The BIGG-REC database makes available all WHO/PAHO evidence informed recommendations.

OBJECTIVES: To build and maintain a living database of the Pan American Health Organization/World Health Organization (PAHO/WHO) recommendations developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). STUDY DESIGN AND SETTING: Guidelines are identified from WHO and PAHO databases. We periodically extract recommendations, according to the health and well-being targets of sustainable development goal 3 (SDG-3). RESULTS: As of March 2022, the International database of GRADE guidelines (https://bigg-rec.bvsalud.org/en) database hosted 2,682 recommendations contained in 285 WHO/PAHO guidelines. Recommendations were classified as follows: communicable diseases (1,581), children's health (1,182), universal health (1,171), sexual and reproductive health (910), noncommunicable diseases (677), maternal health (654), COVID-19 (224), use of psychoactive substances (99), tobacco (14) and road and traffic accidents (16). International database of GRADE guidelines allows searching by SDG-3, condition or disease, type of intervention, institution, year of publication, and age. CONCLUSION: Recommendation maps provide an important resource for health professionals, organizations and member states that use evidence-informed guidance to make better decisions, providing a source for the adoption or adaptation of recommendations to meet their needs. This one-stop shop database of evidence-informed recommendations built with intuitive functionalities undoubtedly represents a long-needed tool for decision-makers, guideline developers, and the public at large.

How I treat Parkinson's disease / Como eu trato a doença de Parkinson

ABSTRACT Background: Parkinson's disease (PD) is a complex neurodegenerative condition. Treatment strategies through all stages of disease progression could affect quality of life and influence the development of future complications, making it crucial for the clinician to be on top of the literature. Objective: This paper reviews the current treatment of PD, from early to advanced stages. Methods: A literature review was conducted focusing on the treatment of PD, in the different stages of progression. Results: Every individual with a new diagnosis of PD should be encouraged to start exercising regularly. In the early stage, treatment should focus on using the lowest dose of levodopa or combination therapy that provides maximum functional capacity, and does not increase the risk of complications, such as peak dose dyskinesias and impulse control disorders. At the moderate and advanced stages, motor fluctuations and complications of treatment dominate the picture, making quality of life one important issue. Rehabilitation programs can improve motor symptoms and should be offered to all patients at any stage of disease progression. Conclusion: Many factors need to be considered when deciding on the best treatment strategy for PD, such as disease progression, presence of risk factors for motor and behavioral complications, potential side effects from dopaminergic therapy and phenotypical variabilities. Treatment should focus on functional capacity and quality of life throughout the whole disease course.

RESUMO Antecedentes: A doença de Parkinson (DP) é uma doença neurodegenerativa complexa. As estratégias de tratamento ao longo de todos os estágios da evolução podem influenciar a qualidade de vida e o desenvolvimento de futuras complicações e, portanto, devem ser devidamente conhecidas pelos médicos que assistem o paciente. Objetivo: Neste artigo são revistos os tratamentos atuais para a DP, desde o estágio inicial até os estágios avançados. Métodos: Uma revisão da literatura foi realizada com enfoque em diferentes estágios da doença. Resultados: Todos os pacientes que recebem o diagnóstico de DP devem ser orientados a praticar atividades físicas regularmente. Em fase inicial do tratamento a estratégia consiste em usar doses mínimas de levodopa ou terapias combinadas que propiciem máxima capacidade funcional, que não aumentem o risco de complicações motoras, tais como discinesias induzidas por levodopa, ou não motoras, como transtornos do controle do impulso. Em estágio moderado ou avançado da doença, complicações como flutuações motoras e discinesias tornam-se relevantes e devem ser manejadas adequadamente. Programas de reabilitação devem ser oferecidos para os pacientes em todos os estágios da DP. Conclusões: Vários fatores devem ser considerados ao se escolher a melhor estratégia para o tratamento da DP. Entre eles destacam-se: fatores de risco para o desenvolvimento de complicações motoras e comportamentais, potenciais efeitos colaterais da terapia dopaminérgica e variabilidade fenotípica. O objetivo das estratégias de tratamento ao longo de toda a evolução da doença é a melhoria da capacidade funcional e da qualidade de vida dos pacientes.

Padecimiento mental y consumo problemático en jóvenes en conflicto con la ley / Padecimiento mental y consumo problemático en jóvenes en conflicto con la ley

El presente recorrido se inserta en el marco del Equipo Interdisciplinario de Responsabilidad Joven (para jóvenes en conflicto con la ley), dependiente de la Dirección de Niñez y Adolescencia del municipio de Tres de Febrero. Este equipo está integrado por dos Lic. en Trabajo Social, tres Lic. en Psicología y una Psicóloga Social, quienes somos convocados por la justicia para evaluar situaciones de vulneración o riesgo de vulneración de derechos en niñas, niños o adolescentes involucrados en alguna causa penal, para ser abordados en función de la restitución de los mismos y, en consecuencia, y realizar estrategias de intervención que tiendan a evitar futuras situaciones de transgresión a la ley penal. En este contexto se reciben casos de jóvenes con causas de robo, abuso sexual, agresiones o contravenciones leves, entre otras y a partir de las cuales se activan los circuitos necesarios para articular con los distintos sectores que participan de la vida cotidiana de los mismos. A partir del caso de un joven de 17 años con quien se interviene desde el año 2019 por haber cometido algunos delitos menores, y sumado a situaciones de violencia familiar, nos proponemos analizar uno de los mayores obstáculos que se presenta en el abordaje intersectorial, producto de la misma complejidad que construye a los casos. Nos referimos a la situación en la que surgen padecimientos duales de su evaluación, con problemáticas de consumo y de salud mental. Con esto, buscamos situar algunas coordenadas propias del abordaje de este equipo en interrelación con los distintos sectores intervinientes. Entre ellos el área de educación y el de salud, con quienes más se articulan nuestras intervenciones cotidianamente

Absence of Bim sensitizes mice to experimental Trypanosoma cruzi infection.

Chagas disease is a life-threatening disorder caused by the protozoan parasite Trypanosoma cruzi. Parasite-specific antibodies, CD8+ T cells, as well as IFN-γ and nitric oxide (NO) are key elements of the adaptive and innate immunity against the extracellular and intracellular forms of the parasite. Bim is a potent pro-apoptotic member of the Bcl-2 family implicated in different aspects of the immune regulation, such as negative selection of self-reactive thymocytes and elimination of antigen-specific T cells at the end of an immune response. Interestingly, the role of Bim during infections remains largely unidentified. To explore the role of Bim in Chagas disease, we infected WT, Bim+/-, Bim-/- mice with trypomastigotes forms of the Y strain of T. cruzi. Strikingly, our data revealed that Bim-/- mice exhibit a delay in the development of parasitemia followed by a deficiency in the control of parasite load in the bloodstream and a decreased survival compared to WT and Bim+/- mice. At the peak of parasitemia, peritoneal macrophages of Bim-/- mice exhibit decreased NO production, which correlated with a decrease in the pro-inflammatory Small Peritoneal Macrophage (SPM) subset. A similar reduction in NO secretion, as well as in the pro-inflammatory cytokines IFN-γ and IL-6, was also observed in Bim-/- splenocytes. Moreover, an impaired anti-T. cruzi CD8+ T-cell response was found in Bim-/- mice at this time point. Taken together, our results suggest that these alterations may contribute to the establishment of a delayed yet enlarged parasitic load observed at day 9 after infection of Bim-/- mice and place Bim as an important protein in the control of T. cruzi infections.

Conocimientos, actitudes, prácticas y subregistro de dengue en el municipio de Tocaima, Cundinamarca, 2019 / Knowledge, acttitudes, practices and dengue under registration Tocaima, Cundinamarca 2019

Introducción. Pese a las estrategias de vigilancia se cree que existe subregistro de dengue, lo que puede ser secundario a la no detección de casos ya sea por no consulta del paciente, por falla en el diagnóstico o diligenciamiento de fichas de notificación. Objetivo. Estimar el subregistro de los casos de dengue en el municipio de Tocaima durante el periodo de enero a septiembre de 2019 y establecer los conocimientos, actitudes y prácticas respecto al dengue de los habitantes del municipio. Metodología. Se realizó un estudio transversal de prevalencia durante el período de enero a septiembre de 2019 en la población urbana de Tocaima, mediante encuestas a dos viviendas de las 262 manzanas seleccionadas por muestreo aleatorio simple en la búsqueda activa comunitaria y en el 100% de los registros individuales de prestación de servicios y del sistema de vigilancia nacional en salud pública SIVIGILA mediante Búsqueda Activa Institucional BAI. Resultados. Se encuestaron 440 personas de las cuales 19 manifestaron haber presentado síntomas y signos de dengue en el periodo de estudio, de estos, seis personas no asistieron a consulta médica. El Subregistro Comunitario por falta de asistencia a consulta médica fue de 31,5%. Se identificaron en SIVIGILA 125 casos de dengue notificados en el periodo y 156 en el Registro Individual de Prestación de Servicios (RIPS), aplicando el método de Chandra-Sekar Deming se estimaron un total de 257 casos, para un Subregistro Institucional de SIVIGILA de 48,5%. Conclusiones. Son diversas las razones por las cuales no se notificaron todos los casos de la enfermedad al sistema de vigilancia, la primera es que solo se notifican los casos de las personas que consultan a los servicios de salud y que además viven en Tocaima, la segunda es que algunos casos detectados no se notificaron al sistema de vigilancia por errores de procedimiento, o por desconocimiento del diagnóstico por el personal de salud.

Introduction. Despite the surveillance strategies, it is believed that there is an underreporting of dengue, which may be secondary to the non-detection of cases, either due to non-consultation of the patient, due to failure in the diagnosis or filling in of notification sheets. Objective. Estimate the under-registration of dengue cases in the municipality of Tocaima during the period from January to September 2019 and to establish the knowledge, attitudes and practices regarding dengue of the inhabitants of the municipality. Methodology and materials. A cross-sectional study of prevalence was carried out during the period from January to September 2019, in the urban population of Tocaima, through surveys of 2 dwellings of the 262 blocks selected by simple random sampling in the active community search, and in 100% of individual records of service provision and Sivigila through institutional active search. Results. 440 people were surveyed, 19 of whom reported having symptoms and signs of dengue in the study period, of these, six people did not attend a medical consultation. The Community Under-registration for lack of attendance at medical consultation was 31.5%. 125 cases of dengue reported in the period were identified in SIVIGILA and 156 in the Individual Service Provision Registry (RIPS), applying the Chandra-Sekar Deming method, a total of 257 cases were estimated, for a SIVIGILA Institutional Sub-registry of 48,5%. Conclusions. There are several reasons why not all cases of the disease were notified to the surveillance system, the first is that only the cases of people who consult the health services and who also live in Tocaima, the second, some cases detected were not notified to the surveillance system due to procedural errors, or due to lack of knowledge of the diagnosis by health personne.

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children.

OBJECTIVE: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. METHODS: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Peri-procedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. RESULTS: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P = 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P = 0.01) compared to those with peri-procedural AIS. CONCLUSIONS: Children with cardiac disease are at risk for AIS at the time of cardiac procedures but also outside of the immediate 72 hours after procedures. Many have acute systemic illness or thrombotic event preceding AIS, suggesting that inflammatory or prothrombotic conditions could act as a stroke trigger in this susceptible population.

Comparison of effectiveness between a conventional catheter and a manual commercial catheter: randomized trial of simulation of intraosseous access in a biological model / Comparación de la eficacia entre un catéter convencional y un catéter comercial manual: ensayo aleatorizado de simulación de acceso intraóseo en modelo biológico

Abstract Introduction: In the emergency services an action of paramount importance in critically ill patients is to obtain an early vascular access. When vascular access is not established, an intraosseous route should be obtained; otherwise, the mortality of these critically ill patients is almost 100%. In Colombia, the intraosseous access is not used because of the high costs of the devices and the lack of training of the healthcare staff to conduct the procedure. Objective: To determine the efficacy of a low-cost device to establish intraosseous access. Materials and methods: Quantitative approach, experimental design in a simulated environment with chicken tarsus and metatarsus. An analysis was conducted using frequency tables and central tendency measurements. Likewise, further analyses were done using Fisher's exact test, Chi2, and Mann-Whitney test. Results: A total of 99% of the procedures were successful with both catheters. The average time for intraosseous access was 6.6 seconds with Insyte 14 catheter and 4.7 seconds with Din 1515x Illinois Desch device (P = 0.001). There were no significant differences in the number of attempts to secure a successful intra-osseous access using any of the 2 devices (P = 0.56). Conclusion: There was no significant difference between the Ci 14 and the Si 14 catheter to establish a successful intraosseous access in the chicken tarsus and metatarsus in a simulated environment.

Resumen Introducción: En los servicios de urgencias una acción de primordial importancia en pacientes críticamente enfermos es obtener un acceso vascular temprano. En los casos en que no se logre obtener un acceso venoso, se debe obtener una vía intraósea, o de lo contrario la mortalidad de estos pacientes críticamente enfermos asciende casi al 100%. En Colombia no se realiza el uso del acceso intraóseo por los altos costos de los dispositivos requeridos y la falta de entrenamiento del personal de salud para dicho procedimiento. Objetivo: Determinar la eficacia de un dispositivo de bajo costo para el acceso intraóseo. Materiales y métodos: Enfoque cuantitativo, diseño experimental en ambiente simulado con tarso-metatarso de pollo. Se realizó un análisis mediante tablas de frecuencia y medidas de tendencia central. Así mismo, se realizaron análisis mediante el test exacto de Fisher, ji cuadrado y test de Mann Whitney. Resultados: El 99% de los procedimientos fueron exitosos con los dos catéteres. La mediana del tiempo para el acceso intraóseo fue de 6.6 segundos con el catéter Insyte 14® y de 4.7 segundos con el dispositivo Din 1515x Illinois Desch® (p=0.001). No se encontraron diferencias significativas en el número de intentos para lograr un acceso intraóseo exitoso con ambos dispositivos (p = 0.56). Conclusiones: No existe diferencia significativa entre el catéter Ci 14 y el Di 15 para lograr un acceso intraóseo exitoso en el tarso metatarso del pollo en un ambiente simulado.

Hipoplasia dérmica focal / Focal Dermal Hypoplasia

El síndrome de Goltz llamado también hipoplasia dérmica focal es una rara dermatosis que fue definida por primera vez por Goltz en el año 1962. Se la considera una genodermatosis de presentación esporádica (95% de los pacientes) aunque se han reportado casos de transmisión familiar. Compromete estructuras derivadas del mesodermo y ectodermo con predominio en el sexo femenino acompañada de herencia dominante ligada al cromosoma X. La mutación en el gen PORCN (locus Xp11.23) es letal en la mayoría de varones. La importancia de su publicación radica en su baja frecuencia y las manifestaciones clínicas características que ayudan al establecer el diagnóstico.

Goltz syndrome, also called focal dermal hypoplasia, is a rare dermatosis that was first defined by Goltz in 1962. It is considered a genodermatosis with sporadic presentation (95% of patients) although familiar aggregation has been reported. It compromises mesodermal and ectodermal structures, most frequently in female patients, its inheritance mode is dominant X linked. The mutation in the PORCN gene (locus Xp11.23) is lethal in the majority of males. The importance of its publication lies in its low frequency and clinical characteristic that helps in establishing the correct diagnosis.

Recomendaciones basadas en la evidencia de terapia transfusional en el paciente oncológico en pediatría / Transfusion therapy evidence-based recommendations for the pediatric cancer patient

Introduction: Transfusion therapy is probably one of the most widely used therapies with poor supporting evidence, despite the long years of practical clinical use. Objective: To adapt the evidence-based recommendations on the use of blood products to the Colombian setting: red blood cells, platelets, cryoprecipitates and irradiated blood products in cancer patients under 18 years of age. Methods: Standard methodologies were followed in the development of recommendations. First, the clinical questions were addressed, and the evidence-based clinical practice guidelines were identified, graded and selected to answer the clinical questions. A systematic methodology was used to qualify, obtain and describe the relevant information to generate recommendations based on the SIGN system. The results were then presented and discussed in a group of experts to establish the practical value of the evidence and to adapt the recommendations to the Colombian environment. Results: Out of 107,441 preliminary titles, 56 studies were analyzed, and from them 3 clinical practice guidelines and 4 Cochrane systematic reviews were selected. This evidence was evaluated using AGREE II and AMSTAR. Red blood cells transfusion support is recommended using the restrictive strategy. Prophylactic platelet transfusion is the recommended indication. Cryoprecipitate is recommended when fibrinogen levels fall below 100mg/dL, and indications on irradiated blood products were established. Conclusion: This paper is an evidence-base approach on the recommendations for transfusion therapy in children with cancer.

Introducción: La terapia transfusional es quizá una de los tratamientos de mayor uso sin buen respaldo de evidencia, a pesar de muchos años de uso en la práctica clínica. Objetiuo:Adaptar recomendaciones basadas en evidencia al contexto colombiano sobre el uso de hemocomponentes: glóbulos rojos, plaquetas, crioprecipitados y hemocomponentes irradiados en el paciente oncológico menor de 18 años. Métodos: Se utilizaron metodologías estándares para el desarrollo de las recomendaciones. Primero se formularon las preguntas clínicas, se identificaron, calificaron y seleccionaron las guías de práctica clínica basadas en la evidencia que respondían las preguntas clínicas, utilizando una metodología sistemática se realizó la calificación, extracción y descripción de los aspectos relevantes para generar recomendaciones usando el sistema SIGN, luego se realizaron exposición y discusión de los resultados obtenidos con un grupo de expertos para seleccionar la utilidad de la evidencia y adaptar las recomendaciones al contexto colombiano. Resultados: De 107.441 títulos preliminares, se analizaron 56 estudios, y de estos se escogieron 3 guías de práctica clínica y 4 revisiones sistemáticas Cochrane. Se evaluó esta evidencia con AGREE II y AMSTAR. Se recomienda soporte transfusional de glóbulos rojos usando la estrategia restrictiva, la estrategia transfusional profiláctica de plaquetas es la indicación recomendada. El valor de fibrinógeno menor de 100mg/dl es el recomendado para utilizar crioprecipitados y se determinaron las indicaciones sobre hemocomponentes irradiados. Conclusiones Este trabajo representa un enfoque basado en la evidencia sobre las recomendaciones de terapia transfusional para niños con cáncer.

La globalización y su impacto en enfermería / Quality of working life in the nursing staff: a review systematic in the current literatura

El siguiente trabajo tiene como finalidad reflexionar acerca del impacto que tiene el proceso de globalización en el personal de enfermería, concluyendo con la importancia que tiene el espíritu de emprendedor y la perspectiva de género.

Manual de práctica clínica basado en la evidencia: controles posquirúrgicos / Evidence-based clinical practice manual: Postoperative controls

Introduction: Post-anesthetic care reduces the anesthesia-related postoperative complications and mortality, shortens the length of stay at the postoperative care units and improves patient satisfaction. Objective: To establish a set of recommendations for immediate post-anesthetic care of patients that received general/regional anesthesia or profound/moderate sedation at the postoperative care units. Methodology: This is a process of "rapid" clinical practice guidelines adaptation, including systematic search. The illegible guidelines for adaptation were rated using AGREE II. The guideline selected to be adapted as the clinical practice handbook was Practice guidelines for post-anesthetic care of the American Society of Anesthesiologists. The manual was evaluated in terms of implementation ability, up-to-date information, relevancy, ethical considerations and patient safety by the group of anesthesiologists and epidemiologists based on Delphi. Result:The manual kept the recommendations on evaluation and monitoring, pharmacological management of postoperative nausea and vomiting, antagonistic actions for sedatives and analgesics and neuromuscular block agents, emergency management and anesthesia recovery, as well as the criteria for discharge from the unit. Indications about the conditions and requirements of the unit and patient admission were also included. Conclusions: This handbook comprises the basic guidelines for primary management of patients at the postoperative care unit. It may be amended or adapted according to the institutional requirements and for specific patient groups and is not intended to replace the existing protocols at the particular institution and does not define outcomes or prognosis.

Introducción: El cuidado posanestésico disminuye las complicaciones y mortalidad poso-peratorias inmediatas relacionadas con la anestesia, acorta la estancia en las unidades de cuidado posoperatoro y mejora la satisfacción de los pacientes. Objetivo: Establecer un conjunto de recomendaciones para el cuidado posantestésico inmediato de los pacientes que recibieron anestesia general/regional o sedación profunda/moderada en la unidades de cuidado posoperatorio. Metodología: Un proceso de adaptación "rápida" de guías de práctica clínica, que incluyó búsqueda sistemática. Se calificaron las guías elegibles a adaptar, mediante AGREE II. La guía seleccionada para su adaptación como manual de práctica clínica fue Practice guidelines for postanesthetic care dela American Society of Anesthesiologists. El manual fue evaluado por un grupo de anestesiólogos y epidemiólogos mediante Delphi, en términos de implementab-ilidad, actualización, pertinencia, consideraciones ética y seguridad del paciente. Resultado: El manual mantuvo las recomendaciones sobre evaluación y monitorización, manejo farmacológico de náuseas y vómito posoperatorio, antagonismo de los efectos de sedantes, analgésicos y agentes de bloqueo neuromuscular, el manejo de la emergencia y recuperación anestésica, y los criterios para egreso de la unidad. Se incluyeron indicaciones sobre condiciones y requisitos de la unidad y el ingreso del paciente a esta. Conclusiones: Este manual es una guía básica sobre el manejo primario de los pacientes en la unidad de cuidado posoperatorio, puede ser modificado o adaptado según los requerimientos institucionales y para grupos específicos de pacientes; no pretende reemplazar los protocolos existentes en cada institución ni puede definir desenlaces ni pronósticos.

Recomendaciones basadas en la evidencia del manejo de complicaciones posquirúrgicas en el contexto colombiano / Evidence-based clinical practice manual: Postoperative complications management

Introduction: Despite advances in perioperative management, acute pain and postoperative nausea and vomitingcontinue to be significant complications worldwide. The frequency and the implications of these complications for the process of recovery impact clinical findings, patient quality of care, and hospital costs. Materials and methods: A search and systematic review of the literature after 2011 was conducted. Three international guidelines were selected and they were paired-rated for quality using the AGREE II tool. Management recommendations, adjusted to the Colombian setting, were adopted on the basis of expert consensus, using the Delphi methodology. Results: Recommendations were generated for adult patients based on the international pain management guidelines for acute pain, postoperative nausea and vomiting, and transfer of critically ill patients. Some of the recommendations are of general nature while others are specific forparticular situations. They were all adapted to the Colombian context, bearing in mind the use of drugs which have not received approval from the healthcare authorities or which are not included in the Mandatory Healthcare Plan. Conclusions: Updating and standardizing clinical management recommendations based on the literature on international guidelines is a useful process, provided it is adapted to the national context. This process and its outcome may be useful for healthcare providers and has a positive effect on patient safety, practitioner performance and efficient use of resources.

Introducción: A pesar de los avances en el manejo perioperatorio, el dolor agudo y las náuseas y vómito posoperatorio aún son importantes complicaciones a nivel mundial. Su frecuencia de presentación y el grado de afectación en el proceso de recuperación impactan aspectos clínicos, la calidad de la atención de los pacientes y los costos hospitalarios. Materiales y métodos: Se realizó búsqueda y revisión sistemática de la literatura a partir de 2011. Se seleccionaron tres guías internacionales y se calificó la calidad de manera pareada con el instrumento AGREE II. Mediante consenso de expertos y utilizando metodología Delphi, se adaptaron las recomendaciones de manejo adaptadas al medio colombiano. Resultados: Se generaron recomendaciones para pacientes adultos extraídas de las guías de manejo internacional de dolor agudo, náuseas y vómito posoperatorio y transporte de paciente complicado. Algunas de las recomendaciones son generales y otras especificas para situaciones particulares. Todas fueron adaptadas al contexto colombiano teniendo en cuenta medicamentos que no cuentan con registro sanitario o no están incluidos en el Plan Obligatorio de Salud. Conclusiones: La actualización y estandarización de recomendaciones de manejo clínico basadas en la literatura de guías internacionales es un proceso útil siempre y cuando se adapte al contexto nacional. Este proceso y su resultado puede ser utilizado por prestadores de salud e impactar positivamente la seguridad del paciente, el desempeño de los profesionales sanitarios y la eficiencia de los recursos.

Caracterizacion clinica, epidemiologica y terapeutica de los pacientes con fotoenvejecimiento cutaneo en un hospital de Cuba / Clinical, epidemiological and therapeutics characteristics of patients with photoaiging in a hospital of Cuba

Caracterizar desde los puntos de vista epidemiol¢gico, cl¡nico y de respuesta terap‚utica a los pacientes con fotoenvejecimiento cut neo (FEC). Pacientes y m‚todo. Estudio descriptivo, longitudinal, ambispectivo, en 109 pacientes con FEC del servicio de Dermatolog¡a del Hospital Hermanos Ameijeiras (La Habana, Cuba) en el per¡odo 2009-2014. Se determinaron edad, sexo, fototipo de piel, estado civil, grado de escolaridad, ocupaci¢n, h bitos t¢xicos, enfermedades concomitantes y caracter¡sticas cl¡nicas de las lesiones. Se describieron los tratamientos recibidos y la respuesta a los mismos. Resultados. Se presentaron con mayor frecuencia pacientes mayores de 40 a¤os del sexo femenino, fototipos de piel II y III, de grado escolar preuniversitario, con h bitos de fumar e ingesti¢n de caf‚ y alcohol. Las lesiones predominantes fueron las arrugas finas y gruesas, lentigos act¡nicos, sequedad, aspereza; localizadas preferentemente en las mejillas, nariz y frente; asociadas a prolongado tiempo de evolucion de la enfermedad, gran  rea de afectaci¢n, elevado n£mero y tama¤o de las lesiones. Los tratamientos utilizados fueron peeling con  cido salic¡lico al 30% (AS-30%), peeling con  cido tricloroac‚tico al 25% (ATA-25%), criocirug¡a y radiocirug¡a. Las lesiones que no respondieron de forma total a los peeling con AS-30% o con ATA-25% se resolvieron con criocirug¡a. Conclusi¢n. Predominaron los pacientes de mayor edad, del sexo femenino, con fototipos II y III; con arrugas finas, gruesas y lentigos act¡nicos. La eficacia terap‚utica fue total o parcial en las modalidades de tratamiento utilizadas, y la criocirug¡a fue una alternativa a los peeling con AS-30% o con ATA-25%.

Objective. The aim was to obtain the clinical and epidemiological characteristics of patients with skin photoaiging and to know the received treatment and their therapeutic efficacy. Patients and method. We perfored a descriptive, ambispective astudy in 109 with skin photoaiging, attended in the dermatology departament of the Hermanos Ameijeiras Hospital between 2009 and December 2014. We determined different epidemiological variables, such as: age, sex skin phototype, civil state, schooling, occupation, toxic habits; the clinical characteristics of the lesions; and were evaluated the received treatments and their response. Results. The most frequents epidemiological characteristics of patients were femenine, older than 40 years old, married, workers, with II and III skin phototype. The most frequents clinical were: very large evolution's time of the illness associated to big affected area and high number and size of the lesions (fine and thick wrinkles, solar lentigo, dryness, asperity, flabbiness, freckle and telangiectasia), localized in cheek, noise and in the forehead. The received treatments were: peeling with 30% salicylic acid (SA-30%), peeling with 25% trchloroacetic acid (TCA-25%), cryosurgery and radiosurgery. Total or partial responses were found in all treatments applied. The skin lesions with partial responses to treatments with peeling with SA-30% or peeling with TCA-25% had better successwith cryosurgery. Conclusions. To predominate women older than 40 years old, with low skin prototype type and many lesions like fine and thinck wrinkles and solar lentigo. Total or partial responses were found in all treatments applied and the cryosurgery is on of the alternatives to treatment with peeling with SA-30% or with TCA-25%.

La importancia de evaluar síntomas y alteraciones funcionales en enfermedades neurológicas crónicas: experiencia en cuidado paliativo y rehabilitación en una institución colombiana / The Importance of Evaluating Symptoms and Functional Alterations in Chronic Neurological Diseases: Experiences in Palliative Care and Rehabilitation at a Colombian Institution / A importância da avaliação de sintomas e limitações funcionais nas doenças neurológicas crônicas: experiência em cuidados paliativos e de reabilitação em uma instituição na Colombia

Existe un incremento en la prevalencia de enfermedades neurológicas y su carga de enfermedad. Debido a ello, identificar la frecuencia de síntomas y las alteraciones funcionales es de vital importancia para definir un adecuado plan de tratamiento. Se llevó a cabo un estudio de corte transversal para identificar los síntomas principales y las alteraciones funcionales en pacientes neurológicos de un centro de referencia colombiano para manejo de rehabilitación. Se encontraron como síntomas y alteraciones funcionales más frecuentes: alteraciones de la marcha (65,5 %), desórdenes de comunicación (36,98 %), alteraciones emocionales y de memoria (38 %), dolor (29,45 %) y alteraciones en las actividades básicas cotidianas (24,3 %). El 50 % de los pacientes que reportaron dolor, el 30 % de los que manifestaron insomnio y el 80 % de los que refirieron estreñimiento no recibieron tratamiento en la primera consulta. Algunos de los síntomas identificados no son características que definen la enfermedad, y no siempre son objeto de intervención. Los resultados de este estudio pueden contribuir a reconocer la carga de los síntomas de las enfermedades neurológicas, sensibilizando a los profesionales de la salud acerca de la importancia del cuidado paliativo en pacientes con enfermedades progresivas no oncológicas.

There is an increase in the prevalence of neurological diseases and the burden they impose. Therefore, identifying the frequency of symptoms and the functional alterations is of paramount importance to develop an adequate treatment plan. A cross-sectional study was carried out to pinpoint the main symptoms and functional alterations in neurological patients at a rehabilitation center in Colombia. The five most frequent symptoms and functional alterations identified were: walking disorders (65.5%), communication disorders (36.98%), memory and emotional alterations (38%), pain (29.45%), and alterations in activities of daily living (24.3%). Fifty percent of the patients who reported pain, 30% of those who complained of insomnia, and 80% of those who mentioned constipation did not receive treatment during the first consultation. Some of the identified symptoms are not characteristics that define the disease, and are not always the subject of intervention. The results of this study can contribute to recognition of the burden of the symptoms of neurological diseases, by making health professionals more aware of the importance of palliative care for patients with non-oncological progressive diseases.

A prevalência de doenças neurológicas e sua carga de doença têm aumentado. Portanto, é de importância vital identificar a freqüência dos sintomas e o comprometimento funcional para definir um plano de tratamento adequado. Para identificar os principais sintomas e a limitação funcional em pacientes neurológicos de um centro de referência para manejo da reabilitação na Colômbia se realizou um estudo transversal. Os sintomas e as limitações funcionais mais freqüentes foram: distúrbio da marcha (65,5%), distúrbios da comunicação (36,98%), distúrbios emocionais e da memória (38%), dor (29,45%) e alterações em atividades básicas diárias (24,3%). O 50% dos pacientes que relataram dor, 30% das pessoas que manifestaram insônia e 80% daqueles que relataram constipação não foram tratados na primeira consulta. Alguns dos sintomas identificados não são características que definem a doença, nem sempre eles são objeto de intervenção. Os resultados deste estudo podem ajudar a reconhecer o peso dos sintomas da doença neurológica através da sensibilização de profissionais da saúde sobre a importância dos cuidados paliativos em pacientes com doenças progressivas não cancerosas.

Manejo farmacológico del dolor neuropático / Pharmacological Management of Neuropathic Pain

El dolor neuropático es una patología cuya prevalencia requiere proponer guías de manejo. Su severidad y, en algunos casos, dificultad para el tratamiento deterioran la calidad de vida. La prevalencia reportada en Europa es del 5%, y en dolor crónico post-operatorio varía entre 5 y 85% dependiendo del tipo de cirugía. El objetivo del presente artículo es revisar las alternativas farmacológicas para el manejo de dolor neuropático de acuerdo con su fundamento fisiopatológico, y presentar sugerencias para el manejo con medicamentos disponibles en Colombia, incluidos y no incluidos en el Plan Obligatorio de Salud.

The prevalence of neuropathic pain requires proposals for management guidelines. In some cases, the degree of severity and the difficulty of treating this disorder has resulted in poor quality of life. In Europe, reported prevalence is 5%, and chronic postoperative pain ranges between 5% and 85%, depending on the type of surgery. The purpose of this paper is to review the pharmacological options for treating neuropathic pain depending on the pathophysiology, and suggest therapeutical approaches with medications available in Colombia, included or not in the Mandatory Health Plan.

Characterization of structurally defined epitopes recognized by monoclonal antibodies produced by chronic lymphocytic leukemia B cells.

Despite a wealth of information about the structure of surface membrane immunoglobulin (smIg) on chronic lymphocytic leukemia (CLL) cells, little is known about epitopes reacting with their binding sites. Probing phage-displayed peptide libraries, we identified and characterized mimetopes for Igs of 4 patients with IGHV mutated CLL (M-CLL) and 4 with IGHV unmutated CLL (U-CLL). Six of these mAbs were representatives of stereotyped B-cell receptors characteristic of CLL. We found that mimetic epitopes for U- and M-CLL Igs differed significantly. M-CLL-derived peptides exhibited better amino acid motifs, were more similar to each other, aligned more easily, and formed tighter clusters than U-CLL-derived peptides. Mono-, oligo-, and polyreactivity of peptides correlated with structural changes within antigen-binding sites of selecting M-CLL mAbs. Although M-CLL-isolated peptides and certain U-CLL mAbs bound more effectively to the selecting mAb, others were not as specific, reacting with M-CLL and U-CLL mAbs; these data suggest that in vivo structurally diverse epitopes could bind smIgs of distinct CLL clones, thereby altering survival and growth. Finally, an M-CLL-derived peptide inhibited, in a dose-dependent manner, binding of its homologous mAb to human B lymphocytes; therefore peptides that inhibit or alter the consequences of antigen-smIg interactions may represent therapeutic modalities in CLL.

Isothermal titration calorimetry reveals differential binding thermodynamics of variable region-identical antibodies differing in constant region for a univalent ligand.

The classical view of immunoglobulin molecules posits two functional domains defined by the variable (V) and constant (C) regions, which are responsible for antigen binding and antibody effector functions, respectively. These two domains are thought to function independently. However, several lines of evidence strongly suggest that C region domains can affect the specificity and affinity of an antibody for its antigen (Ag), independent of avidity-type effects. In this study, we used isothermal titration calorimetry to investigate the thermodynamic properties of the interactions of four V region-identical monoclonal antibodies with a univalent peptide antigen. Comparison of the binding of IgG1, IgG2a, IgG2b, and IgG3 with a 12-mer peptide mimetic of Cryptococcus neoformans polysaccharide revealed a stoichiometry of 1.9-2.0 with significant differences in thermodynamic binding parameters. Binding of this peptide to the antibodies was dominated by favorable entropy. The interaction of these antibodies with biotinylated peptides manifested greater enthalpy than for native peptides indicating that biotin labeling affected the types of Ag-Ab complexes formed. Our results provide unambiguous thermodynamic evidence for the notion that the C region can affect the interaction of the V region with an Ag.

Interaction of radiolabeled antibodies with fungal cells and components of the immune system in vitro and during radioimmunotherapy for experimental fungal infection.

BACKGROUND: The usefulness of radioimmunotherapy (RIT) for infectious diseases was recently demonstrated for several fungal and bacterial infections, but the mechanisms by which RIT is effective against microbes are uncertain. METHODS: We investigated the interaction between polysaccharide capsule-binding 18B7 monoclonal antibodies (MAbs) labeled with alpha-emitter 213Bi and Cryptococcus neoformans cells as well as between 213Bi-18B7 and components of immune system, both in vitro and in vivo. RESULTS: For 213Bi-18B7, the microbicidal effect was predominantly due to "direct-hit" killing, with some contribution from the "crossfire" effect. The efficacy of cell killing correlated with the binding capacity of the MAb to the capsule and was dependent on the MAb isotype. RIT also promoted the apoptosis-like death of fungal cells. Cooperation was observed in vitro between the antifungal activity of macrophages and RIT, suggesting the potential for synergistic action in vivo. RIT was associated with changes in concentration of the cytokines interleukin (IL)-2, IL-4, IL-10, tumor necrosis factor-alpha, and interferon-gamma, suggesting that the therapeutic effects of RIT may result from changes in the inflammatory response. CONCLUSIONS: The present results suggest that the antimicrobial efficacy of RIT involves killing through promotion of fungal cell apoptosis-like death, reduction in yeast capsule size, cooperation with macrophages, and modulation of the inflammatory response.

Cuaderno de Enfermería Pediátrica, Texto oficial / s

Crecimiento y desarrollo. Examen físico de enfermería en el niño. Atención y valoración del recién nacido a término. Asfixia perinatal. Crecimiento intrauterino. La atención del niño de bajo peso. Anexos