Fourth ventricular subarachnoid stent for Chiari malformation type I-associated persistent syringomyelia.

OBJECTIVE: Syringomyelia (syrinx) associated with Chiari malformation type I (CM-I) is commonly managed with posterior fossa decompression, which can lead to resolution in most cases. A persistent syrinx postdecompression is therefore uncommon and challenging to address. In the setting of radiographically adequate decompression with persistent syrinx, the authors prefer placing fourth ventricular subarachnoid stents that span the craniocervical junction particularly when intraoperative observation reveals arachnoid plane scarring. The objective of this study was to evaluate the safety and efficacy of a fourth ventricle stent for CM-I-associated persistent syringomyelia, assess dynamic changes in syrinx dimensions, and report stent-reduction durability, clinical outcomes, and procedure-associated complications. METHODS: The authors performed a single-institution, retrospective review of patients who underwent fourth ventricular subarachnoid stent placement for persistent CM-I-associated syringomyelia following a prior posterior fossa decompression. The authors' institutional Chiari database contains 600 cases with 149 decompressions for CM-I-associated syringomyelia, of which 13 met criteria for inclusion. Data on patient demographics, clinical presentation and outcomes, and MRI findings were collected. The maximal syrinx diameter was estimated by calculating the area of an elliptical cross-section in the largest axial plane from preoperative, immediately postoperative, and late postoperative T2-weighted MR images. RESULTS: All 13 patients experienced a significant decrease in mean syrinx area from the preoperative to the late postoperative MRI (mean syrinx diameter 114.1 ± 81.8 mm2 vs 24.5 ± 23.8 mm2, p < 0.001). The mean time until late postoperative MRI was 19.7 months (range 2.0-70.7 months). The syrinx area reduced on average by 75.0% ± 23.9% at the time of the last postoperative scan. Syrinx resolution was variable, with 4 patients (30.8%) achieving near-complete resolution (> 90%, grade III reduction), 7 patients (50%) having 50%-90% reduction (grade II), and 2 patients (14.3%) having < 50% decrease (grade I). One patient experienced catheter migration into the left brachium pontis with an associated cyst at the tip of the catheter that decreased in size on follow-up imaging. CONCLUSIONS: Placement of fourth ventricular subarachnoid stents spanning the craniocervical junction in patients with persistent CM-I-associated syringomyelia after posterior fossa decompression is a safe therapeutic option and significantly reduced the mean syrinx area, with a greater reductive effect seen over longer follow-up periods.

Comparative Analysis of 2D and 3D Metrics for Evaluation of Postoperative Outcomes Following Endoscopic Suturectomy for Sagittal Craniosynostosis.

To assess whether 3-dimensional (3D) volumetrics can be used to track and evaluate postoperative course of patients treated with endoscopic suturectomy for nonsyndromic sagittal synostosis, we compared changes in 2-dimensional (2D) measurements along with 3D volumetric correlates throughout the period of helmet therapy. Forty-six patients treated at our institution with endoscopic suturectomy for sagittal synostosis were retrospectively reviewed. Head circumference (HC), cephalic index (CI), and total cranial volumes (TCVs) were measured at 3 timepoints following surgery using optical surface scans obtained for helmet orthotics. All measurements showed significant differences between timepoints on the analysis of variance ( P <0.001). There was a significant correlation between CI and TCV (r=0.35, P =0.004) and between HC and TCV (r=0.81, P <0.001). The normalized rate of change over the course of treatment was significantly higher for TCV (36.7%) than for CI (8.8%) and HC (8.4%, P <0.001), with no difference between HC and CI. The authors conclude that 3D metrics were able to reliably follow the course of postoperative 2D metrics. There was a direct and linear correlation between HC and CI with TCV. Total cranial volumes showed the highest rate of sustained change at every timepoint. Although CI and HC plateau after the first measurement, TCV continues to adapt over the course of treatment. These results demonstrate the feasibility and value of volumetrics from 3D imaging to provide a more comprehensive evaluation of postoperative surgical outcomes than traditional 2D metrics without the ionizing radiation traditionally utilized for CT to obtain 3D metrics.

Synthesis, Characterization and Magnetic Hyperthermia of Monodispersed Cobalt Ferrite Nanoparticles for Cancer Therapeutics.

Magnetic nanoparticles such as cobalt ferrite are investigated under clinical hyperthermia conditions for the treatment of cancer. Cobalt ferrite nanoparticles (CFNPs) synthesized by the thermal decomposition method, using nonionic surfactant Triton-X100, possess hydrophilic polyethylene oxide chains acting as reducing agents for the cobalt and iron precursors. The monodispersed nanoparticles were of 10 nm size, as confirmed by high-resolution transmission electron microscopy (HR-TEM). The X-ray diffraction patterns of CFNPs prove the existence of cubic spinel cobalt ferrites. Cs-corrected scanning transmission electron microscopy-high-angle annular dark-field imaging (STEM-HAADF) of CFNPs confirmed their multi-twinned crystallinity due to the presence of atomic columns and defects in the nanostructure. Magnetic measurements proved that the CFNPs possess reduced remnant magnetization (MR/MS) (0.86), which justifies cubic anisotropy in the system. Microwave-based hyperthermia studies performed at 2.45 GHz under clinical conditions in physiological saline increased the temperature of the CFNP samples due to the transformation of radiation energy to heat. The specific absorption rate of CFNPs in physiological saline was 68.28 W/g. Furthermore, when triple-negative breast cancer cells (TNBC) in the presence of increasing CFNP concentration (5 mg/mL to 40 mg/mL) were exposed to microwaves, the cell cytotoxicity was enhanced compared to CFNPs alone.

Linguistic validation of the Spanish version of the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

PURPOSE: The U.S. NCI's PRO-CTCAE is a library of self-report items for assessing symptomatic adverse events in cancer clinical trials from the patient perspective. The aim of this study was to translate and linguistically validate a Spanish version. METHODS: PRO-CTCAE's 124 items were translated from English into Spanish using multiple forward and back translations. Native Spanish speakers undergoing cancer treatment were enrolled at six cancer treatment sites. Participants each completed approximately 50 items and were then interviewed using cognitive probes. The interviews were analyzed at the item level by linguistic themes, and responses were examined for evidence of equivalence to English. Items for which ≥20 % of participants experienced difficulties were reviewed, and phrasing was revised and then retested in subsequent interviews. Items where <20 % of respondents experienced difficulties were also reviewed and were considered for rephrasing and retesting. RESULTS: One hundred nine participants from diverse Spanish-speaking countries were enrolled (77 in Round 1 and 32 in Round 2). A majority of items were well comprehended in Round 1. Two items presented difficulties in ≥20 % of participants and were revised/retested without further difficulties. Two items presented difficulties in <20 %, and when retested exhibited no further difficulties. Two items presented difficulties in <20 %, but were not revised due to lack of alternatives. Sixteen items presented difficulties in ≤12 % and were not revised because difficulties were minor. CONCLUSIONS: The Spanish PRO-CTCAE has been developed and refined for use in Spanish-speaking populations, with high levels of comprehension and equivalence to the English PRO-CTCAE. TRIAL REGISTRATION: ClinicalTrials.gov:NCT01436240.

Acute effects of the short-foot exercise in runners with medial tibial stress syndrome: A quasi-experimental study.

OBJECTIVES: Analyze whether there are immediate changes in peak soleus activation and peak hindfoot eversion after short-foot exercise (SFE) in runners with medial tibial stress syndrome (MTSS). Secondarily, establish differences in peak soleus activation and peak hindfoot eversion between asymptomatic individuals and those presenting MTSS. DESIGN: Quasi-experimental study. SETTING: University Laboratory. PARTICIPANTS: Thirty-two runners participated: 16 with MTSS and 16 in the no-pain group (NPG). MAIN OUTCOME MEASURES: Soleus activation was measured using electromyography, and hindfoot eversion via 3D kinematic analysis. Participants performed SFE, and running data were collected at 9,12 and 15 km/h pre- and post-intervention. RESULTS: SFE reduced peak soleus activation at 9 (p = 0.017) and 15 km/h (p = 0.019) for the MTSS group and at 15 km/h (p < 0.001) for the NPG, suggesting improved neuromuscular efficiency and potentially reduced tibial stress. SFE did not significantly affect peak hindfoot eversion. Significant correlations were found between ankle dorsiflexion range of motion and muscle activation (r = 0.585 to 0.849, p < 0.05). These findings suggest SFE could improve neuromuscular efficiency and reduce tibial stress, and highlights ankle flexibility's role in muscle activation. CONCLUSIONS: SFE significantly reduces soleus activation, potentially improving neuromuscular efficiency and decreasing tibial stress.

Identification of Transferrin Receptor 1 (TfR1) Overexpressed in Lung Cancer Cells, and Internalization of Magnetic Au-CoFe2O4 Core-Shell Nanoparticles Functionalized with Its Ligand in a Cellular Model of Small Cell Lung Cancer (SCLC).

Lung cancer is, currently, one of the main malignancies causing deaths worldwide. To date, early prognostic and diagnostic markers for small cell lung cancer (SCLC) have not been systematically and clearly identified, so most patients receive standard treatment. In the present study, we combine quantitative proteomics studies and the use of magnetic core-shell nanoparticles (mCSNP's), first to identify a marker for lung cancer, and second to functionalize the nanoparticles and their possible application for early and timely diagnosis of this and other types of cancer. In the present study, we used label-free mass spectrometry in combination with an ion-mobility approach to identify 220 proteins with increased abundance in small cell lung cancer (SCLC) cell lines. Our attention was focused on cell receptors for their potential application as mCSNP's targets; in this work, we report the overexpression of Transferrin Receptor (TfR1) protein, also known as Cluster of Differentiation 71 (CD71) up to a 30-fold increase with respect to the control cell. The kinetics of endocytosis, evaluated by a flow cytometry methodology based on fluorescence quantification, demonstrated that receptors were properly activated with the transferrin supported on the magnetic core-shell nanoparticles. Our results are important in obtaining essential information for monitoring the disease and/or choosing better treatments, and this finding will pave the way for future synthesis of nanoparticles including chemotherapeutic drugs for lung cancer treatments.

Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America.

PURPOSE: We present a physician survey of the impact of 21-gene Breast Recurrence Score test results on treatment decisions in clinical practice in Latin America. METHODS: This prospective survey enrolled consecutive patients at 14 sites in Argentina, Colombia, Mexico, and Peru who had routine 21-gene testing. Physician surveys captured patient and tumor characteristics and treatment decisions before and after 21-gene test results. The survey spanned the period before and after Trial Assigning Individualized Options for Treatment (TAILORx) results reported (June 2018). Overall net percent change in adjuvant chemotherapy recommendations was estimated, and asymptotic 95% CIs with continuity correction were calculated. The proportion with a change between pretest treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx. RESULTS: Between March 2015 and December 2019, the survey was completed for 647 patients; 20% were node-positive. The mean patient age was 54 years (24-85 years); 55% were postmenopausal; 17%, 63%, and 20% had grade 1, 2, and 3 tumors, respectively; and 30% had tumors > 2 cm. Recurrence Score (RS) results were as follows: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, chemotherapy recommendations fell by a relative proportion of 39% (95% CI, 33.4 to 44.3) after 21-gene testing (33% decrease in node-negative and 55% decrease in node-positive). Among node-negative patients, the relative decrease in chemotherapy recommendations was 28% (95% CI, 18.9 to 39.5) before TAILORx and 36% (95% CI, 28.4 to 43.7) after. CONCLUSION: To our knowledge, this large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize chemotherapy overuse and underuse in breast cancer. The results showed substantial reductions in chemotherapy use overall-especially after TAILORx reported-indicating the practice-changing potential of that study.

Do not Forget Burkitt´s Lymphoma! Unusual Case of Primary Malignant Lymphoma of the Prostate in a Young Patient.

Primary Burkitt´s lymphoma (BL) of the prostate is rare in the adolescent population. The etiology remains poorly understood. There has been some proposed associations to Epstein-Barr virus and HIV. Clinical and histopathologic data of a 17-year-old patient who underwent transurethral resection of the prostate was obtained. We report the first case of primary malignant BL of the prostate in a 17-year-old Caucasian male who presented with hematuria, lower urinary tract symptoms. Differential diagnosis of a prostatic mass in adolescent patients must be primary or secondary lymphoma of the prostate, including BL as described for the first time in this article.

Triple-Negative Breast Cancer: A Review of Conventional and Advanced Therapeutic Strategies.

Triple-negative breast cancer (TNBC) cells are deficient in estrogen, progesterone and ERBB2 receptor expression, presenting a particularly challenging therapeutic target due to their highly invasive nature and relatively low response to therapeutics. There is an absence of specific treatment strategies for this tumor subgroup, and hence TNBC is managed with conventional therapeutics, often leading to systemic relapse. In terms of histology and transcription profile these cancers have similarities to BRCA-1-linked breast cancers, and it is hypothesized that BRCA1 pathway is non-functional in this type of breast cancer. In this review article, we discuss the different receptors expressed by TNBC as well as the diversity of different signaling pathways targeted by TNBC therapeutics, for example, Notch, Hedgehog, Wnt/b-Catenin as well as TGF-beta signaling pathways. Additionally, many epidermal growth factor receptor (EGFR), poly (ADP-ribose) polymerase (PARP) and mammalian target of rapamycin (mTOR) inhibitors effectively inhibit the TNBCs, but they face challenges of either resistance to drugs or relapse. The resistance of TNBC to conventional therapeutic agents has helped in the advancement of advanced TNBC therapeutic approaches including hyperthermia, photodynamic therapy, as well as nanomedicine-based targeted therapeutics of drugs, miRNA, siRNA, and aptamers, which will also be discussed. Artificial intelligence is another tool that is presented to enhance the diagnosis of TNBC.

Real-World Effectiveness and Tolerability of Pazopanib as First Targeted Therapy in Metastatic Renal Cell Carcinoma: A Retrospective Chart Review in Latin America.

INTRODUCTION: Pazopanib is approved in Latin America as first targeted therapy for patients with metastatic renal cell carcinoma (mRCC). METHODS: A retrospective chart review of adult patients with mRCC who initiated pazopanib as first targeted therapy between January 2011 and March 2016 was conducted among oncology care centers in Argentina, Brazil, Chile, Colombia, and Mexico. Patient characteristics, treatment patterns, overall survival (OS), progression-free survival (PFS), and adverse events were summarized. RESULTS: A total of 156 charts of patients with mRCC receiving first-line pazopanib were reviewed (29, 54, 27, 28, and 18 patients from Argentina, Brazil, Chile, Colombia, and Mexico, respectively). The mean age at initial mRCC diagnosis was 61.6 years, 73.7% were male, and 51.3% were Hispanic. The median dose of pazopanib was 800 mg and the median time from initial mRCC diagnosis to pazopanib start was 2.2 months. The median time on treatment was 10.0 months. At the time of data extraction, 16.7% of patients remained on pazopanib, with clinical progression listed as the main reason for discontinuation. Subsequent therapy was received by 25.6% of patients; the most common were everolimus (9.6%) and axitinib (5.8%). Overall, median PFS and OS were 10.8 and 16.9 months, respectively, and varied across countries. The most common all-grade adverse events were diarrhea (44.9%), asthenia/fatigue (43.6%), and nausea (28.8%). CONCLUSIONS: Pazopanib was used for first-line mRCC treatment in a clinically diverse patient population across Latin America. Real-world PFS and tolerability were similar to clinical studies of pazopanib. FUNDING: Novartis Pharmaceuticals Corporation, Inc.

Odontologia digital - abordagem histórica e conceitual: uma revisão de literatura / Digital dentistry - historical and conceptual approach: a literature review

Introdução: as inovações tecnológicas contribuem e representam um papel importante em diversos aspectos da vida cotidiana dos indivíduos em sociedade. Diferentes áreas do conhecimento trabalham com as ferramentas tecnológicas e digitais, dentre estas áreas, destaca-se a Odontologia e suas especialidades. A Odontologia digital e suas tecnologias associadas têm se destacado de forma progressiva, abordando desde os planejamentos restauradores de forma virtual, as impressões de modelos em impressora 3D e os métodos de confecção de próteses em fresadoras auxiliadas por computadores. Objetivo: este trabalho tem como objetivo realizar uma revisão de literatura, com uma abordagem conceitual e histórica acerca da Odontologia digital, do escaneamento intraoral e da confecção laboratorial das restaurações indiretas por meio dos sistemas CAD/CAM. Fonte dos dados: a pesquisa na literatura foi feita utilizando-se as bases de dados Medline® (PubMed), Scielo e Bireme com as seguintes palavras chaves: "CAD/CAM", "dental prothesis", "dental porcelain", "digital dentistry", "dental scanner", "digital impression". Síntese dos dados: os estudos demonstraram grandes avanços nas técnicas de moldagem com o escaneamento intraoral permitindo a obtenção de imagens fidedignas dos dentes e estruturas adjacentes de forma precisa, otimizando o tempo clínico. Além disto, o desenvolvimento de novos métodos e materiais dentários tem possibilitado a elaboração de modelos de trabalho, restaurações indiretas e infraestruturas de próteses por meio de um processo totalmente digital. Conclusão: podemos concluir que os estudos reportam resultados promissores com os métodos de trabalho por meio do fluxo digital. Além disso, é notável que esta realidade na Odontologia restauradora e reabilitadora continuará evoluindo e possibilitando o acesso a um maior número de profissionais.

Introduction: technological innovations are important and present an important role in various aspects in lives of individuals in society. Different areas of knowledge working with technological and digital tools, and among these areas, Dentistry and its specialties stand out. In the last decades, digital Dentistry and its associated technologies have been highlighting in a progressive way, approaching from the virtual restorative planning, 3D printed models to the prosthesis manufacturing methods in milling machines aided by computer. Objective: the aim of this study is to reach out a literature review, with a conceptual and historical approach about digital Dentistry, intraoral scanning and laboratory press of indirect restorations with CAD/CAM systems. Sources of data: the literature search was done using Medline® (PubMed), Scielo and Bireme databases with the following keywords: "CAD/CAM", "dental prothesis", "dental porcelain", "3D printing". Synthesis of data: the present work demonstrates a great advance in impression technique with intraoral scan allowing the obtention of trustworthy images from teeth and surrounding structures in a precision way, optimizing clinical time. Furthermore, the development of new methods and dental materials have been allowing the elaboration of dental work cast, indirect restorations and prosthesis infrastructures in a fully digital process. Conclusion: it is possible to conclude that the articles report promising results with working methods through the digital flow. Besides that, it is remarkable that this reality in restorative and rehabilitation dentistry will be in a continuous evolution and allowing access to a greater number of professionals.

Effect of adduction during glenohumeral external rotation exercises in the scapulohumeral muscles / Efecto de la adducción durante ejercicios de rotación externa glenohumeral en los músculos escapulohumerales

SUMMARY: The effect of adduction during glenohumeral external rotation (ER) exercises on the scapulohumeral muscles is controversial. The aim of this study was to evaluate the effect of carrying out adduction during external rotation exercises in low and high shoulder positions on the electromyographic (EMG) activity of the infraspinatus (IS), middle deltoid (MD), and posterior deltoid (PD) muscles. EMG activity of the IS, MD, and PD muscles of 20 healthy participants was evaluated. Subjects performed 6 ER exercises that combined two factors: i) different adduction pressures according to biofeedback unit (0, 5 and 10 mmHg), and ii) low and high shoulder position. The pressure was controlled using a biofeedback unit. The low and high shoulder positions were 20? and 90? of abduction. In the low shoulder position, the activity of the IS muscle increased as the pressure on the biofeedback unit increased and the MD and PD muscles presented the highest activity at 10 mmHg. In the high shoulder position, the activity of the IS muscle was higher at 0 and 10 mmHg, the MD muscle presented higher activity at 5 mmHg, and PD muscle activity did not vary with the pressure. The addition of adduction at a pressure of 5 mmHg in the low shoulder position promotes is activity. Likewise, adduction at a pressure of 10 mmHg will promote activity of the IS, MD, and PD.

RESUMEN: El efecto de la aducción durante los ejercicios de rotación externa (RE) glenohumeral sobre los músculos escapulohumerales es controversial. El objetivo de este estudio fue evaluar el efecto de la realización de la aducción durante los ejercicios de rotación externa en posiciones bajas y altas del hombro sobre la actividad electromiográfica (EMG) delos músculos infraespinoso (IS), deltoides medio (DM) y deltoides posterior (DP). Se evaluó la actividad EMG de los músculos IS, MD y PD de 20 participantes sanos. Los sujetos realizaron 6 ejercicios de RE que combinaron dos factores: i) diferentes presiones de aducción de acuerdo con la unidad de biorretroalimentación (0, 5 y 10 mmHg), y ii) posición del hombro baja y alta. La presión se controló mediante una unidad de biorretroalimentación. Las posiciones del hombro baja y alta fueron de 20? y 90? de abducción. En la posición del hombro bajo, la actividad del músculo IS aumentó a medida que aumentaba la presión sobre la unidad de biorretroalimentación y los músculos MD y PD presentaron la actividad más alta a 10 mmHg. En la posición del hombro alto, la actividad del músculo IS fue mayor a 0 y 10 mmHg, el músculo MD presentó mayor actividad a 5 mmHg y la actividad del músculo PD no varió con la presión. La adición de aducción a una presión de 5 mmHg en la posición baja del hombro promueve la actividad del músculo IS. Asimismo, la aducción a una presión de 10 mmHg promoverá la actividad del IS, MD y PD.

Diagnóstico y tratamiento multidisciplinario de melanoma temprano y localmente avanzado. Consenso de expertos. Asociación Colombiana de Hematología y Oncología (ACHO) / Diagnosis and multidisciplinary treatment of early-stage and locally advanced melanoma: Expert consensus, Colombian Association of Hemato-Oncology (ACHO)

Resumen Introducción: El melanoma ocasiona el 75% de las muertes por cáncer de piel. Según GLOBOCAN, en 2018 se presentaron 287.723 casos nuevos de melanoma, con una mortalidad de 60.712 casos, que equivale al 20% del total de los casos incidentes. Las alternativas para el tratamiento del melanoma se fundamentan en la estatificación de la enfermedad, y en las características moleculares de la enfermedad. Objetivo: Consensuar, por común acuerdo de expertos, sugerencias para el diagnóstico y manejo de melanoma temprano basadas en la evidencia y ajustadas al contexto colombiano. Métodos: Se llevó a cabo un consenso de expertos multidisciplinario, constituido por 19 oncólogos clínicos, 2 cirujanos de mama y tejidos blandos, 2 dermatólogos, 2 patólogos y 2 radioterapeutas, miembros activos de la Asociación Colombiana de Hemato Oncología (ACHO). Este consenso se realizó en 4 etapas: 1. Estructuración de 29 preguntas, que se calificaron de 1 a 9. 2. Reenvío de las preguntas no consensuadas. 3. Análisis y discusión de las respuestas. 4. Las respuestas no consensuadas se llevaron a un consenso nominal. Resultados: Se discutieron 29 preguntas relacionadas con el diagnóstico y tratamiento de melanoma temprano, se construyeron sugerencias basadas en evidencia utilizada por los expertos y en guías de manejo de oncología reconocidas internacionalmente, adaptadas al contexto y realidad colombianos. Conclusiones: Se presentan sugerencias multidisciplinarias para el diagnóstico y tratamiento de melanoma temprano, las cuales debe considerarse para orientar la toma de decisiones y homogenizar la práctica clínica de acuerdo al contexto colombiano y a las características propias del sistema de salud del país. Este es un documento académico y no regulatorio.

Abstract Introduction: Melanoma causes 75% of deaths from skin cancer. In 2018, according to GLOBOCAN, 287,723 new melanoma cases were registered, with a mortality of 60,712 cases, which is equivalent to 20% of all incident cases. Alternatives for the treatment of melanoma are based on disease staging and the molecular characteristics of the disease. Objective: To establish a consensus by common agreement of experts and construct suggestions for the diagnosis and management of early-stage melanoma based on evidence and adjusted to the Colombian context. Methods: A multidisciplinary expert consensus was established, wth the participation of 19 clinical oncologists, 2 soft tissue surgeons, 2 dermatologists, 2 pathologists, and 2 radiotherapists, active members of the Colombian Association of Hemato-Oncology (ACHO). This consensus was carried out in four stages: 1) Structuring of 29 questions, which were scored from 1 to 9; 2) Resubmission of non-consensual questions; 3) Analysis and discussion of responses; and 4) Validation of non-consensual responses by nominal consensus. Results: Twenty-nine questions related to the diagnosis and treatment of early-stage melanoma were discussed in order to construct suggestions based on evidence proven by experts, as well as on internationally recognized oncology management guidelines adapted to the Colombian context and reality. Conclusions: Multidisciplinary suggestions are offered for the diagnosis and treatment of early-stage melanoma, which should be considered in order to guide decision-making and homogenize clinical practice according to the Colombian context and the characteristics of the Colombian health care system. This is an academic and non-regulatory document.

Recomendaciones para el diagnóstico, tratamiento y seguimiento del cáncer de mama durante la pandemia de SARS-Cov-2/COVID-19 en Colombia / Recommendations for the diagnosis, treatment and monitoring of breast cancer during the SARS-Cov-2/COVID-19 pandemic in Colombia

Resumen Bajo las nuevas condiciones generadas por la pandemia de COVID-19, los tratamientos para el cáncer de mama requieren algunas reorientaciones y cuidados que se exponen en este artículo. Se consideran aquí las tres fases de gravedad de la pandemia y los respectivos tratamientos que demandan en función de los lineamientos dictados por el Ministerio de Salud y Protección Social de Colombia. Se trata de un conjunto de referencias para orientar las terapias y tratamientos, inspiradas en las políticas de salud regionales, nacionales e institucionales.

Abstract Under the new conditions generated by the COVID-19 pandemic, breast cancer treatments requires some reorientations and cares that are discussed in this article. The three phases of severity of the pandemic and the respective treatments they require -based on the guidelines issued by the Ministry of Health and Social Protection of Colombia- are considered here. It is a set of references to guide therapies and treatments, inspired by regional, national and institutional health policies.

Dopamine receptor dysregulation in hippocampus of aged rats underlies chronic pulsatile L-Dopa treatment induced cognitive and emotional alterations.

L-Dopa is the major symptomatic therapy for Parkinson's disease, which commonly occurs in elderly patients. However, the effects of chronic use on mood and cognition in old subjects remain elusive. In order to compare the effects of a chronic pulsatile L-Dopa treatment on emotional and cognitive functions in young (3 months) and old (18 months) intact rats, an L-Dopa/carbidopa treatment was administered every 12 h over 4 weeks. Rats were assessed for behavioural despair (repeated forced swimming test, RFST), anhedonia (sucrose preference test, SPT) and spatial learning (Morris water maze, MWM) in the late phase of treatment (T). Neuronal expression of Fos in the hippocampus at the early and late phases of T, as well as after MWM was studied. The density and ratio of dopamine D5r, D3r and D2r receptors were also evaluated in the hippocampus using immunohistochemistry and confocal microscopy. Young rats showed similar patterns during behavioural tests, whereas aged treated rats showed increased immobility counts in RFST, diminished sucrose liquid intake in SPT, and spatial learning impairment during MWM. Fos expression was significantly blunted in the aged treated group after MWM. The density of D5r, D3r and D2r was increased in both aged groups. The treatment reduced the ratio of D5r/D3r and D5r/D2r in both groups. Moreover, aged treated subjects had significant lower values of D5r/D3r and higher values of D5r/D2r when compared with young treated subjects. These results indicate that chronic L-Dopa treatment in itself could trigger emotional and cognitive dysfunctions in elderly subjects through dopamine receptor dysregulation.

[Suicide attempt with aluminum phosphide poisoning]. / Tentativa suicida por intoxicación con fosfuro de aluminio.

BACKGROUND: suicide attempt with aluminum phosphide fumigant has high mortality conditions. The aim was to investigate the frequency of aluminum phosphide consumption in suicide attempt. METHODS: a retrospective case series study at the Hospital General de Tejupilco during the period 2009-2011 was done. Thirty-two patients had attempted suicide; we included 18 whose suicide attempt was with aluminum phosphide. The risk of rescue according Weisman's scale was measured. RESULTS: from 18 suicidal patients, 83 % were women (n = 15); the average age was 17.7 ± 4.4 years; 89 % (n = 16) were = 23 years old; and 89 % (n = 16) had depression. The motive for the suicide attempt was being abandoned by a partner in 56 % (10). Mortality rate was 78 % (n = 14) and death ocurred in 4 ± 2 hours. CONCLUSIONS: aluminum phosphide is the most commonly used toxic substance in rural areas for suicide attempts. Among suicides, the most common cause among women was abandonment by her partner and was also related to depression and emotional security to dying.

Introducción: la tentativa suicida con el fumigante denominado fosfuro de aluminio tiene elevada mortalidad. El objetivo fue determinar la frecuencia del consumo de fosfuro de aluminio por tentativa suicida. Métodos: estudio retrospectivo de serie de casos, realizado en el Hospital General de Tejupilco durante los años 2009 a 2011. De 32 pacientes con tentativa suicida, solo se incluyeron 18 que utilizaron fosfuro de aluminio. El riesgo de rescate se calificó de acuerdo con la escala de Weisman. Resultados: de los 18 pacientes suicidas que utilizaron fosfuro de aluminio, 83 % era del sexo femenino (n = 15) y la edad media era de 17.7 ± 4.4 años, 89 % (n = 16) tenía = 23 años de edad y 89 % (n = 16) cursaba con depresión. El motivo detonante del intento suicida fue el abandono de la pareja en 56 % (n = 10). La letalidad del fosfuro de aluminio fue de 78 % (n = 14). Las defunciones sucedieron en 4 ± 2 horas. Conclusiones: el fosfuro de aluminio es el tóxico más usado con intención suicida en el medio rural; su uso predomina en las mujeres abandonadas por su pareja y se relaciona con depresión emocional y seguridad de morir.

Carga de enfermedad en años de vida ajustados por discapacidad del cáncer gástrico en Colombia / Disease Burden of Gastric Cancer in Disability-Adjusted Life Years in Colombia

Resumen Objetivo: el cáncer gástrico es la segunda causa de muerte por cáncer y la quinta neoplasia más frecuente en el mundo. En Colombia, es la primera causa de mortalidad por cáncer. La incidencia y mortalidad anuales son 16,3 y 14,2/100 000 habitantes, respectivamente. El objetivo de este estudio fue estimar su carga de enfermedad, medida en años de vida ajustados por discapacidad (AVAD), en Colombia. Métodos: se desarrolló un estudio con enfoque en prevalencia para el año 2014. Para estimar la prevalencia, se realizó una búsqueda en los registros del Sistema de Información en Protección Social (SISPRO) y el Departamento Administrativo Nacional de Estadística (DANE). La duración promedio de los casos prevalentes y la sobrevida estimada se obtuvieron de la literatura local. Los AVAD fueron calculados sumando los años de vida perdidos por muerte prematura (AVPM) y los años de vida vividos con discapacidad (AVVD), según la metodología de la Organización Mundial de la Salud (OMS). Resultados: las prevalencias estimadas para 5 años en población mayor de 15 años fueron 40,9/100 000 en mujeres y 62,5/100 000 en hombres. El total de AVAD fue 293,418, con una tasa de 623/100 000 habitantes, de los cuales el 97,4% corresponde a AVPM. La tasa de AVVD y AVPM para Colombia fue 16 y 607/100 000, respectivamente. Conclusiones: los datos obtenidos de SISPRO y el DANE estiman una alta carga de enfermedad en Colombia. Es necesaria la implementación de estrategias de detección temprana del cáncer para disminuir la carga de la enfermedad y mejorar el pronóstico de los pacientes.

Abstract Objective: Gastric cancer is the second most common cause of cancer death and the fifth most common neoplasm in the world. In Colombia, it is the leading cause of cancer mortality. The annual incidence and mortality are 16.3/100,000 and 14.2/100,000 inhabitants respectively. The aim of this study was to estimate the disease burden in Colombia as measured in disability-adjusted life years (DALYs). Methods: This study focuses on prevalence in 2014. To estimate prevalence, a search was made in the registries of the Social Protection Information System (SISPRO) and the National Administrative Department of Statistics (DANE). The average duration of cases and estimated survival were obtained from the local literature. DALYs were calculated by adding the years of life lost due to premature death (YLLs) and years of life lived with disability (YLD) according to the methodology of the World Health Organization (WHO). Results: Prevalences estimated for five years in the population older than 15 years were 40.9/100,000 for women and 62.5/100,000 for men. The total DALY was 293,418, with a rate of 623/100,000 inhabitants; 97.4% correspond to YLL. The YLD and YLL for Colombia were 16/100,000 and 607/100,000, respectively. Conclusions: Data obtained from SISPRO and DANE estimate a high disease burden in Colombia. It is necessary to implement early cancer detection strategies to reduce the burden of disease and improve patient prognosis.

Impacto en la calidad de vida por la asociación entre trastornos de sueño y síndrome de intestino irritable / Impact on the Quality of Life of the Association between Sleep Disorders and Irritable Bowel Syndrome

Objetivos: determinar si la presencia de alteraciones del sueño se asocia con el deterioro en la calidad de vida, medida a través del cuestionario SF-36, en pacientes con síndrome de intestino irritable (SII). Métodos: se diseñó un estudio de corte transversal en el que se incluyeron individuos con SII seleccionados con los criterios de Roma III, a los que se les aplicó la escala de Epworth, el cuestionario de Pittsburgh y los criterios para síndrome de piernas inquietas (SPI); de manera simultánea, se les realizó la evaluación de calidad de vida usando la escala SF-36. Resultados: se incluyeron 80 pacientes con SII, la mayoría mujeres; el 81% presentó algún tipo de trastorno del sueño determinado por la alteración en 1 o más escalas. Al estratificar los pacientes con y sin trastornos del sueño, se observó que el subgrupo con trastorno del sueño se asoció con mayores alteraciones en la calidad de vida, con OR 4,8125, IC 95%: 1,17-19,02, p < 0,0076, diferencia estadísticamente significativa. Conclusiones: en este estudio se encontró que hasta un 81% de los pacientes con SII presentan trastornos de sueño, y que las alteraciones del sueño en pacientes con SII se asocian con un mayor compromiso de la calidad de vida según la escala SF-36.

Objectives: The objectives of this study were to determine if sleep disorders in patients with irritable bowel syndrome (IBS) were associated with impaired quality of life as measured by the SF36 questionnaire. Methods: This is cross-sectional study in which individuals with IBS according to the Rome III criteria were evaluated for sleep disorders with the Epworth Sleepiness Scale questionnaire and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. They were also evaluated for restless legs syndrome (RLS) and, simultaneously, the Short Form (36) Health Survey was used to evaluate participants’ quality of life. Results: Eighty patients with IBS, mostly women, were included in this study. 81% had some type of specific sleep disorder as measured by at least one of the questionnaires. Patients were groups into those who had sleep disorders, and those who did not. The group which had sleep disorders had statistically significantly more alterations in quality of life (OR 4.8125, 95% CI: 1.17 to 19.02, p <0.0076). Conclusions: This study found that up to 81% of IBS patients have sleep disorders and that sleep disturbances in patients with IBS are associated with decreased quality of life according to the SF36 scale.

Astrogliosis is temporally correlated with enhanced neurogenesis in adult rat hippocampus following a glucoprivic insult.

2-Deoxy-d-glucose (2-DG) administration causes transient depletion of glucose derivates and ATP. Hence, it can be used in a model system to study the effects of a mild glycoprivic brain insult mimicking transient hypoglycemia, which often occurs when insulin or oral hypoglycemic agents are administered for diabetes control. In the present study, the effect of a single 2-DG application (500mg/kg, a clinically applicable dose) on glial reactivity and neurogenesis in adult rat hippocampus was examined, as well as a possible temporal correlation between these two phenomena. Post-insult (PI) glial reactivity time course was assessed by immunoreaction against glial-fibrillary acidic protein (GFAP) during the following 5 consecutive days. A clear increase of GFAP immunoreactivity in hilus was observed from 48 to 96h PI. Moreover, enhanced labeling of long radial processes in the granule cell layer adjacent to hilus was evidenced. On the other hand, a transient increase of progenitor cell proliferation was detected in the subgranular zone, prominently at 48h PI, coinciding with the temporal peak of glial activation. This increase resulted in an augment of neuroblasts double labeled with 5-bromo-deoxyuridine (BrdU) and with double cortin (DCX) at day 7 PI. Around half of these cells survived 28 days showing matured neuronal phenotype double labeled by BrdU and a neuronal specific nuclear protein marker (NeuN). These findings suggest that a transient neuroglycoprivic state exerts a short-term effect on glial activation that possibly triggers a long-term effect on neurogenesis in hippocampus.

Validación de criterios diagnósticos de esclerosis múltiple con resonancia magnética / Diagnosis of Multiple sclerosis with magnetic resonance

La ecografía Doppler color ha permitido realizar estudios no invasivos de la circulación del pene, en pacientes con impotencia vasogénica. Puede identificar los vasos más pequeños y definir la dirección del flujo en las arterias cavernosas y en las vías colaterales, lo cual permite la perfusión del pene para demostrar los cambios dinámicos en el flujo sanguíneo tras la aplicación de un agente vasoactivo. Las vías colaterales de flujo hacia las arterias cavernosas, de la arteria dorsal del pene, de la arteria cavernosa contralateral o de la arteria bulbouretral (esponjosa) pueden corresponder a variantes anatómicas normales o indicar una enfermedad proximal de la arteria afectada. El estudio de los datos hemodinámicos de la onda espectral Doppler, sumado al análisis de la dirección del flujo en arterias cavernosas y vasos colaterales, suministra una valiosa información para el diagnóstico de disfunción eréctil de tipo vasogénico y para planear un tratamiento quirúrgico efectivo