[Risk factors for basal cell carcinoma: a study from the national dermatology center of Colombia]. / Factores de riesgo de carcinoma basocelular. Un estudio del Centro Nacional de Dermatología de Colombia.

BACKGROUND: Colombia is home to one of the areas with the highest levels of exposure to UV radiation in the world, namely, the Andes Mountains, which stretch along the equator. Recent studies have reported an increase in the incidence of basal cell carcinoma in Colombia, but the risk factors associated with the development of this disease have not been studied. OBJECTIVE: To determine the risk factors for basal cell carcinoma in patients from the National Dermatology Center of Colombia. MATERIAL AND METHODS: We performed a case-control study involving 406 individuals, and analyzed sociodemographic, epidemiological, and clinical factors using multiple logistic regression. RESULTS: The following risk factors were identified: skin phototypes I to III (odds ratio [OR], 15.4), family history of skin cancer (OR, 5.8), past history of actinic keratosis (OR, 3.3), continued residence in a rural area after the age of 30 years (OR, 2.96), practice of outdoor sports (OR, 2.67), history of 10 or more episodes of sunburn (OR, 2.3), actinic conjunctivitis (OR, 2.26), and failure to use a hat in childhood (OR, 2.11). CONCLUSIONS: Different factors specific to Colombia increase the risk of basal cell carcinoma. In particular, the association with phototype III could partly explain the increase in incidence detected in this country. Preventive programs should target the risk groups detected and highlight the importance of basing decisions on local evidence.

Adaptación transcultural de la versión colombiana de la Escala de Soledad de UCLA en pacientes con diagnóstico de cáncer / Transcultural adaptation of the Colombian version of the UCLA Loneliness Scale in patients diagnosed with cancer

Resumen Introducción: La soledad no deseada es un constructo que se ha relacionado con desenlaces negativos en diferentes aspectos de la salud, incluidos aquellos de los pacientes con cáncer. La escala de soledad de UCLA es un instrumento ampliamente utilizado en el contexto de investigación en salud para medir dicho constructo, y en Colombia la versión 03 de dicho instrumento no se encuentra traducida, ni adaptada transculturalmente. Objetivo: Traducir y adaptar transculturalmente la escala de soledad de UCLA, versión 03 para su uso en pacientes con cáncer en Colombia. Métodos: El proceso de traducción y adaptación transcultural siguió la metodología propuesta por el grupo EORTC, con el objetivo de lograr la equivalencia semántica con la versión original de la escala disponible en inglés. Se realizó una prueba piloto con 20 pacientes colombianos diagnosticados con diferentes tipos de cáncer, que asistieron al Instituto Nacional de Cancerología de Colombia. Resultados: No hubo cambios ni en la traducción de instrucciones ni en las opciones de respuesta. En la versión conciliada se modificó el ítem UC1. En la prueba piloto, dos de 20 pacientes informaron que los ítems UC6, UC7, UC11 y UC19 deberían ser modificados y un paciente mencionó que el ítem UC8 era difícil de entender; sin embargo, no se hicieron cambios dado el bajo número de pacientes que reportaron estos hallazgos, y las sugerencias planteadas podían cambiar el sentido y la equivalencia de los ítems de la escala original. Ninguno de los ítems fue ofensivo para los pacientes. Conclusión: Se generó una versión traducida y adaptada transculturalmente para ser validada en pacientes con cáncer en Colombia.

Abstract Introduction: Unwanted loneliness is a construct that has shown relationships with different negative outcomes of health, including those of patients with cancer. In the context of health research, the UCLA loneliness scale is a widely used instrument for measuring this construct. In Colombia, the 03 version of this instrument has still not been neither translated, nor transculturally adapted. Objective: To translate and perform transcultural adaptation of the UCLA loneliness scale, version 03 for its use in patients having cancer in Colombia. Methods: The process of translation and transcultural adaptation followed the methodology proposed by the EORTC group, aimed at achieving semantic equivalence with the original version of the scale. A pilot test has been made with 20 Colombian patients diagnosed with different types of cancer, attending the Instituto Nacional de Cancerología, Colombia. Results: In the reconciliated version, item UC1 has been modified. There has been not changes neither in translation of instructions, nor in response options. In pilot testing two out of 20 patients reported that items UC6, UC7, UC11 y UC19 should be modified and one patient mentioned that item UC8 was difficult to understand; however, no changes were made taking into account the low number of patients describing similar findings, and because these suggestions could change the semantic equivalence of these items. No items were deemed offensive. Conclusion: It is available a transculturally adapted version of the UCLA loneliness scale, version 03 for its validation in patients with cancer in Colombia.

Purification of Art v I, a relevant allergen of Artemisia vulgaris pollen.

An allergenic protein from Artemisia vulgaris pollen has been purified to homogeneity. Its molecular weight in native conditions is 47,000. The purified allergen, hereafter denominated Art v I, is a monomeric protein. It is a clinically relevant allergen since, at least, 70% of the individuals allergic to Artemisia vulgaris pollen have specific IgE in serum and in mast cells, demonstrated by ELISA and skin prick tests, respectively.

[Neck and thorax multifocal rhabdomyoma. A case report and review of the literature]. / Rabdomioma multifocal cervical y torácico. Descripción del caso y revisión de la literarura.

We present one rare case of multifocal rabdomyoma in the cervical region and chest. We describe the presentation, clinical, special tests done for the diagnosis and localization. Therefore we present the type of the treatment and evolution post therapy. We review the literature.

Evolution of Streptococcus pneumoniae serotypes and penicillin susceptibility in Latin America, Sireva-Vigía Group, 1993 to 1999. PAHO Sireva-Vigía Study Group. Pan American Health Organization.

BACKGROUND: Since 1993 the Pan American Health Organization has coordinated a surveillance network with the National Reference Laboratories of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay aimed at monitoring capsular types and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive disease in children <6 years of age. METHODS: The surveillance system included children 6 years of age and younger with invasive disease caused by S. pneumoniae. The identification, capsular typing and susceptibility to penicillin of the isolates were conducted using a common protocol, based on standard methodologies. RESULTS: By June, 1999, 4,105 invasive pneumococcal isolates had been collected mainly from pneumonia (44.1%) and meningitis (41.1%) cases. Thirteen capsular types accounting for 86.1% of the isolates (14, 6A/6B, 5, 1, 23F, 19F, 18C, 19A, 9V, 7F, 3, 9N and 4) remained the most common types during the surveillance period. Diminished susceptibility to penicillin was detected in 28.6% of the isolates, 17.3% with intermediate and 11.3% with high level resistance. Resistance varied among countries and increased during this period in Argentina, Colombia and Uruguay. Serotypes 14 and 23F accounted for 66.6% of the resistance. CONCLUSION: These surveillance data clearly demonstrate the potential impact of the introduction of a conjugate vaccine on pneumococcal disease and the need for more judicious use of antibiotics to slow or reverse the development of antimicrobial resistance.

Antibiotic resistance in Streptococcus pneumoniae in six Latin American countries: 1993-1999 surveillance.

The impact of invasive pneumococcal invasive disease is increased by the emergence of antibiotic resistance. We report regional and temporal variations in antibiotic resistance for 4,105 invasive Streptococcus pneumoniae isolates collected from Latin American children <5 years, between 1993 and 1999. Reduced susceptibility to penicillin was detected in 1,182 isolates (28.8%); 36% of these were resistant (> or = 2 microg/ml), including 12.6% with MIC > or = 4 microg/ml, occurring primarily in serotypes 14 and 23F. Reduced susceptibility to third-generation cephalosporins was detected in 12.1% of the collection. Mexico had the highest proportion of reduced susceptibility to penicillin (51.6%) and to third-generation cephalosporins (22%), whereas Brazil had the lowest at 20.9% and 0.7%, respectively. Isolates cultured from patients with pneumonia were more likely to have reduced susceptibility to third-generation cephalosporins than isolates from patients with meningitis (p < 0.0001). Susceptibility to trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, and vancomycin was tested by disk diffusion for 2.899 isolates. Reduced susceptibility was observed for 45.6%, 11.5%, 6.9%, and 0%, respectively. Thirty-one percent of the strains were resistant to > or = 2 drugs. High levels of antibiotic resistance in Latin America emphasize the need for the development of and adherence to rational antibiotic use guidelines. On-going surveillance will monitor the impact of these programs.

Distribution of capsular types and antimicrobial susceptibility of invasive isolates of Streptococcus pneumoniae in Colombian children. Pneumococcal Study Group in Colombia.

Streptococcus pneumoniae is the leading bacterial cause of childhood pneumonia in the developing world. This study describes the type distribution and antimicrobial susceptibility of invasive pneumococcal isolates from Colombian children and is part of the Sistema Regional de Vacunas (SIREVA), a PAHO regional initiative designed to determine the ideal serotype composition of a protein polysaccharide pneumococcal conjugate vaccine for use in children less than 5 years old in Latin America. In Colombia, during the study period, centres in Bogota, Medellin, and Cali collected 324 S. pneumoniae isolates from invasive diseases, 238 (73.5%) from children under the age of 2. Pneumonia was the clinical diagnosis in 41.3% cases, meningitis in 41%, and sepsis in 11.2%. The seven most frequent types included 14(21.9%), 5(10.5%), 23F(9.6%), 1(9%), 6B(9%), 19F(7.1%), and 6A(6.2%). The frequency of diminished susceptibility to penicillin (DSP) was 12%, with 8.9% of isolates showing intermediate level resistance and 3.1% showing high level resistance. Among DSP isolates, 23% were also resistant to cefotaxime, 33.3% to erythromycin, 48.7% to chloramphenicol, and 74.3% to trimethoprim/sulfamethoxazole. Multiple resistance was detected in 59% of the isolates that have DSP. Penicillin resistance was associated with types 23F (53.8%) and 14 (25.6%). These data provides information on capsular types prevalent in Colombia that will not only allow the formulation of an ideal vaccine for the region but also reinforce the need for ongoing regional surveillance.

Retinal detachment in phakic eyes with anterior chamber intraocular lenses to correct severe myopia.

PURPOSE: To analyze the incidence and characteristics of retinal detachment in patients with severe myopia corrected by implantation of phakic anterior chamber intraocular lenses. METHODS: We studied retinal detachments in 166 consecutive eyes (98 patients) that underwent implantation of angle-supported phakic anterior chamber intraocular lenses (models ZB5M and ZB5MF; Domilens; Lyon, France) for the correction of severe myopia (follow-up +/- SD, 45.26 +/- 14.65 months; range, 20 to 84 months). RESULTS: Retinal detachment occurred in eight eyes (4.8%); four eyes belonged to men and four to women. The time between implanting surgery and retinal detachment was 17.43 +/- 16.4 months (range, 1 to 44 months). In all cases, retinal detachment was spontaneous. In seven eyes, the retina was reattached successfully during the first retinal detachment surgery. Mean best-corrected visual acuity after phakic anterior chamber intraocular lens implantation and before retinal detachment development was 20/50 (range, 20/100 to 20/25). After retinal detachment repair, best-corrected visual acuity was 20/73 (range, 20/2000 to 20/33). In these seven eyes, differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .898, paired Student t test). In one eye, a proliferative vitreoretinopathy was observed, which required additional treatment by vitrectomy and explantation of the phakic anterior chamber intraocular lens. A refractive change was observed after retinal detachment repair, from -1.1 +/- 0.7 diopters (range, 0.00 to -2.50 diopters) before retinal detachment and -2.8 +/- 1.1 diopters (range, -1.00 to -4.50 diopters) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: The implantation of a phakic anterior chamber intraocular lens as a correcting procedure for severe myopia was followed by a 4.8% incidence of retinal detachment. Conventional scleral surgery was successful in most cases, without causing significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after retinal detachment repair in these patients.

Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses(1).

PURPOSE: To assess the incidence of cataract, potential causes of its development, and the outcome of cataract surgery after previous implantation of phakic angle-supported anterior chamber intraocular lenses (AC IOLs) in highly myopic patients. SETTING: Instituto Oftalmológico de Alicante, Department of Refractive Surgery, Spain. METHODS: Two hundred sixty-three highly myopic phakic eyes of 160 patients had implantation of a phakic AC IOL. Follow-up was up to 8 years (range 38.4 to 103.2 months). Eyes that subsequently developed cataract had cataract extraction and were studied during follow-up for clinical association to other preoperative or postoperative data. Cataract surgery was performed after phakic IOL explantation by phacoemulsification and posterior chamber IOL (PC IOL) implantation (Domilens-Chiron AL3). RESULTS: Nuclear cataract developed in 9 cases (3.42%) a mean of 42.91 months +/- 17.7 (SD) after phakic AC IOL implantation. Final best spectacle-corrected visual acuity (BSCVA) was not significantly different from that after phakic AC IOL implantation (P =.25, paired Student t test). Mean endothelial cell loss after cataract surgery was 6.87% +/- 0.42% cells/mm(2). Age at implantation of older than 40 years and axial length greater than 30. 0 mm were the 2 factors significantly related to nuclear cataract development (r = 1.69 and 1.98, respectively; P <.05). CONCLUSIONS: There is a potential risk of nuclear cataract development after phakic AC IOL implantation to correct high myopia in patients older than 40 years and with very high (greater than 30.0 mm) axial myopia. Phakic IOL explantation, phacoemulsification, and PC IOL implantation successfully resolved this complication. The benefits in terms of BSCVA and spherical equivalent obtained after phakic AC IOL implantation were preserved after cataract surgery.

Endophthalmitis after phakic intraocular lens implantation to correct high myopia.

A 36-year-old woman had uneventful implantation of an angle-supported anterior chamber phakic intraocular lens (IOL) to correct high myopia. On the first postoperative day, she developed infectious endophthalmitis likely associated with intraoperative contamination. Group B beta-hemolytic Streptococcus endophthalmitis was confirmed by microbiologic studies. To our knowledge, this is the first documented case of infectious endophthalmitis after anterior chamber phakic IOL implantation to correct high myopia.

Visual performance after congenital nystagmus surgery using extended hang back recession of the four horizontal rectus muscles.

PURPOSE: To evaluate the results of surgical correction of congenital nystagmus based on the use of extensive recessions of the four horizontal rectus muscles. The outcome of this procedure in terms of visual performance of the patients has been analyzed in follow-ups of at least 1 year. METHODS: Surgery was performed on 42 patients. An extended retroequatorial recession of the four horizontal rectus muscles was performed between 13 and 15 mm from the muscle insertion with hang back sutures in every case. Preoperatively, all cases showed either a horizontal pendular (4 cases) or jerk nystagmus (38 cases). RESULTS: After surgery, all cases showed full preservation of ductions in all gaze positions. Torticollis decreased in all cases. Binocular best-corrected vision improved in 19 (45.2%) patients and in the remaining 23 (54.8%) it remained unchanged. Consecutive exotropia was observed postoperatively in 7 patients. A second surgical procedure was performed in 9 cases (21.4%) and a botulinum injection in 3 cases (7%). All cases of diplopia resolved. Patient satisfaction was high in 38 cases (96%). CONCLUSIONS: Extended recession of horizontal rectus muscles using hang back sutures offers a good option for the surgical correction of sensorial and neuromuscular nystagmus, providing improvement in binocular best-corrected vision in 45% of the patients (21.4% more than 0.2 logMar units), a high satisfaction rate, and few associated complications. In patients with low vision this can be considered a success that may improve quality of life.

Delayed-onset postoperative endophthalmitis caused by Hafnia alvei.

PURPOSE: To identify Hafnia alvei as an etiological factor of delayed-onset endophthalmitis. CASE REPORT: A 68-year-old woman had uneventful cataract extraction by phacoemulsification with foldable posterior chamber intraocular lens implantation under topical anesthesia in the left eye. Four weeks later, the patient presented anterior uveitis treated by topical corticosteroids. Seven weeks later a posterior uveitis with retinal vasculitis appeared. The patient was treated by systemic and intravitreal corticosteroids without result. Due to the poor course pars plana vitrectomy was done, and a vitreous sample was taken. Microbiologic examination disclosed Hafnia alvei, gram-negative bacteria rarely isolated from human specimens. CONCLUSIONS: Hafnia alvei should be considered in the etiology of delayed-onset endophthalmitis.

Impact of carbapenem resistance on clinical and economic outcomes among patients with Acinetobacter baumannii infection in Colombia.

Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14-3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74-2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.

Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and meta-analysis.

Acinetobacter baumannii has emerged as a major cause of healthcare-associated infections. Controversy exists as to whether antimicrobial resistance increases the risk of mortality. We conducted a systematic review and meta-analysis to examine this association. We searched MEDLINE and EMBASE databases up to May 2013 to identify studies comparing mortality in patients with carbapenem-resistant A. baumannii (CRAB) vs. carbapenem-susceptible A. baumannii (CSAB). A random-effects model was used to pool Odds Ratios (OR). Heterogeneity was examined using I(2). We included 16 observational studies. There were 850 reported deaths (33%) among the 2546 patients. Patients with CRAB had a significantly higher risk of mortality than patients with CSAB in the pooled analysis of crude effect estimates (crude OR = 2.22; 95% CI = 1.66, 2.98), although substantial heterogeneity was evident (heterogeneity I(2) = 55%). The association remained significant in the pooled adjusted OR of 10 studies. Studies reported that patients with CRAB compared to patients with CSAB were more likely to have severe underlying illness and also to receive inappropriate empirical antimicrobial treatment, which increases the risk of mortality. Our study suggests that carbapenem resistance may increase the risk of mortality in patients with A. baumannii infection. However, cautious interpretation is required because of the residual confounding factors and inadequate sample size in most studies.

Efficacy of mitomycin C associated with direct conjunctival closure and sliding conjunctival graft for pterygium surgery.

AIMS: To evaluate the comparative efficacy of direct conjunctival closure (DCC) and sliding conjunctival graft (SCG), with and without intraoperative mitomycin C 0.02% (MMC) for pterygium surgery. METHODS: A comparative study consisting of a retropective chart review from our private practice was used to compare the outcome of patients who had undergone pterygium surgery. The eyes were classified according to the surgical technique performed. Group 1 was treated by DCC; Group 2 by DCC and intraoperative MMC; Group 3 by SCG; and Group 4 by SCG and intraoperative MMC. Outcome indicators were the appearance of recurrences and the time lapse before recurrences. RESULTS: 482 eyes from 327 European Caucasian patients were included. The average follow-up was 19.7 months (SD 30.6). Group 1 comprised 209 eyes, Group 2 107 eyes, Group 3 101 eyes and Group 4 65 eyes. Recurrences appeared in 7.7% of the eyes in Group 1, 4.7% of the eyes in Group 2, 2% of the eyes in Group 3 and 1.5% of the eyes in Group 4. CONCLUSION: SCG reduces the appearance of recurrences in primary pterygium surgery. MMC seems to improve the results of surgery associated with DCC. SCG and DCC with MMC seem to achieve similar results.