DNA damage and its association with early-life exposome: Gene-environment analysis in Colombian children under five years old.

Environmental exposures and gene-exposure interactions are the major causes of some diseases. Early-life exposome studies are needed to elucidate the role of environmental exposures and their complex interactions with biological mechanisms involved in childhood health. This study aimed to determine the contribution of early-life exposome to DNA damage and the modifying effect of genetic polymorphisms involved in air pollutants metabolism, antioxidant defense, and DNA repair. We conducted a cohort study in 416 Colombian children under five years. Blood samples at baseline were collected to measure DNA damage by the Comet assay and to determine GSTT1, GSTM1, CYP1A1, H2AX, OGG1, and SOD2 genetic polymorphisms. The exposome was estimated using geographic information systems, remote sensing, LUR models, and questionnaires. The association exposome-DNA damage was estimated using the Elastic Net linear regression with log link. Our results suggest that exposure to PM2.5 one year before the blood draw (BBD) (0.83, 95 %CI: 0.76; 0.91), soft drinks consumption (0.94, 0.89; 0.98), and GSTM1 null genotype (0.05, 0.01; 0.36) diminished the DNA damage, whereas exposure to PM2.5 one-week BBD (1.18, 1.06; 1.32), NO2 lag-5 days BBD (1.27, 1.18; 1.36), in-house cockroaches (1.10, 1.00; 1.21) at the recruitment, crowding at home (1.34, 1.08; 1.67) at the recruitment, cereal consumption (1.11, 1.04; 1.19) and H2AX (AG/GG vs. AA) (1.44, 1.11; 1.88) increased the DNA damage. The interactions between H2AX (AG/GG vs. AA) genotypes with crowding and PM2.5 one week BBD, GSTM1 (null vs. present) with humidity at the first year of life, and OGG1 (SC/CC vs. SS) with walkability at the first year of life were significant. The early-life exposome contributes to elucidating the effect of environmental exposures on DNA damage in Colombian children under five years old. The exposome-DNA damage effect appears to be modulated by genetic variants in DNA repair and antioxidant defense enzymes.

Efectividad de la anestesia subaracnoidea con morfina como tratamiento del dolor postoperatorio en cesárea

Fundamento el dolor postoperatorio se considera un dolor con limitaciones de tiempo, a menudo mal controlado. Su manejo representa un gran desafío, ya que la analgesia postoperatoria debe brindar a la madre un control adecuado de este, y a su vez facilitar la atención del bebé. Objetivo evaluar la efectividad de la anestesia subaracnoidea con morfina como tratamiento del dolor postoperatorio en cesárea. Métodos estudio descriptivo y transversal, realizado en el Hospital General Docente Martín Chang Puga, del municipio de Nuevitas, provincia de Camagüey, entre enero de 2021 y diciembre de 2022. La muestra estuvo conformada por 36 pacientes a las cuales se aplicó anestesia subaracnoidea con lidocaína hiperbárica más morfina para la cesárea. Resultados predominó la edad comprendida entre 27-31 años. El 63,9 % de las cesareadas no refirió dolor postoperatorio. Casi la mitad de la población (47,2 %) estudiada presentó efectos secundarios con el uso de la morfina intratecal, principalmente el prurito. El 80,5 % expresó satisfacción con la analgesia postoperatoria. Conclusiones la mayoría de las pacientes encontraron satisfacción con el tratamiento analgésico, a pesar la presencia de efectos adversos, de modo que el uso de morfina intratecal es efectivo en el manejo del dolor poscesárea.

Foundation Postoperative pain is considered time-limited pain, often poorly controlled. Its management represents a great challenge, since postoperative analgesia must provide the mother with adequate control, and at the same time facilitate care for the baby. Objective to evaluate the effectiveness of subarachnoid anesthesia with morphine as a treatment for postoperative pain in cesarean section. Methods descriptive and cross-sectional study carried out at the Martín Chang Puga General Teaching Hospital, in the Nuevitas municipality, Camagüey province, between January 2021 and December 2022. 36 patients to whom subarachnoid anesthesia was applied with Hyperbaric lidocaine plus morphine for cesarean section were considered as the sample. Results the age between 27-31 years predominated. 63.9% of cesarean patients did not report postoperative pain. Almost half of the population (47.2%) studied presented side effects with the use of intrathecal morphine, mainly pruritus. 80.5% expressed satisfaction with postoperative analgesia. Conclusions the majority of patients were satisfied with the analgesic treatment, despite the presence of adverse effects, so that the use of intrathecal morphine is effective in the management of post-cesarean section pain.

Manejo anestésico perioperatorio en histerectomía total abdominal por fibroma uterino en paciente con estenosis aórtica severa. Presentación de un caso

Se presenta el caso de una paciente de 35 años, femenina, con antecedentes de presentar un soplo desde la infancia y que debía ser intervenida quirúrgicamente por fibroma uterino. El anestesiólogo, durante la consulta preoperatoria, constató el soplo ya mencionado por lo que se decidió posponer la cirugía e interconsultar con un cardiólogo. El examen ecocardiográfico demostró que la paciente era portadora de una estenosis aórtica severa con fracción de eyección conservada, prueba ergométrica: clase funcional I, sin isquemia. Mediante anestesia general orotraqueal, se realizó histerectomía total abdominal sin complicaciones. Es de vital importancia para el anestesiólogo el manejo perioperatorio de la estenosis aórtica.

The case of a 35-years-old female patient with a history of presenting a murmur since childhood and who had to undergo surgery for uterine fibroid is presented. The anesthesiologist, during the preoperative consultation, verified the aforementioned murmur, so it was decided to postpone surgery and consult with a cardiologist. The echocardiographic examination showed that the patient had severe aortic stenosis with preserved ejection fraction, stress test: functional class I, without ischemia. Using orotracheal general anesthesia, a total abdominal hysterectomy was performed without complications. The perioperative management of aortic stenosis is of vital importance for the anesthesiologist.

Assessing the relationship between energy-related methane emissions and the burden of cardiovascular diseases: a cross-sectional study of 73 countries.

The energy industry significantly contributes to anthropogenic methane emissions, which add to global warming and have been linked to an increased risk of cardiovascular diseases (CVD). This study aims to evaluate the relationship between energy-related methane emissions and the burden of CVD, measured in disability-adjusted life years (DALYs), in 2019. We conducted a cross-sectional analysis of datasets from 73 countries across all continents. The analyzed datasets included information from 2019 on environmental energy-related methane emissions, burden of DALYs due to CVD. The age-standardized prevalence of obesity in adults and life expectancy at birth were retrieved. The relationship between the variables of interest was evaluated using multiple linear regression models. In the multiple model, we observed a positive linear association between methane emissions and the log-transformed count of DALYs related to CVD. Specifically, for each unit increase in energy-related methane emissions, the burden of CVD increased by 0.06% (95% CI 0.03-0.09%, p < 0.001). The study suggests that reducing methane emissions from the energy industry could improve public health for those at risk of CVD. Policymakers can use these findings to develop strategies to reduce methane emissions and protect public health.

Characterization of the external exposome and its contribution to the clinical respiratory and early biological effects in children: The PROMESA cohort study protocol.

BACKGROUND: Air pollution contains a mixture of different pollutants from multiple sources. However, the interaction of these pollutants with other environmental exposures, as well as their harmful effects on children under five in tropical countries, is not well known. OBJECTIVE: This study aims to characterize the external exposome (ambient and indoor exposures) and its contribution to clinical respiratory and early biological effects in children. MATERIALS AND METHODS: A cohort study will be conducted on children under five (n = 500) with a one-year follow-up. Enrolled children will be followed monthly (phone call) and at months 6 and 12 (in person) post-enrolment with upper and lower Acute Respiratory Infections (ARI) examinations, asthma development, asthma control, and genotoxic damage. The asthma diagnosis will be pediatric pulmonologist-based and a standardized protocol will be used. Exposure, effect, and susceptibility biomarkers will be measured on buccal cells samples. For environmental exposures PM2.5 will be sampled, and questionnaires, geographic information, dispersion models and Land Use Regression models for PM2.5 and NO2 will be used. Different statistical methods that include Bayesian and machine learning techniques will be used for the ambient and indoor exposures-and outcomes. This study was approved by the ethics committee at Universidad Pontificia Bolivariana. EXPECTED STUDY OUTCOMES/FINDINGS: To estimate i) The toxic effect of particulate matter transcending the approach based on pollutant concentration levels; ii) The risk of developing an upper and lower ARI, based on different exposure windows; iii) A baseline of early biological damage in children under five, and describe its progression after a one-year follow-up; and iv) How physical and chemical PM2.5 characteristics influence toxicity and children's health.

Tromboembolismo pulmonar de riesgo intermedio en el posoperatorio mediato de apendicectomía: informe de caso

Introducción: El tromboembolismo pulmonar es una enfermedad de relevancia clínica, en pacientes que se le han realizado intervenciones quirúrgicas. La tasa de mortalidad por esta causa ha disminuido en los últimos años. Objetivo: Describir el manejo diagnóstico y terapéutico del tromboembolismo pulmonar de riesgo intermedio. Caso clínico: Paciente masculino de 62 años de edad que se encontraba ingresado por haber sido operado de una apendicitis gangrenosa. En el posoperatorio mediato comenzó con cuadro de dificultad respiratoria, se realizaron exámenes complementarios incluido ecocardiograma transtorácico, donde se evidenció el signo de McConnell, por lo que se diagnosticó un tromboembolismo pulmonar de riesgo intermedio. El paciente se somete al tratamiento trombolítico estandarizado, luego de lo cual la clínica y los parámetros ecocardiográficos que evolucionaron hacia la mejoría. Conclusiones: Se describió el diagnóstico y tratamiento del tromboembolismo pulmonar de riesgo intermedio en el posoperatorio mediato de apendicectomía, donde se evidenció la utilidad del uso del ecocardiograma doppler transtorácico con la identificación de los signos característicos y la aplicación exitosa de trombolisis sistémica.

Introduction: Pulmonary thromboembolism (PTE) is an entity of clinical relevance in patients in settings related to surgical interventions. The mortality rate from this cause has decreased in recent years. Objective: To describe the diagnostic and therapeutic management of intermediate risk pulmonary thromboembolism. Clinical case: A 62-year-old male patient who was hospitalized for having been operated on for gangrenous appendicitis. In the immediate postoperative period, he begins with symptoms of respiratory distress, complementary tests are performed, including a transthoracic echocardiogram, where McConnell's sign is evident, for which an intermediate-risk pulmonary thromboembolism is diagnosed. The patient undergoes standardized thrombolytic treatment, after which the clinical and echocardiographic parameters evolve towards improvement. Conclusions: The diagnosis and treatment of intermediate risk pulmonary thromboembolism in the immediate postoperative period of appendectomy was described. The usefulness of the use of transthoracic Doppler echocardiography was evidenced with the identification of the characteristic signs and the successful application of systemic thrombolysis.

Breast Implant-associated Anaplastic Large Cell Lymphoma in Colombia: Report of a Multidisciplinary National Registry.

An estimated 43,390 breast augmentation surgeries (86,780 implants) and 1486 breast implant reconstructions are performed annually in Colombia, representing the second-most breast surgery destination in South America, the fourth in the western hemisphere, and the fifth country worldwide. No previous reports have evaluated the incidence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) epidemiology or outcomes in a Hispanic population. Published data on the incidence of this disease in Colombia are unknown; therefore, a National Joint Multidisciplinary Committee was developed between the Colombian scientific societies of Mastology, Plastic Surgery, Hemato-Oncology, and the Invima (The National Food and Drug Surveillance Institute) to track national cases of BIA-ALCL. MATERIALS AND METHODS: We performed a retrospective review (survey-based study) of historical cases since 2011-2019, and a prospective collection of all patients with a confirmed World Health Organization diagnosis of BIA-ALCL identified in a newly established National Registry of BIA-ALCL. The trial was approved by Institutional Review Board (IRB). RESULTS: Eighteen cases of BIA-ALCL were identified in Colombia between 2011 and 2019. Hundred percent developed as sequelae of textured implants. Six patients (33.3%) presented either a peri-implant capsule mass or axillary lymph node involvement. Seven (38.9%) required adjuvant chemotherapy most commonly with CHOP regimen. Different brands of implants were associated with our cases. One death (5.6%) was attributed to BIA-ALCL, and one (5.6%) case displayed with relapsed with bone marrow involvement requiring a bone marrow transplantation. Six cases (33.3%) were identified with advanced stage (IIB-IV). Disease-free survival of 92.3% was achieved at 30.8-month follow-up. CONCLUSIONS: Colombia has one of the highest volumes of breast surgery and use of textured surface breast implants in the world. This study is the initial report of an implant registry in South America. A high proportion of advanced disease may be a consequence of delayed presentation, lack of disease awareness, and timely access to tertiary cancer centers for diagnosis and treatment. Brands other than Allergan and Mentor were found to be associated with BIA-ALCL in our study.

Higher Fecal Short-Chain Fatty Acid Levels Are Associated with Gut Microbiome Dysbiosis, Obesity, Hypertension and Cardiometabolic Disease Risk Factors.

Fiber fermentation by gut microbiota yields short-chain fatty acids (SCFAs) that are either absorbed by the gut or excreted in feces. Studies are conflicting as to whether SCFAs are beneficial or detrimental to cardiometabolic health, and how gut microbiota associated with SCFAs is unclear. In this study of 441 community-dwelling adults, we examined associations of fecal SCFAs, gut microbiota diversity and composition, gut permeability, and cardiometabolic outcomes, including obesity and hypertension. We assessed fecal microbiota by 16S rRNA gene sequencing, and SCFA concentrations by gas chromatography/mass spectrometry. Fecal SCFA concentrations were inversely associated with microbiota diversity, and 70 unique microbial taxa were differentially associated with at least one SCFA (acetate, butyrate or propionate). Higher SCFA concentrations were associated with a measure of gut permeability, markers of metabolic dysregulation, obesity and hypertension. Microbial diversity showed association with these outcomes in the opposite direction. Associations were significant after adjusting for measured confounders. In conclusion, higher SCFA excretion was associated with evidence of gut dysbiosis, gut permeability, excess adiposity, and cardiometabolic risk factors. Studies assessing both fecal and circulating SCFAs are needed to test the hypothesis that the association of higher fecal SCFAs with obesity and cardiometabolic dysregulation is due to less efficient SCFA absorption.

Gut microbiota is associated with obesity and cardiometabolic disease in a population in the midst of Westernization.

Westernization and its accompanying epidemiological transitions are associated with changes in gut microbiota. While the extremes of this lifestyle spectrum have been compared (hunter-gatherers, industrialized countries), populations undergoing such shifts have received little attention. To fill the gap of knowledge about the microbiome evolution following broad lifestyle changes and the emergence of disease-associated dysbiosis, we performed a cross-sectional study in which we characterized the microbiota of 441 Colombian adults through 16S rRNA gene sequencing and determined its relationship with demographic, health-related and dietary parameters. We showed that in the gut microbiota of this cohort thrive taxa proper of both hunter-gatherers (Prevotella, Treponema) and citizens of industrialized countries (Bacteroides, Bifidobacterium, Barnesiella); the relative abundances of these taxa differed from those in Western and non-Western populations. We also showed that the Colombian gut microbiota is composed of five consortia of co-abundant microorganisms that are differentially associated with lifestyle, obesity and cardiometabolic disease, and highlighted metabolic pathways that might explain associations between microbiota and host health. Our results give insights into the evolution of the gut microbiota, and underscore the importance of this community to human health. Promoting the growth of specific microbial consortia could help ameliorating physiological conditions associated with Western lifestyles.

Metformin Is Associated With Higher Relative Abundance of Mucin-Degrading Akkermansia muciniphila and Several Short-Chain Fatty Acid-Producing Microbiota in the Gut.

OBJECTIVE: Recent studies suggest the beneficial effects of metformin on glucose metabolism may be microbially mediated. We examined the association of type 2 diabetes, metformin, and gut microbiota in community-dwelling Colombian adults. On the basis of previous research, we hypothesized that metformin is associated with higher levels of short-chain fatty acid (SCFA)-producing and mucin-degrading microbiota. RESEARCH DESIGN AND METHODS: Participants were selected from a larger cohort of 459 participants. The present analyses focus on the 28 participants diagnosed with diabetes-14 taking metformin- and the 84 participants without diabetes who were matched (3-to-1) to participants with diabetes by sex, age, and BMI. We measured demographic information, anthropometry, and blood biochemical parameters and collected fecal samples from which we performed 16S rRNA gene sequencing to analyze the composition and structure of the gut microbiota. RESULTS: We found an association between diabetes and gut microbiota that was modified by metformin use. Compared with participants without diabetes, participants with diabetes taking metformin had higher relative abundance of Akkermansia muciniphila, a microbiota known for mucin degradation, and several gut microbiota known for production of SCFAs, including Butyrivibrio, Bifidobacterium bifidum, Megasphaera, and an operational taxonomic unit of Prevotella. In contrast, compared with participants without diabetes, participants with diabetes not taking metformin had higher relative abundance of Clostridiaceae 02d06 and a distinct operational taxonomic unit of Prevotella and a lower abundance of Enterococcus casseliflavus. CONCLUSIONS: Our results support the hypothesis that metformin shifts gut microbiota composition through the enrichment of mucin-degrading A. muciniphila as well as several SCFA-producing microbiota. Future studies are needed to determine if these shifts mediate metformin's glycemic and anti-inflammatory properties.

Effect of a comprehensive ambulatory care model on outcomes of patients with acute coronary syndrome in Colombia / Efecto de un modelo integral de atención ambulatoria sobre los resultados en pacientes con síndrome coronario agudo en Colombia

Objective. To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome. Methods. Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30–70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated. Results. Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17–2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13–2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group. Conclusions. Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average “number needed to treat” (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.

Objetivo. Evaluar el efecto de un programa de atención diseñado según un modelo integral de atención ambulatoria (MIAA) en la aparición de nuevos episodios cardiovasculares o coronarios en pacientes con síndrome coronario agudo. Métodos. Como participantes en este estudio de intervención cuasiexperimental se incluyó a pacientes con síndrome coronario agudo de 30 a 70 años de edad. El grupo de intervención (n = 165) recibió atención mediante el MIAA, guiada por un equipo interdisciplinario. El MIAA incluyó la atención transitoria, la estratificación del riesgo según la gravedad, la realización de pruebas fisiológicas (cardiografía de impedancia) y un plan de tratamiento conforme con las directrices actuales. El grupo de referencia (n = 277) recibió la atención convencional recomendada en un programa ambulatorio de rehabilitación cardíaca. Durante el año en que se llevó a cabo el seguimiento, se evaluó el uso de los servicios de urgencia y hospitalarios relacionados con nuevos episodios cardiovasculares y coronarios. Resultados. Se observaron diferencias en el número de episodios cardiovasculares (P = 0,003) y episodios coronarios (P = 0,006) experimentados por los pacientes del grupo de referencia y el grupo de intervención. El cociente de riesgo instantáneo de un episodio cardiovascular (HR = 1,80; IC de 95%: 1,17–2,75; P = 0,007) y de un episodio coronario (HR = 1,81; IC de 95%: 1,13–2,90; P = 0,013), tras ajustar para la edad, el sexo, el tabaquismo y las arterias coronarias afectadas, fue mayor en el grupo de referencia que en el grupo de intervención. Conclusiones. La prestación de atención mediante el MIAA a los pacientes que habían experimentado un episodio coronario agudo redujo en 40% las visitas a servicios de urgencia y las rehospitalizaciones relacionadas con nuevos episodios cardiovasculares y coronarios. El número promedio de pacientes “que es necesario tratar” mediante el MIAA para que tenga repercusión en uno de ellos (en este caso, la prevención de un episodio cardiovascular o coronario), fue de 9 y 11 respectivamente, lo que indica que la intervención es eficaz en función de los costos.

Effect of a comprehensive ambulatory care model on outcomes of patients with acute coronary syndrome in Colombia / Efecto de un modelo integral de atención ambulatoria sobre los resultados en pacientes con síndrome coronario agudo en Colombia

OBJECTIVE: To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome. METHODS: Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30-70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated. RESULTS: Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17-2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13-2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group. CONCLUSIONS: Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average "number needed to treat" (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.

OBJETIVO:Evaluar el efecto de un programa de atención diseñado según un modelo integral de atención ambulatoria (MIAA) en la aparición de nuevos episodios cardiovasculares o coronarios en pacientes con síndrome coronario agudo. MÉTODOS: Como participantes en este estudio de intervención cuasiexperimental se incluyó a pacientes con síndrome coronario agudo de 30 a 70 años de edad. El grupo de intervención (n = 165) recibió atención mediante el MIAA, guiada por un equipo interdisciplinario. El MIAA incluyó la atención transitoria, la estratificación del riesgo según la gravedad, la realización de pruebas fisiológicas (cardiografía de impedancia) y un plan de tratamiento conforme con las directrices actuales. El grupo de referencia (n = 277) recibió la atención convencional recomendada en un programa ambulatorio de rehabilitación cardíaca. Durante el año en que se llevó a cabo el seguimiento, se evaluó el uso de los servicios de urgencia y hospitalarios relacionados con nuevos episodios cardiovasculares y coronarios. RESULTADOS: Se observaron diferencias en el número de episodios cardiovasculares (P = 0,003) y episodios coronarios (P = 0,006) experimentados por los pacientes del grupo de referencia y el grupo de intervención. El cociente de riesgo instantáneo de un episodio cardiovascular (HR = 1,80; IC de 95%: 1,17-2,75; P = 0,007) y de un episodio coronario (HR = 1,81; IC de 95%: 1,13-2,90; P = 0,013), tras ajustar para la edad, el sexo, el tabaquismo y las arterias coronarias afectadas, fue mayor en el grupo de referencia que en el grupo de intervención. CONCLUSIONES: La prestación de atención mediante el MIAA a los pacientes que habían experimentado un episodio coronario agudo redujo en 40% las visitas a servicios de urgencia y las rehospitalizaciones relacionadas con nuevos episodios cardiovasculares y coronarios. El número promedio de pacientes "que es necesario tratar" mediante el MIAA para que tenga repercusión en uno de ellos (en este caso, la prevención de un episodio cardiovascular o coronario), fue de 9 y 11 respectivamente, lo que indica que la intervención es eficaz en función de los costos.

Effect of a comprehensive ambulatory care model on outcomes of patients with acute coronary syndrome in Colombia.

OBJECTIVE: To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome. METHODS: Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30-70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated. RESULTS: Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17-2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13-2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group. CONCLUSIONS: Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average "number needed to treat" (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.

Radioterapia externa parcial acelerada en pacientes con cáncer de seno en estado temprano / External Beam Partial Breast Irradiation for Early Breast Cancer

Objetivo: Demostrar la eficacia y efectividad de la radioterapia parcial acelerada en cáncer temprano de mama en pacientes tratadas con cirugía conservativa. Método: Se trataron cien mujeres con radioterapia externa parcial acelerada, con dosis en un rango de 35 a 38,5 Gy, en 10 fracciones en 5 días dos veces al día con un intervalo de 6 horas. Todas se trataron con 4 campos no cooplanares. El volumen tumoral clínico estuvo cubierto de forma homogénea con la isodosis del 100 %; así mismo el volumen de planeación del blanco, incluido en la isodosis del 95 %. Resultados: El seguimiento promedio fue de 54,3 meses. La tolerancia al tratamiento fue buena y ninguna mujer presentó toxicidad grado 2 o 3. Hasta el momento una paciente presentó recaída ganglionar, local y a distancia. Conclusión: El tratamiento fue bien tolerado, con toxicidad baja y con buenos resultados, en un tiempo corto, con posibles beneficios económicos especialmente en la población de países en vías de desarrollo...

Objective: In this study, our purpose was todemonstrate the feasibility and effectiveness ofexternal beam partial breast irradiation (PBI) inpatients with early-stage breast cancer treated withbreast-conserving surgery. Methods: 100 patientswere treated with PBI with doses ranging from 35to 38.5 Gy, in 10 fractions b.i.d. All patients weretreated with four non-coplanar fields. The clinicaltumor volume was well encompassed withinthe isodose line of 100 % as well as the planningtarget volume which was within the isodose lineof 95 %. Results: The median follow-up was of54.3 months. The treatment was well tolerated,with no more than grade I toxicity. So far, therehas been one patient with local and axillar recurrence.Conclusions: In our experience, thetreatment was well tolerated with low toxicityand with good results, in a shorter treatment time,with the economical benefits this has, especiallyfor populations in developing countries...

Participación ciudadana y exclusión juvenil: crítica práctica y alternativas políticas para construir una democracia radical / Citizen participation and youthful exclusion: critic practice and political alternatives for build a radical democracy

Este trabajo se propone debatir el concepto y la práctica que orienta la promoción de la participación juvenil en los programas y proyectos implementados por el Estado y las organizaciones no gubernamentales (ONGs), en donde la participación de los jóvenes como beneficiarios ocupa un lugar central como objetivo, estrategia y criterio rector. Bajo estas premisas, la participación juvenil, circulando alrededor del restringido espacio de decisión de los “objetivos” y “actividades” de los proyectos institucionales, se concibe con un enfoque psicosocial más que político, que enfatiza la solución individualista, orientada al cambio de actitudes y valores en la medida en que los jóvenes contribuyen a la solución de sus problemas inmediatos, adquiriendo de esta manera las cualificaciones necesarias para incorporarse a un proceso de desarrollo tácitamente aceptado. El texto analiza las vinculaciones entre la condición juvenil y la forma-estado del capitalismo actual, destacando la relación entre las políticas públicas de juventud y una determinada y limitada concepción de la democracia y de la participación ciudadana, procurando establecer los puntos de cuestionamiento a sus proposiciones y desarrollar algunos fundamentos para una práctica socialmente transformadora en la promoción de la participación de los jóvenes.

This paper is going to debate the concept and the practice that orients the promotion of the youthful participation in the programs and projects implemented by the State and the not-governmental organizations (NGO's), in where the participation of the youths fulfills a central place like objective, strategy and criteria. Under these premises, the youthful participation, limited by the “objectives” and “activities” of the institutional projects, conceives itself with an approach social-psychological more than political, that emphasizes the individual solution oriented to the change of attitudes and values in the measure in that contributes to the solution of his immediate problems, acquiring of this way the necessary competences. The text analyzes the bonds between the youthful condition and the role of the State in your capitalist-form, standing out the relation between the politics of youth and a determined and restricted conception of the democracy and of the civic participation, seeking to establish the weaknesses of this position and the possible bases of a practice socially transformer for the promotion of the youthful participation.

Participación ciudadana y exclusión juvenil: crítica práctica y alternativas políticas para construir una democracia radical / Citizen participation and youthful exclusion: critic practice and political alternatives for build a radical democracy

Este trabajo se propone debatir el concepto y la práctica que orienta la promoción de la participación juvenil en los programas y proyectos implementados por el Estado y las organizaciones no gubernamentales (ONGs), en donde la participación de los jóvenes como beneficiarios ocupa un lugar central como objetivo, estrategia y criterio rector. Bajo estas premisas, la participación juvenil, circulando alrededor del restringido espacio de decisión de los “objetivos” y “actividades” de los proyectos institucionales, se concibe con un enfoque psicosocial más que político, que enfatiza la solución individualista, orientada al cambio de actitudes y valores en la medida en que los jóvenes contribuyen a la solución de sus problemas inmediatos, adquiriendo de esta manera las cualificaciones necesarias para incorporarse a un proceso de desarrollo tácitamente aceptado. El texto analiza las vinculaciones entre la condición juvenil y la forma-estado del capitalismo actual, destacando la relación entre las políticas públicas de juventud y una determinada y limitada concepción de la democracia y de la participación ciudadana, procurando establecer los puntos de cuestionamiento a sus proposiciones y desarrollar algunos fundamentos para una práctica socialmente transformadora en la promoción de la participación de los jóvenes(AU)

This paper is going to debate the concept and the practice that orients the promotion of the youthful participation in the programs and projects implemented by the State and the not-governmental organizations (NGO´s), in where the participation of the youths fulfills a central place like objective, strategy and criteria. Under these premises, the youthful participation, limited by the “objectives” and “activities” of the institutional projects, conceives itself with an approach social-psychological more than political, that emphasizes the individual solution oriented to the change of attitudes and values in the measure in that contributes to the solution of his immediate problems, acquiring of this way the necessary competences. The text analyzes the bonds between the youthful condition and the role of the State in your capitalist-form, standing out the relation between the politics of youth and a determined and restricted conception of the democracy and of the civic participation, seeking to establish the weaknesses of this position and the possible bases of a practice socially transformer for the promotion of the youthful participation(AU)

Disección del ganglio centinela. Un nuevo concepto, una nueva técnica quirúrgica / Dissection of the sentinel node. A new concept, a new surgical technique Abstract

La disección del ganglio centinela se ha convertido en el estándar de manejo en estados tempranos de cáncer mamario y melanoma principalmente. Se requiere curva de aprendizaje y validación de la técnica por parte de cirujanos, médicos nucleares y patólogos en cada centro especializado, antes de abandonar definitivamente el vaciamiento ganglionar.El objetivo de esta técnica es racionalizar la linfadenectomía axilar y así disminuir la morbilidad. Para la detección del ganglio centinela se utilizan colorantes como el azul patente, azul de isosulfán, y en nuestro medio el azul de metileno. Igualmente técnicas de medicina nuclear que emplean la inyección de sulfuro coloidal marcado con Tc 99 en el seno, asociado al uso de gammasondas intraoperatorias. Se debe lograr cifras de detección del ganglio centinela superiores al 90 por ciento, con un índice de falsos negativos cercano al 5 por ciento.Se presenta la revisión de la literatura y la recopilación de nuestra experiencia en la Clínica de Seno de la Clínica del Country, Bogotá, Colombia, en donde manejamos 82 por ciento de casos en estados tempranos. Nuestro informe se basa en la experiencia adquirida en una serie de 277 casos recolectados entre enero de 1998 y enero de 2005, con una detección actual del ganglio centinela de más del 98 por ciento y una tasa de falsos negativos de 7 por ciento. Se evita el vaciamiento en 87 por ciento de las pacientes con carcinoma mamario invasivo en estados tempranos de la enfermedad. Esta nueva técnica se convierte en nuestro estándar de manejo en pacientes con carcinoma de seno con axilas clínicamente negativas...

Análisis de sobrevida en una cohorte de 1328 pacientes con carcinoma de seno / Study of survival of a cohort of 1328 patients with breast cancer

Introducción: El cáncer de seno representa un importante problema de salud pública. En Colombia, en la mujer este cáncer ocupa el segundo lugar en frecuencia. Los dos factores pronósticos más importantes que determinan la sobrevida libre de enfermedad y la sobrevida global son el tamaño del tumor primario y el número de ganglios axilares afectados. Objetivos: Reportar las características demográficas de una cohorte de pacientes con carcinoma de seno, el tipo de tratamiento quirúrgico y las terapias adyuvantes empleadas en esta población; asimismo analizar la sobrevida libre de enfermedad y la sobrevida global con base en el estado clínico de la enfermedad y en el número de ganglios axilares afectados. Materiales y métodos: La Unidad Oncológica del Country en Bogotá, Colombia, registró información acerca de las características y el tratamiento de 1.328 pacientes con cáncer de seno desde el año 1989 hasta el 2003. Se realizó un análisis estadístico descriptivo para medir la distribución de frecuencias entre los grupos de carcinoma in situ, estados I, IIA, IIB, IIIA, IIIB y IV; posteriormente se procedió a analizar la sobrevida, teniendo en cuenta como desenlace la recaída local, la recaída sistémica y la mortalidad por cáncer de seno, para lo cual se utilizó el método de Kaplan-Meier.Resultados: Se diagnosticaron 112 pacientes con carcinoma in situ (8,4 por ciento). El 50,8 por ciento de ellas se incluyó con impresión clínica de estados tempranos (I, IIA), mientras que los estados avanzados (IIB, IIIA, IIIB, IV) representaron el 40,7 por ciento. Desde el registro de las pacientes se ha perdido el seguimiento del 9,7 por ciento de éstas. El estado clínico y el número de ganglios positivos presentaron diferencias estadísticamente significativas en la mortalidad y en las recaídas locales y sistémicas. Conclusiones: Los resultados del presente estudio demuestran que el comportamiento y el manejo del cáncer de seno para estados tempranos y avanzados en nuestra población es comparable a los reportes de otros países...

Estudio de los niveles de atención de salud en Venezuela / Study of the health care levels in Venezuela

Expresaba CONFUCIO (551-479 a.c) folósofo chino y creador y fundador de un sistema moral que exalta la fidelidad a la tradicional y familiar, que de haber tenido la oportunidad de ser gobernados del mundo, su primer y más prioritario objetivo hubiese estado constituido realizar un gran esfuerzo de poner de acuerdo a todos los ciudadanos en lo relativo a la interpretación adecuada del significado de las palabras; y agragaba: ®en esta forma y manera podría hecerse más fácil y llevadera la difícil tarea de gobernar¼. A más de 2.000 años de emitidas, estas frases mantienen real vigencia. En la actualidad, la semántica, que no es así que el estudio de la significación de las palabras y lo semántico, es todo aquello relativo al significado de las mismas, adquiere un nivel elevado dentro del listado de las necesidades a resolver por parte de los grupos dirigentes, como parte de los grupos dirigidos. ¡Nunca una necesidad ha sido más necesaria! Y esta necesidad, en concordancia y coexistencia con los procesos de globalización inevitable por el cual atraviesa el mundo, se hace más protuberante