Clinical Characteristics and Outcomes of Patients with Heart Failure of Hypertensive Etiology: Analysis of Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Arterial hypertension represents one of the main comorbidities observed in patients with heart failure (HF) and one of the main risk factors for its development. Despite this, studies assessing this hypertensive etiology are scarce in Latin America. Our objective was to analyze the prevalence of HF of hypertensive etiology and evaluate its prognosis in patients enrolled in the Colombian Heart Failure Registry (RECOLFACA by its Spanish acronym). METHODS: RECOLFACA recruited adult patients diagnosed with HF in 60 centers in Colombia between 2017 and 2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess factors associated with primary outcomes in patients with hypertensive HF. A p value <0.05 was considered significant. All statistical tests were two-tailed. RESULTS: Out of the total number of patients evaluated in RECOLFACA (n = 2,514), 804 had a diagnosis of HF with hypertensive etiology (31.9%). These patients were less frequently males and had a significantly older age and lower prevalence of comorbidities than those with HF of other etiologies. Additionally, patients with hypertensive HF had a higher prevalence of HF with preserved ejection fraction (HFpEF) (34.1% vs. 28.3%; p = 0.004). Finally, type 2 diabetes mellitus, chronic obstructive pulmonary disease diagnosis, and NYHA class IV were classified as independent mortality risk factors. CONCLUSIONS: Hypertensive HF represents about one-third of the total number of patients with HF in RECOLFACA. Compared with HF of other etiologies, it presents a differential clinical profile - older age and a higher prevalence of HFpEF. RECOLFACA has become a useful tool to characterize patients with HF in Colombia, with which it has been possible to carry out a more specific search and reach the diagnosis of this pathology in our population, and it has served as an example to stimulate registries of patients with HF in other countries in the region.

American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients.

BACKGROUND: About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries. HYPOTHESIS: The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. METHODOLOGY: Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test. RESULTS: This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%). CONCLUSIONS: AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.

Characterization of Patients With Heart Failure of Chagas Etiology in Colombia: An Analysis Based on the Colombian Registry of Heart Failure (RECOLFACA).

Chronic Chagas cardiomyopathy (CCM) represents a relevant origin of Heart Failure (HF) in countries where the disease is endemic. CCM exhibits distinct myocardial involvement and is associated with a poorer prognosis compared to different HF etiologies. The aim is to explain the features and prognosis of individuals with HF resultant to CCM registered in the Colombian Registry of Heart Failure (RECOLFACA). RECOLFACA registry enrolled 2528 adult patients with HF. A comparison was made between patients diagnosed with CCM and those diagnosed with other etiologies of HF. Eighty-eight patients (3.5%) present CCM diagnosis. The individuals diagnosed with both HF and CCM were notably younger in age, had less comorbidities, poorer functional class, and significantly inferior ejection fraction. Finally, the presence of CCM diagnosis was linked to a substantially elevated mortality risk throughout the follow-up period (HR 2.01; 95% CI, 1.01-4.00) according to a multivariate model adjusted. CCM represents an important etiology of HF in Colombia, drawing attention to a distinct clinical profile and a higher risk of mortality compared to other HF etiologies.

Comorbidity profile and outcomes in patients with chronic heart failure in a Latin American country: Insights from the Colombian heart failure registry (RECOLFACA).

BACKGROUND: Heart failure (HF) is usually accompanied by cardiovascular and non-cardiovascular comorbidities, which may significantly impact its prognosis. In this study we aimed to characterize the comorbidity profile and its impact in mortality in patients with HF diagnosis from the Colombian Heart Failure Registry (RECOLFACA). METHODS: RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess the impact of the comorbidities in mortality. A p-value of <0.05 was considered significant. RESULTS: From the total 2528 patients included in the registry, 2514 patients (58% males, mean age 68 years) had information regarding comorbidity diagnoses. 2321 patients (92.3%) reported at least one comorbidity. Arterial hypertension was the most frequent individual diagnosis (72%; n = 1811), followed by anemia (30.1%, n = 726). The most frequently observed coexisting comorbidities were coronary disease (CHD) with dyslipidemia, and chronic kidney disease (CKD) with type 2 Diabetes Mellitus (T2DM). Different patterns of comorbidity coexistence were observed when comparing HF patients by sex and left-ventricular ejection fraction (LVEF) classification. The only comorbidities that were significantly associated with mortality after multivariate adjustment were T2DM (HR 1.45. 95% CI 1.01-2.12), anemia (HR 1.48. 95% CI 1.02-2.16), and CHD (HR 1.59. 95% CI 1.09-2.33). CONCLUSION: Multiple comorbidities were frequently observed in the patients from the RECOLFACA. T2DM, anemia and CHD were significantly associated with a higher risk of mortality, highlighting the importance of promoting an optimal follow-up and control of these conditions.

SARS-CoV-2 pneumomediastinum. A proposed pneumomediastinum classification

Pneumomediastinum is a rare complication of viral pneumonias. However, as a result of the COVID-19 pandemic, the reports of SARS-CoV-2 related pneumomediastinum have increased. This type of pneumomediastinum is known as "spontaneous" pneumomediastinum. Spontaneous pneumomediastinum is defined as the presence of air in the mediastinal cavity with no apparent cause, but paradoxically, the group termed "spontaneous" is the one with the greatest trigger. Therefore, we believe that the current classification does not coincide with the definition. We present five SARS-CoV-2 pneumomediastinum cases and propose a pneumomediastinum classification. These are the first published reports in our country. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2252).

El neumomediastino es una complicación poco frecuente de las neumonías virales; sin embargo, a raíz de la pandemia de la COVID-19, los informes de casos de neumomediastino por SARS-CoV-2 se han incrementado. A este tipo de neumomediastino se le denomina espontáneo. Se define como neumomediastino espontáneo a la presencia de aire en la cavidad mediastínica sin ninguna causa aparente, pero paradójicamente, el grupo denominado espontáneo es el que tiene mayor causa desencadenante, por lo tanto, creemos que la clasificación actual no es coherente con el significado. Presentamos cinco casos de neumomediastino por SARS-CoV-2 y proponemos una clasificación para el neumomediastino. Estos son los primeros informes publicados en nuestro país. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2252).

Mental health interventions for college and university students during the COVID-19 pandemic: A critical synthesis of the literature.

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Intervenciones para la salud mental de estudiantes universitarios durante la pandemia por COVID-19: una síntesis crítica de la literatura / Mental health interventions for college and university students during the COVID-19 pandemic: a critical synthesis of the literature

RESUMEN Introducción: Los estudiantes de educación superior son una población vulnerable a los trastornos mentales, más aún durante la pandemia por COVID-19. Su salud mental se ha visto afectada por el confinamiento, las dificultades en el desarrollo de las actividades académicas y las exigencias de las nuevas modalidades pedagógicas. Se planteó entonces la pregunta: en las instituciones de educación superior, ¿cuáles acciones en torno a a) promoción y prevención, b) atención a síntomas mentales y c) adaptaciones pedagógicas pueden desarrollarse con el fin de mejorar la salud mental de sus estudiantes? Métodos: Síntesis crítica a partir de la revisión sistemática de la literatura. Se realizó la búsqueda de artículos científicos de alcance descriptivo, analítico, experimental o evaluativo, así como recursos web de organizaciones relacionadas con el tema. Se realizó una síntesis en función de los 3 focos de la pregunta mediante comparación constante, hasta realizar la agrupación de acciones por similitud en los actores que las ejecutarían y recibirían. Se anticipó una baja calidad de la evidencia, por lo que no se realizó evaluación estandarizada. Resultados: Se exploraron 68 artículos y 99 recursos web. Después de la revisión del texto completo se incluyeron 12 artículos científicos y 11 recursos web. Como lineamentos generales, se encontró que la propuesta más frecuente es el diseño de un programa estructurado específico para el tema de salud mental en las instituciones educativas, que sea multidisciplinario, incluyente, dinámico y sensible a la cultura. Las acciones deben ser divulgadas periódicamente para que los estudiantes y demás miembros de la comunidad educativa las tengan claras, e idealmente se propone mantenerlas hasta el periodo pospandémico e incluir a los egresados. Para a) la promoción y prevención, se encontró la psicoeducación por vía electrónica, donde se expliquen estilos de vida saludable, reacciones emocionales en pandemia, estrategias de afrontamiento y signos de alarma. Se propone la participación de los pares como estrategia de apoyo y espacios de interacción social que no se enfoquen únicamente en aspectos académicos. Se reporta la necesidad de cribar síntomas mentales por medio de envío frecuente de formularios en línea o aplicaciones móviles, donde también se indague por la satisfacción de las necesidades básicas y tecnológicas. En cuanto a b) atención de síntomas mentales, una de las acciones que se encontró con mayor frecuencia es disponer de un centro de consultoría que sea capaz de realizar atención en salud mental por vía telefónica, por tecnologías e incluso presencial, con atención permanente las 24 h o equipos de respuesta rápida ante una situación de crisis, como la conducta suicida y la violencia doméstica. Para c) las adaptaciones pedagógicas, se señala como requisito indispensable la comunicación fluida para tener instrucciones claras sobre el desarrollo de las actividades académicas para disminuir la incertidumbre y, por ende, la ansiedad y favorecer la gestión del tiempo por el estudiante. Los profesores y pedagogos de la institución pueden ofrecer asesorías directas (por videollamadas o reuniones de grupos en línea) para proveer apoyo en hábitos de estudios, materias propias de cada carrera y salud mental. Conclusiones: Los recursos incluidos proponen que la institución educativa cree un programa que aborde específicamente la salud mental de los estudiantes. Esta síntesis puede proveer lineamientos que faciliten la toma de decisiones, sin perder de vista que la institución y el estudiante están inmersos en un contexto complejo, con circunstancias y otros actores en varios niveles que también intervienen en la salud mental. Se requieren investigaciones sobre la evolución de la situación de salud mental y el efecto de las acciones que se vayan tomando.

ABSTRACT Background: College and university students are a population vulnerable to mental disorders, especially during the COVID-19 pandemic. Their mental health has been affected by confinement, difficulties in the development of academic activities, and the demands of new pedagogical modalities. We aimed to respond to the question: what are the actions around a) promotion and prevention, b) mental symptoms care, and c) pedagogical adaptations that can be developed in order to improve the mental health of college and university students? Methods: We conducted a critical synthesis from a systematic review of the literature. A search was made for scientific articles with descriptive, analytical, empirical or evaluative designs, as well as web resources of organizations related to the topic. A synthesis was carried out based on the three aspects of the question by means of a constant comparative method, until the aggregation of actions by similarity in the actors. We anticipated low evidence quality; therefore, a standardized evaluation was not performed. Results: We explored 68 articles and 99 web resources. After reviewing the full text, 12 scientific articles and 11 web resources were included. As general guidelines, we found that the most frequent suggestion is the design of a specific structured mental health program within universities, one that should be multidisciplinary, inclusive, dynamic and culturally sensitive. All actions taken by the university should be reported and published periodically so that students and other members of the university community are clear about them. Ideally, it is suggested to keep them until the post-pandemic period and include alumni. Regarding a) promotion and prevention, digital psychoeducation was recommended, with information about healthy lifestyles, common emotional reactions to epidemics, coping strategies and warning signs. Peer participation is suggested as a support strategy, as well as spaces for social interaction that focus not only on academic aspects but also on leisure. Screening for mental symptoms is suggested through frequent submission of online forms or mobile applications. In addition to mental health, it is important to inquire about the degree of satisfaction of basic and technology-related needs. For b) the care of mental symptoms, one of the actions commonly identified was a consulting centre that can provide mental health care by telephone, by technology, and even in person -if required -, with permanent availability with rapid response teams for crisis situations, such as suicidal behavior and domestic violence. For c) pedagogical adaptations, fluent communication is an indispensable requirement; having clear instructions on academic activities can reduce uncertainty and therefore anxiety. The teaching and pedagogical staff at the institution can offer direct advice (via video calls or online group meetings) to provide support in study habits, degree-specific material and mental health. Conclusions: Included resources suggest the creation of a program that specifically addresses the mental health of students. This synthesis can provide guidelines that facilitate decision-making by the university, without losing sight of the fact that the institution and the student are immersed in a complex context, with circumstances and other actors at various levels that also intervene in mental health. Research is required on the evolution of the mental health situation and the effect of the actions that are being taken.

[Mental health interventions for college and university students during the COVID-19 pandemic: a critical synthesis of the literature]. / Intervenciones para la salud mental de estudiantes universitarios durante la pandemia por COVID-19: una síntesis crítica de la literatura.

BACKGROUND: College and university students are a population vulnerable to mental disorders, especially during the COVID-19 pandemic. Their mental health has been affected by confinement, difficulties in the development of academic activities, and the demands of new pedagogical modalities. We aimed to respond to the question: what are the actions around a) promotion and prevention, b) mental symptoms care, and c) pedagogical adaptations that can be developed in order to improve the mental health of college and university students? METHODS: We conducted a critical synthesis from a systematic review of the literature. A search was made for scientific articles with descriptive, analytical, empirical or evaluative designs, as well as web resources of organisations related to the topic. A synthesis was carried out based on the three aspects of the question by means of a constant comparative method, until the aggregation of actions by similarity in the actors. We anticipated low evidence quality; therefore, a standardised evaluation was not performed. RESULTS: We explored 68 articles and 99 web resources. After reviewing the full text, 12 scientific articles and 11 web resources were included. As general guidelines, we found that the most frequent suggestion is the design of a specific structured mental health programme within universities, one that should be multidisciplinary, inclusive, dynamic and culturally sensitive. All actions taken by the university should be reported and published periodically so that students and other members of the university community are clear about them. Ideally, it is suggested to keep them until the post-pandemic period and include alumni. Regarding a) promotion and prevention, digital psychoeducation was recommended, with information about healthy lifestyles, common emotional reactions to epidemics, coping strategies and warning signs. Peer participation is suggested as a support strategy, as well as spaces for social interaction that focus not only on academic aspects but also on leisure. Screening for mental symptoms is suggested through frequent submission of online forms or mobile applications. In addition to mental health, it is important to inquire about the degree of satisfaction of basic and technology-related needs. For b) the care of mental symptoms, one of the actions commonly identified was a consulting centre that can provide mental health care by telephone, by technology, and even in person --if required --, with permanent availability with rapid response teams for crisis situations, such as suicidal behaviour and domestic violence. For c) pedagogical adaptations, fluent communication is an indispensable requirement; having clear instructions on academic activities can reduce uncertainty and therefore anxiety. The teaching and pedagogical staff at the institution can offer direct advice (via video calls or online group meetings) to provide support in study habits, degree-specific material and mental health. CONCLUSIONS: Included resources suggest the creation of a programme that specifically addresses the mental health of students. This synthesis can provide guidelines that facilitate decision-making by the university, without losing sight of the fact that the institution and the student are immersed in a complex context, with circumstances and other actors at various levels that also intervene in mental health. Research is required on the evolution of the mental health situation and the effect of the actions that are being taken.

Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection.

BACKGROUND: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19. AIM: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems. METHODS: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. RESULT: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives.

Antecedentes: Se requiere la mejor evidencia científica para diseñar intervenciones no farmacológicas efectivas para ayudar a los formuladores de políticas a contener COVID-19. OBJETIVO: Describir qué intervenciones no farmacológicas utilizaron diferentes países y cuándo las implementaron. También explora cómo las intervenciones no farmacológicas afectan el número de casos, la mortalidad y la capacidad de los sistemas de salud. MÉTODOS: Consultamos ocho páginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 países incluidos, y además, incluimos nueve estudios (de 34 identificados) que cumplían con los criterios de inclusión. RESULTADOS: Algunos países implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo. Otros combinaron varias medidas más drásticas de distanciamiento social. El tiempo para implementar las intervenciones varió desde los primeros quince días después de detectar el primer caso hasta más de 30 días. La efectividad de las intervenciones no farmacológicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad. Cuando se controle el número de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses. La toma de decisiones políticas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto económico y social sobre la población en general, pero principalmente sobre los más vulnerables.

Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection / Intervenciones no farmacéuticas para la contención, mitigación y supresión del COVID-19

Abstract Background: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19. Aim: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems. Methods: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. Result: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives.

Resumen Antecedentes: Se requiere la mejor evidencia científica para diseñar intervenciones no farmacológicas efectivas para ayudar a los formuladores de políticas a contener COVID-19. Objetivo: Describir qué intervenciones no farmacológicas utilizaron diferentes países y cuándo las implementaron. También explora cómo las intervenciones no farmacológicas afectan el número de casos, la mortalidad y la capacidad de los sistemas de salud. Métodos: Consultamos ocho páginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 países incluidos, y además, incluimos nueve estudios (de 34 identificados) que cumplían con los criterios de inclusión. Resultados: Algunos países implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo. Otros combinaron varias medidas más drásticas de distanciamiento social. El tiempo para implementar las intervenciones varió desde los primeros quince días después de detectar el primer caso hasta más de 30 días. La efectividad de las intervenciones no farmacológicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad. Cuando se controle el número de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses. La toma de decisiones políticas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto económico y social sobre la población en general, pero principalmente sobre los más vulnerables.

X-linked Lymphoproliferative Disease Type 1 in a Patient With the p.Gly93Asp SH2D1A Gene Mutation and Hemophagocytic Lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis is characterized by uncontrolled activation of the immune system that leads to systemic hyperinflammation. Lymphoproliferative syndrome linked to the X chromosome is a hereditary immunodeficiency characterized by an inability to mount an adequate immune response to an Epstein-Barr virus infection. Hemophagocytic lymphohistiocytosis is one of the main clinical features of X-linked lymphoproliferative syndrome. We report the case of a patient who presented with primary hemophagocytic lymphohistiocytosis associated with Epstein-Barr virus infection without a familial history of immunodeficiency. A mutation in the SH2D1A gene was identified, which confirmed the diagnosis of type 1 X-linked lymphoproliferative syndrome.

Políticas públicas vigentes de salud mental en Suramérica: un estado del arte / Current public policies on mental health in south america: a state of the art / Políticas públicas de saúde mental em vigor na América do Sul: O Estado da Arte

Objetivo: presentar un Estado del Arte sobre el contenido de las políticas públicas de salud mental vigentes en Suramérica, con el propósito de establecer un panorama de los alcances y limitaciones de la normatividad sobre el tema en la región. Metodología:Estudio documental de enfoque hermenéutico mediante el cual se interpretó y explicó las relaciones entre los contenidos de las políticas públicas de salud mental y el contexto de los países suramericanos. Para el análisis se incluyeron documentos normativos de los países, tales como Acuerdos, Resoluciones y Leyes. Igualmente, se utilizaron publicaciones académicas en el periodo comprendido entre 2003 a 2013, que posibilitaron la descripción y el análisis del tema de investigación. Resultados: países como Colombia, Argentina, Paraguay, Brasil, Perú, Ecuador y Uruguay cuentan con disposiciones normativas vigentes (acuerdos, resoluciones y leyes) que sustentan el contenido de las políticas públicas en materia de salud mental. Por otra parte, Chile, Bolivia y Venezuela fundamentan sus políticas en mecanismos administrativos (programas, planes y proyectos) sin apelar a la norma de obligatorio cumplimiento. Conclusión: la noción de salud mental que subyace a cada Política Nacional hace énfasis en la promoción de la salud y la prevención de la enfermedad, desde una concepción positiva del bienestar que resalta el papel activo de los sujetos y poblaciones, las capacidades y libertades disponibles; sin embargo, los recursos, estrategias, acciones y metas están orientados sobre la base de un modelo biomédico que prioriza el diagnóstico y el tratamiento de trastornos mentales

Objective: to present the state of the art regarding the content of the public mental health policies currently in force in South America in order to establish an overview of the scope and limitations of the regulations on the subject in the region. Methodology: a documentary study with a hermeneutic approach explaining the relationships between the contents of the public policies for mental health and the context of the South American countries. For the analysis, we included normative documents of the countries, e.g. agreements, resolutions and acts. Similarly, academic papers from the period between 2003 and 2013 were included. These made it possible to describe and analyze the research subject. Results: countries such as Colombia, Argentina, Paraguay, Brazil, Peru, Ecuador and Uruguay have current regulations (agreements, resolutions and acts) supporting the content of public policies in regards to mental health. On the other hand, Chile, Bolivia and Venezuela base their policies on administrative mechanisms (programs, plans and projects) without enforcing mandatory compliance. Conclusion: the notion of mental health underlying each national policy emphasizes health promotion and prevention equally, and is based on a positive conception of well-being that highlights the active role of subjects and populations as well as the capabilities and liberties available. Nevertheless, their resources, strategies, actions and goals are based on a biomedical model that prioritizes the diagnosis and treatment of mental disorders.

Objetivo: apresenta um Estado da Arte sobre o conteúdo das políticas públicas de saúde mental em vigor na América do Sul, com o objetivo de estabelecer o panorama da abrangência e das limitações das normas sobre esta temática, na região. Metodologia: estudo documental de abordagem hermenêutica que foi interpretado e explicou as relações entre o conteúdo das políticas públicas de saúde mental e do contexto dos países da América do Sul. Para a análise foram incluídos documentos normativos dos países, tais como acordos, resoluções e leis. Da mesma forma, publicações acadêmicas foram utilizados no período de 2003 a 2013, que permitiu a descrição e análise do tema de pesquisa. Resultados: países como a Colômbia, a Argentina, o Paraguai, o Brasil, o Peru, o Equador e o Uruguai têm disposições regulamentares em vigor (acordos, resoluções e leis) que suportam o conteúdo das políticas públicas relacionadas com a saúde mental. Por outro lado, o Chile, a Bolívia e a Venezuela fundamentam as suas políticas em mecanismos administrativos (programas, planos e projetos), sem ter uma regra de cumprimento obrigatório. Conclusão: a noção de saúde mental que que subjaz cada Política Nacional enfatiza na promoção da saúde e da prevenção da doença, partindo de uma concepção positiva do bem-estar, ressaltando a função ativa dos sujeitos e das populações, as capacidades e as liberdades disponíveis. Porém, os recursos, as estratégias, as ações e as metas estão orientadas sobre a base de um modelo biomédico, priorizando o diagnóstico e tratamento de transtornos mentais.

Miofibroblastoma de seno: tumor de abrikossoff, un tumor infrecuente / Myofibroblastoma of the breast: the infrequent Abrikosoff's tumor

Introducción. La incidencia de enfermedades neoplásicas de seno se ha incrementado en los últimos años; por tal razón, existe un acentuado aumento de casos de neoplasias que anteriormente eran de baja frecuencia o inclusive inexistentes. Con la notable mejoría y mayor disposición de técnicas de tamización, de estudios de anatomía patológica y de mejor acceso a la atención clínica oportuna y adecuada, hemos sido testigos del aumento en el diagnóstico de tumores de células granulares, o tumor de Abrikossoff, que se refleja en los reportes disponibles en la literatura científica que sirven para aclarar y obtener una mejor perspectiva en cuanto a su diagnóstico, estudio y manejo. Materiales y métodos. Se hizo una búsqueda sistemática de la literatura científica disponible en la base de datos de Pubmed, sin limitaciones de año de publicación, idioma, sexo, especialidad médica o características del tipo de reporte, comparando los diferentes resultados tanto de técnicas diagnósticas como de tratamientos y seguimiento aplicados. Discusión. Existen múltiples reportes de casos clínicos de tumores de células granulares, aunque hay, hoy en día, algunas discrepancias sobre el tratamiento de estas neoplasias, especialmente cuando se encuentran localizados en la mama, ya que por sus características de comportamiento benigno pueden ser menospreciados y resultar en futuras complicaciones propias de la historia natural de este tipo de trastornos. Por tal razón, se deben enfatizar los nuevos enfoques diagnósticos y en los tratamientos contundentes para disminuir la morbimortalidad de los pacientes, y buscar estandarizar su origen y los criterios clínicos y de laboratorio para su diagnóstico.

Introduction: There is an increasing incidence of neoplastic diseases of the breast being recorded in recent years, with the consequent increase in the number of cases of neoplastic lesions that previously had been infrequent or nonexistent. With the marked improvement and availability of screening techniques, more sophisticated pathological studies, and better access to opportune and adequate medical treatment, we are witnessing an increase in the number of cases of the granular cell tumors of the breast, or Abrikossoff´s tumors. Materials and methods. A systematic search of the literature available in PubMed was conducted, without limitations on the year of publication, language, gender, medical specialty or type of report, comparing the results from diagnostic techniques, management, and follow-up. Discussion. There are multiple clinical reports of cases of granular cell tumors, but currently there are discrepancies regarding their treatment, especially when they are located in the breast, and that because of their benign clinical behavior they can be underestimated with the consequent complications proper of the natural history of these tumors. For this reason the newer diagnostic techniques and treatment modalities should be emphasized so as to diminish morbidity and mortality in these patients, and seek to standardize their origin and the clinical and laboratory criteria for their diagnosis.

Cuerpos sometidos, sujetos educados: apuntes para una interpretación de las luchasdiscursivas por la construcción de la educaciónsexual en Colombia / Bodies subject, educated sujects: notes for an interpretation of discursive struggles for the construction of sex education in Colombia

El presente artículo de investigación utiliza como pre-texto el caso de dos estudiantesexpulsadas de un conocido colegio de Manizales por su orientación sexual, para presentar distintostrabajos que abordan el problema de la educación sexual en Colombia, desde los años 70 hastafinales de los años 90. Si el gesto del Ministerio de Educación Nacional en el año 1994, declarandoobligatorio realizar proyectos pedagógicos de educación sexual, para algunos resultaba inédito, noaparece tan singular -y esta es nuestra tesis- que los criterios para impartir esa educación sexual enla vida misma de las escuelas y colegios, ahora reordenados bajo una reglamentación y al cuidadode los saberes expertos en sexualidad, mantuviesen sustancialmente la homofobia como un productode la educación.

Utilización del aclaramiento ganglionar / Use of lymphatic node clearance

El aclaramiento ganglionar es una técnica por medio de la cual se logra disolver la emulsión y decolorar los tejidos grasos corporales con el fin de identificar fácilmente las estructuras ganglionares. Mediante esta técnica se logró identificar hasta el 100 porciento de los ganglios adicionales en el estudio de las piezas anatomopatológicas de cáncer colorrectal. La técnica tuvo una importancia trascendental en el subgrupo de pacientes con tratamiento neoadyuvante que es el de mayor dificultad en el estudio convencional de patología. El 94 porciento de los ganglios identificados con el aclaramiento eran menores de 5 mm. Existió un cambio de estadificación en 10 porciento de los casos incluidos en el estudio piloto.