Comparison of two different anti-infectious approaches after high-dose chemotherapy and autologous stem cell transplantation for hematologic malignancies in a 12-year period in British Hospital, Uruguay.

Autologous stem cell transplant (ASCT) is a widely used and safe procedure to treat mostly hematologic diseases. These patients are at risk of infectious complications, which represents a major cause of morbidity and it is the second cause of mortality. This retrospective 12-year analysis of the incidence, type, and severity of infections in 266 consecutive unselected ASCT patients at our institution provides novel information addressing this issue. We included 266 ASCT procedures. Patients included in the 2006-2013 period are referred to as group 1 (ciprofloxacin prophylaxis and ceftazidime-amikacin as empirical antibiotics), and those in the 2013-2017 period are group 2 (levofloxacin prophylaxis and meropenem as empirical antibiotics). The incidence of febrile neutropenia was 72% in group 1 and 86.2% in group 2 (p = 0.004). The majority of infectious episodes were associated with fever of unknown origin: 55% in group 1 and 59% in group 2. Febrile of unknown origin episodes were 82.6% in group 1 and 80% in group 2. Significant differences between both groups were found in age, hypogammaglobulinemia, and advanced disease at ASCT. No differences were found between groups regarding the most common agent documented in positive blood cultures (Gram+ were 66.6% in group 1 and 69% in group 2 (p = 0.68)). Mortality within 100 days of transplant was low, 1.87%. Regardless of the prophylactic regimen used, most patients experience febrile episodes in the ASCT setting, fever of unknown origin is the most common infection complication, and Gram+ agents are prevalent in both groups. Mortality rates were low. According to our results, ASCT is a safe procedure and there is no clear benefit in favor of levofloxacin versus ciprofloxacin prophylaxis. Both anti-infectious approaches are acceptable, yielding similar outcomes.

[Malignancies in HIV-infected patients: descriptive study of 129 cases between 1993 and 2010]. / Neoplasias en pacientes con infección por VIH: Estudio descriptivo de 129 casos en el período 1993-2010.

INTRODUCTION: The development of malignancies is a problem associated with HIV infection. The incidence and spectrum of malignancies has been modified with the addition of highly active antiretroviral therapy (HAART). AIM: To describe the clinical and epidemiological characteristics and prognosis of HIV patients who have developed a malignancy. METHODS: Retrospective observational study was conducted in HIV + patients who developed a malignancy between 1993-2010 in a referral hospital. AIDS-defining malignancies (ADN) and non-AIDS-defining malignancies (NADN) were compared. RESULTS: 125 patients were identified with at least one malignancy. The most frequent malignancies were: non-Hodgkin lymphoma (n; 39; 30.2%), Kaposi's sarcoma (n: 20; 15.5%), Hodgkin's disease (n: 11; 8.8%), lung cancer (n: 20; 15.5%) and hepatocellular carcinoma (n: 9; 6.9 %). The mean age was 42 ± 11 years, 84% male, 55.8% were coinfected with HBV and or HCV. The risk behaviors were: 45.6% intravenous drug users, 16.8% men who have sex with men and 20% heterosexuals). There were 67 (52%) NADN and 62 (48%) ADN; NADN patients had a longer story of HIV infection and longer exposure to HAART, better level of immunodeficiency and better virological control than ADN patients. Four patients developed a second malignancy. Overall survival was 34.7%. CONCLUSIONS: We found an increased incidence of NADN, appearing in patients with better virological and immunological control than ADN group. Mortality of patients with HIV infection and malignancy is still very high.

Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study.

1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27-79] vs. 217 [120-596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.

Performance of the CORB (Confusion, Oxygenation, Respiratory Rate, and Blood Pressure) Scale for the Prediction of Clinical Outcomes in Pneumonia.

Background: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality due to misdiagnosis and inappropriate treatment approaches. Objective: To assess the performance of the CORB score in subjects with CAP for predicting in-hospital mortality, death within 30 days of admission, and requirement for invasive mechanical ventilation (IMV) and vasopressor support. Methods: A retrospective, cohort study with diagnostic test analysis of CORB and CURB-65 scores in subjects with CAP according to ATS criteria was undertaken. An alternative CORB score was estimated by replacing SpO2 ≤90% by the SpO2/FiO2 ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a p value <0,05 statistically significant. Results: From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623-0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621-0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589-0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589-0,681) for vasopressor support. CORB performance increases when the SpO2/FiO2 ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654-0,746; p < 0.001) and AUROC of 0,702 (95% CI: 0,66-0,745; p < 0.001), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695-0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695-0,756). Conclusions: CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO2/FiO2 ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. CURB-65 score is superior in the prediction of mortality.

Validity of the ROX index in predicting invasive mechanical ventilation requirement in pneumonia.

BACKGROUND: The ROX index (Respiratory rate-OXygenation) has been described as a prediction tool to identify the need for invasive mechanical ventilation (IMV) in community-acquired pneumonia (CAP) with acute hypoxaemic respiratory failure treated with high-flow nasal cannula in order to avoid delay of a necessary intubation. However, its use in predicting the need for ventilatory support in hospitalised patients with CAP has not been validated. METHODS: This is a retrospective cohort study including subjects with CAP treated in the general ward, emergency service or intensive care unit of a third-level centre in Cundinamarca, Colombia, between January 2001 and February 2020. The ROX index was estimated as the ratio of oxygen saturation/fraction of inspired oxygen to respiratory rate. RESULTS: A total of 895 patients were included, of whom 93 (10%) required IMV. The ROX index proved to be a good predictor, presenting an area under the curve of receiver operating characteristics (AUROC) of 0.733 (95% CI 0.671 to 0.795, p<0.001) when determined by pulse oximetry and an AUROC of 0.779 (95% CI 0.699 to 0.859, p<0.001) when estimated by arterial blood gas (ABG) parameters, with an intraclass correlation of 0.894. The estimated cut-off point was 14.8; a score less than 14.8 indicates high risk of requiring IMV. CONCLUSION: The ROX index is a good predictor of IMV in hospitalised patients with CAP. It presents good performance when calculated through pulse oximetry and can replace the one calculated by ABG.

O fenômeno da transgeracionalidade no ciclo de vida familiar: casal com filhos pequenos / The influence of the transgerational phenomenon on the family life cycle of couples with small children / El fenómeno de la transgeneracionalidad en el ciclo de vida familiar: pareja con hijos pequeños

O presente trabalho investiga a influência do fenômeno da transgeracionalidade no ciclo de vida familiar de casal com filhos pequenos. A partir dos dados levantados por meio de genogramas, foi possível obter uma leitura sistêmica a respeito da família de origem de cada um dos cônjuges, bem como da família nuclear por eles constituída. Durante as sessões de terapia de casal, foi trabalhado, entre outros temas, o conceito de diferenciação do self, possibilitando ao casal o entendimento acerca da origem de seus problemas conjugais, os quais emergiram após o nascimento das filhas. Como consequência, o casal pôde vivenciar mudanças evolutivas na relação conjugal, confirmando o que a terapia boweniana diz sobre o entendimento ser o veículo de cura.

This work investigates the influence of the transgenerational phenomenon on the family life cycle of couples with small children. As of collection of data from genograms, it was possible to obtain a systemic reading on the family origin of each spouse, as well as the nuclear family constituted by them. During the couple’s therapy sessions, they worked on the concept of self-differentiation, allowing the couple to understand the origin of their marital problems, which emerged after the birth of their daughters. As a consequence, the couple may experience evolutionary changes in their marital relationship, confirming what the Bowenian Therapy says about understanding as to the vehicle of healing.

El presente trabajo investiga la influencia del fenómeno de la transgeneracionalidad en el ciclo de vida familiar de pareja con hijos pequeños. A partir de los datos levantados por medio de genogramas, fue posible obtener una lectura sistémica al respecto de la familia de origen de cada uno de los cónyuges, así como de la familia nuclear constituida por ellos. Durante las sesiones de terapia de pareja, fue trabajado, entre otros temas, el concepto de diferenciación del self, posibilitándole a la pareja el entendimiento acerca del origen de sus problemas conyugales, los cuales emergieron después del nacimiento de sus hijas. Como consecuencia, la pareja pudo vivenciar cambios evolutivos en la relación conyugal, confirmando lo que la terapia boweniana dice sobre que el entendimiento es el vehículo de cura.

Características clínicas de los pacientes con crisis hipertensivas que acuden a un Servicio de emergencias médicas

RESUMEN Introducción: los niveles de presión arterial por encima de las cifras normales aumentan el riesgo de padecer enfermedades cardiovasculares y cerebrales. Las complicaciones ocasionadas por las crisis hipertensivas son muy peligrosas y a menudo fatales. Es de suma importancia conocer bien sus características clínicas para tratar de contrarrestar su evolución. Objetivo: describir el comportamiento de las crisis hipertensivas en 500 pacientes del Servicio de Emergencias del Hospital de Clínicas, en el período de enero a junio de 2018. Metodología: estudio descriptivo y retrospectivo. Se utilizaron las hojas de recepción, acogida y clasificación de urgencias y las historias clínicas de pacientes ingresados con crisis hipertensivas. Se emplearon frecuencias absolutas y relativas (porcentaje) para resumir la información, y tablas para su presentación. Resultados: en el estudio predominó el sexo masculino, con 351 (70%) pacientes, y 149 (30%) de sexo femenino. El grupo etario en el que existió mayor predominio de pacientes (49%) fue el de 50-59 años de edad. Se observó un predominio de las urgencias hipertensivas con 399 (79,8%) pacientes, mientras que solo 101 (20,2%) pacientes desarrollaron emergencias hipertensivas. El órgano diana más frecuentemente dañado fue el cerebro en 43 (42,6%) pacientes con un accidente vascular cerebral, seguido por el síndrome coronario agudo en 34 (33,7%) pacientes. La alteración electrocardiográfica mas frecuente fue la hipertrofia del ventrículo izquierdo en 187 (37,4%) pacientes, y en segundo lugar se encontró el supradesnivel del ST, que se presentó en 111 (22,2%) pacientes. Conclusión: las complicaciones y los hallazgos más significativos en estos pacientes con crisis hipertensivas fueron los accidentes vasculares encefálicos y el síndrome coronario agudo, así como la hipertrofia del ventrículo izquierdo y la elevación del segmento ST dentro de las alteraciones electrocardiográficas.

ABSTRACT Introduction: Blood pressure levels above normal levels increase the risk of cardiovascular and cerebral diseases. Complications caused by hypertensive crises are very dangerous and often fatal. It is very important to know their clinical characteristics well to try to counteract their evolution. Objective: To describe the behavior of hypertensive crises in 500 patients of the Emergency Service of the Hospital de Clínicas, in the period from January to June 2018. Methodology: Descriptive and retrospective study. The reception and emergency classification sheets and the medical records of patients admitted with hypertensive crisis were used. Absolute and relative frequencies (percentage) were used to summarize the information, and tables for presentation. Results: In the study the male sex prevailed, with 351 (70%) patients, and 149 (30%) of female sex. The age group in which there was a greater prevalence of patients (49%) was 50-59 years old. A predominance of hypertensive urgencies was observed with 399 (79.8%) patients, while only 101 (20.2%) patients developed hypertensive emergencies. The most frequently damaged target organ was the brain in 43 (42.6%) patients with a stroke, followed by acute coronary syndrome in 34 (33.7%) patients. The most frequent electrocardiographic alteration was left ventricular hypertrophy in 187 (37.4%) patients, and in the second place was the ST elevation, which occurred in 111 (22.2%) patients. Conclusion: The most significant complications and findings in these patients with hypertensive crises were cerebrovascular accidents and acute coronary syndrome, as well as left ventricular hypertrophy and ST-segment elevation within electrocardiographic abnormalities.

Factores de riesgo y cardiopatías prevalentes en mujeres internadas en la división de medicina cardiovascular del hospital de clínicas / Risk factors and prevalent cardiopathies in hospitalized women in the cardiovascular medicine division of the clinical hospital

La representación de las mujeres ha sido marginal en la mayoría de los ensayos clínicos o registros dedicados a las enfermedades cardiovasculares (ECV). Por eso, recientemente, se ha adoptado una política de estimular la inclusión de mujeres en los ensayos clínicos. En este estudio descriptivo retrospectivo y de corte transversal, nos hemos propuesto determinar la forma de presentación de las cardiopatías, describir los factores de riesgo cardiovasculares presentes en estas pacientes, determinar el número de mujeres que presentaron cardiopatía isquémica, y establecer el tratamiento recibido por las mujeres que presentaron cardiopatía isquémica en mujeres internadas en la División de Medicina Cardiovascular del Hospital de Clínicas. El estudio incluyó un total de 250 pacientes, de los cuales 187 (75%) correspondían al sexo masculino y 63 (25%) al sexo femenino. Las edades de las mujeres se encontraban entre 25 y 94 años (60±7,3 años). Las mujeres estudiadas presentaron: insuficiencia cardiaca 26 (41%), síndromes coronarios agudos 20 (32%), valvulopatías 8 (13%), bloqueo AV completo 7 (11%) y otros 2 (3%). De las mujeres con síndrome coronario agudo, 3 pacientes tuvieron enfermedad de 3 vasos, 1 sola tuvo coronarias normales, y 8 (40%) tenían lesiones de la arteria descendente anterior. Los factores de riesgo más frecuentes fueron el sedentarismo en la totalidad de las mujeres, la hipertensión arterial en 55 (87%), dislipidemias en 39 (62%), obesidad en 34 (54%), diabetes mellitus tipo 2 en 12 (19%) y tabaquismo en 12 pacientes (19%). La magnitud del riesgo cardiovascular de la mujer depende no solamente de la alteración de un parámetro sino también de la presencia de otros factores de riesgo, razón por la cual se requiere de un manejo multifactorial integral dentro del concepto de riesgo cardiovascular global en la mujer.

Most of the clinical trials on cardiovascular diseases had scant women representation inthe population studied. Hence, there has been a movement to stimulate the inclusion ofmore women in the clinical studies. In this present descriptive retrospective cross-sectionalstudy we aimed to determine the form of presentation of cardiopathies, to describe thecardiovascular risk factors, to determine the incidence of ischemic cardiopathy and the treatment received in hospitalized women in the Division of Cardiovascular Medicine of theClinical Hospital. The study included 250 patients with 187 male patients (75%) and 63(25%) female patients. The age of the women was between 25 and 94 years old, with anaverage of 60±7,3 years. The women had heart failure 26 (41%), acute coronary syndrome20 (32%), valvulopathy 8 (13%), and complete AV block 7 (11%). Out of the women withacute coronary syndrome, 3 patients had three vessel disease, only 1 had normal coronaryarteries, and 8 patients had stenosis of the anterior descendent coronary artery. All womenhad sedentary lifestyle as cardiovascular risk factor, 55 (87%) arterial hypertension, 39(62%) dyslipidemia, 34 (54%) obesity, 12 (19%) type II diabetes mellitus, and 12 (19%)smoking. The magnitude of the cardiovascular risk factors in women depends not only onthe alteration of one parameter but also on the presence of other risk factors. Therefore, anadequate integral multifactorial management in the global concept of cardiovascular riskfactor in women is required.

El riesgo de los que cuidan el riesgo: FINDRISK en personal de blanco

Introducción: el cuestionario FINDRISK permite evaluar la probabilidad de desarrollar diabetes mellitus (DM) a 10 años. Objetivo: determinar la probabilidad de desarrollar DM a 10 años en el personal de salud, teniendo en cuenta el estilo de vida y su carga familiar utilizando el cuestionario FINDRISK. Materiales y métodos: estudio prospectivo, descriptivo, de corte trasversal, realizado en 100 individuos, personal de blanco del Hospital de Clínicas, desde el 1 de septiembre de 2015 a 31 de octubre de 2015. Resultados: la muestra fue mayoritariamente del sexo femenino (77%), predominantemente joven (73%), 19% tienen padres y/o hermanos con DM. Tenían peso normal 32%, sobrepeso 27%, obesidad GI 24% y obesidad GII 17%. Solo realizan actividad física 30,4%. La mitad consumen frutas y verduras todos los días. Solo 6% presentaban antecedentes de hiperglicemia. El 43% presenta riesgo muy elevado por circunferencia abdominal. Solo 16% consumen regularmente medicamentos para la hipertensión arterial. Aplicando el cuestionario de FINDRISK la media global fue de 14,4 ± 4,4 (rango 7 -24) siendo similar en ambos sexos (p 0,6). En la valoración del riesgo, presentaban FINDRISK riesgo alto casi la mitad (47%) de los funcionarios, seguido de 31% riesgo ligeramente elevado, riesgo moderado 11% y riesgo muy alto 11%. En el análisis bivariado, utilizando como punto de corte de 15 del FINDRISK, encontramos que 38% de los funcionarios tienen nivel de riesgo alto. Conclusión: más de un tercio del personal de blanco tiene un alto nivel de riesgo de desarrollar DM en su evolución si no se toman medidas preventivas para evitarlo. Se deberían tomar medidas para disminuir la aparición de casos nuevos o retardar el inicio de la DM.

Introduction: FINDRISK questionnaire evaluates the probability of developing mellitus (DM) within 10 years. Objective: To determine the probability of developing DM within 10 years in healthcare personnel, considering lifestyle and family burden using the FINDRISK questionnaire. Material and methods: Cross-sectional descriptive prospective study performed in 100 individuals, healthcare personnel of the Hospital de Clínicas from September 1 to October 3, 2015. Results: The sample population was mostly women (77%), predominantly young (73%), 19% has parents and/or brothers/sisters with DM. Thirty two percent had normal weigh, 27% was overweight, 24% had GI obesity and 17% GII obesity. Only 30.4% made physical activity. Half eats fruits and vegetables every day. Only 6% had history of hyperglycemia and 43% presented a very high risk by abdominal circumference. Only 16% used regularly drugs for arterial hypertension. Applying the FINDRISK questionnaire, the global mean was 14.4 ± 4.4 (range 7 - 24) being similar in both genders (p = 0.6). In the risk assessment, almost half (47%) of the employees presented high risk followed by slightly high risk (31%), moderate risk (11%) and very high risk (11%). In the bivariate analysis using 15 of FINDRISK as a cut-off point, it was found that 38% of the employees had high risk levels. Conclusion: More than a third of the healthcare personnel had high risk level of developing DM in their evolution if preventive measures are not taken to avoid it. Measures should be taken to reduce the appearance of new cases or delay the beginning of DM.

Trasplante autólogo de progenitores hematopoyéticos en pacientes con Linfoma no Hodgkin agresivo: Experiencia de un centro / Autologous transplant of Haematopoietic Stem Cells in Patients with Aggressive Non Hodgkin Lymphoma: Experience of a center

Introducción: El Trasplante Autólogo de Progenitores Hematopoyéticos forma parte del tratamiento de pacientes con Linfoma No Hodgkin (LNH) agresivos en respuesta parcial y recaída. Objetivos: evaluar las respuestas y sobrevida en los pacientes con LNH agresivos trasplantados en Hospital Británico. Material y Métodos: estudio retrospectivo de pacientes con LNH agresivos que se trasplantaron entre el 1/01/1995 y el 1/07/2013. Total 65 pacientes. Resultados: el 95% logró una Remisión Completa post Auto-TPH y el 5% una Remisión Parcial. Con una mediana de seguimiento de 74 meses (5-219), la mediana de SG no se ha alcanzado. La media estimada es de 145 meses (122-169) con una SG a 5 años de 71% y a 10 años es de 60%. La mediana de SLE no se ha alcanzado, a 5 años es de 60% y a 10 años es de 58%. Conclusiones: el trasplante Autólogo de Progenitores Hematopoyéticos es una herramienta terapéutica útil. Los resultados de nuestro grupo son comparables a los reportados por grupos internacionales con una baja mortalidad relacionada al procedimiento.

Introduction: Autologous Hematopoietic Stem Cell Transplantation is part of the treatment of patients with aggressive lymphomas in partial response or relapsed. Objectives: To evaluate the responses and survival in aggressive NHL patients transplanted in Hospital Británico. Material and Methods: Retrospective study of patients with aggressive NHL that were transplanted into... between 01/01/1995 and 07/01/2013. Total 65 patients. Results: 95% achieved a complete remission after Auto-SCT and 5% partial remission. With a median follow up of 74 months (5-219), the median OS has not been reached. The estimated mean is 145 months (122-169) with a 5-year OS of 71% and 60% at 10 years. The median DFS has not been reached, at 5 years is 60 % and at 10 years is 58 %. Conclusions: Autologous Hematopoietic Stem Cell Transplantation is a useful therapeutic tool. The results of our group are comparable to those reported by international groups with low procedure-related mortality.

¿El valor de algunos servicios ecosistémicos de los Andes colombianos?: transferencia de beneficios por meta - análisis / Valuation of the ecosystem services in the Colombian Andes. The benefit transfer method: A meta-analysis / ¿O valor de alguns serviços ecossistémicos dos Andes colombianos?: transferência de benefícios por meta-análise

La valoración económica de la biodiversidad y lo servicios ecosistémicos es importante para la planificación de desarrollo socioeconómico de Colombia. La obtención d datos primarios es costosa, pero existe un método denominad "transferencia de beneficios". Se presenta una aproximación: a la valoración de algunos servicios ecosistémicos en lo Andes colombianos incorporando un meta-análisis de lo estudios realizados en Colombia, aplicando: transferencia d funciones y transferencia de valores medios. El valor de lo servicios ecosistémicos (disponibilidad de agua, recreación y conservación), arrojó valores entre 106 a 339 mil millones de dólares en 2011. La determinación del valor global de lo ecosistemas configura un reto complejo, debido a la dificulta en la síntesis de los estudios, la variabilidad de los mismo: y la ausencia de experiencias documentadas. La valoración: económica en Colombia, enfrenta el inconveniente de l presentación, obtención y variabilidad de datos. Se concluyó que la información existente es insuficiente, encontrándose pocos estudios bien diseñados. Esta contribución formula recomendaciones para futuros ejercicios.

The economic valuation of biodiversity and ecosystem services plays an important role in Colombia's conservation planning and economic development, but gathering data to conduct an original study can be expensive. To this end, there is an alternative yet controversial method called "benefits transfer". Here, we present a meta-analysis of available literature on the economic valuation of the Colombian Andes using two approaches: transfer functions and transfer of mean values. The economic value of ecosystem services, which included water availability, recreation and conservation for the Colombian Andes, yielded values between 106 and 339 trillion 2011 USD. However, determining the overall value of ecosystems presents a complex challenge due to the difficulty in the synthesis of the studies, their variability, and the nonexistence of documented experiences. Economic valuation in Colombia is faced with issues in the presentation, collection and variability of data. We concluded that the existing information is insufficient; there are few well-designed studies to procure consistent ecosystem values to support the creation of development policies in Colombia.

A valorização económica da biodiversidade e os serviços ecossistémicos é importante para a planificação do desenvolvimento socioeconómico de Colômbia. A obtenção dos dados primários utiliza um método denominado "transferência de benefícios". Apresenta-se uma aproximação da avaliação de alguns serviços ecossistémicos nos Andes colombianos incorporando uma meta-análise dos estudos realizados em Colômbia, aplicando: transferência de funções e transferência de valores médios. O valor dos serviços ecossistémicos (disponibilidade de água, recreação e conservação), exibiu valores entre 106 a 339 mil milhões de dólares em 2011. A determinação do valor global dos ecossistemas configura um desafio complexo, devido à dificuldade na síntese dos estudos, a variabilidade dos mesmos, e a ausência de experiências documentadas. A avaliação económica em Colômbia, enfrenta o inconveniente da presentação, obtenção e variabilidade de dados. Concluiu-se que a informação existente é insuficiente, encontrando-se poucos estudos bem desenhados. Esta contribuição formula recomendações para futuros exercícios.

Neoplasias en pacientes con infección por VIH: Estudio descriptivo de 129 casos en el período 1993-2010 / Malignancies in HIV-infected patients: Descriptive study of 129 cases between 1993 and 2010

Introduction: The development of malignancies is a problem associated with HIV infection. The incidence and spectrum of malignancies has been modified with the addition of highly active antiretroviral therapy (HAART). Aim: To describe the clinical and epidemiological characteristics and prognosis of HIV patients who have developed a malignancy. Methods: Retrospective observational study was conducted in HIV + patients who developed a malignancy between 1993-2010 in a referral hospital. AIDS-defining malignancies (ADN) and non-AIDS-defining malignancies (NADN) were compared. Results: 125 patients were identified with at least one malignancy. The most frequent malignancies were: non-Hodgkin lymphoma (n; 39; 30.2%), Kaposi's sarcoma (n: 20; 15.5%), Hodgkin's disease (n: 11; 8.8%), lung cancer (n: 20; 15.5%) and hepatocellular carcinoma (n: 9; 6.9 %). The mean age was 42 ± 11 years, 84% male, 55.8% were coinfected with HBV and or HCV. The risk behaviors were: 45.6% intravenous drug users, 16.8% men who have sex with men and 20% heterosexuals). There were 67 (52%) NADN and 62 (48%) ADN; NADN patients had a longer story of HIV infection and longer exposure to HAART, better level of immunodeficiency and better virological control than ADN patients. Four patients developed a second malignancy. Overall survival was 34.7%. Conclusions: We found an increased incidence of NADN, appearing in patients with better virological and immunological control than ADN group. Mortality of patients with HIV infection and malignancy is still very high.

Introducción: Uno de los problemas asociados a la infección por VIH es el desarrollo de neoplasias. La incidencia y espectro de los distintos cánceres se ha visto modificada con la incorporación del tratamiento anti-retroviral de gran actividad (TARGA). El objetivo del presente estudio es describir las características clínicas y epidemiológicas y el pronóstico de pacientes infectados con VIH que han desarrollado una neoplasia. Material y Métodos: Estudio observacional retrospectivo de una cohorte de pacientes con infección por VIH que desarrollaron algún cáncer en el periodo comprendido entre 1993-2010 en un hospital de referencia. Se compararon las variables entre los casos de neoplasias definitorias de SIDA (NDS) y no definitorios de SIDA (NNDS). Resultados: Se identificaron 125 pacientes con al menos una neoplasia. Los cánceres más frecuentes fueron: linfoma no Hodgkin (n: 39; 30,2%), sarcoma de Kaposi (n: 20; 15,5%), enfermedad de Hodgkin (n: 11; 8,8%), neoplasia pulmón (n: 20; 16%) y hepatocarcinoma (n: 9; 6,9 %). La edad media fue 42 ± 11 años, 84% varones, 55,8% estaban co-infectados por VHB y/o VHC. Las conductas de riesgo fueron: 45,6% usuarios de drogas vía parenteral, 16,8% hombres con relaciones sexuales con hombres y 20% heterosexuales. Se encontraron 67 NNDS (52%) y 62 (48%) NDS; los pacientes con NNDS presentaron mayor tiempo de evolución de la infección por VIH y de exposición a TARGA, mayor recuento de CD4 y mejor control virológico que los del grupo de NDS. Desarrollaron un segundo tumor cuatro pacientes. La supervivencia global fue de 34,7%. Conclusiones: Se constata un aumento en la incidencia de NNDS, que se presentan en pacientes con mejor control virológico e in-munológico que los NDS. La mortalidad de los pacientes con infección por VIH y enfermedad tumoral continúa siendo muy elevada.

Trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple: análisis de factores pronósticos y sobrevida: experiencia del Hospital Británico / Autologic transplant of hematopoietic progenitors in patients with multiple myeloma: a study of prognosis and survival at the British Hospital

Introducción: el trasplante autólogo de progenitores hematopoyéticos (TAPH) es considerado estándar en el tratamiento de primera línea en pacientes con mieloma múltiple (MM) menores de 65 años. Objetivo: analizar la sobrevida global (SG) y sobrevida libre de eventos (SLEv) de los pacientes con MM trasplantados en el Hospital Británico. Material y método: se realizó un estudio retrospectivo de los pacientes que recibieron un primer TAPH. Resultados: entre el 1° de julio de 1999 y el 30 de junio de 2010 se realizaron 56 TAPH a 48 pacientes con MM. Del análisis de los pacientes al primer TAPH, 46% eran mujeres y 54%hombres. La mediana de edad fue de 54 años (32-65 años). El 73% eran IgG, 17% IgA y 10% de cadenas livianas. El 60,4% logró una RC/nRC (RC, RC no confirmada y VGPR) posTAPH. Con una media de seguimiento de 58,6 meses (5,84-186,56), la mediana de SG fue de 121,8 meses (IC 95%: 70,1-173,54 meses). No se hallaron diferencias significativas en SG entre los pacientes que lograron RC/nRC posTAPH y quienes no lo lograron (log Rank p=0,162). La mediana de SLEv fue de 56 meses (IC 95%: 42,2-70,4 meses).Conclusiones: el TAPH es una herramienta fundamental en el tratamiento de los pacientes con MM y es un procedimiento seguro en la Unidad de Hematología del Hospital Británico.

Introduction: autologic transplant of hematopoietic progenitors is regarded as the standard in the first line treatmentof patients with multiple myeloma (MM) younger than 65 years old. Objective: to analyse global survival and incident freesurvival in patients with multiple myeloma transplanted at the British Hospital. Method: we conducted a retrospective study of patients who received the first autologic transplant of hematopoietic progenitors. Results: 56 autologic transplants of hematopoietic progenitors were performed from July 1, 1999 through June 30, 2010 in 48 patients with MM. Upon analysis of patients after the first transplant, 46% were women and 54% were men. Median age was 54 years old (32-65 years old). 73% were IgG, 17% were IgA and 10% were light chains.60.4% achieved CR/nCR (CR), non- confirmed CR and VGPR) after transplant. With an average follow-up of 58.6 months (5.84-186.56), the median global survival was121.8 months (IC 95%: 70.1-173.54 months). No significant differences were found in the global survival in patientswho achieved CR/nCR after autologic transplant of hematopoietic progenitors and those who failed to achieve it (log Rank p=0.162. The median incident-free survival was 56 months (IC 95%: 42.2-70.4 months). Conclusions: autologic transplant of hematopoietic progenitors is an essential tool to treat patients with MM and it is a safe procedure at the Hematology Unit of the British Hospital.

Introdução: o transplante autólogo de progenitores hematopoiéticos (TAPH) é considerado um padrão no tratamentode primeira linha de pacientes menores de 65 anos com mieloma múltiple (MM).Objetivo: analisar a sobrevida global (SG) e sobrevida livre de eventos (SLEv) dos pacientes com MMtransplantados no Hospital Britânico.Material e método: um estudo retrospectivo dos pacientes que receberam um primeiro TAPH foi realizado. Resultados: no período 1° de julho de 1999 a 30 de junho de 2010 foram realizados 56 TAPH a 48 pacientes com MM. A análise dos dados dos pacientes no primeiro TAPH mostrou que 46% eram mulheres e 54% homens. A mediana da idade foi 54 anos (32-65 anos). 73% eram IgG, 17% IgA e 10% de cadeias leves. 60,4% conseguiram uma RC/nRC (RC, RC não confirmada e VGPR) pósTAPH. Comuna media de seguimento de 58,6 meses (5,84-186,56), a mediana de SG foi de 121,8 meses (IC 95%: 70,1-173,54meses). Não foram encontradas diferenças significativas na SG entre os pacientes que conseguiram RC/nRCpósTAPH e os que não a conseguiram (log Rank p=0,162). A mediana de SLEv foi 56 meses (IC 95%: 42,2-70,4 meses). Conclusões: o TAPH é uma ferramenta fundamental para o tratamento de pacientes com MM e é umprocedimento seguro na Unidade de Hematologia do Hospital Britânico.