Superior Mesenteric Artery Syndrome and Nutcracker Syndrome as the Presentation of Crohn's Disease in a Young Patient: A Case Report and Review of Literature.

Superior mesenteric artery syndrome and nutcracker syndrome are rare vascular complications most often seen after marked weight loss caused by compression of the duodenum and left renal vein between the superior mesenteric artery and the aorta, respectively. The coexistence of superior mesenteric artery syndrome and nutcracker syndrome has been rarely reported. Herein, we present the case of a 16-year-old male with intermittent periumbilical abdominal pain, bilious vomiting, and weight loss who was found to have both of these vascular complications of significant weight loss as the initial presentation of Crohn's disease. This report provides insight into the diagnosis and treatment of these syndromes while highlighting the importance for practitioners to keep vascular complications on their differential diagnosis of vomiting and abdominal pain in patients with Crohn's disease.

Henoch-Schönlein purpura in the setting of COVID-19 infection: Two pediatrics cases and review of the literature.

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, often following a viral infection. Various types of rashes attributed to COVID-19 infection have been described in the literature; however, HSP has rarely been reported. We report two children with HSP associated with acute COVID-19 infection with a review of the available literature. We highlight the clinical presentation, medical management, outcome and age-related difference of reported patients. A limitation of this article is the retrospective nature, limiting full patient history and associated conditions. The findings of this review show that HSP in the setting of COVID-19 is more common in children than adults, with a male predominance, involving various body systems creating a constellation of presentations. Given that HSP can have long-term morbidity from renal disease if untreated, this review may help guide the practitioner's approach to HSP and recognition in the setting of COVID-19 infection.

Deep molecular tracking over the 12-yr development of endometrial cancer from hyperplasia in a single patient.

Although the progressive histologic steps leading to endometrial cancer (EndoCA), the most common female reproductive tract malignancy, from endometrial hyperplasia are well-established, the molecular changes accompanying this malignant transformation in a single patient have never been described. We had the unique opportunity to investigate the paired histologic and molecular features associated with the 12-yr development of EndoCA in a postmenopausal female who could not undergo hysterectomy and instead underwent progesterone treatment. Using a specially designed 58-gene next-generation sequencing panel, we analyzed a total of 10 sequential biopsy samples collected over this time frame. A total of eight pathogenic/likely pathogenic mutations in seven genes, APC, ARID1A, CTNNB1, CDKN2A, KRAS, PTEN, and TP53, were identified. A PTEN nonsense mutation p.W111* was present in all samples analyzed except histologically normal endometrium. Apart from this PTEN mutation, the only other recurrent mutation was KRAS G12D, which was present in six biopsy samplings, including histologically normal tissue obtained at the patient's first visit but not detectable in the cancer. The PTEN p.W111* mutant allele fractions were lowest in benign, inactive endometrial glands (0.7%), highest in adenocarcinoma (36.9%), and, notably, were always markedly reduced following progesterone treatment. To our knowledge, this report provides the first molecular characterization of EndoCA development in a single patient. A single PTEN mutation was present throughout the 12 years of cancer development. Importantly, and with potential significance toward medical and nonsurgical management of EndoCA, progesterone treatments were consistently noted to markedly decrease PTEN mutant allele fractions to precancerous levels.

Scarcity in abundance? Spatial inequalities in Rheumatoid Arthritis in a health system with financial equity.

BACKGROUND: This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective. METHODS: We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis. RESULTS: The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance). CONCLUSIONS: There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.

Clinical presentations of erosive esophagitis found at endoscopy in neurologically impaired children: a historical study.

BACKGROUND: Data is lacking as to the clinical presentation of erosive esophagitis (EE) in neurologically impaired children compared to non-neurologically impaired children (non-NIC). To determinate the clinical presentation, associations, management, and outcomes of EE in neurologically impaired children compared to children without neurologic impairment. METHODS: Retrospective chart review of all esophagogastroduodenoscopies performed in pediatric patients at the University of Mississippi Medical Center from 1998 to 2020 with the diagnosis of EE. Fisher's exact test was used to compare results from neurologically impaired children group and non-NIC. A probability <0.05 was considered statistically significant. RESULTS: Forty-seven patients were diagnosed with EE and met study criteria. Twenty-six patients were neurologically impaired children, and 21 were non-neurologically impaired children. No significant difference was seen between age at diagnosis, sex, or hematologic markers of anemia. The most common indication for esophagogastroduodenoscopies in neurologically impaired children was hematemesis (65.4%), whereas abdominal pain (33.3%) was the most common in non-NIC. Neurologically impaired children were more likely to be treated with acid-blockade. Nine neurologically impaired children had gastrostomy tubes prior to diagnosis as opposed to 0 non-neurologically impaired children. After diagnosis, 8 neurologically impaired children underwent gastrostomy tube placement compared to 0 non-neurologically impaired children, and fundoplication was performed in 11 neurologically impaired children as compared to 1 non-NIC. The sensitivity of fecal occult blood test for detecting EE was higher for neurologically impaired children (91.7%) than for non-NIC (33.3%). CONCLUSIONS: EE in neurologically impaired children presents differently than in non-neurologically impaired children with blood loss being the most common presentation in neurologically impaired children. Neurologically impaired children are more likely to be treated with acid-blockade prior to diagnosis, likely due to heightened risk for gastroesophageal reflux disease (GERD). Additionally, they are more likely to undergo surgical management of EE than non-neurologically impaired children.

Cambios en el estilo vida de mujeres de raza negra con intervención educativa del programa "Actúa con corazón de mujer" / Changes in lifestyle of black women with educational intervention of the "Actúa con corazón de mujer"

Resumen: Introducción: a diario en Colombia mueren 60 mujeres por enfermedad cardiovascular y las mujeres de raza negra tienen mayor riesgo. Según la Organización Mundial de la Salud (OMS) estas muertes son, en su mayoría, prevenibles. El cuidado como estilo de vida es una intervención del programa "Actúa con corazón de mujer" de la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular (SCC) y la Fundación Colombiana del Corazón (FCC). Objetivo: formar líderes para promover la adopción de comportamientos saludables. Método: se seleccionaron municipios con población de raza negra y compromiso de las autoridades locales. 395 mujeres fueron elegidas. La percepción del riesgo se midió con un instrumento adaptado por la FCC. La intervención educativa se dividió en cuatro sesiones en cada municipio durante cinco meses. Las participantes fueron formadas en toma de presión arterial; se utilizó la automonitorización de presión arterial (AMPA) para confirmar hipertensión y se incluyeron mediciones antropométricas y fisiológicas para calcular el riesgo cardiovascular y de diabetes. Resultados: Los resultados consolidados de los instrumentos y mediciones aplicados demostraron significativos aportes en reducción de riesgo cardiovascular, en razón de una nueva percepción de los peligros y de la incorporación de comportamientos saludables. Conclusiones: las mujeres aprendieron del cuidado. 90% reportaron percepción "ideal" del riesgo, hicieron promesas y adoptaron comportamientos tomando acción frente a sus factores de riesgo y más del 50% evidenciaron cambios en las medidas antropométricas. Los resultados demuestran que estrategias de educación, especialmente con líderes comunitarias, pueden ser de gran relevancia para la salud pública.

Abstract: Introduction: every day in Colombia 60 women die from cardiovascular disease and black women are at higher risk. According to the World Health Organization (WHO) these deaths are preventable. Care as a lifestyle is an intervention of the "Actúa con corazón de mujer" program of the Colombian Society of Cardiology and Cardiovascular Surgery (SCC) and the Colombian Heart Foundation (FCC). Objective: Train leaders to promote the adoption of healthy behaviors. Method: Municipalities with a black population were selected with the commitment of the local authorities. 395 women were elected. Risk perception was measured with an instrument adapted by the FCC. The educational intervention was divided into four sessions in each municipality for five months. Participants were trained in blood pressure measurement, blood pressure self-monitoring (AMPA) was used to confirm hypertension, and anthropometric and physiological measurements were included to calculate cardiovascular and diabetes risk. Results: The consolidated results of the instruments and measurements applied showed significant contributions in reducing cardiovascular risk, due to a new perception of the dangers and the incorporation of healthy behaviors Conclusions: the women learned about care. 90% reported "ideal" perception of risk, made promises and adopted behaviors taking action against their risk factors and more than 50% showed changes in anthropometric measurements. The results show that education strategies, especially with community leaders, can be of great relevance for public health.

Disruptions in Oncology Care Confronted by Patients with Gynecologic Cancer Following Hurricanes Irma and Maria in Puerto Rico.

BACKGROUND: In September 2017, hurricanes Irma and Maria affected Puerto Rico (PR) and the US Virgin Islands (USVI), causing major disruptions in basic services and health care. This study documented the stressors and experiences of patients with gynecologic cancer receiving oncology care in PR following these hurricanes. METHODS: We conducted 4 focus groups (December 2018-April 2019) among women aged ≥21 years from PR who were diagnosed with gynecological cancer between September 2016 and September 2018 (n = 24). Using the same eligibility criteria, we also interviewed patients from the USVI (n = 2) who were treated in PR. We also conducted key-informant interviews with oncology care providers and administrators (n = 23) serving gynecologic cancer patients in PR. Discussions were audio-recorded, transcribed verbatim, and coded to identify emergent themes using a constant comparison method. RESULTS: Analyses of focus group discussions and interviews allowed us to identify the following emergent themes: 1) disruptions in oncology care were common; 2) communication between oncology providers and patients was challenging before and after the hurricanes hit; 3) patient resilience was key to resume care; and 4) local communities provided much-needed social support and resources. CONCLUSIONS: This study provides firsthand information about the disruptions in oncology care experienced by and the resiliency of women with gynecologic cancer following hurricanes Irma and Maria. Our findings underscore the need to incorporate oncology care in the preparedness and response plans of communities, health systems, and government agencies to maintain adequate care for cancer patients during and after disasters such as hurricanes.

Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and María in Puerto Rico.

BACKGROUND: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). OBJECTIVE: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. METHODS: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018-April 2019. RESULTS: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. CONCLUSIONS: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.

Knowledge, Attitudes, and Experiences of Anal Cancer and Anal Cancer Screening Among a Clinical Sample of Hispanic Women.

OBJECTIVE: Anal cancer screening has been recommended for women with lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation recipients. This study described and compared knowledge, attitudes, and experiences related to anal cancer and anal cancer screening between women at high risk for anal cancer and their counterparts. METHODS: This is a cross-sectional study within colposcopy and gynecology oncology clinics in Puerto Rico; 278 women 21 years or older and with prior diagnosis of gynecological neoplasia completed an interviewer-administered questionnaire. Women were categorized according to their medical history as being high risk or non-high risk for anal cancer. The high-risk group included women with a history of lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation. RESULTS: Overall, 40.7% of the study population were at high risk for developing anal cancer. History of anal cancer screening was low among high-risk and non-high-risk women (11.5% vs 5.6%, p > .05). Less than 1% of all women reported to have had a high-resolution anoscopy. Most women (87.6%) had little knowledge about anal Pap test but were willing to have one if their doctors recommended it (96.5%). No major differences in knowledge, attitudes, or screening history were observed between high-risk and non-high-risk women. CONCLUSIONS: Although experts do not recommend routine anal cancer screening for the general population, they do recommend it for women within certain high-risk groups. Study findings highlight the importance of increasing education and awareness of anal cancer among high-risk patients and physicians, to promote better preventive methods, achieve early detection, and improve disease outcomes.

Strengthening Resilience and Adaptive Capacity to Disasters in Cancer Control Plans: Lessons Learned from Puerto Rico.

Patients with cancer are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse of or disruptions in the health care system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans to manage their risks. With extreme weather or disasters becoming more intense and frequent and with the high burden of cancer in the United States and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After Hurricanes Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for patients with cancer was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for patients with cancer should be housed within the emergency support function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.

Absceso epidural en una paciente obstétrica / Epidural abscess in an obstetric patient

Resumen: El absceso epidural es una complicación rara que puede ser causa de una elevada morbimortalidad, por ello es fundamental el diagnóstico y tratamiento oportunos. Nuestra paciente desarrolló un absceso posterior a un bloqueo epidural para una cesárea, la técnica anestésica se realizó en condiciones de asepsia y antisepsia, y se retiró el catéter al terminar la cirugía; fue dada de alta a las 48 horas. Reingresa a los nueve días por presentar fiebre, dolor en miembro pélvico izquierdo y dehiscencia de herida quirúrgica. La resonancia magnética mostró un absceso epidural en L3-L4. Se realizó laminectomía y el cultivo mostró Escherichia coli, fue manejada con antibióticos intravenosos durante cuatro semanas y se dio de alta sin secuelas neurológicas.

Abstract. Spinal epidural abscess is a rare complication, it can be cause a high morbimortality and the prompt diagnosis and treatment is essential. Our patient present an abscess after epidural block for caesarean section, the anesthetic procedure was in aseptic technique and the catheter was withdrawn after surgery, the patient was discharged after 48 hours. She was readmitted nine days later with fever, left leg pain and wound surgery infection. The magnetic resonance showed a spinal epidural abscess in L3-L4. Underwent laminectomy cultured showed Escherichia coli, she was at hospital by intravenous antibiotic treatment for 4 weeks and she was discharged without neurologic sequelae.

Rapid development and use of patient-specific ctDNA biomarkers to avoid a "rash decision" in an ovarian cancer patient.

Epithelial ovarian cancer (OvCa) is the most lethal female reproductive tract malignancy. A major clinical hurdle in patient management and treatment is that when using current surveillance technologies 80% of patients will be clinically diagnosed as having had a complete clinical response to primary therapy. In fact, the majority of women nonetheless develop disease recurrence within 18 mo. Thus, without more accurate surveillance protocols, the diagnostic question regarding OvCa recurrence remains framed as "when" rather than "if." With this background, we describe the case of a 61-yr-old female who presented with a 3-mo history of unexplained whole-body rash, which unexpectedly led to a diagnosis of and her treatment for OvCa. The rash resolved immediately following debulking surgery. Nearly 1 yr later, however, the rash reappeared, prompting the prospect of tumor recurrence and requirement for additional chemotherapy. To investigate this possibility, we undertook a genomics-based tumor surveillance approach using a targeted 56-gene NGS panel and biobanked tumor samples to develop personalized ctDNA biomarkers. Although tumor-specific TP53 and PTEN mutations were detectable in all originally collected tumor samples, pelvic washes, and blood samples, they were not detectable in any biosample collected beyond the first month of treatment. No additional chemotherapy was given. The rash spontaneously resolved. Now, 2 yr beyond the patient's original surgery, and in the face of continued negative ctDNA findings, the patient remains with no evidence of disease. As this single case report suggests, we believe for the first time that ctDNA can provide an additional layer of information to avoid overtreatment.

Cirrhosis complicating Shwachman-Diamond syndrome: A case report.

BACKGROUND: The features of Shwachman-Diamond syndrome (SDS) include exocrine pancreatic insufficiency, skeletal abnormalities and bone marrow dysfunction; an often overlooked feature is hepatic involvement. CASE SUMMARY: We report a child who initially presented with failure to thrive and mildly elevated transaminase levels and was determined to have pancreatic insufficiency due to SDS. During follow-up he had persistently elevated transaminase levels and developed hepatosplenomegaly. An investigation was performed to determine the etiology of ongoing liver injury, including a liver biopsy which revealed hepatic cirrhosis. CONCLUSION: Cirrhosis has rarely been reported with SDS. While many of the hepatic disorders associated with SDS improve with age, there are rare exceptions with serious implications for long-term outcome.

Is Human Papilloma Virus Infection Linked to Periodontitis? A Narrative Review.

PURPOSE OF REVIEW: Research suggests that periodontal tissue might serve as a reservoir for oral human papillomavirus (HPV) infection, while another hypothesis is that chronic inflammation of the tissue might perpetuate an infection with oral HPV infection. In this narrative review, we summarize the evidence related to a potential association between oral HPV infection and periodontitis. RECENT FINDINGS: Twelve articles were identified, and their key findings summarized. Studies vary in sample size, study population, study design, and methods for assessment of oral HPV and periodontitis. Although results are conflicting and still inconclusive, various studies have found an association between oral HPV infection and periodontitis, which is supported by biological plausibility. SUMMARY: Future longitudinal studies should further evaluate this association, using clinical definitions of oral HPV infection and periodontitis, and focusing on high-risk populations for oral HPV infection. Studying this association is important since periodontitis might help identify at-risk individuals for oral HPV infection and potentially HPV-related oropharyngeal cancers.

How much for a broken heart? Costs of cardiovascular disease in Colombia using a person-based approach.

The shift of the Noncommunicable Diseases (NCDs) epidemic, including cardiovascular disease, from developed to Low and Middle Income Countries (LMIC), creates new challenges in contexts where there is poor information on healthcare costs. Clearly this information is essential for planning, and its relevance is even more valuable as a driver for prevention and control of NCDs. This paper begins to address that handicap by estimating the healthcare cost of Cardiovascular Disease (Coronary Heart Disease and Stroke) in Colombia, using a person-based approach. Results show that the annual healthcare cost of a person with Coronary Heart Disease is between INT$ 4,277 and INT$ 4,846, while the cost for a person with Stroke varies between INT$5,816 and INT$6,616. The expansion of the NCDs epidemic combined with such high costs threatens the financial sustainability of health systems; primary prevention and policies targeting structural and intermediate determinants of health are a promising way to make health systems financially sustainable.

Factores de riesgo y enfermedades cardiometabólicas en Risaralda 2017 proyectada a 2050 / Risk factors and cardiometabolic disease in Risaralda 2017 to 2050

Resumen Objetivo: Proyectar el comportamiento de factores de riesgo y de la incidencia de dos enfermedades cardiometabólicas, en una población colombiana entre 2017 y 2050. Metodología: Diseño de cohorte abierta basado en un modelo de microsimulación dinámica para la población adulta de Risaralda, Colombia. Los factores de riesgo analizados son tabaquismo, obesidad global, obesidad central y colesterol total. Se creó una población sintética que replica las características demográficas y de salud de Risaralda en 2010, utilizando algoritmos de emparejamiento e imputación estadística. La evolución a lo largo del curso de vida se simuló basada en reglas derivadas de la literatura, con ecuaciones estocásticas y modelos econométricos. Se calcula la incidencia de diabetes tipo II y de eventos cerebrovasculares isquémicos de 2017 a 2050. Resultados: En 2050, 16.7 % serán fumadores, la tercera parte de ellos presentarán obesidad global y más de la mitad presentarán obesidad central. El promedio de colesterol total aumentará 5 mg/dL. Adicionalmente, se espera que entre 2017 y 2050 se presenten 204.966 casos nuevos de diabetes y 65.758 eventos cerebrovasculares isquémicos. Conclusiones: Los estilos de vida y el envejecimiento poblacional, llevarán a mayor exposición a riesgo y aumentarán la velocidad a la que los risaraldenses se enfermarán de Diabetes y experimentarán eventos cerebrovasculares. La obesidad global y central son factores que explicarían esta tendencia. Se requieren intervenciones intersectoriales que protejan a la población y reduzcan cargas fiscales por condiciones evitables.

Abstract Objective: predict the behavior of the risk factors and the incidence of two cardiometabolic diseases in a population from Colombia between 2017 and 2050. Methodology: Follow up of individual's cohort of an artificial society of Risaralda, Colombia, based on a microsimulation model. The risk factors analyzed in this study are tobacco use, obesity, central obesity and total cholesterol. A synthetic population was created to replicate demographic and health characteristics of Risaralda in 2010, using pairing algorithms and statistical imputation. The evolution along the life course was simulated based on rules from scientific literature, with stochastic equations and econometric estimates. The incidence of type II diabetes and ischemic stroke is calculated for the adult population between 2017 to 2050. Results: 16.7% of the adults by 2050 is expected to be smokers, a third of them will have global obesity and more than half will have central obesity. The average level of serum total cholesterol would increase by 5 mg/dL. Additionally, is expected that between 2017 and 2050 there will be 204.966 incident cases of diabetes and 65.758 first-ever ischemic stroke events. Conclusions: Lifestyles and expected population aging will lead to greater risk of disease and will increase the rate at which local people will get diabetes and ischemic stroke. Risk factors like global and central obesity explain this trend. Effective intersectoral interventions are needed to protect the population and reduce tax burden due to preventable conditions.

Patrones de prescripción de medicamentos para la diabetes mellitus tipo 2 en cinco departamentos de Colombia, en 2014 / Patterns of Medicine Prescriptions for Diabetes Mellitus Type 2 in five Departments of Colombia in 2014 / Padrões de prescrição de medicamento para a Diabetes Mellitus tipo 2 em cinco departamentos da Colômbia em 2014

Resumen Objetivos: Describir los patrones de prescripción de los medicamentos para la diabetes mellitus tipo 2 (DM2) y comorbilidades de pacientes atendidos en cinco instituciones prestadoras de servicios de salud de Colombia. Metodología: Estudio descriptivo transversal, en el cual se revisaron las historias clínicas de 5098 pacientes con DM2, atendidos en centros de atención ambulatoria ubicados en cinco ciudades colombianas entre el 1.º de enero y el 31 de diciembre de 2014. Cada uno de los pacientes con DM2 tenía al menos dos consultas ambulatorias registradas durante el periodo de estudio. La recolección de la información se hizo mediante una encuesta electrónica. Para la categorización de los medicamentos se usaron las guías nacionales e internacionales para el tratamiento de la diabetes. El análisis de los datos fue realizado utilizando el programa IBM SPSS® Statistics versión 21. Resultados: El medicamento de más frecuente prescripción fueron las biguanidas (59 %) y las sulfonilureas (28 %). La prescripción de inhibidores de la dipeptidil peptidasa-4 fue 7 % y la frecuencia de prescripción de agonista del receptor del péptido similar al glucagón tipo 1 (AR GLP-1) fue de 2 %. El medicamento con mayor frecuencia de prescripción como monoterapia fueron las biguanidas (22 %). La combinación más frecuente fue biguanida y las sulfonilureas (21 %), seguida de biguanida e insulina (10 %), y otras combinaciones. El 27 % pacientes con DM2 no recibió ningún tratamiento farmacológico para la diabetes. Con respecto a los medicamentos para comorbilidades, el 52 % de los pacientes utiliza al menos un tipo de antihipertensivo, el 39 % usa al menos un tipo de hipolipemiante y el 35 % utiliza ácido acetilsalicílico. Conclusiones: Las biguanidas fueron el medicamento con mayor frecuencia de prescripción, seguido de las sulfonilureas. Uno de cada cuatro pacientes no tenía registro de prescripción de medicamentos. El uso de ácido acetilsalicílico como prevención del riesgo cardiovascular fue menor al esperado.

Abstract Objetive: to describe the patterns of medicine prescriptions for diabetes mellitus type 2 (dm2) and the comorbidity of patients in five health care institutions in Colombia. Methodology: descriptive cross-sectional study carried out checking the medical records of 5098 patients with dm2 treated at the outpatient service centers in five Colombian cities between January 1 and December 31 of 2014. Each patient with dm2 had a record of at least two outpatient appointments registered during the time of this study. The information was collected through electronic surveys. National and international guides on diabetes treatment were used to categorize the medications. The spss® 21 software was used to analyze the data. Results: the most frequently prescribed medications were biguanides (59%) and sulfonylureas (28%). The prescription of inhibitors for Dipeptidyl peptidase-4 was 7% and the frequency of prescription of glucagon-like peptide-1 receptor agonists (ar glp-1) was 2%. The medication with the highest frequency of prescription as monotherapy were biguanides (22%). The most frequent combination was biguanide and sulfonylureas (21%). The second most frequent combination was biguanide with insulin (10%), and other combinations. 27% of patients with dm2 did not receive any pharmacological treatment for diabetes. Regarding the medicines for comorbidity, 52% of patients use at least one type of antihypertensive drug, 39% use at least one type of hypolipidemic drug and 35% uses acetylsalicylic acid. Conclusions: biguanides were the most frequently prescribed medication, sulfonylureas came after. One in four patients did not have a record of medicine prescription. The prescription of acetylsalicylic acid to prevent cardiovascular risk was lower than expected.

Resumo Objetivo: descrever os padrões de prescrição dos medicamen tos para a Diabetes Mellitus tipo 2 (dm2) e de comorbilidades de pacientes atendidos em cinco instituições de serviço de saú de da Colômbia. Metodologia: estudo descritivo transversal, no qual revisaram-se as histórias clínicas de 5098 pacientes com dm2, atendidos em centros de atendimento ambulatorial localizados em cinco cidades colombianas, entre 1 de janeiro e 31 de dezembro de 2014. Cada paciente com dm2 tinha pelo menos duas consultas ambulatoriais registradas durante o pe ríodo do estudo. A informação coletou-se através de inquérito eletrônico. Para a categorização dos medicamentos, utiliza ram-se os guias nacionais e internacionais para o tratamento da diabete. A análise dos dados realizou-se utilizando o progra ma spss® 21. Resultados: os medicamentos de prescrição mais frequente foram biguanidas (59%) e as sulfoniluréias (28%). A prescrição de inibidores da dipeptidil peptidase IV foi 7% e a frequência de prescrição de agonista do receptor do péptido si milar ao glucagão tipo 1 (ar glp-1) foi de 2%. O medicamento com mais frequência de prescrição como monoterapia foi as biguanidas (22%). A combinação mais frequente foi biguanida e sulfoniluréias (21%). A segunda combinação mais frequente foi biguanida com insulina (10%), e outras combinações. 27% dos pacientes com dm2 não recebeu tratamento farmacológi co nenhum para a diabetes. Respeito dos medicamentos para comorbilidades, 52% dos pacientes utiliza pelo menos um tipo de anti-hipertensivo, 39% utiliza pelo menos um tipo de hi polipemiante e 35% utiliza ácido acetilsalicílico. Conclusões: as biguanidas foram o medicamento com mais frequência de prescrição, e depois as sulfoniluréias. Um de quatro pacientes não rinha registro de prescrição de medicamentos. O uso de ácido acetilsalicílico como prevenção do risco cardiovascular foi menor do que se esperava.

Analysis of the adverse events reported to the office of the clinical director at a dental school in Bogotá, Colombia.

Dentistry is interested in identifying and controlling adverse events, understood as involuntary injuries to the patient during dental care. The aim of this study was to analyze the adverse events reported to the Office of the Clinical Director at the School of Dentistry at Pontificia Universidad Javeriana (Colombia) during 2011-2012. It was an observational, descriptive study that evaluated 227 dental clinical records of patients who filed a complaint with the Office of the Clinical Director. Of these, 43 were adverse events and were used as the basis for this study. Of the 16,060 patients who received care during 2011 - 2012, 0.26% (43) filed a complaint involving an adverse event, of which 97.7 % were considered preventable. Most of these (76.18%, n= 32) occurred during clinical management of treatments in different specialties, 9.5% (4) were the result of deficient external dental laboratory quality, and 14.32% (6) were due to failure in document management, soft tissue injury, misdiagnosis and swallowing foreign objects. Of the patients involved, 65.2% (28) received care from postgraduate students, with the highest number of cases in the Oral Rehabilitation speciality. The occurrence of adverse events during dental care, indicates the need for information about their origin in order to establish protection barriers and prevent their incidence, particularly in the educational area under the student dental clinic service model.

En odontología existe interés por identificar y controlar los eventos adversos, entendidos como las lesiones no voluntarias que ocurren durante la atención odontológica. El objetivo de este estudio fue analizar los eventos adversos reportados a Dirección de Clínicas de la Facultad de Odontología de la Pontificia Universidad Javeriana durante el periodo 2011-2012. Se realizó un estudio observacional descriptivo para el que se evaluaron 227 historias clínicas de pacientes que reportaron una queja a la Dirección de Clínicas, de las cuales en 43 se evidenció la presencia de eventos adversos, a partir de las cuales se registró la información analizada en este estudio. De los 16.060 pacientes atendidos durante el periodo 2011 y 2012, el 0,26% (43) formularon alguna queja que resultó en un evento adverso, de los cuales el 97,7 % se consideraron prevenibles. El mayor porcentaje 76,18 % (32) se presentó durante la gestión clínica de tratamientos en diferentes áreas. El 9,5 % (4), se debieron a fallas en la calidad del trabajo del laboratorio externo; el 14,32% (6) correspondió a eventos generados por fallas en la gestión documental, lesiones de tejidos blandos, fallas de diagnóstico y deglución de objetos extraños. El 65,2 % (28) de los pacientes fueron atendidos por estudiantes de posgrado, con el mayor número de casos en la especialidad de Rehabilitación Oral. La presentación de eventos adversos durante el proceso de atención en odontología, es indicador de la necesidad de conocer su origen para establecer barreras de protección y prevenir su incidencia, especialmente en el área formativa bajo el modelo de atención docencia servicio.

Inhibition of the Nuclear Export Receptor XPO1 as a Therapeutic Target for Platinum-Resistant Ovarian Cancer.

Purpose: The high fatality-to-case ratio of ovarian cancer is directly related to platinum resistance. Exportin-1 (XPO1) is a nuclear exporter that mediates nuclear export of multiple tumor suppressors. We investigated possible clinicopathologic correlations of XPO1 expression levels and evaluated the efficacy of XPO1 inhibition as a therapeutic strategy in platinum-sensitive and -resistant ovarian cancer.Experimental Design: XPO1 expression levels were analyzed to define clinicopathologic correlates using both TCGA/GEO datasets and tissue microarrays (TMA). The effect of XPO1 inhibition, using the small-molecule inhibitors KPT-185 and KPT-330 (selinexor) alone or in combination with a platinum agent on cell viability, apoptosis, and the transcriptome was tested in immortalized and patient-derived ovarian cancer cell lines (PDCL) and platinum-resistant mice (PDX). Seven patients with late-stage, recurrent, and heavily pretreated ovarian cancer were treated with an oral XPO1 inhibitor.Results: XPO1 RNA overexpression and protein nuclear localization were correlated with decreased survival and platinum resistance in ovarian cancer. Targeted XPO1 inhibition decreased cell viability and synergistically restored platinum sensitivity in both immortalized ovarian cancer cells and PDCL. The XPO1 inhibitor-mediated apoptosis occurred through both p53-dependent and p53-independent signaling pathways. Selinexor treatment, alone and in combination with platinum, markedly decreased tumor growth and prolonged survival in platinum-resistant PDX and mice. In selinexor-treated patients, tumor growth was halted in 3 of 5 patients, including one with a partial response, and was safely tolerated by all.Conclusions: Taken together, these results provide evidence that XPO1 inhibition represents a new therapeutic strategy for overcoming platinum resistance in women with ovarian cancer. Clin Cancer Res; 23(6); 1552-63. ©2016 AACR.

Analyisis of the adverse events reported to the office of the clinical director at a dental school in Bogota, Colombia / Análisis de los events adversos reportados a direcciónde clínicas en una facultad de odontología de Bogotá-Colombia

Dentistry is interested in identifying and controlling adverseevents, understood as involuntary injuries to the patient duringdental care. The aim of this study was to analyze the adverse eventsreported to the Office of the Clinical Director at the School ofDentistry at Pontificia Universidad Javeriana (Colombia) during2011­2012. It was an observational, descriptive study thatevaluated 227 dental clinical records of patients who filed acomplaint with the Office of the Clinical Director. Of these, 43were adverse events and were used as the basis for this study. Ofthe 16,060 patients who received care during 2011 ­ 2012, 0.26%(43) filed a complaint involving an adverse event, of which 97.7 %were considered preventable. Most of these (76.18%, n= 32)occurred during clinical management of treatments in differentspecialties, 9.5% (4) were the result of deficient external dentallaboratory quality, and 14.32% (6) were due to failure in documentmanagement, soft tissue injury, misdiagnosis and swallowingforeign objects. Of the patients involved, 65.2% (28) received carefrom postgraduate students, with the highest number of cases inthe Oral Rehabilitation speciality. The occurrence of adverseevents during dental care, indicates the need for information abouttheir origin in order to establish protection barriers and preventtheir incidence, particularly in the educational area under thestudent dental clinic service model.

En odontología existe interés por identificar y controlar loseventos adversos, entendidos como las lesiones no voluntarias que ocurren durante la atención odontológica. El objetivo de este estudio fue analizar los eventos adversos reportados a Dirección de Clínicas de la Facultad de Odontología de la Pontificia Universidad Javeriana durante el periodo 2011­2012.Se realizó un estudio observacional descriptivo para el que se evaluaron 227 historias clínicas de pacientes que reportar onuna queja a la Dirección de Clínicas, de las cuales en 43 se evidenció la presencia de eventos adversos, a partir de las cualesse registró la información analizada en este estudio. De los16.060 pacientes atendidos durante el periodo 2011 y 2012, el0,26% (43) formularon alguna queja que resultó en un evento adverso, de los cuales el 97,7 % se consideraron prevenibles. Elmayor porcentaje 76,18 % (32) se presentó durante la gestión clínica de tratamientos en diferentes áreas. El 9,5 % (4), sedebieron a fallas en la calidad del trabajo del laboratorio externo; el 14,32% (6) correspondió a eventos generados porfallas en la gestión documental, lesiones de tejidos blandos, fallas de diagnóstico y deglución de objetos extraños. El 65,2 %(28) de los pacientes fueron atendidos por estudiantes de posgrado, con el mayor número de casos en la especialidad de Rehabilitación Oral. La presentación de eventos adversos durante el proceso de atención en odontología, es indicador dela necesidad de conocer su origen para establecer barreras deprotección y prevenir su incidencia, especialmente en el área formativa bajo el modelo de atención docencia servicio.