Uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos / Clinical Use of Intravenous Lidocaine for Management of non-Oncologic Neuropathic Pain in Adults

El dolor neuropático es común en la práctica clínica. Se estima que afecta entre el 2 y 3 % de la población a nivel global. Una cantidad considerable de pacientes presentan dolor refractario a tratamientos existentes, volviéndolo un reto diagnóstico y terapéutico. El objetivo de este estudio es describir el uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos. La búsqueda de información se realizó consultando las bases de datos HINARI, SciELO y PubMed. Se seleccionaron artículos en inglés y español de 2017 a 2021. Se utilizaron artículos originales, ensayos clínicos, revisiones bibliográficas y metaanálisis. Las causas de dolor neuropático en las que ha sido utilizada la lidocaína son la neuralgia posherpética, neuropatía diabética y neuralgia del trigémino. El uso de lidocaína intravenosa demostró que disminuye la intensidad del dolor; sin embargo, al compararlo con otros fármacos de primera línea no hay diferencias a largo plazo. La mayoría de efectos secundarios se presentan en el sistema nervioso, gastrointestinal y cardiovascular. La lidocaína intravenosa como monoterapia para manejo de dolor neuropático no oncológico, si bien fue eficaz a corto plazo con dosis de 3-5 mg/Kg, no tuvo un efecto persistente y duradero

Neuropathic pain is common in clinical practice; it is estimated that 2 to 3 % of the global population is affected; a considerable number of patients present pain refractory to existing treatments, making it a diagnostic and therapeutic challenge. The objective of this study is to describe the clinical use of intravenous lidocaine for the management of non-cancer neuropathic pain in adults. The information search was performed by consulting the HINARI, SciELO and PubMed databases. Articles with an obsolescence of no more than five years, both in English and Spanish, were selected. Original articles, clinical trials, bibliographic reviews and meta-analyses were used. The causes of neuropathic pain in which lidocaine has been used were postherpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia. The use of intravenous lidocaine has been shown to decrease pain intensity; however, when compared with other first line drugs, there are no long-term differences. Most side effects occur in the nervous, gastrointestinal, and cardiovascular systems. Intravenous lidocaine as monotherapy for the management of non-cancer neuropathic pain, although effective in the short term with doses of 3-5 mg/Kg, does not have a persistent and long-lasting effect

Attributable Costs of Lung Cancer for the Colombian Health System: A Cost-of-Illness Study.

OBJECTIVES: Lung cancer imposes a significant economic burden on most countries. Nevertheless, there is scarce information about this burden on health systems in low- and middle-income countries. This study aims to estimate the economic burden of lung cancer on the Colombian health system, a middle-income country with universal health coverage in Latin America. METHODS: We conducted a cost-of-illness study that included all direct costs generated by prevalent cases of lung cancer in Colombia during 2017. We used administrative databases containing patient-level information on consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. To decrease the probability of misallocation of costs, we used propensity score matching to estimate the marginal costs of delivering healthcare services to patients with lung cancer. Additionally, ordinary least squares and variations in case definitions were used to assess the robustness of all estimates. RESULTS: Total costs attributable to lung cancer in 2017 ranged from $50 039 588 to $74 468 111, with important differences across insurance regimes (from $4 629 938 for the subsidized regime to $55 342 357 for the contributory regime). Notably, 43% of all costs ($27 081 348) were caused by the consumption of services not included in the health benefit package. There were no significant differences between inpatient and outpatient costs. CONCLUSIONS: Lung cancer imposes a significant economic burden on the Colombian health system. Although all affiliates are entitled to a unique health benefit package, there were important differences in costs across insurance regimes. Further research is needed to identify the main mechanisms underlying these differences.

Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso / Renal autotransplantation in a patient with renal artery aneurysm and a single functional kidney

El autotrasplante renal es un procedimiento quirúrgico poco frecuente, especialmente, cuando el paciente tiene un solo riñón funcional y su indicación es alguna anormalidad vascular compleja. En el presente artículo, se presenta un paciente a quien se practicó una nefrectomía más reconstrucción vascular ex vivo y autotrasplante renal. Además, se reporta su evolución hasta el octavo año después de la cirugía.

Renal autotransplantation is a surgical procedure performed with very low frequency, especially in cases in which the patient has a solitary kidney and in which the procedure is indicated by a vascular abnormality. In this article, we report the case of a 52 year-old patient undergoing a nephrectomy incision with ex-vivo repair of a renal aneurysm plus autotransplantation. Additionally, we report the evolution after surgery at the 8th year of follow up

Universidad y conducta suicida: respuestas y propuestas institucionales, Bogotá 2004-2014 / University and suicidal behavior: institutional response and actions, Bogotá 2004-2014

RESUMEN Objetivo Analizar las respuestas institucionales frente a la conducta suicida de estudiantes de cinco universidades de Bogotá y su relación con los lineamientos de la Política Nacional de Salud Mental (PNSM), de la Atención Primaria Integral en Salud (APS) y los planes establecidos para su abordaje y, a partir de estos, formular recomendaciones para la acción. Métodos Estudio cualitativo de tipo exploratorio-descriptivo basado en la consulta a la memoria de 66 agentes universitarios quienes aportaron acerca del hecho suicida y sus características, y sobre las respuestas y propuestas institucionales asumidas en cinco universidades de Bogotá. Se utilizaron entrevistas semiestructuradas. Resultados Las universidades participantes presentan comprensiones heterónomas frente al fenómeno del suicidio y mecanismos de atención diferentes principalmente direccionados al apoyo administrativo y a la prevención de contagio del comportamiento suicida. Conclusiones Los suicidios consumados de estudiantes le han servido a las universidades para reflexionar sobre esta problemática y a partir de ello se ha hecho más visible el problema de la deshumanización en la formación, el papel del bienestar universitario y los servicios de salud. Emerge con fuerza el tema de la conveniencia de las redes de trabajo interinstitucional e intersectorial, la psicoeducación, la corresponsabilidad, así como la activa participación de los jóvenes en la discusión y formulación de enfoques y programas orientados hacia su bienestar.(AU)

ABSTRACT Objective To analyze the institutional responses and actions towards suicidal behavior of students from five universities in Bogotá, and their relation with the National Mental Health Policy (NMHP), the Comprehensive Primary Health Care Guidelines (APS), and the plans established for approaching this issue, to finally make suggestions based on them. Methods Qualitative, exploratory-descriptive study based on the experiences of 66 university workers, who provided inputs on suicide and its characteristics; this study is also grounded on the institutional response of five universities in Bogotá. Semi-structured interviews were also used. Results Participating universities have a heteronomous understanding of the phenomenon of suicide, as well as different attention mechanisms, which are mainly directed to administrative support and the prevention of suicidal behavior contagion. Conclusions The consummate suicides of students have served the universities to reflect upon this problem, which has made more visible the problem of dehumanization in training, and the role of university well-being and health services. The appropriateness of inter-institutional and intersectoral networks, psychoeducation, co-responsibility, and the active participation of young people in the discussion and formulation of welfare-oriented approaches and programs are strong aspects that arise from this reflection.(AU)

[University and suicidal behavior: institutional response and actions, Bogotá 2004-2014]. / Universidad y conducta suicida: respuestas y propuestas institucionales, Bogotá 2004-2014.

OBJECTIVE: To analyze the institutional responses and actions towards suicidal behavior of students from five universities in Bogotá, and their relation with the National Mental Health Policy (NMHP), the Comprehensive Primary Health Care Guidelines (APS), and the plans established for approaching this issue, to finally make suggestions based on them. METHODS: Qualitative, exploratory-descriptive study based on the experiences of 66 university workers, who provided inputs on suicide and its characteristics; this study is also grounded on the institutional response of five universities in Bogotá. Semi-structured interviews were also used. RESULTS: Participating universities have a heteronomous understanding of the phenomenon of suicide, as well as different attention mechanisms, which are mainly directed to administrative support and the prevention of suicidal behavior contagion. CONCLUSIONS: The consummate suicides of students have served the universities to reflect upon this problem, which has made more visible the problem of dehumanization in training, and the role of university well-being and health services. The appropriateness of inter-institutional and intersectoral networks, psychoeducation, co-responsibility, and the active participation of young people in the discussion and formulation of welfare-oriented approaches and programs are strong aspects that arise from this reflection.

OBJETIVO: Analizar las respuestas institucionales frente a la conducta suicida de estudiantes de cinco universidades de Bogotá y su relación con los lineamientos de la Política Nacional de Salud Mental (PNSM), de la Atención Primaria Integral en Salud (APS) y los planes establecidos para su abordaje y, a partir de estos, formular recomendaciones para la acción. MÉTODOS: Estudio cualitativo de tipo exploratorio-descriptivo basado en la consulta a la memoria de 66 agentes universitarios quienes aportaron acerca del hecho suicida y sus características, y sobre las respuestas y propuestas institucionales asumidas en cinco universidades de Bogotá. Se utilizaron entrevistas semiestructuradas. RESULTADOS: Las universidades participantes presentan comprensiones heterónomas frente al fenómeno del suicidio y mecanismos de atención diferentes principalmente direccionados al apoyo administrativo y a la prevención de contagio del comportamiento suicida. CONCLUSIONES: Los suicidios consumados de estudiantes le han servido a las universidades para reflexionar sobre esta problemática y a partir de ello se ha hecho más visible el problema de la deshumanización en la formación, el papel del bienestar universitario y los servicios de salud. Emerge con fuerza el tema de la conveniencia de las redes de trabajo interinstitucional e intersectorial, la psicoeducación, la corresponsabilidad, así como la activa participación de los jóvenes en la discusión y formulación de enfoques y programas orientados hacia su bienestar.

Una respuesta institucional colombiana a niños/as que viven con VIH/SIDA / A Colombian institutional response to Colombian children infected with HIV/AIDS

El VIH/SIDA en la niñez es un problema social y su abordaje trasciende al sector de la salud. Las respuestas normativas, políticas, institucionales y de servicios tienen particularidades para la infancia. Un acercamiento propuesto se basa en los siguientes ejes: salud, nutrición, educación, condiciones socioeconómicas familiares, repercusiones psicosociales, protección, vivienda y estigmatización y discriminación. Desde estos lineamientos se exploró una institución usando la Teoría Bioecológica del Desarrollo Humano. Se describe y analiza la vida de niños/as en la institución. Es un estudio etnográfico y participaron 31 niños/as y 30 adultos/as. La respuesta institucional es satisfactoria en salud, alimentación, educación y cuidados básicos. La no revelación del diagnóstico, la estigmatización y discriminación contra los niños/as, la validación de la institucionalización, el manejo de las repercusiones psicoemocionales y del estigma y los costos del programa fueron las principales falencias. Los niños/as aprecian la respuesta institucional sobre el cubrimiento de sus necesidades básicas y rechazan algunas prácticas que ellos/as identifican como coercitivas y estigmatizantes. El reintegro de los niños/as a sus familias se recomienda como una estrategia de trabajo futuro sustentada en evidencias que demuestran mejores resultados biopsicosociales y bajo costo.

Children with HIV/AIDS is a social issue,the approach to which transcends the health sector. The normative, political, institutional and service sector responses have specificities related to children. A proposed approach is based on the following points: health care, nutrition, education, family-socioeconomic status, psychosocial repercussions, protection, housing, stigmatization and discrimination. Based on these guidelines,a survey was conducted of an institutional responseapplying the Bioecological Model of Human Development. Life of children in the institution is described and analyzed. A group of 31 children and 30 adults participated in this ethnographic study. The institutional response concerning health, nutrition, education and basic care, is satisfactory. The main weaknesses identified were nondisclosure of the diagnosis, stigmatization and discrimination, institutionalization validation, psychoemotional repercussions and stigmatization management, and the research budget. The children acknowledge that the institution satisfies their basic-needs and disapprove of some stigmatizing and coercive practices. The reintegration of the children with their families is recommended as a future strategy based on evidence that shows it has better bio-psychosocial results and lower costs.

[A Colombian institutional response to Colombian children infected with HIV/AIDS]. / Una respuesta institucional colombiana a niños/as que viven con VIH/SIDA.

Children with HIV/AIDS is a social issue,the approach to which transcends the health sector. The normative, political, institutional and service sector responses have specificities related to children. A proposed approach is based on the following points: health care, nutrition, education, family-socioeconomic status, psychosocial repercussions, protection, housing, stigmatization and discrimination. Based on these guidelines,a survey was conducted of an institutional responseapplying the Bioecological Model of Human Development. Life of children in the institution is described and analyzed. A group of 31 children and 30 adults participated in this ethnographic study. The institutional response concerning health, nutrition, education and basic care, is satisfactory. The main weaknesses identified were nondisclosure of the diagnosis, stigmatization and discrimination, institutionalization validation, psychoemotional repercussions and stigmatization management, and the research budget. The children acknowledge that the institution satisfies their basic-needs and disapprove of some stigmatizing and coercive practices. The reintegration of the children with their families is recommended as a future strategy based on evidence that shows it has better bio-psychosocial results and lower costs.

Crianza y sexualidad de hijos de mujeres prostitutas marginales del centro de Bogotá / Upbringing and sexuality in children from marginal prostitute women downtown in Bogotá

Se exploraron las creencias, actitudes y prácticas de crianza relacionadas con la sexualidad de niños, niñas y adolescentes hijos de mujeres prostitutas del centro de Bogotá. Se establecieron los principales procesos determinantes de la crianza. Es una investigación analítica interpretativa que usó entrevistas a profundidad y un grupo focal. Participaron 10 mujeres, entre 28 y 56 años. Se contemplaron como puntos centrales de exploración la subjetividad de las madres, los retos del desarrollo sexual y los condicionantes sociales y culturales de la crianza. Las violencias estructural, simbólica y económica son las principales determinantes de la crianza. El abuso sexual y la posibilidad de gestación en sus hijas adolescentes son las preocupaciones más importantes. En general, las participantes comparten y reproducen los mismos valores tradicionales sobre el género y el ejercicio de la sexualidad, los cuales son transmitidos y modelados desde la crianza…

Introduction: Child upbringing of women engaged in prostitution has been little explored. Methods: Child upbringing beliefs, attitudes and practices regarding sexuality in prostitutes’children and adolescents were explored downtown in Bogota. Analytical-interpretive research included in-depth interviews and a focus group. There were ten women between 28 and 56 years of age. Core issues were their subjectivity as mothers, sexual development challenges, upbringing social and cultural conditions. Results: Structural, symbolic and economic violence are the main determinants of parenting. Sexual abuse and the possibility of pregnancy in their adolescent daughters are the most important concerns. Conclusions: In general, the participants share the same values and reproduce traditional ideals in gender and sexuality, which are transmitted and modeled from upbringing…

[Upbringing and Sexuality in Children from Marginal Prostitute Women Downtown in Bogotá]. / Crianza y sexualidad de hijos de mujeres prostitutas marginales del centro de Bogotá.

INTRODUCTION: Child upbringing of women engaged in prostitution has been little explored. METHODS: Child upbringing beliefs, attitudes and practices regarding sexuality in prostitutes' children and adolescents were explored downtown in Bogota. Analytical-interpretive research included in-depth interviews and a focus group. There were ten women between 28 and 56 years of age. Core issues were their subjectivity as mothers, sexual development challenges, upbringing social and cultural conditions. RESULTS: Structural, symbolic and economic violence are the main determinants of parenting. Sexual abuse and the possibility of pregnancy in their adolescent daughters are the most important concerns. CONCLUSIONS: In general, the participants share the same values and reproduce traditional ideals in gender and sexuality, which are transmitted and modeled from upbringing.

Silicotuberculosis en cultivadores de papa: reporte de un caso / Silicotuberculosis in potato farmers: case report

La neumoconiosis se define como la acumulación de partículas inanimadas sólidas de origen inorgánico en los pulmones y las reacciones no neoplásicas tisulares provocadas por su presencia. Dentro del grupo de las neumoconiosis se encuentra la silicosis que es causada por la inhalación de dióxido de silicio, comúnmente denominado sílice. Esta enfermedad tiene varias presentaciones clínicas dentro de las cuales están la forma crónica, aguda y la forma acelerada. Además de esto, se considera que la silicosis por los mecanismos fisiopatológicos que involucra, es un factor de riesgo importante en la consecución de otras enfermedades como la tuberculosis y otras micosis como aspergilosis y criptococosis. En este artículo se presenta el caso de un paciente atendido en el Hospital Militar Central de Bogotá, diagnosticado con silicotuberculosis que al parecer fue causado por una exposición crónica en el desempeño de su labor como cultivador de papa en el departamento de Boyacá-Colombia.

Composición químico-nutricional y de factores antinutricionales en semillas de parota (enterolobium cyclocarpum) / Nutritional-chemical composition and antinutritional factors in seeds of Enterolobium cyclocarpum / Composição químico-nutricional e de fatores antinutricionais em sementes de guanacaste (enterolobium cyclocarpum)

Mediante el análisis químico proximal se determinaron proteínas (PC), grasas (GC), fibras (FC), cenizas, humedad y extracto libre de nitrógeno (ELN) de las semillas de Enterolobium cyclocarpum, y con espectrofotometría se determinaron sus factores antinutricionales. Por el contenido de minerales, carbohidratos y proteínas que posee esta leguminosa, tiene potencial industrial, medicinal y químico, siendo una limitante la presencia de factores antinutricionales tales como glucósidos cianogénicos e inhibidores de tripsina. Mediante hidrólisis enzimática (ß-glucosidasa) se analizó la inhibición de tripsina de un extracto acuoso (NaOH 0,1N) de la muestra y en una solución estándar de tripsina se midió la actividad proteolítica en un sustrato sintético (benzoil-arginina-p-nitroanilida). En las semillas completas se encontró PC 26,13%, GC 2,85%, FC 4,95%, cenizas 2,95% y ELN 63,1%. En las almendras desecadas los valores fueron PC 34,5%, GC 7,6%, ausencia de FC, cenizas 3,3% y ELN 54,6%. Se encontraron 4,82 unidades de inhibidores de tripsina/mg, ausencia de hemaglutininas y 0,76mg de ácido cianhídrico en 100g de semillas. Estos valores correspondientes a los factores antinutricionales descritos no constituyen un riesgo al consumir las semillas, ya que son termolábiles y se eliminan por cocción en agua.

Chemical analyses were performed to quantify the protein (CP), fat (CF), fiber (CF), ash, humidity, nitrogen free extract (NFE) and antinutritional factors in extracts from Enterolobium cyclocarpum seeds. E. cyclocarpum seeds have a great potential in pharmaceutical and chemical industries due to the high content of minerals, carbohydrates and proteins. However, the seeds also contain cyanogenic glycosides such as trypsin inhibitory factor and cyanhidric acid, resulting in antinutritional effects. Trough enzymatic hydrolysis (ß-glycosidase), trypsine inhibition on an aqueous extract of the sample (0.1 N NaOH). By using a standard trypsine solution, the proteolytic activity in a synthetic substrate (benzoyl-arginine-p-nitroanilide) was studied. Analyses of the complete seeds showed; CP 26.13%, CF 2.85%, CF 4.95%, Ash 2.95%, and NFE 63.1%. The dried almonds contained CP 34.5%, CF 7.6%, undetectable fiber, ash 3.3%, and NFE 54.6%. No hemaglutinins were detected, whereas 4.82 units/mg of trypsine inhibition and 0.76 mg/100g of HCN were found. The low concentrations of trypsine inhibitor and HCN will be reduced even more by the heat treatment previous consumption, which makes the seeds suitable for human beings or animals.

Mediante a análise química proximal se determinaram proteínas (PC), gorduras (GC), fibras (FC), cinzas, umidade e extrato livre de nitrogênio (ELN) das sementes de Enterolobium cyclocarpum, e com espectrofotometria se determinaram seus fatores antinutricionais. Pelo conteúdo de minerais, carboidratos e proteínas que possui, esta leguminosa têm potencial industrial, medicinal e químico, sendo uma limitante a presença de fatores antinutricionais tais como glicosídeos cianogênicos e inibidores de tripsina. Mediante hidrólise enzimática (ß-glucosidase) se analisou a inibição de tripsina de um extrato aquoso (NaOH 0,1N) da amostra e em uma solução padrão de tripsina se mediu a atividade proteolítica em um substrato sintético (benzoil-arginina-p-nitroanilida). Nas sementes completas se encontrou PC 26,13%, GC 2,85%, FC 4,95%, cinzas 2,95% e ELN 63,1%. Nas amêndoas dissecadas os valores foram PC 34,5%, GC 7,6%, ausência de FC, cinzas 3,3% e ELN 54.6%. Encontraram-se 4,82 unidades de inibidores de tripsina/mg, ausência de hemaglutininas e 0,76mg de ácido cianídrico em 100g de sementes. Estes valores correspondentes aos fatores antinutricionais descritos não constituem um risco ao consumir as sementes, já que são termolábeis e se eliminam por cozimento em água.

Mola hidatidiforme: validez del diagnostico clínico / Hydatidiform mole: validity of clinical diagnosis

Con el fin de evaluar la validez del diagnostico clínico pre-patológico para detectar mola hidatidiforme se llevo a cabo un estudio con muestreo de corte transversal entre abril de 1995 y marzo de 1998 en el hospital universitario Ramón Gonzales Valencia de Bucaramanga. Fueron realizados un total de 3.846 legrados obstetricos encontrando 51 casos de mola hidatidiforme, el 62,7% de las cuales se diagnosticaron antes del estudio histopatologico. En el presente estudio la prevalencia de mola fue 0.013. Para el diagnostico clínico se obtuvieron los siguientes valores: sensibilidad 62.7%, especificidad 99.7%, valor productivo positivo 71.1%, valor predictivo negativo 99.5% y kappa 0.662. Se concluye que se debe continuar con el análisis patológico de todos los legrados para poder establecer el diagnostico de mola hidatidiforme.

To assess the validity of clinical diagnosis to detect pre-disease Hydatidiform mole is carried out a study with cross-sectional sampling between April 1995 and March 1998 at the hospital Ramon Gonzalez Valencia in Bucaramanga. Were performed a total of 3846 obstetric curettage finding 51 cases of hydatidiform mole, 62.7% of whom were diagnosed by histopathologic examination. In this study the prevalence of mola was 0.013. For clinical diagnosis yielded the following values: sensitivity 62.7%, specificity 99.7%, 71.1% positive productive value, negative predictive value 99.5% and kappa 0662. We conclude that we must continue with the pathological analysis of all the scraping to establish the diagnosis of hydatidiform mole.