Riesgo de eventos embólicos en pacientes con miocardiopatía chagásica y fibrilación auricular a pesar de terapia antitrombótica: ¿es la anticoagulación suficiente? / Risk of Embolic Events in Patients with Chagasic Cardiomyopathy and Atrial Fibrillation Despite Antithrombotic Therapy: Is Anticoagulation Enough?

RESUMEN Introducción: La miocardiopatía chagásica (MC) difiere de otras causas de insuficiencia cardíaca en múltiples aspectos, destacándose el riesgo de embolias sistémicas. Sin embargo, pocos estudios han evaluado el riesgo de eventos embólicos en pacientes anticoagulados con MC en comparación con otras miocardiopatías. Objetivo: Nuestro objetivo fue analizar la incidencia de embolias sistémicas en una cohorte de pacientes anticoagulados con diagnóstico de fibrilación auricular (FA) con y sin MC. Material y métodos: Se realizó un estudio de cohorte retrospectivo en hospital de cuarto nivel en Colombia durante el periodo 2014-2020. Se incluyeron todos los pacientes con diagnóstico de miocardiopatía de cualquier etiología y FA que estuvieran en régimen de anticoagulación. El resultado primario fue la incidencia de eventos embólicos. Se realizó un análisis de supervivencia mediante modelos de riesgos proporcionales de Cox ajustados. Un valor de p <0,05 se consideró significativo. Todas las pruebas estadísticas fueron de dos colas. Resultados: Se evaluaron 149 pacientes anticoagulados con miocardiopatía (mediana de edad: 71 años; mujeres: 30,20%). La incidencia acumulada de eventos embólicos fue significativamente mayor en los pacientes con MC (17,50%) en comparación con aquellos con otras miocardiopatías (4,95%), a pesar de que estos últimos tenían una puntuación CHA2DS2-VASc significativamente mayor (p=0,013). Tras el análisis multivariado, los pacientes con MC tuvieron un riesgo significativamente mayor de eventos embólicos independientemente de la puntuación CHA2DS2-VASc y del tipo de anticoagulante prescrito (HR 5,65; IC 95% 1,46-21,83; p=0,012). Conclusiones: La MC se asoció con un riesgo significativamente mayor de eventos embólicos, a pesar del tratamiento anticoagulante en ambos grupos. Se requiere más investigación para comprender el origen de este riesgo observado y traducir este conocimiento en indicaciones específicas de anticoagulación para pacientes con MC.

ABSTRACT Background: Chagasic cardiomyopathy (CC) differs from other heart failure causes in multiple aspects, highlighting the risk of systemic embolisms. However, few studies have evaluated the risk of embolic events in anticoagulated patients with CC compared with other cardiomyopathies. Objective: We aimed to analyze the incidence of systemic embolisms in a cohort of anticoagulated patients diagnosed with atrial fibrillation (AF) with and without CC. Methods: A retrospective cohort study was carried out at a fourth level hospital in Colombia during the period 2014-2020. All patients diagnosed with cardiomyopathy of any etiology and AF, who were on an anticoagulation regimen were included. The primary outcome was the incidence of embolic events. A survival analysis was performed using adjusted Cox proportional hazard models. A p-value <0.05 was considered significant. All statistical tests were two-tailed. Results: A total of 149 anticoagulated patients with cardiomyopathy were evaluated (median age: 71 years; women: 30.20%). The cumulative incidence of embolic events was significantly higher in patients with CC (17.50%) compared with those presenting other cardiomyopathies (4.95%), despite that the latter had a significantly higher CHA2DS2-VASc score (p=0.013). After multivariate analysis, patients with CC had a significantly higher risk of embolic events regardless of the CHA2DS2-VASc score and the type of anticoagulant prescribed (HR 5.65; 95% CI 1.46-21.83; p=0.012). Conclusions: Chagasic cardiomyopathy was associated with a significantly higher risk of embolic events, despite anticoagulation therapy in both groups. More research is required to understand the origin of the risk observed in order to translate this knowledge into specific indications for anticoagulation in patients with CC.

Neuroleptic malignant syndrome associated with atypical antipsychotics: A case report.

INTRODUCTION: Neuroleptic malignant syndrome (NMS) is uncommon, with an incidence of 0.01%-3.23%, and is associated with the use of drugs that intervene with dopamine, causing hyperthermia, muscular rigidity, confusion, autonomic instability and death. CASE REPORT: A 35-year-old man with a history of catatonia, refractory epilepsy and functional impairment, required frequent changes in his anticonvulsant and antipsychotic treatment, due to adverse effects. During 2019, in the month of July, clozapine was changed to amisulpride, in September he developed fever, muscle stiffness, stupor, diaphoresis and tachypnea over a two-week period; paraclinical tests showed elevated creatine phosphokinase (CPK) and leukocytosis, so NMS was considered. The antipsychotic was withdrawn and he was treated with bromocriptine and biperiden, with a good response. Ten days after discharge, he began treatment with olanzapine, which generated a similar episode to the one described in December, with subsequent management and resolution. DISCUSSION: The diagnosis is based on the use of drugs that alter dopamine levels, plus altered state of consciousness, fever, autonomic instability and paraclinical tests showing leukocytosis and elevated CPK. Differential diagnoses must be ruled out. Early diagnosis generally leads to total remission, although some patients will suffer complications, long-term sequelae or recurrences. The recurrence in this case derived from the early reintroduction of the neuroleptic after the first episode. Treatment should be individualised according to severity to avoid mortality. CONCLUSIONS: Atypical antipsychotics are rarely suspected of generating NMS. Moreover, the time to reintroduction after an episode must also be taken into account.

Síndrome neuroléptico maligno asociado a antipsicóticos atípicos: a propósito de un caso

Introducción: El síndrome neuroléptico maligno (SNM) es infrecuente, con una incidencia del 0,01 al 3,23%, y tiene relación con el consumo de fármacos que interfieren con la dopamina; genera hipertermia, rigidez muscular, confusión, inestabilidad autonómica y la muerte. Caso clínico: Un varón de 35 arios, con antecedentes de catatonía, epilepsia refractaria y deterioro funcional, en tratamiento anticonvulsivo y antipsicótico, requirió cambio frecuente por efectos adversos de este. En julio de 2019 se cambió la clozapina por amisulprida; en septiembre se inicia un cuadro de 2 semanas de fiebre, rigidez muscular, estupor, diaforesis y taquipnea; los paraclínicos mostraron aumento de la creatininasa (CK) y leucocitosis, por lo que se consideró SNM. Se retiró el antipsicótico y se trató con bromocriptina y biperideno, que obtuvieron buena respuesta. A los 10 días del egreso, se inició tratamiento con olanzapina, que generó en diciembre un cuadro clínico similar al descrito, con posterior tratamiento y resolución. Discusión: El diagnóstico se basa en la toma de fármacos que alteren la dopamina, más alteración del estado de conciencia, fiebre e inestabilidad autonómica, junto con paraclínicos como leucocitosis y elevación de la CK. Se debe descartar diagnósticos diferenciales. El diagnóstico temprano generalmente lleva a la remisión total; algunos tendrán complicaciones, secuelas a largo plazo o recidivas. La recurrencia en este caso derivó de la reintroducción temprana del neuroléptico después del primer episodio. El tratamiento se debe individualizar según la gravedad para evitar la muerte. Conclusiones: Rara vez se sospecha que los antipsicóticos atípicos generen SNM; a su vez se debe tener en cuenta el tiempo a la reintroducción después de un episodio.

Introduction: Neuroleptic malignant syndrome (NMS) is uncommon, with an incidence of 0.01% to 3.23%, and is associated with the use of drugs that intervene with dopamine, causing hyperthermia, muscular rigidity, confusion, autonomic instability and death. Case report: A 35-year-old man with a history of catatonia, refractory epilepsy and functional impairment, required frequent changes in his anticonvulsant and antipsychotic treatment, due to adverse effects. During 2019, in the month of July, clozapine was changed to amisul-pride, in September he developed fever, muscle stiffness, stupor, diaphoresis and tachypnea over a two-week period; paraclinical tests showed elevated creatine phosphokinase (CPK) and leukocytosis, so NMS was considered. The antipsychotic was withdrawn and he was treated with bromocriptine and biperiden, with a good response. Ten days after discharge, he began treatment with olanzapine, which generated a similar episode to the one described in December, with subsequent management and resolution. Discussion: The diagnosis is based on the use of drugs that alter dopamine levels, plus altered state of consciousness, fever, autonomic instability and paraclinical tests showing leukocy-tosis and elevated CPK. Differential diagnosis must be ruled out. Early diagnosis generally leads to total remission, although some patients will suffer complications, long-term sequelae or recurrences. The recurrence in this case derived from the early reintroduction of the neuroleptic after the first episode. Treatment should be individualised according to severity to avoid mortality. Conclusions: Atypical antipsychotics are rarely suspected of generating NMS. Moreover, the time to reintroduction after an episode must also be taken into account.

Más allá de los límites de la disciplina con niños prematuros: una reflexión holística / Beyond the Limits of Discipline with Premature Children: A Holistic Reflection / Além dos limites da disciplina com bebés prematuros: uma reflexão holística

Introducción. En este artículo se presenta una reflexión sobre la necesidad de tener una visión holística en la problemática de la prematurez, para que los equipos del área de salud puedan tener una comprensión de la multiplicidad de factores presentes en el parto prematuro, y sus consecuencias para el menor, la madre, los familiares y el personal de salud involucrado. Tema de reflexión. El tema se sustenta en dos investigaciones realizadas con las madres, los padres y los niños beneficiarios del Programa Madre Canguro en un hospital del Estado, en dos momentos, 2012 y 2014, con algunos de los autores del presente artículo. Conclusiones. Además de la revisión de la literatura científica relacionada con el tema y la problemática, se concluye que, bajo una mirada holística, se comprende de manera integral la problemática y se propicia una mejor comunicación con los padres; con el equipo de la atención en salud, se logra un manejo transdisciplinario, superando los objetos de estudios aislados. Se da así un abordaje integrador y significativo en la cotidianidad de cada actor, desde la piel, con el Programa Madre Canguro, hasta la racionalidad de la ciencia.

Introduction. This article presents a reflection on the need for a holistic view of the problem of premature births, so that healthcare teams can understand the multiplicity of factors present in premature births, and its consequences for the minor, the mother, the family members, and the healthcare staff involved. Topic of reflection. The topic is based on two investigations carried out with mothers, fathers, and children's beneficiaries of the Mother Kangaroo Program in a State hospital, at two moments, 2012 and 2014, with some of the authors of this article. Conclusions. In addition to the review of the scientific literature related to the topic and the problem, it is concluded that, under a holistic view, the problem is understood in a comprehensive way and better communication with the parents is encouraged. With the healthcare team, cross-disciplinary handling is achieved, overcoming the objects of isolated studies. As such, there is an integrative and significant approach in the daily life of each actor, from the skin, with the Mother Kangaroo Program, to the rationality of science.

Introdução. Este artigo apresenta uma reflexão sobre a necessidade de se ter uma visão holística da problemática da prematuridade, para que as equipes da área da saúde possam ter uma compreensão da multiplicidade de fatores presentes no parto prematuro, e suas consequências para a criança, a mãe, os familiares e o pessoal de saúde envolvido. Tópico de reflexão. O tema é baseado em duas pesquisas realizadas com mães, pais e filhos beneficiários do Programa Mãe Canguru em um hospital estadual, em dois momentos, 2012 e 2014, com alguns dos autores deste artigo. Conclusões. Além da revisão da literatura científica relacionada ao tópico e ao problema, conclui-se que, sob uma visão holística, o problema é plenamente compreendido e incentiva-se uma melhor comunicação com os pais; com a equipe de saúde, consegue-se uma gestão transdisciplinar, superando os objetos de estudos isolados. Isto proporciona uma abordagem integradora e significativa no cotidiano de cada ator, desde a pele, com o Programa Mãe Canguru, até a racionalidade da ciência.

Inclusión educativa en pandemia: interseccionalidad y situación de menores venezolanos en Bogotá / Educational inclusion in a pandemic, intersectionality, and the situation of Venezuelan minors in Bogotá / Inclusão educacional em uma pandemia, interseccionalidade e a situação dos menores venezuelanos em Bogotá

Resumen (analítico) El objetivo de este artículo es comprender las dinámicas de inclusión de niñas, niños y adolescentes venezolanos en los flujos migratorios internacionales en la ciudad de Bogotá. A partir de una investigación mixta, se presentan cifras frente a la relación migración y derecho a la educación, complementadas con entrevistas semiestructuradas y grupos focales a representantes de instituciones, organizaciones de la sociedad civil y agencias internacionales, así como resultado de talleres de cartografía social con menores venezolanos. El análisis se realiza desde el enfoque de interseccionalidad en los entornos escolares, más allá de la escuela. Se evidencia que los desarrollos frente a las intersecciones entre edad, género, etnia, discapacidad, clase social, entre otras, son bastante precarios en los estudios de migración en Colombia.

Abstract (analytical) The objective of this article is to understand the dynamics of inclusion of Venezuelan Children and Adolescents in international migratory flows in the city of Bogotá. Based on a mixed research, figures are presented regarding the relationship between migration and right to education, complemented with semi-structured interviews and focus groups with representatives of institutions, civil society organizations and international agencies, as well as the results of social mapping workshops with Venezuelan minors. The analysis is carried out from the intersectionality approach in school environments, beyond the school, showing that the developments in the intersections between age, gender, ethnicity, disability, social class, among others, are quite precarious in studies of migration in Colombia.

Resumo (analítico) O objetivo deste artigo é compreender a dinâmica de inclusão de crianças e adolescentes venezuelanos nos fluxos migratórios internacionais na cidade de Bogotá. Com base em pesquisas mistas, são apresentados números sobre a relação entre migração e direito à educação, complementados com entrevistas semiestruturadas e grupos focais com representantes de instituições, organizações da sociedade civil e agências internacionais, bem como os resultados de oficinas de mapeamento social com menores venezuelanos. A análise é realizada a partir da abordagem da interseccionalidade em ambientes escolares, além da escola, mostrando que os desenvolvimentos nas interseções entre idade, gênero, etnia, deficiência, classe social, entre outros, são bastante precários nos estudos de migração na Colômbia.

Neuroleptic Malignant Syndrome Associated with Atypical Antipsychotics: A Case Report. / Síndrome neuroléptico maligno asociado a antipsicóticos atípicos: a propósito de un caso.

INTRODUCTION: Neuroleptic malignant syndrome (NMS) is uncommon, with an incidence of 0.01% to 3.23%, and is associated with the use of drugs that intervene with dopamine, causing hyperthermia, muscular rigidity, confusion, autonomic instability and death. CASE REPORT: A 35-year-old man with a history of catatonia, refractory epilepsy and functional impairment, required frequent changes in his anticonvulsant and antipsychotic treatment, due to adverse effects. During 2019, in the month of July, clozapine was changed to amisulpride, in September he developed fever, muscle stiffness, stupor, diaphoresis and tachypnea over a two-week period; paraclinical tests showed elevated creatine phosphokinase (CPK) and leukocytosis, so NMS was considered. The antipsychotic was withdrawn and he was treated with bromocriptine and biperiden, with a good response. Ten days after discharge, he began treatment with olanzapine, which generated a similar episode to the one described in December, with subsequent management and resolution. DISCUSSION: The diagnosis is based on the use of drugs that alter dopamine levels, plus altered state of consciousness, fever, autonomic instability and paraclinical tests showing leukocytosis and elevated CPK. Differential diagnosis must be ruled out. Early diagnosis generally leads to total remission, although some patients will suffer complications, long-term sequelae or recurrences. The recurrence in this case derived from the early reintroduction of the neuroleptic after the first episode. Treatment should be individualised according to severity to avoid mortality. CONCLUSIONS: Atypical antipsychotics are rarely suspected of generating NMS. Moreover, the time to reintroduction after an episode must also be taken into account.

Toxicity evaluation of ConvitVax breast cancer immunotherapy.

ConvitVax is a personalized vaccine for the treatment of breast cancer, composed of autologous tumor cells, bacillus Calmette-Guérin (BCG) and low concentrations of formalin. Previous pre-clinical studies show that this therapy induces a potent activation of the immune system and achieves an effective response against tumor cells, reducing the size of the tumor and decreasing the percentage of immunosuppressive cells. In the present study, we evaluate the toxicity of ConvitVax in healthy BALB/c mice to determine potential adverse effects related to the vaccine and each of its components. We used standard guidelines for pain, discomfort and distress recognition, continuously evaluated the site of the injection, and completed blood and urine clinical tests. Endpoint necropsy was performed, measuring the weight of organs and processing liver, kidney, thymus and lung for histological examination. Results show that the vaccine in its therapeutic dose, at 3 times its therapeutic concentration, and its individual components did not cause death or behavioral or biological changes, including any abnormalities in whole-body or organ weights, and tissue damage. These results support the safety of ConvitVax with minimal to no side-effects.

Detection of Toxoplasma gondii in water for human consumption from water wells (jagüeyes) in the rural area of the municipality of Sincelejo / [Detección de Toxoplasma gondii en agua para el consumo humano proveniente de jagüeyes del área rural del municipio de Sincelejo].

Introduction: Toxoplasmosis is an orally-transmitted zoonosis that may appear after consuming food contaminated with any infective form of Toxoplasma gondii. Its transmission by water has been reported in several countries including Colombia. The rural population of Sincelejo could be at risk of contracting toxoplasmosis through this route given that they lack potable water. Objective: To evaluate T. gondii contamination in water for human consumption from water wells (jagüeyes) in the rural area of Sincelejo and establish its relationship with different social determinants of health in the study area. Materials and methods: Using nested PCR we evaluated 96 water samples obtained from 48 farms located in eight rural townships in Sincelejo. We took two samples in each farm: one of raw water from water wells and the other intended for direct consumption. We conducted a survey on each farm to collect information on the physical characteristics of dwellings, the presence of cats, and the availability and uses of water. Statistical relationships were evaluated through Fisher tests. Results: Of the 96 samples analyzed, 13 were contaminated with T. gondii (13.5%): Nine corresponded to raw water and four to water for direct consumption. No statistical association was found between the positive samples and the social determinants of health under evaluation (p>0.05). Conclusion: The rural population of Sincelejo could be at risk of contracting toxoplasmosis through the use and/or consumption of water from its water wells. The contamination of these water bodies by T. gondii may be influenced by unstudied social determinants.

Introducción. La toxoplasmosis es una zoonosis que se transmite por vía oral al consumir alimentos contaminados con cualquier forma infectiva de Toxoplasma gondii. Su transmisión por agua ha sido documentada en varios países, incluido Colombia. Al no disponer de agua potable, la población rural de Sincelejo podría estar en riesgo de contraer toxoplasmosis por esta vía. Objetivo. Evaluar la contaminación por T. gondii del agua para consumo humano proveniente de jagüeyes de la zona rural de Sincelejo y establecer su relación con diferentes determinantes sociales de la salud en el área de estudio. Materiales y métodos. Mediante PCR anidada, se evaluaron 96 muestras de agua obtenidas en 48 fincas ubicadas en ocho corregimientos rurales de Sincelejo. En cada finca se obtuvieron dos muestras: una de agua cruda de jagüey y otra destinada al consumo directo. En cada finca se hizo una encuesta para recolectar información sobre características físicas de la vivienda, presencia de gatos, y disponibilidad de agua y sus usos. Las relaciones estadísticas se evaluaron con el test de Fisher. Resultados. De las 96 muestras analizadas, 13 resultaron contaminadas con T. gondii (13,5 %): nueve de agua cruda y cuatro de agua para el consumo directo. No se encontró asociación estadística entre las muestras positivas y los determinantes sociales de la salud evaluados (p>0,05). Conclusión. La población rural de Sincelejo podría estar en riesgo de contraer toxoplasmosis por el uso y consumo del agua proveniente de sus jagüeyes. La contaminación de estos cuerpos de agua por T. gondii puede estar influenciada por otros determinantes sociales de la salud no contemplados aquí.

Detección de Toxoplasma gondii en agua para el consumo humano proveniente de jagüeyes del área rural del municipio de Sincelejo / Detection of Toxoplasma gondii in water for human consumption from water wells (jagüeyes) in the rural area of the municipality of Sincelejo

Resumen | Introducción. La toxoplasmosis es una zoonosis que se transmite por vía oral al consumir alimentos contaminados con cualquier forma infectiva de Toxoplasma gondii. Su transmisión por agua ha sido documentada en varios países, incluido Colombia. Al no disponer de agua potable, la población rural de Sincelejo podría estar en riesgo de contraer toxoplasmosis por esta vía. Objetivo. Evaluar la contaminación por T. gondii del agua para consumo humano proveniente de jagüeyes de la zona rural de Sincelejo y establecer su relación con diferentes determinantes sociales de la salud en el área de estudio. Materiales y métodos. Mediante PCR anidada, se evaluaron 96 muestras de agua obtenidas en 48 fincas ubicadas en ocho corregimientos rurales de Sincelejo. En cada finca se obtuvieron dos muestras: una de agua cruda de jagüey y otra destinada al consumo directo. En cada finca se hizo una encuesta para recolectar información sobre características físicas de la vivienda, presencia de gatos, y disponibilidad de agua y sus usos. Las relaciones estadísticas se evaluaron con el test de Fisher. Resultados. De las 96 muestras analizadas, 13 resultaron contaminadas con T. gondii(13,5 %): nueve de agua cruda y cuatro de agua para el consumo directo. No se encontró asociación estadística entre las muestras positivas y los determinantes sociales de la salud evaluados (p>0,05). Conclusión. La población rural de Sincelejo podría estar en riesgo de contraer toxoplasmosis por el uso y consumo del agua proveniente de sus jagüeyes. La contaminación de estos cuerpos de agua por T. gondii puede estar influenciada por otros determinantes sociales de la salud no contemplados aquí.

Abstract | Introduction:Toxoplasmosis is an orally-transmitted zoonosis that may appear after consuming food contaminated with any infective form of Toxoplasma gondii. Its transmission by water has been reported in several countries including Colombia. The rural population of Sincelejo could be at risk of contracting toxoplasmosis through this route given that they lack potable water. Objective: To evaluate T. gondii contamination in water for human consumption from water wells (jagüeyes) in the rural area of Sincelejo and establish its relationship with different social determinants of health in the study area. Materials and methods: Using nested PCR we evaluated 96 water samples obtained from 48 farms located in eight rural townships in Sincelejo. We took two samples in each farm: one of raw water from water wells and the other intended for direct consumption. We conducted a survey on each farm to collect information on the physical characteristics of dwellings, the presence of cats, and the availability and uses of water. Statistical relationships were evaluated through Fisher tests. Results: Of the 96 samples analyzed, 13 were contaminated with T. gondii (13.5%): Nine corresponded to raw water and four to water for direct consumption. No statistical association was found between the positive samples and the social determinants of health under evaluation (p>0.05). Conclusion: The rural population of Sincelejo could be at risk of contracting toxoplasmosis through the use and/or consumption of water from its water wells. The contamination of these water bodies by T. gondii may be influenced by unstudied social determinants.

Linfomas en pacientes con VIH: una asociación compleja y frecuente. Revisión narrativa de la literatura / HIV-related lymphomas: a complex and frequent association. A narrative review of the literature

En Colombia, la infección por el virus de la inmunodeficiencia humana (VIH) es una epidemia en aumento. Ante la mejoría de la supervivencia general con la terapia antirretroviral altamente efectiva, la aparición de neoplasias malignas ha ido desplazando las complicaciones infecciosas como principal problema en esta población. Los linfomas no Hodgkin son las neoplasias malignas definitorias de síndrome de inmunodeficiencia adquirida (SIDA) más frecuentes después del sarcoma de Kaposi, siendo el linfoma B difuso de células grandes y el linfoma de Burkitt las variantes más comunes; por otra parte, el riesgo de desarrollar linfoma de Hodgkin clásico es 5 a 20 veces mayor en pacientes positivos para VIH en comparación con la población general. Realizar un diagnóstico temprano es un reto, debido a infecciones oportunistas y a la presentación atípica de la enfermedad en este grupo de pacientes. El tratamiento de la enfermedad también supone un desafío debido a las comorbilidades y el estado funcional de los pacientes al momento del diagnóstico; sin embargo, en conjunto con esquemas combinados de quimioterapia y al uso concomitante de la terapia antirretroviral, se ha mejorado considerablemente el pronóstico, el cual actualmente se acerca al de los pacientes seronegativos. Por medio de esta revisión, se pretende describir las principales características de los linfomas asociados al VIH, de tal forma que permita a los trabajadores en salud, tener mayores elementos para el abordaje integral de esta población en nuestro país

In Colombia, human immunodeficiency virus (HIV) infection is a growing epidemic. Given the improvement in overall survival with highly effective antiretroviral therapy, cancer has been displacing infectious complications in this population. Non-Hodgkin's lymphoma is the most common AIDS defining malignancy after Kaposi's sarcoma. Diffuse large B-cell lymphoma and Burkitt's lymphoma are the most common variants; meanwhile, the risk of developing classical Hodgkin lymphoma is 5 to 20-fold higher compared to HIV-negative individuals. Making an early diagnosis is a challenge, due to opportunistic infections and the atypical presentation of the disease in this group of patients. Treatment of the disease is also a challenge given the comorbidities and patient condition at diagnosis; however, in conjunction with combined chemotherapy regimens and the concomitant use of antiretroviral therapy, the outcome of patients with AIDS-related lymphomas has significantly improved, currently approaching that of seronegative patients. The aim of this review article is to describe the main characteristics of the disease, in such a way that it allows health workers to have more elements for a comprehensive approach in patients with AIDS-related lymphomas in our country

Estereotipos sobre la población adulta mayor en tres grupos etarios de cuidadores de personas mayores dependientes / Stereotypes About the Elderly Adult Population in Three Age Groups of Carers of Dependent Elderly People

Resumen La presencia de estereotipos en cuidadores implica efectos desfavorables para las personas adultas mayores dependientes. Objetivo. Este estudio de carácter cualitativo fenomenológico se planteó como propósito describir los estereotipos que existen hacía los adultos mayores en cuidadores de tres grupos etarios (adultos jóvenes, medios y mayores). Método. Se aplicó una entrevista semi-estructurada a 20 cuidadores de personas mayores dependientes, el reporte se analizó por medio de codificación axial utilizando las categorías de estereotipos biológicos, cronológicos, psicológicos y sociológicos. Resultados. Se identificaron estereotipos positivos y negativos en los tres grupos etarios, aunque predominan los negativos relacionados con aspectos biológicos como la pérdida y la enfermedad.

Abstract The presence of stereotypes in carers implies unfavourable effects for dependent elderly people. Objective. This qualitative phenomenological study was therefore intended to describe the stereotypes that exist towards elderly adults in caregivers of three age groups (young, middle and older adults). Method. A semi-structured interview was applied to 20 caregivers of dependent older adults. The report was analyzed via axial coding using biological, chronological, psychological and sociological stereotype categories. Results. Positive and negative stereotypes were identified in the three age groups, although negative stereotypes related to biological aspects such as loss and disease prevail.

Hospital Outcomes of Adult Diabetic Patients by Glycated Hemoglobin Level in Nonsurgical Pathology in a High-Complexity Institution.

Recent evidence supports the relationship between in-hospital hyperglycemia and inpatient complications. Besides, glycated hemoglobin (HbA1c) can predict the clinical course of patients with type 2 diabetes mellitus (DM2) during hospital stays. This study aimed to assess the relationship between HbA1c levels and inpatient outcomes. Type 2 diabetes mellitus patients with age greater than 18 years, hospital length of stay greater than 24 hours, and one HbA1c report during their in-hospital management were included. All the electronic care records of patients admitted at the Clinical Versalles, a high-volume institution, in Manizales-Colombia were revised. The following variables were considered: hospital length of stay, diagnoses at the arrival, complications, capillary glucose levels, and treatment at discharge. Variables were categorized by HbA1c levels: group 1 = ⩽ 7%, group 2 = 7.01% to 8.5%, group 3 = 8.51% to ⩽10% and group 4 = >10%. There were a total of 232 patients. Average age was 69.7 years, mean HbA1c was 7.19 ± 2.03, average body mass index (BMI) was 28.8 ± 5.6. About HbA1c, 146 (62.9%) had ⩽7.5%. The most frequent admission diagnosis was by cardiovascular diseases. Average hospitalization was 7.5 ± 5.7 days. There was no relationship between the levels of HbA1c with hospital stays, inpatient complications, or readmissions. Infections and respiratory diseases were more common conditions related to higher HbA1c levels, especially when these were 8.5%. In diabetic patients with nonsurgical diseases and high HbA1c levels, there was no association with clinical complications, length of stay, readmissions, or in-hospital mortality, but changes in treatment at discharge were observed.

Características de la personalidad de los padres o cuidadores de los menores que asisten a controles de salud en entidades de salud públicas y privadas (2013-2015) / Personality traits of parents or caregivers of children attending health check-ups at public and private healthcare entities (2013-2015) / Características da personalidade dos pais ou cuidadores acompanhantes de menores nas consultas periódicas em instituições de saúde públicas e privadas (2013-2015)

Introducción. El estudio de la personalidad resulta complejo por una multiplicidad de factores (biológicos, psicológicos, sociales, culturares, entre otros). Los rasgos indican personalidad funcional (saludable) o disfuncional (patológica). Los estudios de personalidad más destacados se enfocan en trastornos o alteraciones de la personalidad. En el 2017, la Organización Mundial de la Salud (OMS) reportó una mayor prevalencia del trastorno afectivo bipolar (60 millones de pacientes), la esquizofrenia y otras psicosis (21 millones de pacientes), y la demencia (47,5 millones de pacientes). Sin embargo, son escasos los estudios de salud mental en personas con personalidad funcional, como lo plantea esta investigación. La OMS afirma que la salud mental es más que la ausencia de trastornos mentales y es parte integral de la salud, pues no hay salud sin salud mental. El objetivo es describir los rasgos de personalidad de los padres que asisten con sus hijos a controles de salud en entidades de salud públicas y privadas (2013-2015). Metodología. Estudio descriptivo de corte transversal que evalúa 14 variables de personalidad; muestra por conveniencia: 145 padres que asisten a los controles de salud con sus hijos de hospitales locales, públicos de Girón y Bucaramanga y la empresa privada de carácter social, "El Comité de Rehabilitación" (Medellín). Se recolectó información con el cuestionario sociodemográfico y el Test CUIDA (Cuestionario para la Evaluación de Adoptantes, Cuidadores, Tutores y Mediadores). Resultados. El 93.1 % de los padres o cuidadores son mujeres y el 6.9 %, hombres; el 84.8 % está entre los 30 y 59 años de edad; sus estratos socioeconómicos son 1, 2 y 3; el 50 % son madres cabeza de hogar. Los padres o cuidadores con personalidad funcional, presentaron debilidades en los puntajes de las pruebas, pues manifestaron dependencia emocional, baja autoestima, poca tolerancia a la frustración, poca flexibilidad, dificultad para establecer vínculos afectivos y baja capacidad de resolución de duelo, entre otros. Pocos padres tuvieron puntajes altos en los factores que benefician el cuidado de sus hijos; entre el 0 % y el 22.9 %. Conclusiones. En la muestra, compuesta en su mayoría por madres cabeza de hogar, pocas lograron puntajes altos en las pruebas; aquellos que se esperaban en personas con personalidad funcional. Por el contrario, predominaron los puntajes bajos, que poco favorecen el cuidado de la salud de los hijos. Las características de personalidad funcionales o no, son transmitidas en el proceso de crianza maternal más que paternal. [Díaz-Gordon P, Ortega-Ortíz ME, Díaz-Cadavid D, Naranjo-García AS. Características de la personalidad de los padres o cuidadores de los menores que asisten a controles de salud en entidades de salud públicas y privadas (2013-2015). MedUNAB. 2018;21(2):12-28. doi:10.29375/01237047.2424].

Introduction. The study of personality is complex due to a multiplicity of factors (biological, psychological, social and cultural, among others). Traits indicate a personality that is functional (healthy) or dysfunctional (pathological). The most outstanding personality studies focus on personality disorders or abnormalities. In 2017, the World Health Organization (WHO) reported a higher prevalence of bipolar affective disorder (60 million patients), schizophrenia and other psychoses (21 million patients), and dementia (47.5 million patients). However, there are few studies of mental health in people with a functional personality, as considered in this research. The WHO assets that mental health is more than the absence of mental disorders and it is an integral part of health, since there is no health without mental health. The objective is to describe the personality traits of parents attending health check-ups with their children at public and private healthcare entities (2013-2015). Methodology. Descriptive cross-sectional study that assesses 14 personality variables; convenience sample: 145 parents attending health check-ups with their children at local public hospitals in Girón and Bucaramanga, and private social company "The Rehabilitation Committee" (Medellín). Information was gathered using the sociodemographic questionnaire and the CUIDA Test (Questionnaire for the Assessment of Adoptive Parents, Caregivers, Guardians and Mediators). Results. 93.1% of the parents or caregivers are women and 6.9% are men; 84.8% aged between 30 and 59; their socioeconomic levels are 1, 2 and 3; 50% are single mothers. The parents or caregivers with a functional personality showed weaknesses on test scores, as they showed emotional dependency, low self-esteem, low frustration tolerance, limited flexibility, difficulty in establishing emotional ties and low grief resolution capacity, among others. Few parents had high scores on the factors that benefit the care of their children: between 0% and 22.9%. Conclusions. In the sample, mostly made up of single mothers, few achieved the high-test scores that were expected in people with a functional personality. On the contrary, low scores predominated, which are not very favorable for the care for children's health. Personality traits, whether they are functional or not, are transmitted more in the child rearing process by mothers than by fathers. [Díaz-Gordon P, Ortega-Ortíz ME, Díaz-Cadavid D, Naranjo-García AS. Personality traits of parents or caregivers of children attending health checkups at public and private healthcare entities (2013-2015). MedUNAB.2018;21(2):12-28. doi:10.29375/01237047.2424].

Introdução. O estudo da personalidade é complexo por uma multiplicidade de fatores (biológicos, psicológicos, sociais, culturais, entre outros). Traços indicam personalidade funcional (saudável) ou disfuncional (patológica). Os estudos de personalidade mais destacados focam em transtornos ou alterações da personalidade. Em 2017, a Organização Mundial da Saúde (OMS) relatou uma maior prevalência de transtorno afetivo bipolar (60 milhões de pacientes), esquizofrenia e outras psicoses (21 milhões de pacientes), e demência (47,5 milhões de pacientes). Entretanto, existem poucos estudos de saúde mental em pessoas com personalidade funcional, como sugere esta pesquisa. A OMS afirma que a saúde mental é mais que a ausência de transtornos mentais e é uma parte importante da saúde, já que não há saúde sem saúde mental. O objetivo é descrever os traços de personalidade dos pais que acompanham seus filhos nas consultas periódicas de saúde em instituições de saúde públicas e privadas (2013-2015). Métodos. Estudo descritivo transversal que avalia 14 variáveis de personalidade; amostra por conveniência: 145 pais que acompanham seus filhos nas consultas periódicas ou check-up de saúde em hospitais locais públicos de Girón e Bucaramanga, e na empresa privada de natureza social "El Comité de Rehabilitación" (Medellín). As informações foram coletadas usando um questionário sociodemográfico e o Questionário para Avaliação de Adotantes, Cuidadores, Tutores e Mediadores ou Teste CUIDA (por suas siglas em espanhol). Resultados.93,1% dos pais ou cuidadores são mulheres e 6,9% homens; 84,8% têm entre 30 e 59 anos de idade; suas classes socioeconômicas são 1, 2 e 3; 50% são mães chefes de família. Os pais ou cuidadores com personalidade funcional, mostraram fraquezas nos resultados dos testes, pois manifestaram ter dependência emocional, baixa autoestima, pouca tolerância à frustração, inflexibilidade, dificuldade em estabelecer laços afetivos e pouca capacidade para lidar com o processo de luto, entre outros. Poucos pais tiveram altas pontuações nos fatores que beneficiam o cuidado dos filhos; entre 0% e 22,9%. Conclusões: Na amostra, composta principalmente por mães chefes de família, poucas delas conseguiram altas pontuações nos testes, como esperado em pessoas com personalidade funcional. Pelo contrário, predominaram as pontuações baixas, o que não favorece a atenção à saúde dos filhos. As características da personalidade funcional, ou não, são transmitidas no processo de criação materna mais do que paterna. [Díaz-Gordon P, Ortega-Ortíz ME, Díaz-Cadavid D, Naranjo-García AS. Características da personalidade dos pais ou cuidadores acompanhantes de menores nas consultas periódicas em instituições de saúde públicas e privadas (2013-2015). MedUNAB. 2018;21(2):12-28. doi:10.29375/01237047.2424].

Personality traits of parents or caregivers of children attending health check-ups at public and private healthcare entities (2013-2015) / Características de la personalidad de los padres o cuidadores de los menores que asisten a controles de salud en entidades de salud públicas y privadas (2013-2015) / Características da personalidade dos pais ou cuidadores acompanhantes de menores nas consultas periódicas em instituições de saúde públicas e privadas (2013-2015)

Introduction. The study of personality is complex due to a multiplicity of factors (biological, psychological, social and cultural, among others). Traits indicate a personality that is functional (healthy) or dysfunctional (pathological). The most outstanding personality studies focus on personality disorders or abnormalities. In 2017, the World Health Organization (WHO) reported a higher prevalence of bipolar affective disorder (60 million patients), schizophrenia and other psychoses (21 million patients), and dementia (47.5 million patients). However, there are few studies of mental health in people with a functional personality, as considered in this research. The WHO assets that mental health is more than the absence of mental disorders and it is an integral part of health, since there is no health without mental health. The objective is to describe the personality traits of parents attending health checkups with their children at public and private healthcare entities (2013-2015). Methodology. Descriptive cross-sectional study that assesses 14 personality variables; convenience sample: 145 parents attending health checkups with their children at local public hospitals in Girón and Bucaramanga, and private social company "The Rehabilitation Committee" (Medellín). Information was gathered using the sociodemographic questionnaire and the CUIDA Test (Questionnaire for the Assessment of Adoptive Parents, Caregivers, Guardians and Mediators). Results. 93.1% of the parents or caregivers are women and 6.9% are men; 84.8% aged between 30 and 59; their socioeconomic levels are 1, 2 and 3; 50% are single mothers. The parents or caregivers with a functional personality showed weaknesses on test scores, as they showed emotional dependency, low self-esteem, low frustration tolerance, limited flexibility, difficulty in establishing emotional ties and low grief resolution capacity, among others. Few parents had high scores on the factors that benefit the care of their children: between 0% and 22.9%. Conclusions. In the sample, mostly made up of single mothers, few achieved the high test scores that were expected in people with a functional personality. On the contrary, low scores predominated, which are not very favorable for the care for children's health. Personality traits, whether they are functional or not, are transmitted more in the child rearing process by mothers than by fathers. [Díaz-Gordon P, Ortega-Ortíz ME, Díaz-Cadavid D, Naranjo-García AS. Personality traits of parents or caregivers of children attending health checkups at public and private healthcare entities (2013-2015). MedUNAB.2018;21(2): 29-44. doi:10.29375/01237047.2424].

Introducción. El estudio de la personalidad resulta complejo por una multiplicidad de factores (biológicos, psicológicos, sociales, culturares, entre otros). Los rasgos indican personalidad funcional (saludable) o disfuncional (patológica). Los estudios de personalidad más destacados se enfocan en trastornos o alteraciones de la personalidad. En el 2017, la Organización Mundial de la Salud (OMS) reportó una mayor prevalencia del trastorno afectivo bipolar (60 millones de pacientes), la esquizofrenia y otras psicosis (21 millones de pacientes), y la demencia (47,5 millones de pacientes). Sin embargo, son escasos los estudios de salud mental en personas con personalidad funcional, como lo plantea esta investigación. La OMS afirma que la salud mental es más que la ausencia de trastornos mentales y es parte integral de la salud, pues no hay salud sin salud mental. El objetivo es describir los rasgos de personalidad de los padres que asisten con sus hijos a controles de salud en entidades de salud públicas y privadas (2013-2015). Metodología. Estudio descriptivo de corte transversal que evalúa 14 variables de personalidad; muestra por conveniencia: 145 padres que asisten a los controles de salud con sus hijos de hospitales locales, públicos de Girón y Bucaramanga, y la empresa privada de carácter social, "El Comité de Rehabilitación" (Medellín). Se recolectó información con el cuestionario sociodemográfico y el Test CUIDA (Cuestionario para la Evaluación de Adoptantes, Cuidadores, Tutores y Mediadores). Resultados. El 93.1% de los padres o cuidadores son mujeres y el 6.9%, hombres; el 84.8% está entre los 30 y 59 años de edad; sus estratos socioeconómicos son 1, 2 y 3; el 50% son madres cabeza de hogar. Los padres o cuidadores con personalidad funcional, presentaron debilidades en los puntajes de las pruebas, pues manifestaron dependencia emocional, baja autoestima, poca tolerancia a la frustración, poca flexibilidad, dificultad para establecer vínculos afectivos y baja capacidad de resolución de duelo, entre otros. Pocos padres tuvieron puntajes altos en los factores que benefician el cuidado de sus hijos; entre el 0% y el 22.9%. Conclusiones. En la muestra, compuesta en su mayoría por madres cabeza de hogar, pocas lograron puntajes altos en las pruebas; aquellos que se esperaban en personas con personalidad funcional. Por el contrario, predominaron los puntajes bajos, que poco favorecen el cuidado de la salud de los hijos. Las características de personalidad funcionales o no, son transmitidas en el proceso de crianza maternal más que paternal. [Díaz-Gordon P, Ortega-Ortíz ME, Díaz-Cadavid D, Naranjo-García AS. Características de la personalidad de los padres o cuidadores de los menores que asisten a controles de salud en entidades de salud públicas y privadas (2013-2015). MedUNAB.2018;21(2):29-44. doi:10.29375/01237047.2424].

Introdução. O estudo da personalidade é complexo por uma multiplicidade de fatores (biológicos, psicológicos, sociais, culturais, entre outros). Traços indicam personalidade funcional (saudável) ou disfuncional (patológica). Os estudos de personalidade mais destacados focam em transtornos ou alterações da personalidade. Em 2017, a Organização Mundial da Saúde (OMS) relatou uma maior prevalência de transtorno afetivo bipolar (60 milhões de pacientes), esquizofrenia e outras psicoses (21 milhões de pacientes), e demência (47.5 milhões de pacientes). Entretanto, existem poucos estudos de saúde mental em pessoas com personalidade funcional, como sugere esta pesquisa. A OMS afirma que a saúde mental é mais que a ausência de transtornos mentais e é uma parte importante da saúde, já que não há saúde sem saúde mental. O objetivo é descrever os traços de personalidade dos pais que acompanham seus filhos nas consultas periódicas de saúde em instituições de saúde públicas e privadas (2013-2015). Métodos. Estudo descritivo transversal que avalia 14 variáveis de personalidade; amostra por conveniência: 145 pais que acompanham seus filhos nas consultas periódicas ou check-up de saúde em hospitais locais públicos de Girón e Bucaramanga, e na empresa privada de natureza social "El Comité de Rehabilitación" (Medellín). As informações foram coletadas usando um questionário sociodemográfico e o Questionário para Avaliação de Adotantes, Cuidadores, Tutores e Mediadores ou Teste CUIDA (por suas siglas em espanhol). Resultados. 93.1% dos pais ou cuidadores são mulheres e 6.9% homens; 84,8% têm entre 30 e 59 anos de idade; suas classes socioeconômicas são 1, 2 e 3; 50% são mães chefes de família. Os pais ou cuidadores com personalidade funcional, mostraram fraquezas nos resultados dos testes, pois manifestaram ter dependência emocional, baixa autoestima, pouca tolerância à frustração, inflexibilidade, dificuldade em estabelecer laços afetivos e pouca capacidade para lidar com o processo de luto, entre outros. Poucos pais tiveram altas pontuações nos fatores que beneficiam o cuidado dos filhos; entre 0% e 22.9%. Conclusões. Na amostra, composta principalmente por mães chefes de família, poucas delas conseguiram altas pontuações nos testes, como esperado em pessoas com personalidade funcional. Pelo contrário, predominaram as pontuações baixas, o que não favorece a atenção à saúde dos filhos. As características da personalidade funcional, ou não, são transmitidas no processo de criação materna mais do que paterna. [Díaz-Gordon P, Ortega-Ortíz ME, Díaz-Cadavid D, Naranjo-García AS. Características da personalidade dos pais ou cuidadores acompanhantes de menores nas consultas periódicas em instituições de saúde públicas e privadas (2013-2015). MedUNAB.2018;21(2):29-44. doi:10.29375/01237047.2424].

Factores que intervienen en el manejo del dolor oncológico: un reto para el profesional de enfermería / Factors involved in the management of cancer pain: a challenge for nursing professionals

Introducción: El dolor es el síntoma principal en la mayoría de los pacientes que padecen de cáncer. La evidencia epidemiológica demuestra que en todo el mundo existen 37.1 millones de casos de cáncer al año, los cuales ocasionan 6.9 millones de muertes. Por desgracia, muchos de los pacientes que durante algún estadio de su enfermedad sufren dolor, reciben poca o ninguna atención. Informes de Twycross, tras estudio de 2,000 pacientes, sugieren que la mayoría de ellos, no reciben un alivio satisfactorio del dolor. Objetivo: Identificar en la literatura reportada en las bases de datos los factores que intervienen en el manejo del dolor del paciente oncológico y el rol de enfermería en este manejo. Metodología: Se hizo revisión sistematizada de la literatura entre los años 2001 y 2014 utilizando los descriptores MeSH: “pain management”, “oncology” and “nursing”, en las bases de datos Pubmed, Ebsco, ProQuest, Scielo, y Ovid. Resultados: la literatura reporta que son múltiples los factores que intervienen en el manejo del dolor por parte de los profesionales de enfermería tales como la poca credibilidad que el profesional de enfermería tiene, para aceptar como cierta la intensidad del dolor que el paciente refiere, así como la inadecuada evaluación de la intensidad del dolor, entre otros. Conclusiones: Se requiere que el profesional de enfermería posea conocimientos sobre el manejo del dolor oncológico, ya que es parte del equipo médico y es quien asiste permanentemente al paciente, lo que le permite determinar la eficacia del tratamiento y comentar la evolución para hacer los respectivos cambios.

Introduction: Pain is one of the most feared symptoms of cancer patients, representing the main symptom in most patients who suffer from it. Epidemiological evidence shows that worldwide there are 37.1 million cases of cancer annually, which cause 6.9 million deaths. Unfortunately, many of the patients, who during some stage of their illness suffer pain, receive little or no medical attention. Twycross reports, after the study of 2,000 patients, suggest that most of them do not receive a satisfactory pain relief. Objective: To identify, in the reviewed literature in databases, the factors involved in pain management of cancer patients and the role of nursing in its handling. Methodology: A systematic review of the literature between 2001 and 2014 was performed using the MeSH descriptors: "pain management", "oncology" and "nursing" in PubMed, EBSCO, ProQuest, Scielo, and Ovid databases. Results: the literature reports that there are multiple factors involved in pain management by nursing professionals, such as low credibility that the nurse has when accepting, as true, the intensity of pain referred by the patient, as well as the improper evaluation of pain intensity among others. Conclusion: It is required that the nurse has the knowledge about the management of cancer pain because he/she is part of the medical staff and who permanently assists the patient, which allows to determine the effectiveness of the treatment and discuss the evolution to do the corresponding changes.

Introdução: A dor é o principal sintoma, na maioria dos pacientes que padecem de câncer, sendo este o que mais eles temem. A evidência epidemiológica mostra que no mundo, existem 37.1 milhões de casos de câncer por ano, causando 6.9 milhões de mortes. Infelizmente, muitos dos pacientes durante algum estágio de sua doença sofrem de dor e recebem pouca ou nenhuma atenção. Twycross, após um estudo com 2.000 pacientes relata que a maioria deles não receberam alívio satisfatório da dor. Objetivo: Identificar na base de dados da literatura consultada os fatores implicados no tratamento da dor de pacientes com câncer e o rol de profissionais da enfermagem nestes casos. Metodologia: Se fez uma revisão sistemática da literatura entre 2001 e 2014 utilizando os descritores MeSH: “pain management”, “oncology” and “nursing”, na base de dados Pubmed, Ebsco, ProQuest, Scielo e Ovid. Resultados: A literatura relata que há vários fatores que intervém no tratamento da dor, tais como: pouca credibilidade do profesional da enfermagem em aceitar a dor forte que expresa o paciente, igualmente existe uma avaliação inadequada da intensidade da dor, etc. Conclusão: É necessária que os profissionais da enfermagem saibam como intervir na dor com pacientes de oncologia porque eles fazem parte da equipe médica e estão sempre, atendendo os pacientes. Este conhecimento lhes permite avaliar o tratamento e comentar sua evolução para fazer as mudanças que se considerem necessárias.