Sex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in Colombia.

To date, the therapeutic use of cannabinoids in chronic pain management remains controversial owing to the limited clinical evidence found in randomized clinical trials (RCTs), the heterogeneous nature of the clinical indication, and the broad range of cannabis-based medicinal products (CBMPs) used in both experimental and observational clinical studies. Here we evaluate patient-reported clinical outcomes (PROMS) in a cohort of adult patients, diagnosed with chronic pain of diverse etiology, who received adjuvant treatment with oral, cannabis-based, magistral formulations between May and September 2021 at the Latin American Institute of Neurology and Nervous System (ILANS-Zerenia) in Bogotá, Colombia. During this period, 2,112 patients completed a PROMS questionnaire aimed at capturing the degree of clinical improvement of their primary symptom and any potential side effects. Most participants were female (76.1%) with an average age of 58.7 years old, and 92.5% (1,955 patients) reported some improvement in their primary symptom (p < 0.001). Two monovarietal, full-spectrum, cannabis formulations containing either cannabidiol (CBD 30 mg/mL; THC <2 mg/mL) or a balanced composition (THC 12 mg/mL; CBD 14 mg/mL) accounted for more than 99% of all prescriptions (59.5 and 39.8%, respectively). The degree of improvement was similar between both formulations, although males reported less effectiveness in the first 4 weeks of treatment. Sex-specific differences were also found in prescription patterns, with male patients increasing the intake of the balanced chemotype overtime. For many patients (71.7%) there were no adverse side effects associated to the treatment and those most reported were mild, such as somnolence (13.0%), dizziness (8.1%) and dry mouth (4.2%), which also appeared to fade over time. Our results constitute the first real-world evidence on the clinical use of medicinal cannabis in Colombia and suggest that cannabis-based oral magistral formulations represent a safe and efficacious adjuvant therapeutic option in the management of chronic pain.

Unusual primary central nervous system T-cell/histiocyte-rich large B-cell lymphoma: a case report.

We report the case of a 54-year-old immunocompetent woman who presented with a primary T-cell/histiocyte-rich large B-cell lymphoma (TCHRLBCL) of the central nervous system without systemic involvement, diagnosed by means of a brain biopsy. She was treated with corticosteroids and we subsequently started chemotherapy with rituximab, methotrexate, ifosfamide and intrathecal cytarabine. The patient's symptoms gradually improved over the first weeks and we followed-up with autologous haematopoietic cell transplantation. The patient has been in complete remission for a year. Primary TCHRLBCL of the central nervous system in an immunocompetent patient is an extremely rare condition that requires a multidisciplinary approach. This case highlights the importance of undergoing a sequential work-up and establishing a treatment despite the absence of evidence-based guidelines.

Neighbourhood green space and health disparities in the global South: Evidence from Cali, Colombia.

Increasing attention has been given to the role of green space in reducing health disparities. However, robust evidence to support decision making is lacking in the global South. We investigate the relationship between green space and health as well as its underlying mechanism in Cali, Colombia. Results indicate that neighbourhood greenness is associated with enhanced self-rated 'good' health and reduced physical and mental distress. The health benefits of green space appear to be stronger for people living in wealthier neighbourhoods than those in poor neighbourhoods. Results highlight the importance of considering health disparities for future green infrastructure planning in the global South context.

The heartbeat of the city.

Human activity is organised around daily and weekly cycles, which should, in turn, dominate all types of social interactions, such as transactions, communications, gatherings and so on. Yet, despite their strategic importance for policing and security, cyclical weekly patterns in crime and road incidents have been unexplored at the city and neighbourhood level. Here we construct a novel method to capture the weekly trace, or "heartbeat" of events and use geotagged data capturing the time and location of more than 200,000 violent crimes and nearly one million crashes in Mexico City. On aggregate, our findings show that the heartbeats of crime and crashes follow a similar pattern. We observe valleys during the night and peaks in the evening, where the intensity during a peak is 7.5 times the intensity of valleys in terms of crime and 12.3 times in terms of road accidents. Although distinct types of events, crimes and crashes reach their respective intensity peak on Friday night and valley on Tuesday morning, the result of a hyper-synchronised society. Next, heartbeats are computed for city neighbourhood 'tiles', a division of space within the city based on the distance to Metro and other public transport stations. We find that heartbeats are spatially heterogeneous with some diffusion, so that nearby tiles have similar heartbeats. Tiles are then clustered based on the shape of their heartbeat, e.g., tiles within groups suffer peaks and valleys of crime or crashes at similar times during the week. The clusters found are similar to those based on economic activities. This enables us to anticipate temporal traces of crime and crashes based on local amenities.

Vitamin D and other environmental risk factors in Colombian patients with multiple sclerosis.

OBJECTIVE: The aim of this study was to explore the association between MS and vitamin D levels, as well as Epstein-Barr virus (EBV) seropositivity and smoking history in a Colombian population. METHODS: We conducted a cross-sectional study between 2017 and 2018. We measured vitamin D levels and EBV antibody titers and administered a questionnaire to assess dietary habits, smoking, second-hand smoking and duration of smoking, sunlight exposure, physical activity, and personal and family history in individuals with and without multiple sclerosis during adolescence. A multivariable logistic regression model was then performed to explore the association between vitamin D status and MS. RESULTS: A total of 87 individuals with MS (mean age 40.9 years; 65.52% females) and 87 without MS (mean age 55 years; 65.52% females) were included in the analysis. In the multivariable analysis, after controlling for supplementation vitamin D levels did not differ between both groups and no difference was found regarding tobacco smoke exposure. The proportion of individuals who tested positive for anti-EBV nuclear antigen was significantly higher in individuals with MS (95.4% vs 82.76%, p = 0.028) CONCLUSION: : We did not find a statistically significant association between MS and vitamin D levels while anti-EBV nuclear antigen titers behaved as previously described in the literature. This study provides new evidence of the association between MS and different risk factors in our country, reinforcing the hypothesis that the pathogenesis of MS is multifactorial. Further studies are needed to better define the association between environmental factors and the development of MS in low prevalence areas.

Qué se debe saber en esclerosis múltiple: 16 preguntas prácticas / What one needs to know in multiple sclerosis: 16 practical questions

RESUMEN La esclerosis múltiple (EM) es la más frecuente de las enfermedades desmielinizantes del sistema nervioso central. Se trata de una patología compleja, con mecanismos fisiopatológicos aún no elucidados completamente y una presentación clínica variada. Es una entidad crónica, de alto costo para el sistema de salud, y usualmente se asocia a una importante discapacidad en los pacientes afectados. No existe una cura para la EM, sin embargo, se cuenta con más de 13 terapias modificadoras de la enfermedad que actúan en distintas dianas terapéuticas, enlentecen la progresión y mejoran el pronóstico. El objetivo de este escrito es presentar una actualización de EM, a través de 16 preguntas y temas controversiales. Estos 16 puntos responden a dudas puntuales y actuales, son presentados, analizados y, en los casos en los que la evidencia lo permite, se plantean recomendaciones. Las preguntas abordadas incluyen temas como diagnóstico, tratamiento, uso de nuevas tecnologías y manejo de los efectos adversos. Este escrito está destinado a neurólogos, médicos generales, residentes de neurología y cualquier profesional interesado en las enfermedades desmielinizantes.

SUMMARY Multiple sclerosis (MS) is the most common demyelinating disorder of the central nervous system. It is a complex disease, with a pathogenesis not fully understood and multiple clinical presentations. MS is a chronic disease, represents a great cost to healthcare systems and is often associated with a high burden of disability in patients. Despite the absence of a cure, there are at least13 disease-modifying therapies that act on different targets of the pathogenic process. The main purpose of this review is to solve 16 controversial and current topics in MS. These 16 topics are analysed, and when there is enough evidence, we issue recommendations. The topics include diagnosis, treatment, use of new technologies in MS, and medication side effects. This paper is meant for neurologists, neurology residents, general physicians and any other healthcare personnel interested in demyelinating diseases.

II Consenso Colombiano para el Manejo de la Osteoporosis Posmenopáusica / Second Colombian Consensus on the Management of Post-menopausal Osteoporosis: 2017 Update

Resumen La Asociación Colombiana de Osteoporosis y Metabolismo Mineral se reunió a principios de 2017 para actualizar el Consenso Colombiano de Osteoporosis, elaborado por primera vez en 2005, un paso que se consideró necesario en vista del subdiagnóstico de esta enfermedad, el impacto esperado del envejecimiento poblacional y los cambios en el tratamiento farmacológico que ha habido desde entonces. Se seleccionó un equipo técnico con especialistas de múltiples áreas y amplia trayectoria, repartidos en 4 grupos de trabajo: definición y epidemiología, diagnóstico, tratamiento farmacológico y medidas no farmacológicas. Luego de una revisión de la literatura científica, en reuniones de trabajo se generaron las definiciones y recomendaciones que se resumen en este documento.

Abstract The Colombian Osteoporosis and Mineral Metabolism Association met in early 2017 to update the Colombian Consensus on Osteoporosis. This was first issued in 2005, and is seen as a necessary step in view of the underdiagnosed status of this disease, and the expected impact of population ageing. A technical team was formed with specialists with long experience across multiple disciplines, who were assigned to four working groups: definitions and epidemiology, diagnosis, pharmacological treatment, and non-pharmacological treatment. After a scientific literature review and a series of meetings, the definitions and recommendations are summarised in this article.

In silico study of Moxifloxacin derivatives with possible antibacterial activity against a resistant form of DNA gyrase from Porphyromonas gingivalis.

We performed a homology modeling of the structure of a non-mutated and mutated Ser83→Phe DNA gyrase of Porphyromonas gingivalis. The model presented structural features conserved in type II topoisomerase proteins. We designed and evaluated in silico structural modifications to the core of Moxifloxacin by molecular docking, predicted toxicity and steered molecular dynamics simulations (SMD). Our results suggest that 8D derivative of Moxifloxacin could present a strong inhibitory activity in Porphyromonas gingivalis bacteria that exhibits resistance to some conventional fluoroquinolone drugs. Also, our results suggest that hydrophobic radicals in the hydroxyl group at position 3 of the quinolone core would increase the antibacterial activity of the compound when a reported mutation Ser83→Phe is present in the DNA gyrase protein. In addition, new candidates that could have a higher antibacterial activity compared to Moxifloxacin in non-resistant bacteria are proposed.

Seronegative Paraneoplastic Limbic Encephalitis Associated with Thymoma.

Paraneoplastic limbic encephalitis is an autoimmune syndrome characterized by the acute or subacute onset of encephalopathy, memory loss, confusion, temporal lobe seizures, and behavioral and mood changes. Although most patients with paraneoplastic limbic encephalitis have antineuronal antibodies, advances in the field now permit the diagnosis without autoantibody test results. In this case illustrating the new diagnostic criteria, we report a 70-year-old woman who was brought to the emergency room after the acute onset of cognitive impairment, altered mental status, and choreoathetoid movements. Brain magnetic resonance imaging showed hyperintense signals in both temporal lobes, and a chest computed tomogram revealed a thymoma. Because the patient met current diagnostic criteria for autoimmune limbic encephalitis, we were able to start treatment before her antibody tests were processed. The patient received immunotherapy and her tumor was resected. Her choreoathetoid movements disappeared and her other neurologic symptoms improved. Her cerebrospinal fluid proved to be negative for paraneoplastic limbic encephalitis antibodies. Most but not all patients with paraneoplastic limbic encephalitis associated with thymoma have evidence of paraneoplastic antibodies. Prompt management of the underlying malignancy determines whether patients survive and may minimize future cognitive and functional impairment. Practicing neurologists and psychiatrists should be aware of this diagnosis.

Neuropad for the detection of cardiovascular autonomic neuropathy in patients with type 2 diabetes.

BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a prevalent and neglected chronic complication of diabetes, with a large impact on morbidity and mortality. Part of the reason why it is not detected and treated opportunely is because of the complexity of the tests required for its diagnosis. We evaluated the Neuropad®, a test based on sudomotor function, as a screening tool for CAN in adult patients with type 2 diabetes in Bogotá, Colombia. METHODS: This was a cross-sectional evaluation of Neuropad® for the detection of CAN. Patients were 20-75years of age and did not suffer from any other type of neuropathy. CAN was diagnosed using the Ewing battery of tests for R-R variability during deep breathing, Valsalva and lying-to-standing maneuvers. Additionally, distal symmetric polyneuropathy (DSP) was diagnosed using a sign-based scale (Michigan Neuropathy Disability Score - NDS) and a symptom-based score (Total Symptom Score - TSS). The primary outcome was the sensitivity and specificity of the Neuropad® for the diagnosis of CAN, and secondary outcomes were the sensitivity and specificity of Neuropad® for DSP. RESULTS: We studied 154 patients (74 men and 80 women). Prevalence of CAN was extremely high (68.0% of study participants), but also DSP was prevalent, particularly according to the signs-based definition (45%). The sensitivity of the Neuropad® for any degree of CAN was 70.1%, being slightly higher for the deep breathing and Valsalva tests than for lying-to-standing. The specificity of the Neuropad® for any type of CAN was only 37.0%, as expected for a screening exam. The negative predictive value was higher for the deep breathing and Valsalva tests (69.4 and 81.6%, respectively). Neuropad showed also a good sensitivity and negative predictive value for DSP. The sensitivity and specificity of Neuropad were better among men, and among patients with diabetes duration above the group median. CONCLUSIONS: The Neuropad is a simple and inexpensive device that demonstrated an adequate performance as a screening tool for cardiovascular autonomic neuropathy in Latin American patients with DM2.

Divertículo de Meckel Perforado en Paciente en un Paciente de 13 Años, Reporte de un Caso / Perforated Meckel diverticulum in an 13-year-old patient, a case report

Dentro las patologías quirúrgicas causantes de abdomen agudo, son varias las que se deben de considerar y por lo tanto, discriminar en el marco de lo que se refiere al diagnóstico diferencial. Se presenta el caso clínico de una paciente adolescente, con el diagnóstico de abdomen agudo, en cuyo inicio se lo considera de origen apendicular, con posterior rectificación diagnóstica en el momento de la laparotomía, descubriendo que se trataba de una Diverticulitis de Meckel necrosada perforada con compromiso de íleon terminal, llamando la atención una perforación en la unión íleocecal, por lo cual se realiza una resección de íleon terminal, ciego, apéndice y colon ascendente, por compromiso de su irrigación.

Among the diseases that cause acute abdominal surgery, there are several that must be considered and therefore, it's important to discriminate respect to various differential diagnosis. We report a case of an adolescent patient with the diagnosis of acute abdomen, which was considered in a beginning as an appendix origin problem. With subsequent rectification of diagnosis at the moment of the laparotomy, finding out that it was a Meckel's Perforated necrotic Diverticulum, with important compromise of the terminal ileum, drawing attention to a hole in the ileocecal junction.The procedure performed consisted on the resection of terminal ileum, cecum, appendix and ascending colon, becauseof an important compromise of blood supply.

Evaluacion a 24 meses post-tratamiento con Benznidazol en niños de 6 a 12 años infectados con T. Cruzi / Annual Reports 1997 / Evaluation at 24 month post-treatment with Benznidazole in T. Cruzi- infected children between 6 to 12 years old

En este estudio se evaluó la acción terapéutica de Benznidazol a 6, 12, 18 y 24 meses de post tratamiento en 20 niños de 6 a 12 años de edad infectado por T-cruzi. Estos niños eran procedentes de dos compañías del Departamento Paraguarí, endémicas para la enfermedad del Chagas. Las viviendas de estas zonas fueron entomológicamente evaluadas y posteriormente rociadas antes de iniciar el tratamiento. Los 20 niños fueron sometidos a un examen clínico y laboratorial antes del tratamiento. Los examenes laboratoriales fueron hemocultivo, xenodiagnóstico, parasitemia directa y confirmación serológica por ELISA, IFI y westem blot. De manera a detectar posible efectos colaterales, se realizaron determinaciones basales y a los 20 días post tratamiento de hemograma, GOT, GPT, bilirrubina total, directa e indirecta. En el estudio basal, el 15 por ciento (11/12) xenodignóstico positivo. El tratamienode benznidazol fue a una dosis de 5-7 mg/kg de peso por 60 días. No hubieron variaciones entre las determinaciones hematológicas y químicas vasales y las realizada a los 20 días. El 100 por ciento de las muestra presentaron resultados parasitológicos negativos tanto a los 12 como a los 24 meses post-tratamiento. Nuestros resultados son alentadores, ya que se obtuvo 100 por ciento de negativización por los metodos paracitológicos, icluyendo el xenodiagnóstico, a los 24 meses pots-tratamiento, además de la caída significativa en la densidades opticas del tes de ELISA (100 por ciento de las muestras), al comparar el estudio basal hasta los 2 años seguimiento

Tratamiento laparoscópico de la colecistitis aguda / laparoscópico Processing of the acute colecistitis

Presenta un estudio prospectivo realizado en el Hospital Clínica "Miguel H. Alcívar" de la ciudad de Guayaquil, desde ene.- a nov. 1996, se incluyen 30 pacientes con diagnóstico de Colecistitis Aguda en quines se realizó Colecistectomía laparoscópica. La edad promedio fue de 51 (22-89) años, 21 (70 por ciento) presentaban Colecistitis aguda, y 9 (30 por ciento) presentaron Colecistitis crónica en período de agudización. Esta patología fue más frecuente en el sexo femenino (26 pctes. 86 por ciento), 20 (66.5 por ciento) pacientes presentaron patologías asociadas, 11 (36 por ciento) pacientes presentaban antecedentes quirúrgicos en cavidad abdominal. El tiempo quirírgico fue de 66 (35-120) minutos promedio. en 4 pacientes (15 por ciento) se realizó la punción vesicular. Los problemas más comunes que se presentaron durante la cirugía fueron: pérdida neumoperitoneo, hemorragia, ruptura de vesícula, caída de cálculos, falla del instrumental. En 4 (13 por ciento) pacientes se realizó la ampliación de la incisión T2 para facilitar la extracción de la vesícula biliar. La conversión del procedimiento se realizó en 4 (13 por ciento) casos. La estadía hospitalaria fue en promedio de 1.7 (1-5) días...

Tratamiento con benznidazol en niños de seis a doce años infectados con T. cruzi / Annual reports 1995 / Treatment with benznidazole in six-twelve aged children infected with T. cruzi

Este estudio se realizò en el marco del Programa Nacional de Control de la Enfermedad de Chagas se desarrollò a fin de evaluar el èxito terapèutico del benznidazol en niños de 6 a 12 años de edad infectados con T. cruzi y establecer las mejores tècnicas para determinar la cura parasitològica y serològica de las personas tratadas. Para ello, 20 niños en edad escolar procedentes de dos compañias del Departamento de Paraguarì (àrea endèmica para la enfermedad de Chagas), cuya infecciòn con T. cruzi fue determinada mediante un tamizaje serològico (ELISA), fueron tratados con benznidazol (5-7mg/kg de peso por 60 dìas). Antes del inicio del tratamiento, los niños fueron sometidos a un examen clìnico de control, hemocultivo, xenodiagnòstico, parasitemia directa, reacciòn en cadena de la polimerasa (PCR) y confirmaciòn serològica (ELISA, IFI). Ademàs, se realizaron determinaciones basales y a los 20 dìas del tratamiento de hemograma, GOT, bilirrubina total, directa e indirecta para controlar la apariciòn de efectos colaterales del tratamiento. No se observaron variaciones entre las determinaciones hematològicas y quìmicas basales y las realizadas a los 20 dìas. En el estudio basal, el 15 por ciento (3/20) de las muestras tuvo parasitemia directa positiva, el 5 por ciento (1/20) tuvo hemocultivo positivo, el 55 por ciento (11/20) de los xenodiagnòsticos fue positivo y el 85 por ciento (17/20) tuvo PCR positivo. En cuanto a la serologìa, el 100 por ciento de las muestras fueron positivas tanto por ELISA como por IFI. A los seis meses de finalizado el tratamiento, se realizò la primera evaluaciòn serològica y parasitològica detectàndose en el 100 por ciento de las muestras parasitemia negativa. La serologìa para T. cruzi siguiò siendo positiva en todos los casos por ambos mètodos (ELISA e IFI) pero se observò una disminuciòn de los tìtulos que fue estadìsticamente significativa tanto por ELISA (p<0,0001) como por IFI (p<0,05). A los seis meses del tratamiento, si bien todas las muestras fueron negativas por todos los mètodos parasitològicos incluyendo al PCR, tècnica altamente sensible en la fase crònica de la enfermedad de Chagas y al xenodiagnòstico, no se puede hablar aùn de cura en forma concluyente debido a la positividad de los mètodos serològicos que puede indicar presencia del paràsito o una memoria inmunològica remanente. Sin embargo, se debe resaltar la disminuciòn, estadìsticamente significativa, de los tìtulos serològicos por los dos mètodos utilizados

Tratameinto con benznidazol en niños de seis a doce años infectados con T. cruzi / Annual reports 1995 / Treatment with benznidazole in six-twelve aged children infected with T. cruzi

Este estudio se realizò en el marco del Programa Nacional de Control de la Enfermedad de Chagas se desarrollò a fin de evaluar el èxito terapèutico del benznidazol en niños de 6 a 12 años de edad infectados con T. cruzi y establecer las mejores tècnicas para determinar la cura parasitològica y serològica de las personas tratadas. Para ello, 20 niños en edad escolar procedentes de dos compañias del Departamento de Paraguarì (àrea endèmica para la enfermedad de Chagas), cuya infecciòn con T. cruzi fue determinada mediante un tamizaje serològico (ELISA), fueron tratados con benznidazol (5-7mg/kg de peso por 60 dìas). Antes del inicio del tratamiento, los niños fueron sometidos a un examen clìnico de control, hemocultivo, xenodiagnòstico, parasitemia directa, reacciòn en cadena de la polimerasa (PCR) y confirmaciòn serològica (ELISA, IFI). Ademàs, se realizaron determinaciones basales y a los 20 dìas del tratamiento de hemograma, GOT, bilirrubina total, directa e indirecta para controlar la apariciòn de efectos colaterales del tratamiento. No se observaron variaciones entre las determinaciones hematològicas y quìmicas basales y las realizadas a los 20 dìas. En el estudio basal, el 15 por ciento (3/20) de las muestras tuvo parasitemia directa positiva, el 5 por ciento (1/20) tuvo hemocultivo positivo, el 55 por ciento (11/20) de los xenodiagnòsticos fue positivo y el 85 por ciento (17/20) tuvo PCR positivo. En cuanto a la serologìa, el 100 por ciento de las muestras fueron positivas tanto por ELISA como por IFI. A los seis meses de finalizado el tratamiento, se realizò la primera evaluaciòn serològica y parasitològica detectàndose en el 100 por ciento de las muestras parasitemia negativa. La serologìa para T. cruzi siguiò siendo positiva en todos los casos por ambos mètodos (ELISA e IFI) pero se observò una disminuciòn de los tìtulos que fue estadìsticamente significativa tanto por ELISA (p<0,0001) como por IFI (p<0,05). A los seis meses del tratamiento, si bien todas las muestras fueron negativas por todos los mètodos parasitològicos incluyendo al PCR, tècnica altamente sensible en la fase crònica de la enfermedad de Chagas y al xenodiagnòstico, no se puede hablar aùn de cura en forma concluyente debido a la positividad de los mètodos serològicos que puede indicar presencia del paràsito o una memoria inmunològica remanente. Sin embargo, se debe resaltar la disminuciòn, estadìsticamente significativa, de los tìtulos serològicos por los dos mètodos utilizados