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BACKGROUND: Two-thirds of global cancer occur in low/middle income countries (LMICs). Northern Central America is the largest LMIC region in the western hemisphere, and lack cancer registries to guide cancer control. We conducted a gastric cancer (GC) survival study in rural western Honduras, characterized as having among the highest GC incidence rates in Latin America. METHODS: The cohort of incident GC diagnosed between 2002-2015 was studied with active follow-up, with household visits. The regional gastric cancer registry was primary for case identification, with completeness examination with hospital data and national death certificates. Cox regression models were used for survival calculations. RESULTS: Survival follow-up was achieved in 741/774 patients (95.7%). Household interviews were conducted in 74.1% (n=549). 65.7% were male, median age at diagnosis was 64 years, 24.5% were <55. 43.9% of tumors had pyloric obstruction. 45.2%, 43.2%, and 7.3% of histology was intestinal, diffuse, and mixed, respectively. 24.7% patients received treatment. 5-year survival rates were 9.9% for both males and females, 7.7% for age <45, and 7.9% for diffuse GC. Median survival time was 4.8 months (95%CI,4.2-5.6). In the final Cox regression model including age, sex, Lauren subtype, and poverty index, only treatment was significantly associated with survival (HR 2.43, 95%CI,1.8-3.2). CONCLUSIONS: Markedly low gastric cancer 5-year survival rates are observed in rural Central America. The majority of patients present with advanced disease, and a minority have access to therapy. IMPACT: The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.
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Proteus mirabilis is a leading cause of urinary tract infections and a common commensal of the gastrointestinal tract. Our recent study (JB) showed that P. mirabilis strain BL95 employs a novel contact-dependent killing system against enteric bacteria in the mouse gut and in vitro. To uncover the genetic determinants of this system, we performed whole-genome sequencing of BL95 and compared it with 98 complete genomes of P. mirabilis. BL95 carries 56 coding sequences (CDSs) not found in other P. mirabilis. Over half of these unique genes are located on a novel integrative conjugative element (ICE) named ICEPm2, inserted in tRNA-Phe and exclusive to BL95. ICEPm2 has integration, conjugation, and DNA replication modules nearly identical to ICEPm1 (common in P. mirabilis), but ICEPm2 of BL95 carries two unique operons for P. mirabilis-a phenazine biosynthesis and a contact-dependent growth inhibition (CDI) system. ICEPm2 is absent in the P. mirabilis (AR_0156) closest to BL95 and it is present in the genomes of several Escherichia coli from mouse intestines, indicating its recent horizontal mobilization. BL95 shares over 100 genes of five different secretion systems with other P. mirabilis, mostly poorly studied, making a large pool of candidate genes for the contact-dependent growth inhibition.
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BACKGROUND: Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and leading infection-associated cancer. GC has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the U.S., GC represents a marked disparity with incidence rates that are 2-3 times higher in Hispanics compared to non-Hispanic whites. METHODS: We conducted a national retrospective study of incident GC in El Salvador from to 2000-2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n=5), governmental employee hospitals (ISSS, n=5), and private facilities (n=6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014-2016. RESULTS: 10,039 unique cases of GC were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95%CI;14.4-20.7) and 12.2 per 100,000 persons (95%CI;10.9-13.5), respectively, in the period 2010-2014 with all centers operational. Intestinal GC was 2.8 times more common than diffuse GC. 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBER positivity was 10.2%. CONCLUSIONS: A high incidence of gastric cancer was confirmed in El Salvador, and nearly half of patients were female. IMPACT: The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.
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BACKGROUND: Gastric adenocarcinoma (GC) is the fourth leading cause of cancer-related mortality, and leading infection-associated cancer. GC has striking geographic variability, with high incidence in East Asia and mountainous Latin America. Reliable cancer data and population-based cancer registries (PBCRs) are lacking for the majority of LMICs, including the Central American Four region (CA-4, Nicaragua, El Salvador, Honduras, and Guatemala). METHODS: Mortality data for Nicaragua were obtained from the highly-rated Ministry of Health death registry. All the patients were diagnosed with gastric cancer between 1997 and 2012 (ICD-10 codes C16.0-C16.9) and death due to any cause were included in the study. Data on variables such as sex, age (stratified by 5-year age groups), municipality, urban/rural, altitude, and year of death were analyzed. RESULTS: A total of 3,886 stomach cancer deaths were reported in Nicaragua between 1997 and 2012, of which 2,214 (56.9%) were male. The ASMR were 13.1 and 8.7 per 100,000 habitants for males and females, respectively, and without significant change during the study period (APC= -0.7, P=0.2). An average of 17.9 years were lost per death (AYLL), accounting for 67,964 years of life lost (YYL). CONCLUSIONS: The burden of gastric cancer mortality is high in Nicaragua with significantly elevated ASMR, YYL, and AYLL. IMPACT: The projected increase in mortality portends the double cancer burden in northern Central America, with persistent infection-associated cancers and growing transition cancers (e.g., breast and colon cancers), which has implications for cancer control in Mesoamerica and U.S. Latino populations.
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Se presenta a un paciente con liposarcoma mediastinal gigante con dolor torácico, disnea, cuyos estudios por imágenes revelaban la presencia de una gran tumoración de 42 cm en su diámetro mayor que abarcaba todo el mediastino, comprometía ambas cavidades torácicas, rechazaba los pulmones, corazón y grandes vasos. La biopsia con aguja cortante bajo guía ecográfica fue informada como liposarcoma. El paciente tuvo resección completa del tumor mediante la incisión Clamshell. En el post operatorio inmediato, presentó shock circulatorio más disfunción multiorgánica (DOMS): plaquetopenia, insuficiencia renal aguda con necesidad de soporte dialítico, injuria hepática. El soporte y monitoreo especializado en la Unidad de Cuidados Intensivos (UCI) permitió mejoría clínica y buena evolución. Salió de alta en buenas condiciones.
We present a patient with giant mediastinal liposarcoma with chest pain, dyspnea, whose imaging studies revealed the presence of a large tumor measuring 42 cm in its greatest diameter that covered the entire mediastinum, involved both thoracic cavities, rejected the lungs, heart and big glasses. The sharp needle biopsy under ultrasound guidance was reported as liposarcoma. The patient had complete resection of the tumor through the Clamshell incision. In the immediate postoperative period, he presented circulatory shock plus multiple organ dysfunction (DOMS): plateletopenia, acute renal failure with the need for dialytic support, liver injury. Specialized support and monitoring in the Intensive Care Unit (ICU) allowed clinical improvement and good evolution. He was discharged in good condition.
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Humanos , Masculino , Adulto , Toracotomia , Lipossarcoma/cirurgia , Neoplasias do Mediastino/diagnóstico , Choque , Dor no Peito , Tomografia , Tosse , Cuidados Críticos , Tratamento Farmacológico , Dispneia , Biópsia Guiada por Imagem , Insuficiência de Múltiplos Órgãos/cirurgiaRESUMO
Cryptic conjugative plasmids lack antibiotic-resistance genes (ARGs). These plasmids can capture ARGs from the vast pool of the environmental metagenome, but the mechanism to recruit ARGs remains to be elucidated. To investigate the recruitment of ARGs by a cryptic plasmid, we sequenced and conducted mating experiments with Escherichia coli SW4848 (collected from a lake) that has a cryptic IncX (IncX4) plasmid and an IncF (IncFII/IncFIIB) plasmid with five genes that confer resistance to aminoglycosides (strA and strB), sulfonamides (sul2), tetracycline [tet(A)], and trimethoprim (dfrA5). In a conjugation experiment, a novel hybrid Tn21/Tn1721 transposon of 22,570 bp (designated Tn7714) carrying the five ARG mobilized spontaneously from the IncF plasmid to the cryptic IncX plasmid. The IncF plasmid was found to be conjugative when it was electroporated into E. coli DH10B (without the IncX plasmid). Two parallel conjugations with the IncF and the new IncX (carrying the novel Tn7714 transposon) plasmids in two separate E. coli DH10B as donors and E. coli J53 as the recipient revealed that the conjugation rate of the new IncX plasmid (with the novel Tn7714 transposon and five ARGs) is more than two orders of magnitude larger than the IncF plasmid. For the first time, this study shows experimental evidence that cryptic environmental plasmids can capture and transfer transposons with ARGs to other bacteria, creating novel multidrug-resistant conjugative plasmids with higher dispersion potential. IMPORTANCE: Cryptic conjugative plasmids are extrachromosomal DNA molecules without antibiotic-resistance genes (ARGs). Environmental bacteria carrying cryptic plasmids with a high conjugation rate threaten public health because they can capture clinically relevant ARGs and rapidly spread them to pathogenic bacteria. However, the mechanism to recruit ARG by cryptic conjugative plasmids in environmental bacteria has not been observed experimentally. Here, we document the first translocation of a transposon with multiple clinically relevant ARGs to a cryptic environmental conjugative plasmid. The new multidrug-resistant conjugative plasmid has a conjugation rate that is two orders of magnitude higher than the original plasmid that carries the ARG (i.e., the new plasmid from the environment can spread ARG more than two orders of magnitude faster). Our work illustrates the importance of studying the mobilization of ARGs in environmental bacteria. It sheds light on how cryptic conjugative plasmids recruit ARGs, a phenomenon at the root of the antibiotic crisis.
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Antibacterianos , Conjugação Genética , Elementos de DNA Transponíveis , Escherichia coli , Plasmídeos , Plasmídeos/genética , Elementos de DNA Transponíveis/genética , Escherichia coli/genética , Escherichia coli/efeitos dos fármacos , Antibacterianos/farmacologia , Lagos/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Transferência Genética Horizontal , Farmacorresistência Bacteriana/genéticaRESUMO
ANTECEDENTES: Las gestaciones múltiples sugieren un mayor riesgo de mortalidad perinatal. Dentro de estas estadísticas, la muerte de un solo gemelo ocurre en hasta el 6% de los embarazos múltiples. La incidencia general después de las 20 semanas de gestación (sdg) se estima entre el 2.6% y el 6.2% de todos estos embarazos. Se ha demostrado que es la coriónicidad, más que la cigosidad, la que influye en el resultado de esta complicación, debido a la angioarquitectura placentaria de las circulaciones en los embarazos monocoriónicos. Las tasas de pérdida de hasta el 30-50% se han asociado con embarazos monocoriónicos y monoamnióticos. Si ocurre antes de las 14 sdg, el embrión puede desaparecer; entre las 14 y las 20 sdg, el feto se reduce en tamaño y volumen. Y, si ocurre después de 20 sdg, el feto permanece dentro del útero hasta el final de la gestación. CASO CLÍNICO: femenina de 18 años de edad, quien acudió a revisión obstétrica con reporte ultrasonográfico de un embarazo gemelar monocorial biamniótico de 30.4 sdg, y muerte de uno de los gemelos. Tras demostrar estabilidad hemodinámica del feto sobreviviente, así como estabilidad materna, se decidió internamiento para monitoreo estrecho. Una semana después desarrolló trabajo de parto pretérmino y se decidió la interrupción de la gestación de manera urgente. Se obtuvo un recién nacido masculino con edad gestacional sugestiva de 32 sdg, con dificultad respiratoria y requirió hospitalización para monitoreo estrecho del recién nacido prematuro. Madre egresó a las 48 horas, nunca desarrolló datos de coagulación intravascular diseminada (CID) y el recién nacido se mantuvo en hospitalización aproximadamente 3 semanas y media hasta que se egresó por adecuada adaptación. Nunca se demostró afectación neurológica o de algún otro órgano o sistema. CONCLUSIONES: Los factores más importantes al considerar el riesgo para el gemelo sobreviviente son la edad gestacional a la que ocurre la muerte del otro feto, y la corionicidad. El manejo debe incluir ecografías seriadas y programadas para el crecimiento. Estudios de Doppler arterial/venoso periférico e intracardiaco y una resonancia magnética al menos 3 semanas después de la muerte fetal para buscar cambios en el cerebro del gemelo sobreviviente. A pesar de que existen casos reportados de manejo conservador, es necesario el seguimiento estricto de datos de CID maternos, así como de desprendimiento prematuro de placenta normoinserta. (provisto por Infomedic International)
BACKGROUND: Multiple gestations suggest an increased risk of perinatal mortality. Within these statistics, death of a single twin occurs in up to 6% of multiple pregnancies. The overall incidence after 20 weeks gestation (sdg) is estimated to be between 2.6% and 6.2% of all such pregnancies. Chorionicity, rather than zygosity, has been shown to influence the outcome of this complication, due to the placental angioarchitecture of the circulations in monochorionic pregnancies. Loss rates of up to 30-50% have been associated with monochorionic and monoamniotic pregnancies. If it occurs before 14 sdg, the embryo may disappear; between 14 and 20 sdg, the fetus is reduced in size and volume. And, if it occurs after 20 sdg, the fetus remains inside the uterus until the end of gestation. CLINICAL CASE: 18-year-old female, who attended an obstetric check-up with an ultrasonographic report of a biamniotic monochorionic twin pregnancy of 30.4 sdg, and death of one of the twins. After demonstrating hemodynamic stability of the surviving fetus, as well as maternal stability, it was decided to hospitalize her for close monitoring. One week later she developed preterm labor and it was decided to terminate the pregnancy urgently. A male newborn was obtained with a gestational age suggestive of 32 sdg, with respiratory distress and required hospitalization for close monitoring of the premature newborn. Mother was discharged at 48 hours, never developed disseminated intravascular coagulation (DIC) and the newborn remained in hospital for approximately 3 and a half weeks until he was discharged due to adequate adaptation. No neurologic or other organ or system involvement was ever demonstrated. CONCLUSIONS: The most important factors when considering the risk to the surviving twin are the gestational age at which the death of the other fetus occurs, and chorionicity. Management should include serial and scheduled ultrasounds for growth. Peripheral arterial/venous and intracardiac Doppler studies and MRI at least 3 weeks after fetal death to look for changes in the brain of the surviving twin. Although there are case reports of conservative management, close monitoring of maternal DIC data, as well as normoinsert placental abruption, is necessary. (provided by Infomedic International)
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BACKGROUND: Congenital heart disease poses a therapeutic challenge, specifically pulmonary valve stenosis. This has been treated for many years with invasive procedures and bioprostheses, which over time, become dysfunctional due to the accumulation of fibrous tissue and calcification. OBJECTIVE: The aim of this study is to describe the use of endovascular management in the right ventricular outflow tract, as the beginning of an ongoing effot to improve pediatric outcomes in developing countries. METHODS: Seven pediatric patients with endovascular management of the right outflow tract are presented. Three of them underwent surgical valvuloplasty with persistent pulmonary stenosis. They decided to insert a percutaneous transcatheter pulmonary valve (PPVI) with a Melody valve using the valve-in-valve technique, with 100% stenosis and no complications associated with the procedure. RESULTS: Four patients with successful percutaneous valve implantation had different congenital heart diseases. In addition, the case of a patient in whom an intentional pulmonary valve fracture was performed, an innovative procedure in pediatric endovascular management in the country, is highlighted. CONCLUSIONS: The procedure was minimally invasive, safe, and effective. The IVPP technique could be a viable option in our country for managing failed primary valve implantations or even in native tracts.
ANTECEDENTES: Las cardiopatías congénitas plantean un desafío terapéutico, específicamente la estenosis de la válvula pulmonar. Esta ha sido tratada durante muchos años con procedimientos invasivos e inserción de bioprótesis, que con el tiempo se vuelven disfuncionales y pueden reestenosarse por acumulación de tejido fibroso y calcificación. Debido a las complicaciones generadas por la injuria quirúrgica, se han descrito medidas menos invasivas para el manejo de la estenosis residual e inicial por medios endovasculares en adultos y más recientemente en población pediátrica. OBJETIVO: El objetivo de este reporte es describir la misma en el manejo endovascular del tracto de salida del ventrículo derecho, como el inicio de un trabajo continuo para la mejoría de los resultados pediátricos en países en vía de desarrollo. MÉTODOS: Se presentan siete casos pediátricos de manejo endovascular del tracto de salida derecho; tres de ellos sometidos a valvuloplastia quirúrgica con persistencia de la estenosis pulmonar, por lo cual se decidió inserción percutánea de una válvula pulmonar (IVPP) transcatéter con válvula Melody utilizando la técnica valve-in-valve, con lo que se consiguió una resolución del 100% de la estenosis y no se presentó ningún tipo de complicación asociada al procedimiento. RESULTADOS: En cuatro pacientes se logró una implantación exitosa de la válvula por vía percutánea en diferentes cardiopatías congénitas, siendo uno de ellos en tracto nativo; además, destaca el caso de un paciente en quien se realizó fractura intencional de la válvula pulmonar, procedimiento innovador en el manejo endovascular pediátrico en Colombia. CONCLUSIONES: En estos pacientes el procedimiento resultó ser poco invasivo, seguro y efectivo. La técnica IVPP podría ser considerada una opción viable en Colombia (y en otros países en desarrollo) para el manejo de implantes valvulares primarios fallidos o incluso en tractos nativos.
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Cardiopatias Congênitas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Estenose da Valva Pulmonar , Valva Pulmonar , Humanos , Criança , Implante de Prótese de Valva Cardíaca/métodos , Colômbia , Resultado do Tratamento , Cateterismo Cardíaco/métodos , Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Cardiopatias Congênitas/cirurgia , Desenho de PróteseRESUMO
Resumen Antecedentes: Las cardiopatías congénitas plantean un desafío terapéutico, específicamente la estenosis de la válvula pulmonar. Esta ha sido tratada durante muchos años con procedimientos invasivos e inserción de bioprótesis, que con el tiempo se vuelven disfuncionales y pueden reestenosarse por acumulación de tejido fibroso y calcificación. Debido a las complicaciones generadas por la injuria quirúrgica, se han descrito medidas menos invasivas para el manejo de la estenosis residual e inicial por medios endovasculares en adultos y más recientemente en población pediátrica. Objetivo: El objetivo de este reporte es describir la misma en el manejo endovascular del tracto de salida del ventrículo derecho, como el inicio de un trabajo continuo para la mejoría de los resultados pediátricos en países en vía de desarrollo. Métodos: Se presentan siete casos pediátricos de manejo endovascular del tracto de salida derecho; tres de ellos sometidos a valvuloplastia quirúrgica con persistencia de la estenosis pulmonar, por lo cual se decidió inserción percutánea de una válvula pulmonar (IVPP) transcatéter con válvula Melody utilizando la técnica valve-in-valve, con lo que se consiguió una resolución del 100% de la estenosis y no se presentó ningún tipo de complicación asociada al procedimiento. Resultados: En cuatro pacientes se logró una implantación exitosa de la válvula por vía percutánea en diferentes cardiopatías congénitas, siendo uno de ellos en tracto nativo; además, destaca el caso de un paciente en quien se realizó fractura intencional de la válvula pulmonar, procedimiento innovador en el manejo endovascular pediátrico en Colombia. Conclusiones: En estos pacientes el procedimiento resultó ser poco invasivo, seguro y efectivo. La técnica IVPP podría ser considerada una opción viable en Colombia (y en otros países en desarrollo) para el manejo de implantes valvulares primarios fallidos o incluso en tractos nativos.
Abstract Background: Congenital heart disease poses a therapeutic challenge, specifically pulmonary valve stenosis. This has been treated for many years with invasive procedures and bioprostheses, which over time, become dysfunctional due to the accumulation of fibrous tissue and calcification. Objective: The aim of this study is to describe the use of endovascular management in the right ventricular outflow tract, as the beginning of an ongoing effot to improve pediatric outcomes in developing countries. Methods: Seven pediatric patients with endovascular management of the right outflow tract are presented. Three of them underwent surgical valvuloplasty with persistent pulmonary stenosis. They decided to insert a percutaneous transcatheter pulmonary valve (PPVI) with a Melody valve using the valve-in-valve technique, with 100% stenosis and no complications associated with the procedure. Results: Four patients with successful percutaneous valve implantation had different congenital heart diseases. In addition, the case of a patient in whom an intentional pulmonary valve fracture was performed, an innovative procedure in pediatric endovascular management in the country, is highlighted. Conclusions: The procedure was minimally invasive, safe, and effective. The IVPP technique could be a viable option in our country for managing failed primary valve implantations or even in native tracts.
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La vacuna contra el SARS-CoV-2 ha demostrado eficacia comprobada para el control de la enfermedad, sin embargo, aún se encuentra en estudio los efectos adversos no comunes debido a esta terapia, algunos de tipo renal. Se plantea que una respuesta inmunológica no adecuada podría ser la causa de enfermedades glomerulares asociada a la vacunación. Se reporta el caso de una paciente de 26 años, sin antecedentes de importancia, recibió la inmunidad por la vacuna de SARS-CoV-2 (Sinopharm), posterior a ello inició con proteinuria en rango nefrótico (proteinuria: 24gr en 24 horas), además tuvo albúmina de 2,36 mg/dL y tuvo prueba COVID-19 negativo. Se le realizó biopsia renal con guía ecográfica, con resultado anatomo-patológico de glomeruloesclerosis focal y segmentaria, variante de punta, observándose 17 glomérulos. La paciente fue hospitalizada y recibió inmunosupresión con pulsos de metilprednisolona, prednisona vía oral (1mg/kg/día), atorvastatina (20mg/día), antiagregación plaquetaria con AAS (100mg/día), omeprazol (20mg/día) y profilaxis con trimetoprima-sulfametoxazol. Dos semanas después, la paciente, tuvo una baja de peso (10 kg) y los edemas disminuyeron notoriamente. Cuatro semanas de iniciar el tratamiento, presentó proteinuria < 500 mg/ día, la cual al momento se encuentra en valores normales. Es posible el desarrollo de una glomeruloesclerosis focal y segmentaria de novo, tras la administración de la vacuna contra el SARS-CoV-2, y que respondió al uso de corticoides.
The vaccine against SARS-CoV-2 has demonstrated proven efficacy to control the disease, rare adverse effects due to this therapy are still being studied, some of them renal. It is suggested that an inadequate immune response could be the cause of glomerular diseases associated with vaccination. We describe a 26-year-old patient, with no significant history, received immunity from the SARS-CoV-2 vaccine (Sinopharm), after which he began with proteinuria in the nephrotic range. Proteinuria: 24g in 24 hours. Albumin: 2.36 mg/ dl. COVID-19 test negative. Renal biopsy was performed with ultrasound guidance, with anatomopathological result of Focal and Segmental Glomerulosclerosis, tip variant, observing 17 glomeruli. The patient was hospitalized and received immunosuppression with pulses of methylprednisolone, oral prednisone 1mg/ kg/day, atorvastatin 20mg/day, antiplatelet therapy with ASA 100mg/day, omeprazole 20mg/day, and trimethoprim-sulfamethoxazole prophylaxis. Two weeks later, the patient had a weight loss (10 kg), the edemas decreased significantly. Four weeks after starting treatment, she presented proteinuria <500 mg/day, which at the moment is within normal values. The development of de Novo focal segmental glomerulosclerosis is possible, after administration of the SARS-CoV-2 vaccine, and that responds to the use of corticosteroids.
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La neuropatía diabética se presenta hasta en el 60 % de los pacientes diabéticos. La neuropatía diabética periférica es la causa más común de neuropatía en el mundo. La fisiopatología de la neuropatía diabética involucra daño periférico nervioso por acumulación de productos tóxicos derivados de la hiperglicemia. El sistema nervioso central se ve posteriormente involucrado a través de sensibilización, disminución de la función del sistema inhibitorio y aumento en la excitabilidad del sistema de facilitación. La clínica más común se manifiesta de manera simétrica afectando fibras sensitivas pequeñas y grandes, aunque se han encontrado formas atípicas de presentación. Las pruebas diagnósticas confirmatorias se reservan para la duda diagnóstica, casos de síntomas atípicos o investigación. El consenso en cuanto a tratamiento es el uso de gabapentinoides, antidepresivos tricíclicos e inhibidores de recaptura de serotonina y noradrenalina. Estas tres familias se consideran como primera línea de tratamiento.
Diabetic neuropathy occurs in up to 60% of diabetic patients. Diabetic peripheral neuropathy is the most common cause of neuropathy in the world. The pathophysiology of diabetic neuropathy involves peripheral nerve damage due to the accumulation of toxic products derived from hyperglycemia. The central nervous system is subsequently involved through sensitization, decreased function of the inhibitory system, and increased excitability of the facilitative system. The most common symptoms manifest symmetrically, affecting small and large sensory fibers, although atypical forms of presentation have been found. Confirmatory diagnostic tests are reserved for diagnostic doubt, atypical symptoms, or research. The consensus regarding treatment is the prescription of gabapentinoids, tricyclic antidepressants, and serotonin and norepinephrine reuptake inhibitors. These three families are considered the first line.
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Purpose: Primary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities. Methods: We analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox's regression, stratified by city and year of diagnosis. Results: During the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7-11.8), 6.4 (95% CI, 4.2-9.8), 2.8 (95% 2.1-3.8), 2.0 (95% CI, 1.3-2.8) and 2.3 (95% CI, 1.7-3.0), respectively. Conclusion: We found that half of Colombia's children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.
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Objetivo: conociendo la frecuencia de pacientes infectados con SARS-CoV-2 sometidos a apendicectomía de urgencia en el Hospital Obrero N°1 en la gestión 2020, el presente estudio busca describir las complicaciones relacionadas a la morbimortalidad postoperatoria en estos pacientes; siendo éstas un reflejo de la repercusión de esta infección en la práctica quirúrgica. Material y métodos: el estudio es descriptivo transversal. Se utilizó la revisión documental como técnica para la recolección de información. Tras revisar la estadística quirúrgica anual se identifican pacientes infectados con SARS-CoV-2 sometidos a apendicectomía urgente, se revisan sus expedientes clínicos digitales recolectando información perioperatoria con énfasis en el postoperatorio. Resultados: 1847 cirugías realizadas en 2020, 18 apendicectomías de urgencia en pacientes infectados con SARS-CoV-2. La mayoría de pacientes se encontraba entre 21 y 40 años, el género masculino fue el más frecuente. 39% de los casos presentaron apendicitis aguda gangrenada y otro 39% apendicitis perforada. 11% presentó peritonitis generalizada. La morbilidad postoperatoria corresponde a 6 pacientes que presentan complicaciones: 5 casos de seroma de herida operatoria, 2 casos de íleo paralítico transitorio, 1 caso de íleo paralítico prolongado y 1 solo caso de neumonía atípica por SARS-CoV-2. No se identificaron casos de mortalidad postoperatoria. Conclusiones: descritas la morbilidad y la ausencia de mortalidad postoperatorias en los pacientes infectados con SARS-CoV-2 que fueron sometidos a apendicetomía de urgencia, se observa que las conductas y prácticas adoptadas, acompañadas de las medidas de seguridad pertinentes fueron seguras para esta población
Objective: knowing the frequency of patients infected with SARS-CoV-2 who underwent emergency appendectomy at Obrero Hospital N°1 in the 2020, this study seeks to describe the complications related to postoperative morbidity and mortality in these patients; these being a reflection of the repercussion of this infection in surgical practice. Material and methods: the study is descriptive crosssectional. Documentary review was used as a technique for collecting information. After reviewing the annual surgical statistics, patients infected with SARS-CoV-2 undergoing emergency appendectomy are identified, their digital clinical records are reviewed, collecting perioperative information with emphasis on the postoperative period. Results: 1847 surgeries performed in 2020, 18 emergency appendectomies in patients infected with SARSCoV-2. Most of the patients were between 21 and 40 years old, the male gender was the most frequent. 39% of the cases presented acute gangrenous appendicitis and another 39% perforated appendicitis. 11% presented generalized peritonitis. Postoperative morbidity corresponds to 6 patients presenting complications: 5 cases of surgical wound seroma, 2 cases of transient paralytic ileus, 1 case of prolonged paralytic ileus, and only 1 case of atypical pneumonia due to SARS-CoV-2. No cases of postoperative mortality were identified. Conclusions: after describing the postoperative morbidity and absence of mortality in patients infected with SARS-CoV-2 who underwent emergency appendectomy, it is observed that the behaviors and practices adopted, accompanied by the relevant security measures, were safe for this population
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Background: Stomach cancer is among the most frequent, is a leading cause of mortality in low- and middle-income countries. Assessing its survival is important to guide evidence-based health policies. Aims: To estimate stomach cancer survival in Colombia (2014-2019) with data from the National Cancer Information System (NCIS) and in Cali with data from the Cali Population Cancer Registry (RPCC) (1998-2017). Methods: NCIS estimated the overall 3-year net survival for 8,549 people, while RPCC estimated 5-year net survival for 6,776 people. Results: The 3-year net survival was 36.8% (95% CI: 35.5-38.1). Net survival was higher in people with special insurance (61.7%; 95% CI: 44.8-74.8) or third payer (40.5%; 95% CI: 38.7-42.3) than state insurance (30.7%; 95% CI: 28.7-32.8). It was also higher in women and people diagnosed at early stages. Multivariable analysis showed consistency with survival estimations with a higher risk of death in men, people with state insurance, and diagnosed at advanced stages. In Cali, the 5-year net survival remained stable in men during the last 20 years. In women the 5-year net survival in women increased 8.60 percentage points, equivalent to a 50% increase compared to the 1998-2002 period. For 2013-17, it was 19.1% (95%CI: 16.2-22.2) in men, and 24.8% (95% CI: 20.4-29.3) in women. Conclusions: Population survival estimates from the RPCC were lower than those observed in the NCIS. The differences in their methods and scope can explain variability. Nevertheless, our findings could be complementary to improve cancer control planning in the country.
Antecedentes: El cáncer de estómago se encuentra entre los más frecuentes y es una de las principales causas de mortalidad en los países de ingresos bajos y medianos. Evaluar su supervivencia es importante para orientar las políticas de salud basadas en la evidencia. Objetivos: Estimar la supervivencia del cáncer de estómago en Colombia (2014-2019) con datos del Sistema Nacional de Información del Cáncer (NCIS) y en Cali con datos del Registro Poblacional de Cáncer de Cali (RPCC) (1998-2017). Métodos: El NCIS estimó la supervivencia neta a tres años para 8,549 personas y el RPCC la calculó a 5 años para 6,776 personas registradas en sus bases de datos. Resultados: La supervivencia neta a tres años en Colombia fue del 36.8% (IC 95%: 35.5-38.1). La supervivencia neta fue mayor en personas con seguro especial (61.7%; IC 95%: 44.8-74.8) o tercer pagador (40.5%; IC 95%: 38.7-42.3) que el seguro estatal (30.7%; IC 95%: 28.7-32.8). También fue mayor en mujeres y personas diagnosticadas en etapas tempranas. El análisis multivariable mostró consistencia con la estimación de supervivencia con mayor riesgo de muerte en hombres, personas con seguro estatal y diagnosticados en estadios avanzados. En Cali, la supervivencia neta a 5 años se mantuvo estable en los hombres durante los últimos 20 años. En las mujeres aumentó 8.60 puntos porcentuales, equivalente a un aumento del 50% en comparación con el período 1998-2002. Para el período 2013-17 fue 19.1% (IC 95%: 16.2-22.2) en los hombres y 24.8% (IC 95%: 20.4-29.3) en las mujeres. Conclusiones: Las estimaciones de supervivencia del RPCC fueron más bajas que las obtenidas por el NCIS. Las diferencias en sus métodos y alcance pueden explicar la variabilidad. Sin embargo, nuestros hallazgos pueden ser complementarios para mejorar la planificación del control del cáncer en el país..
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Objetivo. Describir la prevalencia de la anemia entre pacientes con tratamiento de hemodiálisis crónica en una población de altura (3200 m s. n. m.), en el Departamento de Junín (Perú). Métodos. Estudio observacional, retrospectivo. Se tomaron los datos del Registro Nacional de Diálisis (RENDES, 2021) en el Departamento de Junín (Perú) y de las historias clínicas de los pacientes de hemodiálisis del Seguro Social EsSalud del año 2021. La población muestral estuvo compuesta por todos los pacientes que constituían el Programa de Hemodiálisis Crónica de la Región Junín. Se analizaron los datos descriptivos en Stata, versión 17.0. Resultados. La prevalencia de anemia fue del 3,9 %. Solo 5 pacientes presentaron anemia asociada a la enfermedad renal crónica (ERC) (3,9 %). Fueron recolectados datos de 128 pacientes. 64,8 % (n = 83) eran de sexo masculino. La principal causa de la ERC fue la hipertensión arterial (HTA) (37,5 %), luego la diabetes mellitus tipo 2 (24,2 %). El promedio de hemoglobina fue 12,8 ± 2,38 g/dL. El promedio de volumen corpuscular medio (VCM) fue 95,42 ± 4,9 fl, hemoglobina corpuscular media (HCM) 32,13 ± 1,9 pc, y la concentración de hemoglobina corpuscular media (CHCM) promedio fue 33 ± 1,15 gr/dL. El nivel de hierro sérico promedio fue 100 micromol/L y el nivel de ferritina en promedio fueron de 1300 ng / ml. Los pacientes utilizaban en promedio 23000 UI de eritropoyetina (EPO) mensual, 400 mg de hierro mensual y 4 mg de hidroxocobalamina mensual. Conclusiones. Las tasas de anemia en pacientes con tratamiento de hemodiálisis crónica en Huancayo, Junín, en una ciudad de altura, son bajas (3,9 %).
Objective. To describe the prevalence of anemia among patients undergoing chronic hemodialysis treatment in an altitude population (3200 m a.s.l.) in the Department of Junín (Peru). Methods. Observational, retrospective study. Data were taken from the National Dialysis Registry (RENDES, 2021) in the Department of Junín (Peru) and from the medical records of hemodialysis patients of the EsSalud Social Security in the year 2021. The sample population consisted of all patients who constituted the Chronic Hemodialysis Program of the Junín Region. Descriptive data were analyzed in Stata, version 17.0. Results. The prevalence of anemia was 3.9%. Only 5 patients had anemia associated with chronic kidney disease (CKD) (3.9%). Data were collected from 128 patients. 64.8% (n = 83) were male. The main cause of CKD was arterial hypertension (AHT) (37.5%), then type 2 diabetes mellitus (24.2%). The mean hemoglobin was 12.8 ± 2.38 g/dL. Mean mean corpuscular volume (MCV) was 95.42 ± 4.9 fl, mean corpuscular hemoglobin (MCH) 32.13± 1.9 pc, and mean corpuscular hemoglobin concentration (MCHC) mean was 33 ± 1.15 g/dL. The average serum iron level was 100 micromol/L and the average ferritin level was 1300 ng/ml. Patients used on average 23000 IU of erythropoietin (EPO) monthly, 400 mg of iron monthly and 4 mg of hydroxocobalamin monthly. Conclusions. Anemia rates in patients with chronic hemodialysis treatment in Huancayo, Junín, in a high altitude city, are low (3.9%).
Objetivo. Descrever a prevalência de anemia entre pacientes submetidos a tratamento de hemodiálise crônica em uma população de alta altitude (3200 m.a.s.l., no Departamento de Junín (Peru). Métodos. Estudo observacional, retrospectivo. Os dados foram retirados do Registro Nacional de Diálise (RENDES, 2021) no Departamento de Junín (Peru) e dos registros médicos dos pacientes de hemodiálise da Previdência Social EsSalud em 2021. A população da amostra consistia de todos os pacientes do programa de hemodiálise crônica na Região de Junín. Os dados descritivos foram analisados em Stata, versão 17.0. Resultados. A prevalência da anemia foi de 3,9%. Apenas 5 pacientes tinham anemia associada à doença renal crônica (CKD) (3,9 %). Foram coletados dados de 128 pacientes. 64,8 % (n=83) eram homens. A principal causa do CKD foi hipertensão arterial (AHT) (37,5%), depois diabetes mellitus tipo 2 (24,2%). A hemoglobina média era de 12,8 ± 2,38 g/dL. O volume corpuscular médio (VMC) foi 95,42 ± 4,9 fl, a hemoglobina corpuscular média (HGM) foi 32,13± 1,9 pc, e a concentração corpuscular média de hemoglobina (HGM) foi 33 ± 1,15 g/dL. O nível médio de ferro sérico era de 100 micromol/L e o nível médio de ferritina era de 1300 ng/ml. Pacientes utilizados em média 23000 IU mensais de eritropoietina (EPO), 400 mg mensais de ferro e 4 mg mensais de hidroxocobalamina. Conclusões. As taxas de anemia em pacientes em tratamento de hemodiálise crônica em Huancayo, Junin, em uma cidade de alta altitude, são baixas (3,9%).
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Señor editor: Existen pocos estudios sobre la prevalencia de Enfermedad Renal Crónica (ERC) y factores asociados en el Perú, Francis publicó un estudio realizado en zonas urbanas de la costa del Perú (Lima y Tumbes), además Percy Herrera realizó un estudio con datos de pacientes de la Red Rebagliati de EsSalud en Lima. Esto preocupa, ya que no existen datos actualizados a nivel de otras regiones del Perú.
Dear Editor: There are few studies on the prevalence of Chronic Kidney Disease (CKD) and associated factors in Peru, Francis published a study conducted in urban areas of the coast of Peru (Lima and Tumbes), also Percy Herrera conducted a study with data from patients of the Red Rebagliati of EsSalud in Lima. This is of concern, since there are no updated data for other regions of Peru.
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Abstract Background: Population-based cancer survival is an indicator of the effectiveness of cancer services that reflects the survival of all cancer patients in the population, regardless of socioeconomic status and disease characteristics. Aim: Provision of an up-to-date survival estimate of patients recorded within Cali Population Cancer Registry (RPCC) in 1998-2017. As a second objective, results will be compared with those reported by the CONCORD study for cancers prioritized by the current Ten-Year Cancer Control Plan of Colombia, 2012-2021. Methods: Adult cancer cases (aged 15 to 99 years) for nine cancer types diagnosed between 1998 and 2017, with follow-up to 2018, were obtained from the RPCC. The 5-year age-standardized net survival estimates (NS) were estimated using the Pohar-Perme. The results for the period 1995- 2014 were compared with those reported by the CONCORD study for the following locations: stomach (C16), breast (C50), cervix (C53), prostate (C61), and lung (C33-34). Results: Five-year survival estimates for breast and prostate cancers improved ten percentage points through 2007 (70.8 to 81.1 for breast and 79.9 to 90.2 for prostate) and remained stable during 2008-2017. For cervical cancer, survival estimates has remained stable for the last two decades at 53%. For stomach cancer and lung cancer, five-year NS was lower than 25% over the study period. For colorectal cancer, survival estimates increased from 37.9% in 1998-2002 to 54.8% in 2013-2017. Compared to previous 5-year survival estimates of cases diagnosed in 2010-2014, the estimates in this study are significantly higher than those obtained by CONCORD. Survival estimates of patients diagnosed in 1995-2009 showed no difference to CONCORD study. Conclusions: Periodic update of vital status and date of last contact reduces bias in survival estimates in population-based cancer registries with passive follow-up.
Resumen Antecedentes: La supervivencia del cáncer es un indicador de la eficacia de los servicios oncológicos que refleja la supervivencia de todos los pacientes con cáncer de la población, independientemente del nivel socioeconómico y las características de la enfermedad. Objetivo: Realizar una estimación actualizada de la supervivencia de los pacientes registrados en el Registro Poblacional de Cáncer de Cali durante 1998-2017. Como segundo objetivo, los resultados se compararán con los reportados por el estudio CONCORD para los cánceres priorizados por el actual Plan Decenal de Control del Cáncer de Colombia, 2012-2021. Métodos: Los casos de cáncer en adultos (15 a 99 años) para nueve tipos de cáncer diagnosticados entre 1998 y 2017, con seguimiento hasta 2018, se obtuvieron del RPCC. Las estimaciones de supervivencia neta (NS) estandarizada por edad a 5 años se estimaron utilizando el método de Pohar-Perme. Los resultados del periodo 1995-2014 se compararon con los obtenidas por el estudio CONCORD para las siguientes localizaciones: estómago (C16), mama (C50), cuello uterino (C53), próstata (C61) y pulmón (C33-34). Resultados: La SN-5a para los cánceres de mama y próstata mejoró diez puntos porcentuales hasta 2007 (SN=70.8 a 81.1 para mama y NS=79.9 a 90.2 para próstata) y se mantuvo estable durante 2008-2017. Para el cáncer de cuello uterino fue 53% y permaneció estable durante dos décadas. Para el cáncer de estómago y el cáncer de pulmón, la SN-5años fue inferior al 25%. Para cáncer colorrectal las estimaciones de supervivencia aumentaron de 37.9% en 1998-2002 a 54.8% en 2013-2017. En comparación con estimaciones anteriores de supervivencia a 5 años de casos diagnosticados en 2010-2014, las estimaciones de este estudio son significativamente más altas que las obtenidas por CONCORD-3. Para la década 1995-2009 no hubo diferencia. Conclusión: La actualización periódica del estado vital y la fecha de último contacto reduce el sesgo en las estimaciones de supervivencia en los registros de cáncer de base poblacional que hacen seguimiento pasivo.
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IntroducciónEl virus de Epstein-Barr (VEB) está clasificado como carcinógeno del grupo 1. Su principal vía de transmisión es la oral, a través de la saliva. Determinamos la frecuencia de detección del VEB en la cavidad oral en estudiantes de secundaria en Cali (Colombia).Materiales y métodosEstudio transversal analítico para estimar la frecuencia de detección del genoma del VEB en la cavidad oral, las razones de prevalencia y su asociación con diversos factores en 1.565 individuos. Las variables analizadas fueron factores sociodemográficos, de higiene y salud oral, comportamiento sexual, consumo de cigarrillos e ingesta de alcohol. La asociación entre la detección y las variables evaluadas se realizó mediante un modelo de regresión lineal generalizado con vínculo logarítmico y distribución de Poisson con varianza robusta.ResultadosLa exposición al VEB en la cavidad oral fue del 38,40% (IC 95%: 36,02-40,84). La frecuencia de presentar exposición al VEB fue un 22% mayor en los varones, y el riesgo se incrementó según el comportamiento sexual. Se encontró asociación inversa con el grado escolar: los participantes de undécimo grado tuvieron un 27% menos frecuencia de exposición al VEB que los de grados inferiores (sexto a octavo). Cuando se utilizó el modelo logístico para estudiar la asociación entre la detección del VEB y las variables independientes, se sobreestimó la asociación. El rango de sobreestimación fue entre el 27-47% según el tipo de variable.ConclusiónLa frecuencia de detección del VEB en la cavidad oral de estudiantes sanos fue similar a la previamente descrita. Factores asociados al comportamiento sexual incrementan el riesgo de oportunidad para la exposición al VEB.
IntroductionThe Epstein-Barr virus (EBV) is classified as a group 1 carcinogen. The main route of EBV transmission is oral, through saliva. The present study aimed to determine the frequency of EBV detection in the oral cavity in high school students in the city of Cali (Colombia).Materials and methodsAnalytical cross-sectional study in order to determine the frequency of EBV detection in the oral cavity, the reasons for its prevalence and its association with several factors, in 1,565 individuals. The variables analyzed were sociodemographic factors, oral hygiene, oral health, sexual behavior, cigarrete smoking and alcohol intake. The association between the EBV detection and the variables evaluated was done through a generalized linear regression model with logarithmic linkage and Poisson distribution with robust variance.ResultsThe percentage of exposure to EBV in the oral cavity was 38.40% (CI 95%: 36.02-40.84). The frequency of presenting EBV exposure was 22% higher in men and the risk increased according to sexual behaviour. An inverse association with the school grade was found: the eleventh-grade participants had 27% less frequency of exposure to EBV than the lower grades (sixth to eighth). When analyzing the logistic model to study the association between EBV detection and independent variables, the association was overestimated. The overestimation ranged from 27 to 47% depending on the type of variable.ConclusionsThe frequency of EBV detection in the oral cavity of healthy students was similar to that previously described. Factors associated to sexual behavior increased the risk of opportunity to be exposed to EBV.