The Impact of Health Inequities on Population-Based Breast Cancer Survival in a Colombian Population, 2008-2015.

OBJECTIVE: To obtain breast cancer survival estimates in Manizales, Colombia, considering socioeconomic level, health insurance regime and residential area, while adjusting for age, histology and stage at diagnosis. METHODS: Analytical cohort study based on breast cancer incident cases recorded by the Population-based Manizales Cancer Registry between 2008-2015. Patients were followed-up for 60 months. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the Wilcoxon-Breslow-Gehan test for differences. Cox multivariate regression models were fitted. RESULTS: 856 breast cancer cases were included. The 5-year cause-specific survival for the entire cohort was 78.2%. It was higher in women with special/exception health insurance, high socioeconomic level, <50 years old, ductal carcinoma, and stages I and II. Residential area did not impact survival. In Cox models, the subsidized health insurance regime (HR: 4.87 vs contributory) and low socioeconomic level (HR: 2.45 vs high) were predictors of the hazard of death in women with breast cancer, adjusted for age, histology, stage and interactions age-stage and insurance-stage. A positive interaction (synergistic effect modification) between health insurance regime and stage regarding to survival was observed. CONCLUSION: Socioeconomic factors significantly contribute to the inequities in breast cancer survival, independent of the stage at diagnosis. This suggests the need for comprehensive interventions to remove barriers to accessing the health system. This research provides evidence of survival gaps mediated by certain social determinants of health and generates data on the overall performance of the Colombian health system.

Synthesis, characterization and structural analysis of complexes from 2,2':6',2''-terpyridine derivatives with transition metals.

The synthesis and structural characterization of three families of coordination complexes synthesized from 4'-phenyl-2,2':6',2''-terpyridine (8, Ph-TPY), 4'-(4-chlorophenyl)-2,2':6',2''-terpyridine (9, ClPh-TPY) and 4'-(4-methoxyphenyl)-2,2':6',2''-terpyridine (10, MeOPh-TPY) ligands with the divalent metals Co2+, Fe2+, Mn2+ and Ni2+ are reported. The compounds were synthesized from a 1:2 mixture of the metal and ligand, resulting in a series of complexes with the general formula [M(R-TPY)2](ClO4)2 (where M = Co2+, Fe2+, Mn2+ and Ni2+, and R-TPY = Ph-TPY, ClPh-TPY and MeOPh-TPY). The general formula and structural and supramolecular features were determinated by single-crystal X-ray diffraction for bis(4'-phenyl-2,2':6',2''-terpyridine)nickel(II) bis(perchlorate), [Ni(C21H15N3)2](ClO4)2 or [Ni(Ph-TPY)2](ClO4)2, bis[4'-(4-methoxyphenyl)-2,2':6',2''-terpyridine]manganese(II) bis(perchlorate), [Mn(C22H17N3O)2](ClO4)2 or [Mn(MeOPh-TPY)2](ClO4)2, and bis(4'-phenyl-2,2':6',2''-terpyridine)manganese(II) bis(perchlorate), [Mn(C21H15N3)2](ClO4)2 or [Mn(Ph-TPY)2](ClO4)2. In all three cases, the complexes present distorted octahedral coordination polyhedra and the crystal packing is determined mainly by weak C-H...π interactions. All the compounds (except for the Ni derivatives, for which FT-IR, UV-Vis and thermal analysis are reported) were fully characterized by spectroscopic (FT-IR, UV-Vis and NMR spectroscopy) and thermal (TGA-DSC, thermogravimetric analysis-differential scanning calorimetry) methods.

Acquisition of new function through gene duplication in the metallocarboxypeptidase family.

Gene duplication is a key first step in the process of expanding the functionality of a multigene family. In order to better understand the process of gene duplication and its role in the formation of new enzymes, we investigated recent duplication events in the M14 family of proteolytic enzymes. Within vertebrates, four of 23 M14 genes were frequently found in duplicate form. While AEBP1, CPXM1, and CPZ genes were duplicated once through a large-scale, likely whole-genome duplication event, the CPO gene underwent many duplication events within fish and Xenopus lineages. Bioinformatic analyses of enzyme specificity and conservation suggested a greater amount of neofunctionalization and purifying selection in CPO paralogs compared with other CPA/B enzymes. To examine the functional consequences of evolutionary changes on CPO paralogs, the four CPO paralogs from Xenopus tropicalis were expressed in Sf9 and HEK293T cells. Immunocytochemistry showed subcellular distribution of Xenopus CPO paralogs to be similar to that of human CPO. Upon activation with trypsin, the enzymes demonstrated differential activity against three substrates, suggesting an acquisition of new function following duplication and subsequent mutagenesis. Characteristics such as gene size and enzyme activation mechanisms are possible contributors to the evolutionary capacity of the CPO gene.

Incidence and mortality by cancer in the Pasto municipality, Colombia. 2013-2017.

Introduction: The information permanently produced by population cancer registries is the input used by decision makers of the local and national health systems in order for planning cancer prevention strategies and evaluating the impact of their interventions. Objective: To determine the incidence and mortality from cancer in the municipality of Pasto Colombia, 2013-2017 period. Methods: Descriptive observational study of cancer morbidity and mortality. The collection and processing of information was carried out following the recommendations of the IARC. Rates were calculated by sex, age, and tumor location. Results: The overall incidence of cancer was 3,759 cases; 1,608 in men (AAR= 169.4 cases/100,000 men-year), and 2,151 cases in women (AAR= 176.6 cases/100,000 women-year). The most frequent tumors in men were: prostate (25.9%), stomach (16.5%) and lung (4.8%); and in women: breast (19.7%), thyroid (12.2%) and cervix (10.6%). There were 2,130 cancer deaths, 934 in men (AAR=97.8 deaths/100,000 men-year) and 1,196 deaths in women (AAR=95.1 deaths/100,000 women-year). The main causes of mortality in men were tumors of the stomach (24.8%), prostate (12.8%) and lung (7.5%). In women: breast (12.2%), stomach (11.6%) and cervix (10.0%). Conclusion: The five-year follow-up of cancer burden indicators allows to make comparisons at both national and international levels, in order to provide the basis for planning and evaluating the implementation of public health policies; especially those related to the prevention and care of the most common causes of morbidity and mortality from cancer in Pasto-Colombia.

Introducción: La información producida permanentemente por los registros poblacionales de cáncer es el insumo utilizado por los tomadores de decisiones del sistema de salud local y nacional para planificar las estrategias de prevención del cáncer y evaluar el impacto de sus intervenciones. Objetivo: Determinar la incidencia y mortalidad por cáncer en el municipio de Pasto Colombia periodo 2013-2017. Métodos: Estudio observacional descriptivo de la morbimortalidad por cáncer. La recolección y procesamiento de información se realizaron siguiendo recomendaciones del IARC. Las tasas se calcularon según sexo, edad y ubicación del tumor. Resultados: La incidencia global de cáncer fue de 3.759 casos, 1.608 en hombres (Tasa Estandarizada de Edad TAE= 169.4 casos/100,000 hombres-año) y 2.151 casos en mujeres (TAE= 176.6 casos/100,000 mujeres-año). Los tumores más frecuentes en hombres fueron: próstata (25.9%), estómago (16.5%) y pulmón (4.8%) y en mujeres: mama (19.7%), tiroides (12.2%) y cérvix (10.6%). Se presentaron 2.130 muertes por cáncer, 934 en hombres (TAE=97.8 muertes/100,000 hombres-año) y 1.196 muertes en mujeres (TAE=95.1 muertes/100,000 mujeres-año). Las principales causas de mortalidad en hombres fueron los tumores de estómago (24.8%), próstata (12.8%) y pulmón (7.5%). En mujeres: mama (12.2%), estómago (11.6%) y cérvix (10.0%). Conclusión: El seguimiento quinquenal de los indicadores de carga de cáncer permite realizar comparaciones a nivel nacional e internacional con el fin de ofrecer las bases para planificar y evaluar la implementación de las políticas públicas de salud, relacionadas con la prevención y atención de las causas más comunes de morbimortalidad en Pasto-Colombia.

Sociodemographic and clinical characteristics related to the final condition of patients intoxicated by paraquat in a hospital in southwestern Colombia / Características sociodemográficas y clínicas relacionadas con la condición final de pacientes intoxicados por paraquat en un hospital del suroccidente de Colombia.

Introduction: Paraquat is an agrochemical that constitutes the first cause of death by poisoning in different countries. Objective: To relate sociodemographic and clinical characteristics with the final condition of patients intoxicated by paraquat in a hospital in southwestern Colombia. Materials and methods: This was an observational, descriptive, analytical, crosssectional, and retrospective study. We reviewed the medical records of patients diagnosed with paraquat poisoning at a level III hospital in Pasto, Colombia, from 2013 to 2018. We collected the data regarding their final condition (alive or deceased) and their sociodemographic, clinical, and paraclinical information. We established group comparisons and designed a binary logistic regression model. Results: We reviewed 299 records and, after the exclusion, we analyzed 160 cases. The characteristics related to the final condition of the patients were length of stay (OR = 0.124; 95% CI: 0.03-0.6; p = 0.009), heart rate (OR = 35.65; 95% CI: 1.44-884.78; p = 0.029), and initial creatinine (OR = 1.73; 95% CI: 1.23-2.44; p = 0.002). Conclusion: The proportion of case fatality was higher in patients with short hospital stay times and elevated heart rates and admission creatinine levels. This report may be useful as a rationale for the creation of a severity scale for the early detection of patients with adverse outcomes and their timely treatment.

Introducción. El herbicida paraquat constituye la primera causa de decesos por intoxicaciones en distintos países. Objetivo. Relacionar las características sociodemográficas y clínicas con la condición final de pacientes intoxicados por paraquat atendidos en un hospital del suroccidente de Colombia. Materiales y métodos. En este estudio observacional, descriptivo, analítico, transversal y retrospectivo, se revisaron las historias clínicas de pacientes atendidos por intoxicación con paraquat en una institución de tercer nivel de complejidad en Pasto (Colombia) entre el 2013 y el 2018. Se recolectó la información sobre la condición final (vivo o fallecido) de cada paciente, así como los datos sociodemográficos, clínicos y de los exámenes paraclínicos. Se establecieron comparaciones por grupos y se diseñó un modelo de regresión logística binaria. Resultados. Se filtró la información de 299 registros y se analizaron finalmente 160 casos. Las características relacionadas con la condición final de los pacientes fueron el tiempo de estancia (OR=0,124; IC95% 0,03-0,6; p=0,009), la frecuencia cardiaca (OR=35,65; IC95% 1,44-884,78; p=0,029) y la creatinina inicial (OR=1,73; IC95% 1,23-2,44; p=0,002). Conclusiones. La proporción de la letalidad fue mayor entre los pacientes con estancia hospitalaria corta, taquicardia y elevación de la concentración sérica de creatinina al ingreso. Este reporte puede ser útil como fundamento de una escala de gravedad para detectar a los pacientes con resultados adversos en la fase temprana para que puedan recibir una intervención oportuna.

Fragmentation of prostatic needle biopsy cores containing adenocarcinoma: the role of specimen submission.

OBJECTIVE: To determine the factors contributing to the fragmentation of prostatic core biopsies containing prostatic carcinoma, which might complicate the quantification of the number cores with cancer and/or the amount of tumour in a core. MATERIALS AND METHODS: Prostate biopsy cases containing fragmented cores with cancer and cancer cases present only in unfragmented cores were sought in records from the consultant service of one of the authors. A 'part' corresponded to the site-specific jar submitted by the urologist (i.e. left or right; left apex, left mid, etc.). Cases of prostatic adenocarcinoma with fragmented cores containing cancer (463) and cases with cancer lacking fragmented cores (200) were compared. RESULTS: The mean number of parts per case was 8.1 and 7.5 in the unfragmented and fragmented cases, respectively (not significant). The mean number of cores per part was significantly higher in the fragmented group than the unfragmented group (2.6 vs 2.1, P = 0.004). The number of parts containing cancer was higher in cases with fragmented cores than in cases with unfragmented cores (2.8 vs 1.6, P < 0.001). A higher mean Gleason score was associated with the cancer in fragmented cores than in unfragmented cores (6.6 vs 6.2, P < 0.001). Multivariate regression analysis showed that fragmentation was associated with the number of parts with cancer (P < 0.001), cores per part (P < 0.001) and Gleason score (P < 0.04). CONCLUSIONS: The number of parts per case with cancer, number of cores submitted per part, and Gleason score contribute to the likelihood of fragmentation of cores containing prostatic adenocarcinoma.

Non-invasive papillary urothelial neoplasms: the 2004 WHO/ISUP classification system.

The classification and grading of papillary urothelial neoplasms has been a long-standing subject of controversy. Previously, numerous diverse grading schemes for bladder tumor, including the 1973 World Health Organization (WHO) classification, existed whereby one of the major limitations was poor inter-observer reproducibility among pathologists. The WHO/International Society of Urological Pathology (ISUP) consensus classification system of urothelial neoplasms of the urinary bladder was developed in 1998 and was revised most recently in 2003 (published in 2004). Importantly, the current classification system provides detailed histological criteria for papillary urothelial lesions and allows for designation of a lesion (papillary urothelial neoplasm of low malignant potential) with a negligible risk of progression. Thus, the latest system is designed to be a universally acceptable one for bladder tumors that not only could be effectively used by pathologists, urologists, and oncologists, but also stratifies the tumors into prognostically significant categories. This article outlines the 2004 WHO/ISUP classification system regarding the specific histological criteria for non-invasive papillary urothelial neoplasms and the clinical significance of each category.

Mechanisms of action of paraoxon, an organophosphorus pesticide, on in vivo dopamine release in conscious and freely moving rats.

Paraoxon is the active metabolite of parathion, an organophosphorus pesticide which can cause neurotoxic effects in animals and humans. In the present work, we investigated the effects of 5 mM paraoxon on striatal dopamine, DOPAC and HVA levels in conscious and freely moving rats, after treatment with TTX, reserpine, nomifensine, KCl, Ca++-free/EDTA medium, AP-5 or L-NAME. The intrastriatal administration of paraoxon for 60 min, through the microdialysis probe, significantly produced an increase of the dopamine to 1066 ±â€¯120%, relative to basal levels. Administration of paraoxon to 20 µM TTX, 10 mg/kg reserpine or Ca++-free/EDTA medium-pretreated animals decreased the dopamine levels to 73%, 81%, and 70%, respectively, when compared with the effect of 5 mM paraoxon. Infusion of 50 µM nomifensine induced a maximal increase in extracellular dopamine levels to 1435 ±â€¯387%, and when nomifensine was coadministered with paraoxon, striatal dopamine levels increased to 2429 ±â€¯417%, an increase that was ∼230% higher that observed with the administration of the pesticide alone. Coinfusion of KCl and paraoxon produced an increase in extracellular dopamine to 1957 ±â€¯445%, that was significantly higher than that observed with POX or KCl (1104 ±â€¯220%) administered individually. Pretreatment with 650 µM AP-5 or 100 L-NAME reduced the effect of paraoxon on extracellular dopamine levels by 49.1% and 53.7%, respectively. Our results suggest that paraoxon induces dopamine release by a vesicular-, Ca++-, and deporalization-dependent mechanism, being independent of dopamine transporter. In addition, the paraoxon-induced dopamine release is mediated by glutamatergic and nitrergic neurotransmitter systems.

Epidemiologic Profile of Erectile Dysfunction in Patients with Systemic Lupus Erythematosus: The Latin American Landscape.

OBJECTIVE: The aim of this study was to describe the prevalence of erectile dysfunction (ED), as well as associated demographic and clinical features, in men with systemic lupus erythematosus (SLE), by means of a systematic, standardized evaluation. METHODS: We performed a transversal study in 8 tertiary care centers in Latin America. We included male patients ≥ 16 years who fulfilled ≥ 4 American College of Rheumatology criteria for SLE and had regular sexual activity, and evaluated them with the International Index of Erectile Function-5 questionnaire. Relevant demographic, clinical, and serological characteristics were recorded. We included 2 control groups: the first was made up of healthy men and the second of men with autoimmune diseases other than SLE (non-SLE group). RESULTS: We included 590 subjects (174 SLE, 55 non-SLE, and 361 healthy controls). The prevalence of ED in the SLE group was 69%. Mean age in that group was 36.3 ± 1.03 years. Among SLE patients with and without ED, these factors were significantly different: the presence of persistent lymphopenia (p = 0.006), prednisone dose (9.3 ± 1.2 vs 5.3 ± 1.3 mg, p = 0.026), and the Systemic Lupus International Collaborating Clinics damage score (1.25 ± 0.14 vs 0.8 ± 0.16 points, p = 0.042). Independent risk factors for ED in patients with SLE were persistent lymphopenia (OR 2.79, 95% CI 1.37-5.70, p = 0.001) and corticosteroid use in the previous year (OR 2.15, 95% CI 1.37-3.37, p = 0.001). CONCLUSION: Regardless of comorbidities, treatment (excluding steroids), and type of disease activity, patients with SLE have a high prevalence of ED, especially considering that most patients are young. Recent corticosteroid use and persistent lymphopenia, which could be related to endothelial dysfunction, are risk factors for this complication in men with SLE.

Characterization of acute intrastriatal effects of paraoxon on in vivo dopaminergic neurotransmission using microdialysis in freely moving rats.

Paraoxon (POX) is an extremely neurotoxic organophosphorous compound (OP) which main toxic mechanism is the irreversible inhibition of cholinesterase. Although the cholinergic system has always been linked as responsible for its acute effects, experimental studies have suggested that the dopaminergic system also may be a potential target for OPs. Based on this, in this study, the acute intrastriatal effects of POX on dopaminergic neurotransmission were characterized in vivo using brain microdialysis in freely moving rats. In situ administration of POX (5, 25 and 50 nmol, 60 min) significantly increased the striatal dopamine overflow (to 435 ± 79%, 1066 ± 120%, and 1861 ± 332%, respectively), whereas a lower concentration (0.5 nmol) did not affect dopamine levels. Administration of POX (25 nmol) to atropine (15 nmol) pretreated animals, produced an increase in dopamine overflow that was ∼63% smaller than those observed in animals not pretreated. Administration of POX (25 nmol) to mecamylamine (35 nmol) pretreated animals did not significantly affect the POX-induced dopamine release. Our results suggest that acute administration of POX increases the dopamine release in a concentration-dependent way, being this release dependent on acetylcholinesterase inhibition and mediated predominantly by the activation of striatal muscarinic receptors, once the muscarinic antagonist atropine partially blocks the POX-induced dopamine release.

Estenosis traqueal postintubación después de neumonía grave por coronavirus / Postintubation Tracheal Stenosis after Severe Coronavirus Pneumonia

Introducción: La rápida propagación del SARS­CoV­2 ha provocado una pandemia mundial. Si bien puede salvar vidas, la intubación traqueal presenta el riesgo inherente de inducir daño en la mucosa traqueal con estenosis, con una incidencia estimada de 4,9 casos por millón cada año. Objetivo: Caracterizar la presentación de una estenosis traqueal por intubación prolongada en un paciente que sufrió neumonía grave por coronavirus. Presentación del caso: Se asiste a un paciente de 55 años que sufrió neumonía grave por coronavirus y necesitó intubación orotraqueal prolongada. Una vez recuperado comienza con disnea de empeoramiento progresivo. Se diagnostica una estenosis traqueal y se decide tratamiento quirúrgico donde se realiza resección y anastomosis. El paciente no presentó complicaciones y evolucionó satisfactoriamente. Conclusiones: La estenosis traqueal debe reconocerse como una complicación potencial, aun cuando los pacientes se recuperan de una neumonía grave por COVID-19. El diagnóstico definitivo de estenosis traqueal se realiza mediante fibrobroncoscopia. La resección traqueal con anastomosis entre tráquea y tráquea es el procedimiento más comúnmente realizado(AU)

Introduction: The rapid spread of SARS-CoV-2 has resulted in a global pandemic. Although tracheal intubation can save lives, it presents the inherent risk of inducing tracheal mucosal damage with stenosis, with an estimated annual incidence of 4.9 cases per million. Objective: To characterize a case of tracheal stenosis due to prolonged intubation in a patient with severe coronavirus pneumonia. Case presentation: A 55-year-old patient who suffered severe coronavirus pneumonia and required prolonged orotracheal intubation was attended. Once recovered, the patient began with progressively worsening dyspnea. Tracheal stenosis was diagnosed and surgical treatment was decided, in which resection and anastomosis were performed. The patient did not present any complications and evolved satisfactorily. Conclusions: Tracheal stenosis should be recognized as a potential complication, even when patients recover from severe COVID-19 pneumonia. A definitive diagnosis of tracheal stenosis is made by fibrobronchoscopy. Tracheal resection with anastomosis between trachea is the most commonly performed procedure(AU)

Mucocele apendicular benigno / Benign Appendiceal Mucocele

Introducción: El mucocele apendicular se considera una lesión rara del apéndice que se caracteriza por la dilatación de la luz del órgano con acumulación de moco. Este puede ser benigno o maligno. Objetivo: Caracterizar un caso de mucocele apendicular de comportamiento benigno en un paciente adulto masculino. Presentación del caso: Se asiste a un paciente, en estudio de tumor de vías digestivas, que se interviene quirúrgicamente con cuadro peritoneal agudo hallando masa de localización apendicular. Se realiza apendicectomía convencional y se estudia la pieza por anatomía patológica como mucocele apendicular benigno. La evolución del paciente fue satisfactoria. Conclusiones: Se presenta clínicamente de forma inespecífica, lo que posibilita que su diagnóstico sea intraoperatorio con mayor frecuencia. La estrategia quirúrgica depende de los hallazgos intraoperatorios donde la apendicectomía y la hemicolectomía derecha son las técnicas más utilizadas. El pseudomixoma peritoneal es una complicación temida(AU)

Introduction: Appendiceal mucocele is considered a rare lesion of the appendix characterized by dilatation of the organ lumen with mucus accumulation. It can be benign or malignant. Objective: To characterize a case of appendiceal mucocele with benign behavior in an adult male patient. Case presentation: A patient under study of digestive tract tumor is attended. The patient underwent surgery for having acute peritoneal symptoms; a mass of appendicular location was found. Conventional appendicectomy was performed and the piece was studied by pathological anatomy, being a benign appendicular mucocele. The patient's evolution was satisfactory. Conclusions: This condition is presented clinically in a nonspecific manner, which makes for its diagnosis to be more frequently intraoperative. The surgical strategy depends on the intraoperative findings, in which appendectomy and right hemicolectomy are the most used techniques. Pseudomyxoma peritonei is a feared complication(AU)

Incidence and mortality by cancer in the Pasto municipality, Colombia. 2013-2017 / Incidencia y mortalidad por cáncer en el municipio de Pasto - Colombia, 2013-2017

Abstract Introduction: The information permanently produced by population cancer registries is the input used by decision makers of the local and national health systems in order for planning cancer prevention strategies and evaluating the impact of their interventions. Objective: To determine the incidence and mortality from cancer in the municipality of Pasto Colombia, 2013-2017 period. Methods: Descriptive observational study of cancer morbidity and mortality. The collection and processing of information was carried out following the recommendations of the IARC. Rates were calculated by sex, age, and tumor location. Results: The overall incidence of cancer was 3,759 cases; 1,608 in men (AAR= 169.4 cases/100,000 men-year), and 2,151 cases in women (AAR= 176.6 cases/100,000 women-year). The most frequent tumors in men were: prostate (25.9%), stomach (16.5%) and lung (4.8%); and in women: breast (19.7%), thyroid (12.2%) and cervix (10.6%). There were 2,130 cancer deaths, 934 in men (AAR=97.8 deaths/100,000 men-year) and 1,196 deaths in women (AAR=95.1 deaths/100,000 women-year). The main causes of mortality in men were tumors of the stomach (24.8%), prostate (12.8%) and lung (7.5%). In women: breast (12.2%), stomach (11.6%) and cervix (10.0%). Conclusion: The five-year follow-up of cancer burden indicators allows to make comparisons at both national and international levels, in order to provide the basis for planning and evaluating the implementation of public health policies; especially those related to the prevention and care of the most common causes of morbidity and mortality from cancer in Pasto-Colombia.

Resumen Introducción: La información producida permanentemente por los registros poblacionales de cáncer es el insumo utilizado por los tomadores de decisiones del sistema de salud local y nacional para planificar las estrategias de prevención del cáncer y evaluar el impacto de sus intervenciones. Objetivo: Determinar la incidencia y mortalidad por cáncer en el municipio de Pasto Colombia periodo 2013-2017. Métodos: Estudio observacional descriptivo de la morbimortalidad por cáncer. La recolección y procesamiento de información se realizaron siguiendo recomendaciones del IARC. Las tasas se calcularon según sexo, edad y ubicación del tumor. Resultados: La incidencia global de cáncer fue de 3.759 casos, 1.608 en hombres (Tasa Estandarizada de Edad TAE= 169.4 casos/100,000 hombres-año) y 2.151 casos en mujeres (TAE= 176.6 casos/100,000 mujeres-año). Los tumores más frecuentes en hombres fueron: próstata (25.9%), estómago (16.5%) y pulmón (4.8%) y en mujeres: mama (19.7%), tiroides (12.2%) y cérvix (10.6%). Se presentaron 2.130 muertes por cáncer, 934 en hombres (TAE=97.8 muertes/100,000 hombres-año) y 1.196 muertes en mujeres (TAE=95.1 muertes/100,000 mujeres-año). Las principales causas de mortalidad en hombres fueron los tumores de estómago (24.8%), próstata (12.8%) y pulmón (7.5%). En mujeres: mama (12.2%), estómago (11.6%) y cérvix (10.0%). Conclusión: El seguimiento quinquenal de los indicadores de carga de cáncer permite realizar comparaciones a nivel nacional e internacional con el fin de ofrecer las bases para planificar y evaluar la implementación de las políticas públicas de salud, relacionadas con la prevención y atención de las causas más comunes de morbimortalidad en Pasto-Colombia.

Características sociodemográficas y clínicas relacionadas con la condición final de pacientes intoxicados por paraquat en un hospital del suroccidente de Colombia / Sociodemographic and clinical characteristics related to the final condition of patients intoxicated by paraquat in a hospital in southwestern Colombia

Introducción. El herbicida paraquat constituye la primera causa de decesos por intoxicaciones en distintos países. Objetivo. Relacionar las características sociodemográficas y clínicas con la condición final de pacientes intoxicados por paraquat atendidos en un hospital del suroccidente de Colombia. Materiales y métodos. En este estudio observacional, descriptivo, analítico, transversal y retrospectivo, se revisaron las historias clínicas de pacientes atendidos por intoxicación con paraquat en una institución de tercer nivel de complejidad en Pasto (Colombia) entre el 2013 y el 2018. Se recolectó la información sobre la condición final (vivo o fallecido) de cada paciente, así como los datos sociodemográficos, clínicos y de los exámenes paraclínicos. Se establecieron comparaciones por grupos y se diseñó un modelo de regresión logística binaria. Resultados. Se filtró la información de 299 registros y se analizaron finalmente 160 casos. Las características relacionadas con la condición final de los pacientes fueron el tiempo de estancia (OR=0,124; IC95% 0,03-0,6; p=0,009), la frecuencia cardiaca (OR=35,65; IC95% 1,44-884,78; p=0,029) y la creatinina inicial (OR=1,73; IC95% 1,23-2,44; p=0,002). Conclusiones. La proporción de la letalidad fue mayor entre los pacientes con estancia hospitalaria corta, taquicardia y elevación de la concentración sérica de creatinina al ingreso. Este reporte puede ser útil como fundamento de una escala de gravedad para detectar a los pacientes con resultados adversos en la fase temprana para que puedan recibir una intervención oportuna.

Introduction: Paraquat is an agrochemical that constitutes the first cause of death by poisoning in different countries. Objective: To relate sociodemographic and clinical characteristics with the final condition of patients intoxicated by paraquat in a hospital in southwestern Colombia. Materials and methods: This was an observational, descriptive, analytical, crosssectional, and retrospective study. We reviewed the medical records of patients diagnosed with paraquat poisoning at a level III hospital in Pasto, Colombia, from 2013 to 2018. We collected the data regarding their final condition (alive or deceased) and their sociodemographic, clinical, and paraclinical information. We established group comparisons and designed a binary logistic regression model. Results: We reviewed 299 records and, after the exclusion, we analyzed 160 cases. The characteristics related to the final condition of the patients were length of stay (OR = 0.124; 95% CI: 0.03-0.6; p = 0.009), heart rate (OR = 35.65; 95% CI: 1.44-884.78; p = 0.029), and initial creatinine (OR = 1.73; 95% CI: 1.23-2.44; p = 0.002). Conclusion: The proportion of case fatality was higher in patients with short hospital stay times and elevated heart rates and admission creatinine levels. This report may be useful as a rationale for the creation of a severity scale for the early detection of patients with adverse outcomes and their timely treatment.

[Perceptions about their own old age from the perspective of a group of epidemiologists in training]. / Percepciones de un grupo de epidemiólogos en formación acerca de su propia vejez.

OBJECTIVE: Exploring, from the perspective of a group of epidemiologists in training, the perceptions about their own old age. MATERIAL AND METHODS: Exploratory, qualitative-descriptive study, in which ethnographic tools were applied: observation, field diary and group interview (GF). RESULTADOS: Explored from the perspective of a group of epidemiologists in training. The group agreed that to plan to reach a functional and decent old is important, despite the current unfavorable and adverse conditions, recognizing that not all will reach there, and it is less common for young people to think and plan their own old age, and even less work with and for the elderly. The meaning of aging most often mentioned by the group contain the word "phase", in which concept and care reflect the high standards desired individually. It became clear, that nursing homes for old age people are necessary, but the services provided are differentiated since "the economy determines the care for the elderly". CONCLUSION: Reflecting on the perception of old age itself, for the group of epidemiologists in training, helped visualize their concerns, fears, expectations, and to reflect on their responsibilities and possibilities in providing scientific evidence to plan and make sound decisions for a dignified old age and aging of the population from Nariño.

OBJETIVO: Explorar desde la mirada de un grupo de epidemiólogos en formación, las percepciones sobre su propia vejez. MATERIAL Y MÉTODOS: Estudio exploratorio, cualitativo - descriptivo, en el cual se hizo aplicación de herramientas etnográficas: observación, diario de campo y entrevista grupal (GF). RESULTADOS: El grupo consensuo que programarse para llegar a una vejez funcional y digna es importante, a pesar de las desfavorables y adversas condiciones actuales, reconociendo que no todos lograrán llegar a ella, y que es menos común en los jóvenes pensar y planear su propia vejez, y menos trabajar con y para los viejos. Los significados sobre vejez más frecuentemente referidos por el grupo contienen la palabra "etapa", en cuyo concepto y cuidados se reflejan los altos estándares deseados a nivel individual. Se puso de manifiesto que los hogares para ancianos son necesarios, pero que los servicios prestados son diferenciados pues "la economía determina la atención para el anciano". CONCLUSIÓN: La reflexión acerca de la percepción de la propia vejez, para el grupo de epidemiólogos en formación, ayudó a visualizar sus inquietudes, miedos, expectativas y a reflexionar acerca de su responsabilidad y posibilidades en el aporte de evidencia científica que permita planear y tomar decisiones acertadas para un envejecimiento y vejez dignas de la población nariñense.

Effects and mechanism of action of isatin, a MAO inhibitor, on in vivo striatal dopamine release.

Isatin is an endogenous indole that inhibits monoamine oxidase (MAO), being more selective for MAO-B than MAO-A isoform. By inhibiting MAO, isatin increases dopamine levels in the brain and, in animal models of Parkinson's disease (PD) isatin is able to prevent dopamine depletion. Contradictorily, some studies indicate that isatin did not increase striatal dopamine levels, although it was able to improve the motor signs in PD model. Given these conflicting data, our aim was to study the effects and neurochemical mechanisms of action of isatin on in vivo dopamine release from rat dorsal striatum using brain microdialysis technique in conscious and freely moving animals. Our results showed that intrastriatal administration of 1, 5 or 10 mM isatin, for 1 h, significantly increased dopamine levels to 355 ± 104%, 700 ± 72%, and 1241 ± 146%, when compared with basal values, respectively. The highest concentration of isatin (10 mM) was used to investigate whether the dopamine overflow is due to an exocytotic release or due to a possible action on dopamine transporter (DAT). The removal of Ca(++) from medium, administration of TTX (10 µM), or pretreatment with reserpine (10 mg/kg) significantly decreased by 90%, 83%, and 78%, respectively, the effect of isatin on dopamine levels. The blockade of DAT with nomifensine (50 µM) did not alter the effect of isatin; and isatin significantly increased the depolarization-evoked release of dopamine. These results suggest that isatin-induced dopamine release depends on vesicular dopamine content, and takes place due to a previous entry of Ca(++) and terminal depolarization.

Hipoglucemia hiperinsulínica en un adulto con nesidioblastosis / Hyperinsulinic Hypoglycemia in an Adult with Nesidioblastosis

RESUMEN Introducción: La Nesidioblastosis es una rara afección pancreática que provoca hipoglucemia por hipersinsulinismo endógeno en la infancia. Es poco habitual en el adulto; solo se han publicado casos aislados desde su descripción. Objetivo: Caracterizar la presentación de una hipoglucemia hiperinsulínica en un paciente adulto con Nesidioblastosis. Caso clínico: Paciente adulto de 35 años, blanco, sexo masculino, sospecha de insulinoma, con episodios de hipoglucemia en ayunas o tras un ejercicio que revertía con la ingesta de alimentos o soluciones glucosadas. Se le realizó pancreatectomía de un 85 por ciento y en el estudio histológico se detectó una Nesidioblastosis. Conclusiones: Es infrecuente en el adulto, realizar su diagnóstico es difícil, se llega a la cirugía con el conocimiento de un estado hiperinsulínico endógeno, sin la certeza de su origen(AU)

ABSTRACT Introduction: Nesidioblastosis is a rare pancreatic condition that causes hypoglycemia due to endogenous hypersinsulinism in childhood. It is unusual in adults; only isolated cases have been published including its description. Objective: To characterize a case of hyperinsulinic hypoglycemia, in an adult patient with nesidioblastosis. Clinical case: A 35-year-old, white, male, adult patient with suspected insulinoma, with episodes of hypoglycemia in the fasting state or after exercise that was reversed with ingestion of food or glucose solutions. 85 percent pancreatectomy was performed and nesidioblastosis was detected in the histological study. Conclusions: It is rare in adults, making its diagnosis is difficult, and surgery is reached with the knowledge of an endogenous hyperinsulinic state, without the certainty of its origin(AU)

Multimodal image data fusion for Alzheimer's Disease diagnosis by sparse representation.

Alzheimer's Diasese (AD) diagnosis can be carried out by analysing functional or structural changes in the brain. Functional changes associated to neurological disorders can be figured out by positron emission tomography (PET) as it allows to study the activation of certain areas of the brain during specific task development. On the other hand, neurological disorders can also be discovered by analysing structural changes in the brain which are usually assessed by Magnetic Resonance Imaging (MRI). In fact, computer-aided diagnosis tools (CAD) that have been recently devised for the diagnosis of neurological disorders use functional or structural data. However, functional and structural data can be fused out in order to improve the accuracy and to diminish the false positive rate in CAD tools. In this paper we present a method for the diagnosis of AD which fuses multimodal image (PET and MRI) data by combining Sparse Representation Classifiers (SRC). The method presented in this work shows accuracy values up to 95% and clearly outperforms the classification outcomes obtained using single-modality images.

Calidad percibida de la atención en salud en una red pública del municipio de Pasto, Colombia / Perceived quality of health care in a public network in the municipality of Pasto, Colombia

Resumen Introducción: Las percepciones de los usuarios frente a los servicios de salud son indicadores indispensables de calidad sobre procesos de atención sanitaria. Objetivo: Conocer las percepciones de los usuarios de una red pública del municipio de Pasto, Colombia frente a la calidad de los servicios de salud del primer nivel de atención. Materiales y métodos: Investigación cualitativa con enfoque histórico hermenéutico con 28 participantes, usuarios de centros de atención rurales y urbanos. Las técnicas de recolección de información desarrolladas fueron entrevistas semiestructuradas y un grupo focal. El proceso investigativo abordó las dimensiones: confianza, fiabilidad, responsabilidad, capacidad de respuesta y tangibilidad. Resultados: En las dimensiones se identificaron como limitantes en la calidad, dificultades de acceso por aspectos administrativos y geográficos, problemas en la oportunidad en la atención especializada, fallas en la referencia y contra referencia y la necesidad de generar mejoras en la infraestructura de las IPS. Se reconoció que el buen trato del personal asistencial es un aspecto que incide de manera positiva en la percepción de la calidad. Conclusiones: Mejorar la calidad de los servicios sanitarios, requiere reconocer a los usuarios como el centro de la atención, con miras a la integralidad, continuidad, eficacia, eficiencia y la equidad de los servicios, bajo el imperante fundamental de la garantía y protección del derecho a la salud y a la vida digna de los pacientes.

Abstract Introduction: Perceptions of users from the health services are indispensable indicators for quality on the processes of health care. Objective: To know the perceptions of the users of a public network of the municipality of Pasto, Colombia versus the quality of health services at the first level of attention. Materials and methods: A qualitative research with a hermeneutic historical approach was conducted with 28 participants, who were users of rural and urban centers of care. The techniques developed for collecting the information were semi-structured interviews and a focal group. The research process addressed five dimensions: trust, reliability, responsibility, responsiveness and tangibility. Results: In the dimensions mentioned before, the difficulties of access by administrative and geographical aspects, problems in the opportunity in the specialized attention, faults in the reference and counter-reference and the necessity of infrastructure improvements in the IPS were identified as limitations in the quality. Moreover, it was recognized that the good treatment of the healthcare personnel is an aspect that affects in a positive way in the perception of the quality. Conclusions: Improving the quality of health services, requires recognizing users as the center of attention, with a view to the integrality, continuity, efficiency, efficiency and fairness of services, under the fundamental principle of guarantee and protection of the right to health and life worthy of patients.

High-grade papillary urothelial carcinoma of the urinary tract: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center.

About one half of all bladder neoplasms are noninvasive, and in those, the histologic grade is a crucial prognosticator. Few single-center studies have assessed the recurrence, progression, and cancer-related mortality rates of noninvasive high-grade papillary urothelial carcinomas. With this aim, we evaluated the clinicopathologic and outcome features of 85 patients with high-grade papillary urothelial carcinoma. Median age was 68 years, and 80.5% were men. Tumor size ranged from 0.3 to 13.0 cm (median, 1.6 cm). Recurrence was found in 36.5% of the patients, whereas tumor progression, defined as invasion of lamina propria or beyond, was identified in 40% of all cases. When present, lesion reappearance involved mostly 1 to 2 episodes. Metastasis appeared in 20% of the patients, and 15% died of disseminated bladder cancer. All cancer-related deaths occurred in the group of patients with progression, whereas patients with recurrence showed similar outcomes to those with no recurrence. For patients with tumor progression, clinical stage was significantly associated with outcome (P = .002). As for prognosis, tumor size was strongly associated with progression (P < .01). In conclusion, recurrence, progression, and cancer-specific mortality rates were 36.5%, 40%, and 15%, respectively. All the patients who died of cancer had a history of tumor progression. Patients with recurrences showed similar outcomes to those with no recurrence. Tumor size was strongly associated with tumor progression and cancer-specific survival, whereas clinical stage was significantly associated with outcome in the progression group. In light of the high recurrence and progression rates of high-grade papillary urothelial carcinoma, strict clinical surveillance aimed to detect early recurrent lesions, especially in patients with larger tumors, is warranted.