WHO checklist.

Objectives: To assess the quality of the meta-analyses that review the WHO surgical safety checklist. Methods: A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. Results: In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. Conclusions: The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

Sentinel node in breast cancer as an indicator of quality in medical care: Evaluation of statistics in Colombia.

BACKGROUND: Sentinel lymph node biopsy in breast cancer is considered the standard of staging in cases of clinically negative lymph nodes. Its omission in favor of axillary dissection generates significant morbidity. OBJECTIVE: To determine the total number of sentinel node biopsy procedures in breast cancer in Colombia from 2017 through 2020, model and analyze them as if they were performed only in stage I breast cancer patients, and integrate their results into the concepts of quality of medical care. METHODS: Search in a database of the Ministry of Health and Social Protection of Colombia with sentinel lymph node biopsy codes, and filters of breast cancer and year. Their results are contrasted with the number of cases in stage I of breast cancer. RESULTS: Breast cancer TNM staging was reported in 22154 cases, 3648 stage I. In the same time frame, the number of sentinel lymph node biopsies for breast cancer in Colombia was 1045, 28.64% of the total cases reported in stage I. CONCLUSIONS: Colombia is far from complying with the standard indicator of sentinel lymph node biopsy. It is recommended to concentrate breast cancer cases in hospitals that provide the conditions for its performance.

In-situ acetylation followed by liquid-liquid extraction and gas chromatography - mass spectrometry for the determination of bromophenols in urine.

A novel and simple method combining in-situ acetylation, liquid-liquid extraction and gas chromatography-mass spectrometry (GC-MS) has been developed for the quantification of 10 bromophenols in urine, used as biomarkers of exposure to polybrominated diphenyl ethers. The analytical process involves an enzymatic hydrolysis of the bromophenol glucuronide fraction followed by an aqueous derivatization of the phenol group with acetic anhydride. A subsequent liquid-liquid extraction of the sample with hexane allows the injection of the organic layer, using a programmed temperature vaporizer, into a gas chromatograph coupled to a single quadrupole mass spectrometer. Quantification is performed by the standard addition method. Limits of detection are in the pg mL-1 range. Trueness, assessed in terms of percentages of recovery, varies between 100 % and 118 % in synthetic urine and between 79 % and 117 % in human urine. Precision, assessed at two different levels, 0.25 ng mL-1 and 2.5 ng mL-1, shows values of relative standard deviation below 14 % both in intra- and inter-day studies for both matrices. The method has been applied to the analysis of seven urine samples, measuring concentrations higher than the LOQ in three of them. These levels are in agreement with others found in literature, but they have been obtained by applying a much simpler and faster protocol. In addition, the replacement of silylating reagents by acetic anhydride, to derivatize the phenol moiety, provides a greener alternative to other GC-MS procedures published up to date.

Mortality from Breast Cancer in Women under 50 Years of Age in Colombia.

OBJECTIVE: To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region. METHODS: Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage. RESULTS: In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group. CONCLUSION: Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.

Ultrasound-Assisted Extraction, Followed by Gas Chromatography-Mass Spectrometry for the Simultaneous Quantification of Ethinyl Estradiol and Drospirenone in Contraceptive Formulations.

Contraceptive tablets typically contain a combination of two synthetic versions of an estrogen and a progestogen, which work together to inhibit the ovulation process. An accurate and precise quantification of these components is essential for contraceptive producers. In this study, we have developed the first gas chromatography-mass spectrometry (GC-MS) method for the simultaneous quantification of 17α-ethinyl estradiol (EE) and drospirenone (DP) in contraceptive formulations. Under the final working conditions, analytes were extracted from the solid by ultrasound-assisted extraction (15 min) in methanol. The resulting suspension was diluted in ethyl acetate, subjected to centrifugation and, finally, the supernatant was directly injected into the GC-MS system. No derivatization reagents were utilized. To correct for instrumental variations, calibration was performed using the internal standard method, with cholesterol as the internal standard. A good linearity was achieved throughout the calibration range for both EE (3-12 µg mL-1) and DP (300-1200 µg mL-1), with R2 values exceeding 0.99. Trueness, assessed in terms of percentages of recovery, was also found to be satisfactory for both analytes, with recovery rates of 106 ± 8% for EE and 93 ± 9% for DP. Furthermore, intra-day and inter-day precision studies yielded relative standard deviation values below 6% for both analytes. In terms of sensitivity, the instrumental limits of detection were 0.25 µg mL-1 for EE and 6.6 µg mL-1 for DP, and the instrumental limits of quantification 0.82 µg mL-1 for EE and 22 µg mL-1 for DP. The method was successfully applied to the analysis of contraceptive tablets from three different pharmaceutical companies. No differences were observed between the measured and the declared amount of active principle per tablet, demonstrating the applicability of the procedure. In addition, a stability study conducted on both the standards and sample extracts demonstrated that they can be stored at room temperature for a minimum period of seven days.

Assessing the impact of a major electronic music festival on the consumption patterns of illicit and licit psychoactive substances in a Mediterranean city using wastewater analysis.

The consumption patterns of five categories of psychoactive substances (PS), including "conventional" illicit drugs, new psychoactive substances (NPS), therapeutic opioids, alcohol and nicotine, were studied in the city of Split, Croatia, using wastewater-based epidemiology (WBE), with an emphasis on the impact of a large electronic music festival. The study involved the analysis of 57 urinary biomarkers of PS in raw municipal wastewater samples collected in three characteristic periods, including the festival week in the peak-tourist season (July) and reference weeks in the peak-tourist season (August) and the off-tourist season (November). Such a large number of biomarkers allowed the recognition of distinct patterns of PS use associated with the festival, but also revealed some subtle differences between summer and autumn seasons. The festival week was characterized by markedly increased use of illicit stimulants (MDMA: 30-fold increase; cocaine and amphetamine: 1.7-fold increase) and alcohol (1.7-fold increase), while consumption of other common illicit drugs (cannabis and heroin), major therapeutic opioids (morphine, codeine and tramadol) and nicotine remained rather constant. Interestingly, NPS and methamphetamine clearly contributed to the festival PS signature in wastewater, but their prevalence was rather low compared to that of common illicit drugs. Estimates of cocaine and cannabis use were largely consistent with prevalence data from national surveys, whereas differences were found for typical amphetamine-type recreational drugs, particularly MDMA, and for heroin. The WBE data suggest that the largest proportion of morphine came from heroin consumption and that the percentage of heroin users seeking treatment in Split is probably rather low. The prevalence of smoking calculated in this study (30.6 %) was consistent with national survey data for 2015 (27.5-31.5 %), while the average alcohol consumption per capita >15 years (5.2 L) was lower than sales statistics suggest (8.9 L).

Use of a guard column coupled to mass spectrometry as a fast semi-quantitative methodology for the determination of plasticizer metabolites in urine.

For the first time, a very simple and fast method combining the use of a guard column coupled to tandem mass spectrometry (guard column-MS/MS) has been proposed for the determination of plasticizer metabolites in urine. Briefly, samples (1.0 mL) were submitted to enzymatic hydrolysis for 10 min, filtered, diluted 1/10 v/v with ultrapure water and directly injected into the system. A fast run of only 2 min (3 min including the injection cycle) allowed the determination of 19 analytes. Enzymatic hydrolysis, filtering material, and guard column-MS/MS conditions were optimized. Intra-day precision at the low-level concentration (expressed as relative standard deviation, %RSD) obtained from the analysis of synthetic urine samples varied between 11 and 20%. Limits of quantification ranged from 2.8 to 60 ng/mL. Trueness values, calculated as apparent recoveries, ranged from 70 to 135%. To correct for matrix effects, analyte concentrations in real urine were quantified by the standard addition method. To confirm the results obtained by guard column-MS/MS, an ultra(high)-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method was also applied (total chromatographic run time 17 min, including column re-equilibration). Concentrations measured with both methods were in good agreement. Hence, we propose the use of guard column-MS/MS to analyse a large number samples in a very short time (semi-quantification), and apply the chromatographic analysis only to those samples with levels close to/higher than the concentrations equivalent to the safe maximum daily intakes of the parent compounds (confirmation). This double strategy (semi-quantification by guard column-MS/MS and confirmation-when needed-by UHPLC-MS/MS) implies important savings in time and money.

Virus en el tratamiento de cáncer de mama / Viruses in the treatment of breast cancer

Resumen OBJETIVO: Sintetizar las conclusiones de artículos que estudiaron la aplicación de virus en el tratamiento de cáncer de mama humano. METODOLOGÍA: Búsqueda bibliográfica de artículos registrados en PubMed, sin uso de filtros, efectuada en el mes de noviembre de 2019 con los términos: oncolytic virus in breast cancer. Los artículos seleccionados se agruparon en cuadros según el tipo de virus. Se obtuvieron datos del primer autor, año de publicación, vector y conclusiones principales. RESULTADOS: Se encontraron 271 publicaciones de las que se excluyeron 128 en el cribado por título y resumen, 31 por tratarse de artículos de revisión. Si bien no hubo restricción por idioma, se excluyó un artículo en chino y seis cuyo objetivo principal fue el estudio del cáncer de mama en caninos. Las demás exclusiones se hicieron por falta de vínculo con el tema objeto de revisión. De los 143 artículos seleccionados para lectura completa se excluyeron 17 por no ser pertinentes con el objetivo, lo mismo que una comunicación breve. CONCLUSIONES: La información seleccionada de virus para tratamiento de pacientes con cáncer de mama proviene casi toda de investigación preclínica con respuestas que favorecen la acción experimental de los oncovirus. En los estudios de investigación clínica, los resultados aún son escasos, pero insinúan su potencial de desarrollo, sobre todo en combinación con oncovirus o con otros agentes terapéuticos.

Abstract OBJECTIVE: To synthesise the findings of articles that studied the application of viruses in the treatment of human breast cancer. METHODOLOGY: Bibliographic search of articles registered in PubMed, without the use of filters, carried out in November 2019 with the terms: oncolytic virus in breast cancer. The selected articles were grouped in tables according to the type of virus. Data were obtained on the first author, year of publication, vector and main conclusions. RESULTS: With the search terms, 271 publications were found. Of these, 128 were excluded in the screening by title and abstract, 31 of them because they were review articles. Although there was no language restriction, one article in Chinese and six whose main objective was the study of canine breast cancer were excluded. The other exclusions were made because they were not associated with the subject under review. Among the 143 articles that were selected for full reading, 17 of them were also excluded as not relevant for the purpose of this review and one because it was a short communication. CONCLUSIONS: The selected data on viruses for the treatment of breast cancer patients comes almost entirely from preclinical research with responses favoring the experimental action of oncoviruses. In clinical research studies, results are still scarce, but hint at their potential for development, especially in combination with oncoviruses or other therapeutic agents.

Inter-observer agreement in the diagnosis of breast atypical ductal hyperplasia: A systematic review.

OBJECTIVE: To review the concordance between pathologists in the diagnosis of atypical ductal hyperplasia of the breast. METHODS: Systematic review of articles registered in the PubMed database with the terms "pathologists" and "atypical ductal hyperplasia", "atypical ductal hyperplasia" and "interobserver variability", in Embase with "interobserver agreement in atypical ductal hyperplasia" and Lilacs with the terms in Spanish "patólogos" and "hiperplasia ductal atípica", without the use of filters, between 03/16/2022 and 03/26/2022 searching for articles that assess inter-observer agreement in the diagnosis of atypical ductal hyperplasia by using the kappa statistic. Review articles, conference proceedings, and commentaries were excluded. RESULTS: With the search terms, 507 publications were found. Of these, 491 were excluded from the screening by title and abstract. Of the full reading of the remaining articles, 6 were selected for qualitative analysis. The kappa values ranged from slight agreement, kappa = 0.17, to substantial agreement, 0.69 obtained from pathologists dedicated or experienced in breast pathology and who received a prior tutorial session to review the general criteria for atypia. CONCLUSIONS: This study reviews the reproducibility in the diagnosis of atypical ductal hyperplasia. A better concordance was obtained with a previous teaching process offered to pathologists dedicated or experienced in breast pathology.

Comparación entre las clasificaciones de hiperplasia endometrial. Revisión sistemática y evaluación de calidad / Comparison between endometrial hyperplasia classifications. Systematic review and quality evaluation

RESUMEN Antecedentes: La hiperplasia endometrial se clasifica actualmente en hiperplasia sin atipia o benigna y en lesión precancerosa, hiperplasia atípica / neoplasia intraepitelial endometrioide o EIN, según dos sistemas, el de la Organización Mundial de la Salud (OMS) que modificó sus anteriores clasificaciones en 2014 -aunque la de 1994 sigue siendo muy usaday el sistema de neoplasia intraepitelial endometrial (EIN). Aún no está claro qué sistema de clasificación de la hiperplasia endometrial debe utilizarse para el control y tratamiento de las pacientes. Objetivo: Revisar y evaluar metaanálisis que comparen los sistemas de clasificación para la hiperplasia endometrial de la Organización Mundial de la Salud y el sistema EIN. Métodos: Revisión sistemática de estudios de metaanálisis utilizando los términos de búsqueda 'hiperplasia endometrial' en las bases de datos PubMed, Embase y Lilacs. Los metaanálisis finalmente seleccionados se calificaron con la herramienta de evaluación AMSTAR 2. Resultados : Se encontraron 154 artículos de los cuales, después de selección y lectura completa, finalmente se extrajeron tres para análisis cualitativo. La calificación de los metaanálisis revisados con la herramienta de evaluación AMSTAR 2 encontró que la confianza general de sus resultados fue críticamente baja. Conclusiones : Los datos muestran que la morfometría objetiva en el sistema EIN es más confiable que los criterios de la OMS para evaluar el riesgo de progresión de la hiperplasia endometrial a cáncer. La comparación entre el sistema de la OMS y el sistema subjetivo de EIN dio como resultado valores pronósticos similares. Otro metaanálisis mostró una clara discrepancia entre el sistema de la OMS de 1994 y el sistema EIN. La evaluación mediante la herramienta de evaluación AMSTAR-2 mostró que la confianza general en los resultados de los estudios evaluados fue críticamente baja.

ABSTRACT Background : Endometrial hyperplasia is currently classified into non-atypical or benign hyperplasia and precancerous lesion, atypical hyperplasia/endometrioid intraepithelial neoplasia or EIN, according to two systems, the World Health Organization (WHO) which modified its previous classifications in 2014 -although the 1994 classification is still widely usedand the endometrial intraepithelial neoplasia (EIN) system. It is still unclear which classification system for endometrial hyperplasia should be used for patient management and treatment. Objective : To review and evaluate meta-analyses comparing the World Health Organization classification systems for endometrial hyperplasia and the EIN system. Methods : Systematic review of meta-analysis studies using the search terms "endometrial hyperplasia" in PubMed, Embase and Lilacs databases. The meta-analyses finally selected were scored using the AMSTAR 2 assessment tool. Results : We found 154 articles of which, after selection and complete reading, three were finally extracted for qualitative analysis. The rating of the meta-analyses reviewed with the AMSTAR 2 assessment tool found that the overall confidence of their results was critically low. Conclusions : The data show that objective morphometry in the EIN system is more reliable than the WHO criteria for assessing the risk of progression of endometrial hyperplasia to cancer. Comparison between the WHO system and the subjective EIN system resulted in similar prognostic values. Another meta-analysis showed a clear discrepancy between the 1994 WHO system and the EIN system. Evaluation using the AMSTAR-2 assessment tool showed that the overall confidence in the results of the evaluated studies was critically low.

Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs.

The number of Hematopoietic Stem Cell Transplantations has risen in the past 20 years. The practice of outpatient Hematopoietic Stem Cell Transplantation programs is increasing in an attempt to improve the quality of patient care and reduce the demand for hospital admission. A systematic review of 29 comparative studies between in-hospital and outpatient treatment of Hematopoietic Stem Cell Transplantation, with no restriction by outpatient regime was conducted. This study aims to analyse the current evidence on the effects of the outpatient model on patient-centred outcomes, comparing both in-hospital and outpatient models for autologous and allogeneic HSCT using the Triple Aim framework: health outcomes, costs and experience of care. We found evidence on improved health outcomes and quality of life, on enhanced safety and effectiveness and on reduced overall costs and hospital stays, with similar results on overall survival rates comparing both models for autologous and allogeneic patients. We also found that the outpatient Hematopoietic Stem Cell Transplantation is a safe practice as well as less costly, it requires fewer days of hospital stay both for autologous and allogeneic transplantations. Under a situation of an increasing number of transplants, rising healthcare costs and shortages of hospital capacity, incorporating outpatient models could improve the quality of care for people requiring Hematopoietic Stem Cell Transplantation programs.

Primary lymphoma of the uterine cervix: case report

ABSTRACT Introduction: Primary lymphoma of the uterine cervix is a rare disease, with nonspecific symptoms, that seldom alters Pap smear results since it develops in the cervical stroma. Chemotherapy, radiation therapy, and surgery, as well as their combination, are some of the medical options available for treatment. The unique location of the lymphoma in the cervix is considered a good prognostic factor. Case presentation: A 49-year-old female patient consulted due to pelvic pain and vaginal discharge and bleeding. She underwent a colposcopy due to cytology findings of ASC-H (atypical squamous cells that do not exclude high-grade squamous intraepithelial lesions). The biopsy reported diffuse large B-cell lymphoma, which was initially treated with three cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, and was then switched to two cycles with rituximab, ifosfamide, carboplatin and etoposide due to a poor response with the first scheme. A new biopsy was performed after the last cycle of chemotherapy with a report of endocervical polyp and abundant clusters of glandular cells with focal atypia. Post-treatment diagnostic imaging studies reported concentric thickening of the cervix-vagina junction. Seven years after being diagnosed with lymphoma, another biopsy was performed. The result was negative for dysplasia or malignancy. At the time of writing this case report, 10 years after diagnosis, the patient is asymptomatic and disease-free. Conclusions: Primary lymphoma of the uterine cervix is an unusual condition that is rarely detected through an abnormal Pap smear result, as in this case. A colposcopy was done because of this finding, confirming the diagnosis of diffuse large B-cell lymphoma. This case report describes the satisfactory evolution of the patient and disease-free survival after 10 years.

RESUMEN Introducción. El linfoma primario del cuello uterino es una patología infrecuente, de síntomas inespecíficos y que pocas veces altera el examen de citología del cuello uterino dado que se desarrolla en el estroma cervical. Para su tratamiento existen varias opciones, incluyendo quimioterapia, radioterapia y cirugía, así como combinaciones de estas. La localización única del linfoma en el cuello uterino se considera un factor de buen pronóstico. Presentación del caso. Paciente femenina de 49 años, quien consultó por dolor pélvico y flujo y sangrado genital. Se ordenó colposcopia por reporte de ASC-H (células escamosas atípicas que no excluyen lesiones intraepiteliales de alto grado) en citología vaginal. La biopsia reportó linfoma difuso de células B grandes, el cual se trató con rituximab, ciclofosfamida, doxorrubicina, vincristina y prednisolona por tres ciclos, y con rituximab, ifosfamida, carboplatino y etopósido por dos ciclos; este cambio se hizo debido a una mala respuesta con el primer esquema. Se realizó nueva biopsia después del último ciclo de quimioterapia con reporte de pólipo de tipo endocervical y abundantes grupos de células glandulares con atipia focal. Los estudios de imágenes diagnósticas posteriores al tratamiento reportaron engrosamiento concéntrico de la unión entre cuello uterino y vagina. A los 7 años del diagnóstico del linfoma se realizó otra biopsia que resultó negativa para displasia o malignidad. Al momento de la elaboración del presente reporte, 10 años después del diagnóstico, la paciente se encontraba asintomática y libre de enfermedad. Conclusiones. El linfoma primario del cuello uterino es una patología rara que en pocas oportunidades se evidencia con anormalidad en la citología vaginal como en el caso reseñado. Dado este hallazgo se realizó una colposcopia mediante la cual se confirmó el diagnostico de linfoma difuso de células B grandes. Se presenta un caso con evolución satisfactoria y supervivencia libre de enfermedad después de 10 años.

First nation-wide estimation of tobacco consumption in Spain using wastewater-based epidemiology.

Wastewater-based epidemiology (WBE) has become a very useful tool to monitor a population's drug consumption or exposure to environmental and food contaminants. In this work, WBE has been applied to estimate tobacco consumption in seven Spanish regions. To this end, 24 h composite wastewater samples were taken daily for one week in 17 wastewater treatment plants, covering altogether a population of ca. 6 million inhabitants. The samples were treated by enzymatic deconjugation and the wastewater content of two human-specific nicotine metabolites (namely, cotinine and trans-3'-hydroxycotinine) was measured to estimate the daily consumption of nicotine. The population-weighted average nicotine consumption in the seven analyzed regions was 2.2 g/(day∙1000 inh.), without any daily pattern. This average estimated nicotine consumption value agreed with the value derived from official tobacco sales data. Differences in consumption among the seven studied regions were found, being Galicia, the region with the lowest rate, and the Basque Country and Catalonia those with the highest rates. However, no conclusive correlation was found between those values and the prevalence data taken from two different national surveys, nor sociodemographic and health data. This study demonstrates that this tool can complement other indicators in order to accurately assess tobacco consumption rates at regional and national levels and provides the most extensive application of the approach in the Spanish territory.

Evidence of conflicts of interest in Medicine / Evidencia sobre conflictos de intereses en medicina

Abstract Introduction: Physicians' main responsibility is to practice medicine for the benefit of patients. However, there are situations where secondary interests affect this commitment and give rise to conflicts of interest. Objective: To analyze currently available systematic reviews and meta-analyses on conflicts of interest in medicine to summarize relevant evidence in this regard. Material and methods: A literature search was performed in the MEDLINE and LILACS databases using the following search strategy: systematic reviews and meta-analysis on conflicts of interests in medicine published in serialized scientific journals; no publication time or language limits were applied. Studies that met the inclusion criteria were grouped according to the medical activity they assessed, and information on the type and number of studies and conclusions of all publications included in the review was collected. Results: 29 publications were included, and they were classified as follows: studies based on research articles, on clinical practice guidelines, on clinical practice, and on patient-oriented papers. Conclusions: It was found that the authors of the original research papers included in the meta analyses and systematic reviews analyzed here do not always state if they have conflicts of interest or not. Nevertheless, when said conflicts are reported, they tend to present results favoring the drugs or medical technologies of their sponsor.

Resumen Introducción. La principal responsabilidad de los médicos es la de actuar en beneficio de los pacientes; sin embargo, existen situaciones en las cuales surgen intereses secundarios que pueden afectar este compromiso y generar conflictos de intereses. Objetivo. Analizar las revisiones sistemáticas y los metaanálisis actualmente disponibles en la literatura sobre el conflicto de intereses en medicina para sintetizar la información al respecto. Materiales y métodos. Se realizó una búsqueda en las bases de datos MEDLINE y LILACS mediante la siguiente estrategia de búsqueda: revisiones sistemáticas y metaanálisis sobre conflictos de intereses en medicina publicados en revistas científicas seriadas; no se aplicaron restricciones de idioma o año de publicación. Los estudios que cumplieron con los criterios de inclusión fueron agrupados según la actividad médica evaluada; además, de cada uno de ellos se extrajo la cantidad y el tipo de estudios y las conclusiones. Resultados. Se seleccionaron 29 publicaciones que se agruparon en estudios basados en artículos de investigación, en guías de práctica clínica, en la práctica clínica, y en publicaciones orientadas a los pacientes. Conclusiones. Los estudios originales incluidos en las revisiones sistemáticas y los metaanálisis analizados en el presente estudio no siempre reportan los conflictos de intereses; sin embargo, cuando estos se mencionan, hay una tendencia a presentar resultados que favorecen el medicamento o la tecnología del patrocinador.

Use of legal and illegal substances in Malé (Republic of Maldives) assessed by wastewater analysis.

This study used wastewater-based epidemiology (WBE) to investigate the lifestyle of the inhabitants of Malé, the capital of the Republic of Maldives. Raw wastewater 12-h composite samples were collected from nine pumping stations serving the city area - thus representative of the whole Malé population. Samples were analysed by liquid chromatography coupled to mass spectrometry for estimating the profile of use of a large number of substances including illicit drugs, alcohol, caffeine, tobacco and pharmaceuticals. The illicit drugs most used were cannabis (THC) and heroin (700 and 18 g/day), with lower consumption of cocaine and amphetamines (0.1-1.2 g/day). It is important to note that the consumption of cannabis in Malé was comparable to that measured in other countries, while the consumption of heroin was higher. Among cathinones, mephedrone was detected at the highest levels similar to other countries. Consumption of alcohol, which is not allowed in Maldives, was found (1.3 L/day/1000 inhabitants), but at a low level compared with other countries (6-44 L/day/1000 inhabitants), while the consumption of caffeine and tobacco was generally in line with reports from other countries. Unique information on pharmaceuticals use was also provided, since no official data were available. Human lifestyle was evaluated by applying for the first time the full set of WBE methodologies available in our laboratory. Results provided valuable epidemiological information, which may be useful for national and international agencies to understand population lifestyles better, including illicit drug issues, and for planning and evaluation of drug prevention programs in Malé.

Carcinoma seroso de ovario. Serie de 14 casos y revisión de la bibliografía / Serous ovarian cancer. Report of 14 cases and review of the bibliography

Resumen OBJETIVO: Describir las características epidemiológicas, clínicas, de laboratorio, de tratamiento médico-quirúrgico y patología, en una serie de 14 pacientes con carcinoma seroso de ovario atendidas en un hospital de alta complejidad y revisión de la bibliografía con el fin de actualizar los conceptos. MATERIALES Y MÉTODOS: Estudio de serie de casos retrospectivo y descriptivo de pacientes con cáncer de ovario seroso confirmado por patología. Las pacientes se estudiaron en un hospital general de alta complejidad entre 2013 y 2016. Variables de estudio: epidemiológicas, clínicas, de laboratorio, del tratamiento médico quirúrgico, comorbilidades y patología. Revisión narrativa de la bibliografía correspondiente a la información relacionada con las variables evaluadas. RESULTADOS: Se diagnosticaron 14 mujeres, de 50 a 80 años; 3 casos con antecedente de histerectomía y 1 de salpingoclasia. Diagnóstico histológico: 10 con tumor seroso de alto grado, 2 moderadamente diferenciado, 1 seroso de bajo grado y otro no clasificado. Procedimientos quirúrgicos: histerectomía, salpingooforectomía bilateral, linfadenectomía, omentectomía en 8 casos. Clasificación en estadios: IV en 6, 3 IIIB, 2 IC, 1 IIIC y una 1 IB. Tratamiento: 10 mujeres con carboplatino y paclitaxel. Revisión de 2227 artículos encontrados, 41 seleccionados. CONCLUSIONES: El carcinoma seroso de ovario se clasifica, actualmente, en bajo y alto grado (más frecuente y agresivo). Este tipo fue el más frecuente, los factores de riesgo encontrados, por el número reducido de pacientes, no permiten emitir conclusiones.

Abstract OBJECTIVE: To describe the epidemiological, clinical, laboratory, surgical medical management and pathology characteristics in a series of 14 patients with serous ovarian carcinoma in a highly complex hospital and review of the literature in order to update the concepts. MATERIALS AND METHODS: Retrospective and descriptive case series study of a patient with serous ovarian cancer confirmed by pathology. The patients were studied in a highly complex general hospital between 2013 and 2016. Study variables: Epidemiological, clinical, laboratory surgical medical treatment, comorbidities, and pathology. Narrative review of the bibliography corresponding to information related to the evaluated variables. RESULTS: Fourteen women between the ages of 50 and 80 were diagnosed, 3 with a history of hysterectomy and 1 with tubal ligation. Histological diagnosis: 10 with high-grade serous tumor, 2 moderately differentiated, 1 low-grade serous and one not classified. Surgical procedures: hysterectomy, bilateral salpinges-oophorectomy, lymphadenectomy, omentectomy in 8 cases. They classified into states: IV in 6, 3 IIIB, 2 IC, 1 IIIC and 1 IB. Treatment 10 women with carboplatin and paclitaxel. Review 2227 articles were found, 41 sectioned. CONCLUSIONS: Serous ovarian carcinoma is currently classified as low and high grade (more frequent and aggressive). This type was the most frequent, the risk factors found by the reduced number do not allow conclusions to be drawn.

Factores que influyen en el rendimiento académico de residentes de Obstetricia y Ginecología de una universidad en Bogotá, Colombia / Factors that influence the academic performance of residents of Obstetrics and Gynecology of a university in Bogotá, Colombia

RESUMEN La formación de postgrado en medicina, conocida como Residencia, es un período de alta exigencia para el médico en formación. El rendimiento académico durante este período puede ser afectado por algunos factores socioeconómicos, psicoafectivos y otros que dependen de la característica del programa de postgrado. Para evaluar la influencia de estos factores en los residentes de Obstetricia y Ginecología de una universidad, se realizó un estudio descriptivo transversal. Los factores con mayor influencia en el rendimiento académico fueron los de contar con una motivación constante y poseer estabilidad económica propia y familiar. En la evaluación de los factores psicoafectivos, aquellos con mayores respuestas positivas fueron las consideraciones de que la función primordial es aprender, la percepción de que los exámenes no evalúan realmente lo aprendido y el hecho de enfrentar en el hospital los problemas emocionales con calma. Los residentes afirmaron que nunca han sido víctimas de intimidación, acoso, ofensas o agresiones por parte de sus compañeros. En conclusión, varios factores influyen, de manera muy importante, en el rendimiento académico de este grupo de residentes, principalmente, la estabilidad económica propia y de otros miembros de la familia, motivación constante, estar en función de aprendizaje, manejo con calma de los problemas emocionales y la apreciación de que los exámenes no evalúan realmente lo aprendido. Estos factores deben ser tenidos en cuenta porque, además de afectar la formación del residente, pueden también interferir en la atención de los pacientes y su identificación puede promover programas de bienestar para estos profesionales.

ABSTRACT Postgraduate training in medicine, known as Residence, is a period of high demand for the medical practitioner. The academic performance of this professional can be affected by some socioeconomic, psycho-affective and other factors that depend on the characteristic of the postgraduate program. To evaluate the influence of these factors on residents of Obstetrics and Gynecology of an university, a cross-sectional descriptive study was performed. The factors with the greatest influence on academic performance were those of having a constant motivation and have their own and family economic stability. In the evaluation of psycho-affective factors, the factors with the highest positive responses were the consideration that the primary function as a resident is to learn, the perception that exams do not really assess what they have learned and the fact of facing emotional problems in the hospital with calm. All residents said they have never been victims of constant intimidation, harassment, offenses or attacks by any of their partners. In conclusion, several factors have a very important influence on the academic performance of this group of residents, mainly their own economic stability and of the other family members, constant motivation, being in a learning function, calmly handling emotional problems and the appreciation that exams do not really assess what they have learned. These factors must be taken into account, because in addition to affecting the resident's training they can also interfere with patient care and identifying them can promote wellness programs for these professionals.

Determination of human metabolites of chlorinated phosphorous flame retardants in wastewater by N-tert-butyldimethylsilyl-N-methyltrifluoroacetamide-derivatization and gas chromatography-high resolution mass spectrometry.

The analysis of wastewater for the determination of human biomarkers of exposure (human metabolites) is a non-intrusive, economic and complementary alternative to the analysis of urine in the monitoring of human exposure to chemicals of concern. This study provides the first gas chromatography-based method for the determination of three metabolites of chlorinated organophosphorous flame retardants (OPFRs: bis(2-chloroethyl) phosphate, bis(chloropropyl) phosphate and bis(1,3-dichloro-2-propyl) phosphate) in wastewater. A solid-phase extraction procedure based on the use of mixed-mode reversed-phase weak anion exchange sorbents was optimized including a fractionated elution of OPFRs and their metabolites. Analytes derivatization was investigated by comparing two silylating reagents, N-tert-butyldimethylsilyl-N-methyltrifluoroacetamide and N-methyl-N-(trimethylsilyl)trifluoroacetamide, the first one providing better results. Determination was performed by gas chromatography-high resolution mass spectrometry with a quadrupole-time-of-flight system (GC-QTOF) in order to improve selectivity. Furthermore, the use of GC-QTOF combined with the specific ion obtained from silylated metabolites (m/z 154.9924) can be exploited to screen for other phosphate ester metabolites. Under final conditions, the overall method performance was satisfactory, affording method detection limits ranging from 1.1 to 4.6 ng/L, percentages of recovery from 90% to 110%, and relative standard deviations below 13%. The analysis of composite raw wastewater samples collected over 24 h in the NW of Spain allowed to quantify, for the first time in this matrix, the metabolite bis(chloropropyl) phosphate at levels over 60 ng/L.

[Cost-effectiveness of risk-reducing salpingo-oophorectomy in cases of BRCA1 gene mutation in Colombia]. / Costo efectividad de la cirugía reductora de riesgo en trompas y ovarios en casos con mutación del gen BRCAI en Colombia.

OBJECTIVE: To assess the usefulness of risk reduction salpingo-oophorectomy in cases with mutation of the BRCA1 gene in Colombia. MATERIAL AND METHODS: Cost-effectiveness analysis in which three processes are incorporated: a. Patients with screening tests for breast and ovarian cancer. b. Risk reduction surgery in the fallopian tubes and ovaries c. Reductive surgery in the fallopian tubes and ovaries with bilateral mastectomy. The outcome is evaluated as the gain in years of survival. RESULTS: The cohort with risk reduction surgery in the fallopian tubes and ovaries and bilateral mastectomy is the one with the highest gain with 13 years, while the risk reduction surgery in the fallopian tubes and ovaries gain 4.95 years with respect to the follow-up group. CONCLUSIONS: The three options evaluated are acceptable, but of them the one with the greatest gain in survival is the combination of risk-reducing surgery in the fallopian tubes and ovaries with bilateral mastectomy.

OBJETIVO: Evaluar la utilidad de la cirugía reductora de riesgo en trompas y ovarios en casos con mutación del gen BRCA1 en Colombia. MATERIAL Y MÉTODOS: Análisis de costo-efectividad en el que se incorporan tres procesos: a. Pacientes con pruebas de tamización para cáncer de mama y ovario. b. cirugía reductora de riesgo en trompas y ovarios c. cirugía reductora de riesgo en trompas y ovarios con mastectomía bilateral. Se evalúa como desenlace la ganancia en años de supervivencia. RESULTADOS: La cohorte con cirugía reductora de riesgo en trompas y ovarios y mastectomía bilateral es la de mayor ganancia con 13 años mientras que la cirugía reductora de riesgo en trompas y ovarios gana 4,95 años con respecto al grupo de seguimiento. CONCLUSIONES: Las tres opciones evaluadas son aceptables, pero de ellas la de mayor ganancia en la supervivencia es la combinación de cirugía reductora de riesgo en trompas y ovarios con mastectomía bilateral.

[Evaluation of the need for specialists in oncology, Bogota, Colombia, 2015]. / Evaluación de la necesidad de especialistas oncólogos en Bogotá, Colombia, 2015.

OBJECTIVE: To evaluate the need of oncologists for cancer care in Bogotá. MATERIAL AND METHODS: The Ministerio de Salud y Protección Social de Colombia (SISPRO) consultation report of malignant neoplasms is compared to a model of four treatment consultations and two of controls per year, according to the estimation of incidence and prevalence. Based on these data, the need for oncologists is calculated and compared with the registry that this ministry has of independent professionals (private practice in the office) and public and private health care institutions. RESULTS: When comparing the consultations made with those estimated for the care, it Is found that the indispensable consultations are not met with notable exception in lymphomas and leukemias, with more consultations than expected, and in ovary cancers, thyroid, cancers in other body parts and unspecified. The productivity of professionals in relation to the number of independent professionals is low, with excess supply in surgical oncology specialties except for urology; and there is a deficit in hematology oncology, clinical oncology and radiotherapy. But in this last situation, when including other sources, it is not found that the number of these specialists is lower than required. CONCLUSIONS: The oncological surgical specialties have an oversupply in Bogotá except for urology, while clinical oncology and radiotherapy, that have a number under the register of independent professionals, are supplemented by physicians from public and / or private health care institutions.

OBJETIVO: Evaluar la necesidad de médicos oncólogos para la atención de cáncer en Bogotá. MATERIAL Y MÉTODOS: El reporte de consultas de neoplasias malignas del Ministerio de Salud y Protección Social de Colombia (SISPRO) se compara con un modelo de cuatro consultas para tratamiento y dos de controles para el año según la estimación de incidencia y prevalencia. Con base en estos datos, se calcula la necesidad de oncólogos que se comparan con el registro que tiene este ministerio de profesionales independientes (práctica privada en consultorio) e instituciones prestadoras de salud públicas y privadas. RESULTADOS: Al comparar las consultas realizadas con las estimadas para la atención se encuentra que no se cumplen las consultas indispensables con excepción notable en linfomas y leucemias, con más consultas que las esperadas, y en los cánceres de ovario, tiroides, cánceres en otros sitios y los no especificados. La productividad de los profesionales con relación al número de profesionales independientes es baja, con exceso de oferta en las especialidades oncológicas quirúrgicas con excepción de urología, y hay déficit en hematología oncológica, oncología clínica y radioterapia. Pero en esta última situación, al incluir otras fuentes, tampoco se encuentra que el número de estos especialistas sea inferior al requerido. CONCLUSIONES: Las especialidades quirúrgicas oncológicas tienen sobreoferta en Bogotá con excepción de urología, mientras que oncología clínica y radioterapia, que presentan un número inferior con respecto al registro de profesionales independientes, se suplen con los médicos de instituciones prestadoras de salud públicas y/o privadas.