Terapias no quirúrgicas para el carcinoma basocelular: revisión / Nonsurgical Therapies for Basal Cell Carcinoma: A Review

El carcinoma basocelular (CBC) es el tumor maligno más frecuente en seres humanos, y tiene la capacidad de causar una significativa morbilidad asociada a su potencial de destrucción local. El tratamiento del CBC demanda altos costes de atención para los sistemas de salud, por la gran incidencia de esta enfermedad, especialmente en pacientes mayores. El tratamiento estándar para la mayoría de los CBC consiste en la resección quirúrgica con márgenes y control histológico de los bordes de sección, o mediante cirugía micrográfica de Mohs. Sin embargo, en algunos pacientes con contraindicación para cirugía, que tienen comorbilidades importantes o altas expectativas estéticas, existen en la actualidad nuevas alternativas terapéuticas no quirúrgicas, con las cuales se puede lograr muy buen control local, preservar la función y obtener un excelente resultado cosmético (AU)

Basal cell carcinoma (BCC) is the most prevalent malignant tumor in humans and the local destruction of tissue that can result from excision has a significant impact on well-being. Treating BCC is costly for health care systems given the high incidence of this tumor, especially in older patients. Standard treatment involves either resection with histologic assessment of margins or Mohs micrographic surgery. Surgery is sometimes contraindicated, however, due to the presence of significant comorbidity or high cosmetic expectations. For such patients, nonsurgical treatments have become available. These alternatives can offer good local control of disease, preserve function, and achieve excellent cosmetic results (AU)

Nonsurgical Therapies for Basal Cell Carcinoma: A Review. / Terapias no quirúrgicas para el carcinoma basocelular: revisión.

Basal cell carcinoma (BCC) is the most prevalent malignant tumor in humans and the local destruction of tissue that can result from excision has a significant impact on well-being. Treating BCC is costly for health care systems given the high incidence of this tumor, especially in older patients. Standard treatment involves either resection with histologic assessment of margins or Mohs micrographic surgery. Surgery is sometimes contraindicated, however, due to the presence of significant comorbidity or high cosmetic expectations. For such patients, nonsurgical treatments have become available. These alternatives can offer good local control of disease, preserve function, and achieve excellent cosmetic results.

The impact of skin diseases on quality of life: A multicenter study.

INTRODUCTION: To date, no formal study has been published regarding how Colombian patients with skin disorders could be affected according to their perception of disease. OBJECTIVE: To determine the impact in quality of life of skin diseases in a Colombian population. METHODS: This multicenter study included patients with skin disease from almost the whole country. Individuals >18 years old; of any gender; with any skin disease and who signed informed consent, were included. We applied the Colombian validated version of the Skindex-29 instrument. RESULTS: A total of 1896 questionnaires had sufficient information for the analyses. No significant differences in sociodemographic characteristics of patients who returned the questionnaire incomplete vs. complete, were found. Participants mean age was 41.5 years. There were no statistical differences in men vs. women regarding the global (p=0.37), symptoms (p=0.71) and emotions (p=0.32) domains, whereas statistical differences were found in the function domain (p=0.04; Mann-Whitney U test). Psoriasis, contact dermatitis, atopic dermatitis, urticaria, hair disorders, Hansen's disease, scars, hyperhidrosis and genital human papillomavirus disease scored the highest. LIMITATIONS: Skindex-29 score variability as a result of differences in the location of the skin lesions, their inflammatory or non-inflammatory nature, and the start of therapy. CONCLUSIONS: Even the most localized or asymptomatic skin lesion in our population leads to a disruption at some level of patient's wellness. This study adds well supported scientific data of the burden of skin diseases worldwide.

Red Europea de Seguridad del Paciente y Calidad (Eupean Network for Patient Safety and Quality of Care). Desarrollo y resultados preliminares en Europa y en el Sistema Nacional de Salud / European Union Network for Patient Safety and Quality of Care (PASQ). Development and preliminary results in Europe and in the Spanish National Health System

Antecedentes: La acción cooperativa conocida como European Union Network for Patient Safety and Quality of Care (PaSQ) pretende promover la seguridad del paciente (SP) en la Unión Europea (UE) y facilitar el intercambio de experiencias entre los Estados Miembros y otras organizaciones interesadas en aspectos relacionados con la calidad asistencial (CA), la SP y la participación de los pacientes. En este artículo se presentan el desarrollo y los resultados preliminares de esta iniciativa, especialmente en el Sistema Nacional de Salud español (SNS). Desarrollo y metodología de trabajo: PaSQ se desarrolló a través de 7 paquetes de trabajo, liderados por diferentes países, que estaban orientados prioritariamente a: a) el intercambio de buenas prácticas sobre CA y SP que habían sido identificadas a través de cuestionarios específicos y seleccionadas a través de criterios explícitos consensuados, y b) la implementación de prácticas clínicas seguras (PCS) de comprobada efectividad, acordadas por los Estados Miembros de la Unión Europea. Evolución de la acción cooperativa: Se identificaron 482 buenas prácticas (39% remitidas por profesionales españoles). Se realizaron un total de 34 eventos en la UE, 11 con participación española, que permitieron compartir algunas de estas buenas prácticas. Un total de 194 centros sanitarios (49% españoles) están implementando las 4 PCS acordadas (higiene de manos, cirugía segura, conciliación de la medicación y escala de detección temprana de deterioro clínico en pediatría). Logros alcanzados y perspectivas futuras: PaSQ está facilitando reforzar la colaboración entre organizaciones y profesionales a nivel de la UE y del SNS en torno a la SP y la CA (AU)

Background: The joint action, European Union Network for Patient Safety and Quality of Care: PaSQ, aims to promote patient safety (PS) in the European Union (EU) and to facilitate the exchange of experiences among Member States (MS) and stakeholders on issues related to quality of care, PS, and patient involvement. The development and preliminary results are presented here, especially as regards the Spanish National Health System (SNHS). Development and methodology: PaSQ is developed through 7 work packages, primarily aimed at sharing good practices (GP), which were identified using specific questionnaires and selected by means of explicit criteria, as well as to implement safe clinical practices (SCP) of proven effectiveness and agreed among MS. Evolution of the joint action: A total of 482 GP (39% provided by Spanish professionals) were identified. The 34 events organised in the EU, 11 including Spanish participation, facilitate sharing these practices. A total of 194 Health Care centres (49% in Spain) are implementing SCP (hand hygiene, safe surgery, medication reconciliation, and paediatric early warning scores). Achievements and future perspectives: PaSQ is making it possible to strengthen collaboration between organizations and professionals at EU and SNHS level regarding PS and quality of care (AU)

Appraisal of the difference between the mesiodistal diameters of deciduous incisors and molars and permanent teeth.

AIM: Difference in tooth size between deciduous and permanent teeth can resolve space problems during development of the dentition. AIM: To determine the difference in size between deciduous and permanent teeth in the anterior and posterior areas of the mouth in a group of school-age children from Medellin, Colombia. DESIGN: this longitudinal prospective, descriptive investigation was carried out in 139 skeletal Class I dental stone casts from school-age children from Medellin. Patients were followed annually from 6 to 12 years of age. The final sample consisted of 53 children (35 girls and 18 boys). Leeway space and the incisor liability were determined. RESULTS: A higher positive leeway space was found in the mandible than in the maxilla (3.622 mm and 1.556 mm, respectively). Incisor liability was negatively higher in the maxilla than in the mandible (-7.884mm and -5.386mm, respectively). Six patients showed a negative leeway space between -1.582 mm and -3.184 mm for the mandible and the maxilla, respectively. No statistical significant differences were found by gender; girls showed higher leeway space and incisor liability than boys. CONCLUSION: Normal values for one ethnic group should not be considered normal for another and each group must be treated according to its own characteristics.

[European Union Network for Patient Safety and Quality of Care (PASQ). Development and preliminary results in Europe and in the Spanish National Health System]. / Red Europea de Seguridad del Paciente y Calidad (Eupean Network for Patient Safety and Quality of Care). Desarrollo y resultados preliminares en Europa y en el Sistema Nacional de Salud.

BACKGROUND: The joint action, European Union Network for Patient Safety and Quality of Care: PaSQ, aims to promote patient safety (PS) in the European Union (EU) and to facilitate the exchange of experiences among Member States (MS) and stakeholders on issues related to quality of care, PS, and patient involvement. The development and preliminary results are presented here, especially as regards the Spanish National Health System (SNHS). DEVELOPMENT AND METHODOLOGY: PaSQ is developed through 7 work packages, primarily aimed at sharing good practices (GP), which were identified using specific questionnaires and selected by means of explicit criteria, as well as to implement safe clinical practices (SCP) of proven effectiveness and agreed among MS. EVOLUTION OF THE JOINT ACTION: A total of 482 GP (39% provided by Spanish professionals) were identified. The 34 events organised in the EU, 11 including Spanish participation, facilitate sharing these practices. A total of 194 Health Care centres (49% in Spain) are implementing SCP (hand hygiene, safe surgery, medication reconciliation, and paediatric early warning scores) ACHIEVEMENTS AND FUTURE PERSPECTIVES: PaSQ is making it possible to strengthen collaboration between organizations and professionals at EU and SNHS level regarding PS and quality of care.

La epidemiología en el tratamiento de enfermedades Aviares / Epidemiologycal surveillance in avian diseases

Este artículo presenta una visión general del seguimiento epidemiológico desde la perspectiva del manejo de la información de campo, la trazabilidad y el análisis de riesgo. Se resalta la problemática de las enfermedades transmitidas por los alimentos, cuyo control depende de su diagnóstico y posterior seguimiento; la importancia de la trazabilidad en las poblaciones avícolas es relevante ya que se relaciona directamente con el análisis de riesgo y la toma de decisiones; las medidas utilizadas para llevar a cabo el seguimiento epidemiológico en dichas explotaciones es vital si se tienen en cuenta las expectativas que se tienen para el comercio internacional...

La profesión médica en Colombia / The medical profession in Colombia

Se presentan resultados de un estudio realizado con el objetivo de conocer las transformaciones que estan sucediendo en el paradigma profesional de la medicina y en las formas como se regula el servicio que ésta presta a la sociedad. Se identifican los principales momentos de la profesionalización de la medicina en Colombia, se muestran las diversas disposiciones que han regulado esta práctica durante el siglo XX y se describe la situación de los médicos en el contexto de la reforma a la seguridad social, según como la perciben diferentes actores entrevistados

[Aortic coarctation in children. Analysis of 100 cases]. / Coartación de aorta en el niño. Análisis de 100 casos.

One hundred clinical records of coarctation of aorta are presented with 78% catheterization and 31% postmortem examination. Surgical treatment was performed in 46%, 8, in the first month of life, 13 from 1 to 6 month, 5, from 6 to 12 month, 9 from 12 to 24 month and 11 older than 2 years. The surgical mortality was 13%. There was recoarctation in 7.5%. The mortality in the patients not operated on was 31%. This mortality was influenced by the severity of associated malformations. The most frequent associated cardiac malformations were left to right shunts followed by left heart pathology. The association with complex cardiopathies was frequent.

Uhl's anomaly associated with pulmonary atresia.

We present a case of Uhl's anomaly associated with atresia of the pulmonary valve. The rarity of this association is noteworthy, only three cases having previously been published. Our case presents the peculiarity of a patient with a normal tricuspid valve.

[Clinicopathological correlations in the common atrioventricular canal]. / Corrélations clinico-pathologiques dans le canal auriculo-ventriculaire complet.

20 patients with endocardial cushion defects were studied. Partial forms of common atrioventricular canal and those associated with complex congenital malformations were not considered. The right and left ventricular inflow and outflow tracts were measured and average values of inflow tract/outflow tract were calculated for each anatomical form of the disease. We found this ratio to be significantly smaller in Group B2 compared to Group B1 of Enriquez de Salamanca's classification, the first group being considered to be a more severe congenital malformation than the second. The inflow tract/outflow tract ratio of the right ventricle ranged between 80% and 50%, with an average of 62.3% in Group B1 compared to 62% and 24% with an average of 49% in Group B2. Using Studert's test, this difference was shown to be statistically significant (p = 0.02). On the other hand, there was no correlation between the other parameters or between the severity of the anatomical lesions and the clinical condition. The reduction of the right ventricular inflow tract may give an indication as to the type of atrioventricular valve which may be present.

[Right ventricle with double outlet and intact interventricular septum. Report of 1 case and review of the literature]. / Ventricule droit à double issue avec septum interventriculaire intact. Présentation d'un cas et révision de la littérature.

Double outlet right ventricle with an intact interventricular septum is an exceedingly rare malformation. Only six other cases have been found in the world literature. The clinical, electrocardiographic, radiological and anatomical features of this condition were reviewed on the occasion of the diagnosis of a new case. Cardiac catheterisation and angiography performed in only one other case is not definitive in the presence of mitral atresia.

[Parachute tricuspid valve associated with Fallot's tetralogy]. / Valvule tricuspide en parachute associée à une tétralogie de Fallot.

Parachute deformity of the tricuspid valve was observed with a severe form of Fallot's Tetralogy with pulmonary atresia in a newborn. Signs of tricuspid stenosis (peripheral oedema, right atrial dilatation, hepatomegaly and conduction defects) were associated with the clinical signs of the principal malformation (severe hypoxaemia). To our knowledge, this is the first reported case of parachute deformity of the tricuspid valve.

Intracardiac heterotopia--mesenchymal and endodermal.

A case is reported of an intracardiac 'epithelial heterotopia' with a predominant mesenchymal component. This is thought to have resulted from the differentiation of aberrant primitive cell(s) displaced into the heart during its development. Though microscopically resembling a myxoma, this lesion is clearly distinguished by the presence of glandular structures. The myxoid component exhibited a startling invasiveness which resulted in occlusion of the superior vena cava, causing symptoms very early in life and death at the age of 6 months.

[Coarctation of the aorta. In infancy (author's transl)]. / Coartación aórtica en el lactante.

We review our experience in 38 patients with coarctation of the aorta during infancy. Cardiac failure was present in 30 patients, being the maximal incidence during the first and second weeks of the life. Sixteen infants died, 43% of them during the first week. Cardiac catherization and angiocardiography were performed in 22 infants. The coarctation of the aorta was isolated in 38 infants (36%). The most frequently associated malformations were: patent ductus arteriosus (6 cases), ventricular septal defect (5 cases) and the pathology of the left heart. The post mortem examination was performed in 11 infants; in all of them the CoAo was preductal with patent ductus arteriosus; the most frequently associated malformation was ventricular septal defect (6 cases). 5 infants were operated upon with succes during the first year of the life.