Comparison of immediate colposcopy, repeat conventional cytology and hrHPV testing for the clinical management of ASC-US cytology in routine health services of Medellin, Colombia: The ASCUS-COL Trial.

In the context of opportunistic cervical cancer screening settings of low-and-middle-income countries, little is known about the benefits of high-risk human papillomavirus (hrHPV) testing on high-grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC-US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC-US) (RC), and hrHPV testing (colposcopy if hrHPV-positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20-69 years with ASC-US in routine care. Participants (n=2,661) were evenly randomized into three arms (n=882 IC, n=890 RC, n=889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality-control external panel (QC). The primary endpoint was the first QC-diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow-up (between enrolment and exit visit), and exit visit. The trial is completed. Colposcopy was done on 88%, 42%, and 52% of participants in IC, RC, and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (p=0.821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2-year routine follow-up (relative proportion 0.35, 95% CI 0.09-0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC-US cytology.

Propuesta de un modelo de registro médico integral para la evaluación de depresión y ansiedad en atención primaria en Colombia: estudio de grupos focale / Proposing a comprehensive medical record form to assess depression and anxiety within the framework of primary care in Colombia: focus groups / Proposta de modelo de registro médico integral em atenção primária para a avaliação da depressão/ansiedade na Colômbia: estudo de grupos focai

La depresión y la ansiedad representan las principales enfermedades de salud mental a nivel mundial. Se estima que para el 2020 se aumenten en un 15 %, convirtiéndose en la segunda causa de morbimortalidad. En nuestro país, en la Ley 1616 del 2013 (Ley en salud mental), se promueve el derecho a la atención oportuna integral desde la atención primaria de las personas que tienen riesgo y de las que ya tienen una enfermedad mental. Sin embargo, no se ha instaurado un modelo de historia clínica que pueda atender la necesidad de estos pacientes; por lo tanto, es importante generar una propuesta que sea fácil de usar. Por esta razón, el objetivo de este estudio surge de la necesidad de crear un modelo de historia clínica en la que se incluyan diferentes variables y características que permitan el diagnóstico, el seguimiento y el tratamiento de los pacientes con trastornos de depresión y ansiedad en la atención primaria. Materiales y métodos. Se utilizó un enfoque metodológico múltiple: cuantitativo y cualitativo. Este método facilitó la recolección de distintas fuentes primarias (revisión sistemática) y secundarias (grupos focales). El análisis se hizo mediante los Primary Care Assessment Tools. Resultados. Los instrumentos de tamización en la atención primaria son un gran apoyo de manejo fácil, los cuales pueden usarse de forma directa o en una aplicación médica. Estas escalas permiten evaluar la gravedad y hacer el seguimiento del trastorno depresivo y de la ansiedad. Conclusión. Para la elaboración de la propuesta de historia clínica, consideramos que se debe incluir lo concerniente al contexto personal, familiar y social de los pacientes, con herramientas de tamización que faciliten al médico de atención primaria hacer el diagnóstico y el seguimiento de estas enfermedades

Overview: Depression and anxiety account for the leading men-tal health illnesses worldwide and by 2020 they are expected to increase 15% becoming the second leading cause of morbidity and mortality. In Colombia, Law 1616, promulgated in 2013, fosters the right to timely and comprehensive assistance for people dealing with mental health issues. Still, the implementation of a medical record suitable to meet these patients needs is yet to be introduced. It is therefore important to generate a proposal that is easy to use. Objective: Creating a comprehensive medical record, including various variables and features that allow for diagnosing, following up and treating patients bearing depression and anxiety disorders, within the framework of Primary Care. Materials and methods: A multi methodological approach, blen-ding both quantitative and qualitative tools was used to facilitate data gathering from primary sources, such as systematic reviews and secondary sources, such as focus groups. Data analysis was done utilizing PCAT (Primary care assessment tools). Results: The use of primary care screening tools proved to be a valuable resource, being its friendly usage and reliability. These scales also allow for follow up on depression and anxiety disorders. Conclusion: To implement a medical record proposal it is ne-cessary to include background on personal, familiar and social information regarding the patient. It is also key to include screening tools that allow the physician to come up with a proper diagnosis and follow up.

Introdução. A depressão e a ansiedade representam as principais doenças de saúde mental no mundo, calcula-se que para 2020 este problema aumente em 15%, sendo a segunda causa de morbimortalidade. Na Colômbia, segundo a lei 1616 de 2013 "lei de saúde mental", que promove o direito à atenção integral de atenção primária para os doentes e quem está em risco. No entanto o país ainda não conta com um modelo de história clínica que atenda às necessidades destes pacientes. Materiais e métodos. O viés metodológico do trabalho é multi-metodológico, quantitativo e qualitativo, coleta diversas fontes tanto primárias (grupos focais) como secundárias (revisão sistemática). A análise foi feita através da ferramenta PCAT (Primary care assessment tools). Resultados. O uso de instrumentos para teste de rastreio em atenção primária é muito útil para serem administrados diretamente ou como aplicação médica e facilitam a avaliação de escalas para estabelecer níveis de gravidade e acompanhamento destes transtornos mentais. Conclusão. Na elaboração da proposta da história clínica que facilite a compreensão da condição mental do paciente é preciso considerar contexto familiar, social e pessoal dos pacientes, usando testes de rastreio como ferramentas da atenção primária

Conversion of a Surgically Arthrodesed Knee to a Total Knee Arthroplasty-Is it Worth it? A Meta-Analysis.

BACKGROUND: Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a select group of patients who are not satisfied with their results. However, there is a paucity of literature on this topic. A systematic review of literature was performed to (1) describe the overall demographic characteristics; (2) evaluate the clinical outcomes; (3) determine the overall rate of complications; and (4) evaluate the overall satisfaction of patients who underwent conversion of an arthrodesed knee to TKA. METHODS: A comprehensive literature search was systematically performed to evaluate all studies included in the literature until July 2015. The specific search terms used were "fusion knee" and "arthrodesis knee," which revealed a total of 2206 studies. A review and selection of these abstracts were then performed based on inclusion and/or exclusion criteria; a total of 10 articles were used for final review. RESULTS: There were a total of 98 surgically arthrodesed knees that subsequently underwent TKA. Patients had a mean age of 55 years and were followed up for a mean of 5 years. Using a random effects model, there was an overall complication rate of 47%, an overall revision rate of 25%, and an overall failure rate of 11%. However, most patients were overall satisfied with the procedure. CONCLUSION: Fusion takedown is a challenging procedure that should only be performed by experienced surgeons after extensive discussion with the patients. The clinical outcomes are good with overall patient satisfaction, but complication rates are high including risk of repeat fusion or amputation.

Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia.

OBJECTIVE: To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. METHODS: Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología-Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. RESULTS: There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m(2) vs. 28.7 kg/m(2), P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). CONCLUSIONS: Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies.

Neoplasias en aparato reproductor en perras: estudio restrospectivo a 6 años / Neoplasias in the reproductive system in female dogs: retrospective study of 6 years

Las noeplasias en tracto genital son poco frecuentes en perras, y suelen estar asociadas a problemas reproductivos secundarios. El objetivo del presente estudio fue analizar la frecuencia de neoplasias en el aparato reproductor de perras en México, haciendo una revisión retrospectiva de biopsias remitidas al Departamento de Patología de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad Nacional Autónoma de México, desde 1988 hasta 1993. Con ese fin se revisaron 2062 biopsias, de las cuales 117 (5.6 por ciento) correspondieron a neoplasias en el aparato reproductor. Se localizaron 48 neoplasias en vagina (41.02 por ciento), 40 en vulva (34.18 por ciento), 18 en ovario (15.38 por ciento) y 11 en útero (9.4 por ciento). De acuerdo con el tipo histológico, las neoplasias más frecuentes fueron: 8 casos de tumor de células de la granulosa (44.4 por ciento) en ovario, 5 casos de adenoma (45.5 por ciento) en útero y 31 (64.6 por ciento) y 22 (55 por ciento) casos de tumor venéreo transmisible en vagina y vulva, respectivamente. Las edades de los animales fueron de más de 5 años. Los datos encontrados concuerdan con lo referido en la literatura