Primary central nervous system germ cell tumors in Central America and the Caribbean Region: an AHOPCA 20-year experience.

Background: Primary central nervous system germ cell tumors (GCT) are rare neoplasms in pediatrics. Treatment depends on the histological subtype and extent of the disease. Overall survival (OS) is above 90% for germinomas and 70%-80% for nongerminomatous GCT (NGGCT) in high-income countries (HIC) while data are usually lacking for patients in Low-Middle Income country (LMIC). Objective: This study aims to describe the experience of treating patients with CNS GCT in four of eight countries, members of the Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA), and determine their 5-year OS. Design/methods: We conducted a retrospective chart review of patients treated for CNS GCT. Epidemiological and clinical characteristics, histology, treatment modalities, and outcomes were analyzed. Results: From 2001 to 2021, 48 patients were included: 22 from Guatemala, 18 from Nicaragua, three from the Dominican Republic, and five from El Salvador. Thirty-one (64.6%) were boys; the median age at diagnosis was 10.2 years (range: 1 to 17 years). Presenting symptoms were headaches (n = 24, 50%), visual disturbances (n = 17, 35.4%), vomiting (n = 12, 25%), nausea (n = 8, 16.7%), and diabetes insipidus (n = 7, 14.6%). Two patients with NGGCT presented with precocious puberty. Biopsy or tumor resection was performed in 38 cases (79.2%): 23 (88.4%) germinomas, 11 (78.6%) NGGCT, and four (50%) CNS GCT. Eight patients were diagnosed and treated based on CSF tumor marker elevation; four germinomas (BHCG 11.32-29.41 mUI/mL) and four NGGCT (BHCG 84.43-201.97 mUI/mL or positive AFP > 10 UI/mL). Tumor locations included suprasellar (n = 17, 35.4%), pineal (n = 13, 27.1%), thalamus/basal ganglia (n = 5, 10.4%), other (n = 12, 25%), and one bifocal. Four (8.3%) had metastatic disease, and six had positive CSF; staging data were incomplete in 25 patients (52%). Patients were treated with varied chemotherapy and radiotherapy modalities. Nine patients had incomplete data regarding treatment. Five-year OS was 65% (68% for germinoma, 50.6% for NGGCT, and 85.7% for unclassified GCT). Conclusions: Germinoma was the most common histology, and there was a male predominance. More than half of patients had incomplete staging data and treatment was variable across the region. OS is lower compared to HIC. Standardized treatment protocols will aid in adequate staging and treatment planning, prevent complications, and improve survival.

Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico.

Introduction: Data on medulloblastoma outcomes and experiences in low- and middle-income countries, especially in Latin America, is limited. This study examines challenges in Mexico's healthcare system, focusing on assessing outcomes for children with medulloblastoma in a tertiary care setting. Methods: A retrospective analysis was conducted, involving 284 patients treated at 21 pediatric oncology centers in Mexico. Results: High-risk patients exhibited markedly lower event-free survival than standard-risk patients (43.5% vs. 78.3%, p<0.001). Influential factors on survival included anaplastic subtype (HR 2.4, p=0.003), metastatic disease (HR 1.9, p=0.001); residual tumor >1.5cm², and lower radiotherapy doses significantly impacted event-free survival (EFS) and overall survival (OS). Platinum-based chemotherapy showed better results compared to the ICE protocol in terms of OS and EFS, which was associated with higher toxicity. Patients under 3 years old displayed notably lower OS and EFS compared to older children (36.1% vs. 55.9%, p=0.01).

[Design and implementation of a transdisciplinary care model for patients with hereditary angioedema, in a Colombian health institution]. / Diseño e implementación de un modelo de atención transdisciplinaria para pacientes con angioedema hereditario, en una institución de salud colombiana.

OBJECTIVE: Describe the design and implementation of a transdisciplinary care model for patients with hereditary angioedema in Colombia. METHODS: Descriptive longitudinal observational study. 140 patients with hereditary angioedema were included in a transdisciplinary care model for one year. Seizure rates, hospitalizations, emergency room visits, quality of life, and pharmacological adherence were measured. RESULTS: The model was associated with reductions of 76% in seizures, 66% in hospitalizations, and 87% in emergency room visits. Pharmacological adherence increased 19% and was complete after four months. The quality of life increased significantly. CONCLUSIONS: Hereditary angioedema is an orphan disease that requires a comprehensive approach for effective care.

OBJETIVO: Describir el diseño e implementación de un modelo transdisciplinario de atención para pacientes con angioedema hereditario en Colombia. MÉTODOS: Estudio observacional longitudinal descriptivo. 140 pacientes con angioedema hereditario fueron incluidos en un modelo de atención transdisciplinario por un año. Se midieron tasas de crisis, hospitalizaciones, visitas a urgencias, calidad de vida y adherencia farmacológica. RESULTADOS: El modelo se asoció con reducciones del 76% en crisis, 66% en hospitalizaciones y 87% en visitas a urgencias. La adherencia farmacológica aumentó 19% y fue completa después de cuatro meses. La calidad de vida aumentó significativamente. CONCLUSIÓN: El angioedema hereditario es una enfermedad solitaria que requiere un abordaje integral para la atención eficaz.

Alta proporción de macrodisco en pacientes de dos centros oftalmológicos en el occidente de Honduras / High proportion of macrodisc in patients from two ophthalmological centers in western Honduras

Antecedentes: Cuando el nervio óptico presenta una superficie mayor a 2.5 mm2 , y sin patologías asociadas, se trata de un macrodisco, cuya excavación es proporcional al tamaño aumentado del mismo. Con base en la distribución bajo la curva de Gauss, se define como "macrodisco" cuando está por encima de 2 desviaciones estándar arriba de la media. Se espera que solo el 2.3% de la población exceda estos límites. Objetivo: Determinar el tamaño promedio del disco óptico y proporción de macrodisco en la población sin glaucoma ni patologías retinianas que acude a dos clínicas oftalmológicas del occidente de Honduras, en el periodo de julio 2021 hasta julio 2022. Métodos: Estudio retrospectivo descriptivo. Se midieron los parámetros morfométricos del disco óptico mediante Tomografía de Coherencia Óptica ZEISS Cirrus HD Model 4000. Se definió macrodisco como: área del disco óptico >2.5 mm 2 y área del disco más 2 o más desviaciones estándar arriba de la media. Resultados: La proporción de macrodisco fue de 31% tomando en cuenta la definición de área de disco >2.5 mm2 , y 3% considerando la definición con base a la distribución bajo la curva de Gauss (>3.17mm2 ). Se obtuvo un promedio de área de disco óptico de 2.28±0.45 mm 2 , ratio copa/disco (C/D) de 0.59±0.13, ratio C/D vertical de 0.56±0.13, área de anillo neuroretiniano de 1.37±0.22 mm 2 , espesor de Capa de Fibras Nerviosas Retinianas (CFNR) de 97.4±10.664µm. Discusión: El área de disco promedio obtenido es mayor que los caucásicos, similar a lo reportado en los hispánicos, y menor que afrodescendientes y asiáticos...(AU)

The frequency of complications in a cohort of patients diagnosed with hemophilia A and hemophilia B receiving prophylactic treatment in Colombia: A retrospective noninterventional study.

INTRODUCTION: Hemophilia A and B are disorders associated with the deficit of coagulation factors VIII and IX. OBJECTIVE: Was to determine the incidence of complications in a cohort of patients diagnosed with moderate and severe hemophilia A or B under treatment in a specialized institution. METHODS: A retrospective study of a cohort of patients with replacement therapy for hemophilia A or B, evaluating treatment and complications between January/2012 and July/2019. Sociodemographic, clinical and disease management-related variables were extracted from the medical records. Time to inhibitor development and rate associated with bleeding and hospitalizations were evaluated. RESULTS: A total of 159 male patients were identified with hemophilia A (n = 140; 88.1%) and B (n = 19; 11.9%) with a mean follow-up of 5.9±2.3 years. The mean age was 23.6±16.1 years, hemophilia was reported as severe in 125 patients in hemophilia A (89.3%) and 13 patients in hemophilia B (68.4%). Primary prophylaxis was registered in 17.0% of patients, 44.7% secondary, and 38.3% tertiary, with recombinant factors (n = 84; 52.8%) followed by plasma derived factors (n = 75; 47.2%). The incidence of inhibitor development was 0.3 per 100 patients/year, with mean time to event of 509 days. The incidence of bleeding was 192 per 100 patients/year, especially at the joint (n = 99; 62.3%) and muscle (n = 25; 15.7%) level. The incidence of hospitalization was 3.7 per 100 patients/year. CONCLUSIONS: The most common complication was joint bleeding which was expected in this type of patients. Low proportion of patients developed factor inhibitors during the follow up.

Adsorption of chloroquine, propranolol, and metformin in aqueous solutions using magnetic graphene oxide nanocomposite.

The work proposes the application of a nanocomposite formed by graphene oxide and magnetite to remove chloroquine, propranolol, and metformin from water. Tests related to adsorption kinetics, equilibrium isotherms and adsorbent reuse were studied, and optimization parameters related to the initial pH of the solution and the adsorbent dosage were defined. For all pharmaceuticals, adsorption tests indicated that removal efficiency was independent of initial pH at adsorbent dosages of 0.4 g L-1 for chloroquine, 1.2 g L-1 for propranolol, and 1.6 g L-1 for metformin. Adsorption equilibrium was reached within the first few minutes, and the pseudo-second-order model represented the experimental data well. While the equilibrium data fit the Sips isotherm model at 298 K, the predicted maximum adsorption capacities for chloroquine, propranolol, and metformin were 44.01, 16.82, and 12.23 mg g-1, respectively. The magnetic nanocomposite can be reused for three consecutive cycles of adsorption-desorption for all pharmaceuticals, being a promising alternative for the removal of different classes of pharmaceuticals in water.

Infantile metastatic ependymoma with a novel molecular profile and favorable outcome to intensive chemotherapy without irradiation: Case-based review.

Ependymal tumors are the third most common brain tumor under 14 years old. Even though metastatic disease is a rare event, it affects mostly young children and carries an adverse prognosis. The factors associated with dissemination and the best treatment approach have not yet been established and there is limited published data on how to manage metastatic disease, especially in patients under 3 years of age. We provide a review of the literature on clinical characteristics and radiation-sparing treatments for metastatic ependymoma in children under 3 years of age treated. The majority (73%) of the identified cases were above 12 months old and had the PF as the primary site at diagnosis. Chemotherapy-based approaches, in different regimens, were used with radiation reserved for progression or relapse. The prognosis varied among the studies, with an average of 50%-58% overall survival. This study also describes the case of a 7-month-old boy with metastatic posterior fossa (PF) ependymoma, for whom we identified a novel SPECC1L-RAF1 gene fusion using a patient-centric comprehensive molecular profiling protocol. The patient was successfully treated with intensive induction chemotherapy followed by high-dose chemotherapy and autologous hematopoietic progenitor cell rescue (AuHSCR). Currently, the patient is in continuous remission 5 years after his diagnosis, without radiation therapy. The understanding of the available therapeutic approaches may assist physicians in their management of such patients. This report also opens the perspective of newly identified molecular alterations in metastatic ependymomas that might drive more chemo-sensitive tumors.

Factors influencing outcomes of older children with medulloblastoma over 15 years in Peru, a resource-limited setting.

BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. While survival has improved in high-income countries (HIC), the outcomes for patients in low-to-middle-income countries (LMIC) are unclear. Therefore, we sought to determine the survival of children with medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 and 2013 in Peru. METHODS: Between 1997 and 2013, data from 103 children older than 3 years with medulloblastoma were analyzed. Fourteen patients were excluded. The patients were split into two distinct cohorts, 1997-2008 and 2009-2013, corresponding with chemotherapy regimen changes. Event-free (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method, whereas prognostic factors were determined by univariate analysis (log-rank test). RESULTS: Eighty-nine patients were included; median age was 8.1 years (range: 3-13.9 years). The 5-year OS was 62% (95% CI: 53%-74%), while EFS was 57% (95% CI: 48%-69%). The variables adversely affecting survival were anaplastic histology (compared to desmoplastic; OS: HR = 3.4, p = .03), metastasis (OS: HR = 3.5, p = .01; EFS: HR = 4.3, p = .004), delay in radiation therapy of 31-60 days (compared to ≤30 days; EFS: HR = 2.1, p = .04), and treatment 2009-2013 cohort (OS: HR = 2.2, p = .02; EFS: HR = 2.0, p = .03). CONCLUSIONS: Outcomes for medulloblastoma at INEN were low compared with HIC. Anaplastic subtype, metastasis at diagnosis, delay in radiation therapy, and treatment in the period 2009-2013 negatively affected the outcomes in our study. Multidisciplinary teamwork, timely delivery of treatment, and partnerships with loco-regional groups and colleagues in HIC is likely beneficial.

Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil.

BACKGROUND: Medulloblastoma (MB),the most common malignant brain tumor of childhood has survival outcomes exceeding 80% for standard-risk and 60% for high-risk patients in high-income countries (HICs). These results have not been replicated in low- and middle-income countries (LMICs), where 80% of children with cancer live. METHODS: This is a retrospective review of 114 children aged 3-18 years diagnosed with MB from 1997 to 2016 at National Cancer Institute (INCA). Sociodemographic, clinical, and treatment data were extracted from the medical records and summarized descriptively. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. RESULTS: The male-to-female ratio was 1.32 and the median age at diagnosis was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most common presenting symptoms. Five-year OS was 59.1% and PFS was 58.4%. The OS for standard-risk and high-risk patients was 69% and 53%, respectively. The median time to diagnosis interval was 50.5 days and the median time from surgery to radiation therapy initiation was 50.4 days. Patients who lived >40 km from INCA fared better (OS = 68.2% vs. 51.1%, p = .032). Almost 20% of families lived below the Brazilian minimum wage. Forty-five patients (35%) had metastatic disease at admission. Gross total resection was achieved in 57% of the patitents. CONCLUSIONS: Although there are considerable barriers to deliver effective MB treatment in countries like Brazil, the OS seen in the present study demonstrates that good outcomes are not only feasible but can and should be increased with appropriate interventions.

Desafíos de la terapia ocupacional en salud mental: reflexiones desde una experiencia de docencia / Desafios da terapia ocupacional em saúde mental: reflexões a partir de uma experiência docente / Challenges for occupational therapy in mental health: an approach from the teaching experience

Resumen Reflexionar la terapia ocupacional en salud mental desde la práctica docente, con enfoque cualitativo y crítico permite identificar desafíos profesionales en los contextos habituales de las personas y colectivos. Priorizar el contexto clínico para la atención ha condicionado la integralidad y continuidad de los procesos. La terapia ocupacional en salud mental debe transitar además por los contextos habituales, en los que las personas participan en ocupaciones. Este artículo presenta las reflexiones hechas, en torno a los desafíos de la terapia ocupacional en la atención integral en salud mental, desde la práctica docente. Dichas reflexiones parten del uso de técnicas cualitativas de análisis empleadas por las docentes del área psicosocial entre 2013 y 2020, entre las cuales se incluye la revisión y el análisis documental del marco normativo y conceptual, diarios de campo, documentos de sistematización de experiencias, observación participante y espacios académicos de discusión. Se observa que la terapia ocupacional en salud mental en Colombia, se ha estructurado principalmente en contextos clínicos, con enfoque resolutivo que frecuentemente da respuesta a necesidades individuales relacionadas con sintomatología asociada a los trastornos prevalentes; esta institucionalización de las prácticas limita la continuidad de los procesos. Es necesario realizar una aproximación a reflexiones que se vienen dando, en las que se reconoce al terapeuta ocupacional como el profesional que promueve el análisis, la interacción entre sistemas, contextos, personas, poblaciones y ocupaciones; perspectiva que permitiría responder a planteamientos actuales de política; de atención integral e inclusión social. La profesión debe contemplar el abordaje de necesidades ocupacionales subjetivas en los contextos habituales, redimensionando el uso de la ocupación como herramienta para la autonomía e inclusión social.

Resumo Refletir a terapia ocupacional em saúde mental desde a prática docente, com enfoque qualitativo e crítico, permite identificar desafios profissionais nos contextos habituais das pessoas e coletivos. Priorizar o contexto clínico para o atendimento condicionou a integralidade e continuidade dos processos. A terapia ocupacional em saúde mental deve transitar também pelos contextos habituais, nos quais as pessoas participam de ocupações. Este artigo aborda reflexões desde a prática docente sobre os desafios da terapia ocupacional na atenção integral em saúde mental. Essas reflexões são baseadas no uso de técnicas de análise qualitativa utilizadas por docentes da área psicossocial, entre 2013 e 2020, entre os quais se inclui a revisão e análise documental do marco normativo e conceitual, diários de campo, documentos de sistematização de experiências, observação participante em espaços acadêmicos de discussão. Observa-se que a terapia ocupacional em saúde mental na Colômbia tem sido estruturada principalmente em contextos clínicos, com enfoque resolutivo. Frequentemente dá resposta a necessidades individuais relacionadas com a sintomatologia associada aos transtornos prevalentes; esta institucionalização das práticas limita a continuidade dos processos. É necessário realizar uma aproximação a reflexões que vêm se dando, nas quais se reconhece o terapeuta ocupacional como o profissional que promove a análise, a interação entre sistemas, contextos, pessoas, populações e ocupações; perspectiva que permitiria responder a abordagens atuais de política de atenção integral e inclusão social. A profissão deve contemplar a abordagem de necessidades ocupacionais subjetivas nos contextos habituais, redimensionando o uso da ocupação como ferramenta para a autonomia e inclusão social.

Abstract Reflecting on occupational therapy in mental health from an academic practice while utilizing a critical qualitative approach allows one to identify professional challenges in the daily live contexts of individuals and groups. Prioritizing the clinical context to care has conditioned integral and continuous processes. Occupational therapy in mental health must also transit the daily contexts in which people participate in occupations. This article reflects on occupational therapy challenges in mental health care from academic practice. These reflections are based on the use of qualitative analysis techniques used by two educators in the psychosocial area between 2013 and 2020, among which are included the documentary revision and analysis of the normative and conceptual framework, field journal, documents of systematization of experiences, participant observation and academic spaces for discussion. It allows us to observe that occupational therapy in mental health in Colombia has been structured mainly in clinical contexts, with a resolutive approach. It frequently responds to individual needs related to symptoms associated with prevalent disorders; this institutionalization of the practices limits the continuity of the processes. It is necessary to recognize the current reflections in which occupational therapists are valued professionals who promote the analysis and interaction between systems, contexts, people, populations, and occupations. This dynamic would allow responding to current policy approaches, comprehensive care, and social inclusion. The profession must contemplate subjective occupational needs in daily life contexts, making use of occupation as a tool for autonomy and social inclusion.

Comprensiones de lo comunitario en Terapia Ocupacional: aproximaciones desde la Revista Ocupación Humana, 1996- 2021 / Understandings of community in Occupational Therapy: approaches from the perspective of the Revista Ocupación Humana, 1996 to 2021 / Entendimentos do comunitário na Terapia Ocupacional: abordagens a partir da Revista Ocupación Humana, 1996-2021

Este artículo identifica y analiza el camino recorrido en las maneras de concebir lo comunitario en las publicaciones de la Revista Ocupación Humana, entre los años 1996 y 2021. Como metodología, se realizó una revisión documental de los artículos publicados en esta revista y disponibles en línea, guiada por la presencia de las palabras comunidad, comunitario y participación comunitaria, en español, en los títulos, resúmenes y palabras clave. El corpus documental quedó conformado por 13 artículos. De la revisión documental emergieron dos formas de entender lo comunitario: la primera, como un grupo poblacional a intervenir, y la segunda, en clave relacional. Este artículo aporta a la comprensión de lo comunitario en Terapia Ocupacional y contribuye a los análisis situados y críticos locales.

This article identifies and analyzes how 'community' has been conceived in the publications of the Revista Ocupación Humana between 1996 and 2021. The employed methodology consisted of a documentary review of digital publications guided by the terms community, communitarian, and community participation, in Spanish. These were identified in the titles, abstracts, and keywords. The documentary corpus was made up of 13 articles. As a result of the documentary review, two ways of understanding the community emerged: the first linked to an understanding of 'community' as a population group to intervene, and the second of 'community' as a relational form. This article contributes to the understanding of the community in occupational therapy and local situated and critical analyses.

Este artigo identifica e analisa o caminho percorrido nas formas de conceber o comunitário nas publicações da Revista Ocupación Humana, entre os anos de 1996 e 2021. Como metodologia, foi realizada uma revisão documental dos artigos publicados nesta revista e disponíveis online. A exploração foi orientada pela presença das palavras "comunidade", "comunitário" e "participação da comunidade" nos títulos, resumos e palavras-chave. O corpus documental ficou composto em 13 artigos. Duas formas de compreensão do comunitário emergiram desta revisão: a primeira é entendida como um grupo populacional para intervenção, e a segunda, como uma chave relacional. Este artigo contribui para a compreensão do comunitário em Terapia Ocupacional e também para as análises situadas e as críticas locais.

Validated quantitative needs assessment differences in the management of children with central nervous system cancer between Brazil, an upper middle-income country, and the United States of America, a high income country.

BACKGROUND: Pediatric cancer cure rates differ among high-income countries (HIC) and upper middle-income countries (UMIC). We have compared individual capacities of two major referral pediatric centers from a HIC and an UMIC caring for children with central nervous system (CNS) cancer. METHODS: A quantitative needs assessment questionnaire and key informant interviews, distributed in March of 2017, were used to evaluate the treatment of children with CNS cancer at Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) children's cancer center in São Paulo, Brazil and Nationwide Children's Hospital (NCH) in Columbus, Ohio, United States of America (USA). RESULTS: Both hospitals had 24-hour pediatric oncology, nursing and intensivist coverage. Supportive care available at both institutions included social workers, psychologists, child life specialists, and physical/occupational/speech therapists. Differences included two part-time neuroradiologists and one pathologist specializing in neuropathology at IOP/GRAACC/UNIFESP, whereas eight full-time neuroradiologists and two neuropathologists at NCH/OSU. There were four pediatric neurosurgeons on staff at each hospital; however, there were only 2 operative days per week at IOP/GRAACC/UNIFESP, compared with 7 days at NCH/OSU. Additionally, time to initiation of radiation therapy at IOP/GRAACC/UNIFESP extended 2-4 weeks compared with less than 1 week at NCH/OSU. CONCLUSIONS: Center-specific differences in resources exist in highly specialized hospitals caring for children with CNS cancer in HIC and UMIC. This quantitative needs assessment may facilitate the development of targeted strategies for effective interventions to improve on the management of children with CNS cancers.

Evaluation of the Pediatric Neuro-Oncology Resources Available in Chile.

PURPOSE: Pediatric neuro-oncology resources are mostly unknown in Chile. We report the human and material resources available in Chilean hospitals providing pediatric neuro-oncology services. METHODS: A cross-sectional survey was distributed to 17 hospitals providing pediatric neuro-oncology services (Programa Infantil Nacional de Drogas Antineoplásicas [PINDA] hospitals, 11; private, 6). RESULTS: Response rate was 71% (PINDA, 8; private, 4). Pediatric neuro-oncology services were mainly provided within general hospitals (67%). Registries for pediatric CNS tumors and chemotherapy-related toxicities were available in 100% and 67% of hospitals, respectively. CNS tumors were treated by pediatric oncologists in 92% of hospitals; none were formally trained in neuro-oncology. The most used treatment protocols were the national PINDA protocols. All WHO essential medicines for childhood cancer were available in more than 80% of the hospitals except for gemcitabine, oxaliplatin, paclitaxel, and procarbazine. The median number of pediatric neurosurgeons per hospital was two (range, 2-6). General neuroradiologists were available in 83% of the centers. Pathology specimens were sent to neuropathologists (58%), adult pathologists (25%), and pediatric pathologists (17%). Intensity-modulated radiotherapy, conformal radiotherapy, and cobalt radiotherapy were used by 67%, 58%, and 42% of hospitals, respectively. Only one private hospital performed autologous hematopoietic cell transplant for children with CNS tumors. CONCLUSION: A wide range of up-to-date treatment modalities are available for children with CNS tumors. Our survey highlights future directions to improve the pediatric neuro-oncology services available in Chile such as the expansion of multidisciplinary clinics, palliative care services, long-term cancer survivorship programs, dedicated clinical research support teams, establishing standardized mechanism for sending pathologic specimen for second opinion to international specialized centers, and establishing specialized neuro-oncology training program.

Fibroma condromixoide en el iliaco. Reporte de caso / Chondromyxoid fibroma in the iliac. Case report

Se trata de un paciente masculino de 31 años con diagnóstico de fibroma condromixoide del ilíaco derecho manejado en el Hospital Universitario San Ignacio en febrero del 2018. El paciente fue llevado inicialmente a biopsia abierta para confirmación histológica, posteriormente fue llevado a embolización preoperatoria, manejo intralesional con curetaje, fresado extendido, manejo adyuvante local y aplicación de cemento óseo. Se realiza seguimiento postoperatorio por 18 meses sin evidencia clínica ni radiográfica de recidiva tumoral. El objetivo de este trabajo es hacer una revisión de la literatura sobre el fibroma condromixoide con énfasis en su localización pélvica y su tratamiento.

We report a case of a 31-year-old male patient with diagnosis of chondromyxoid fibroma (CMF) of the iliac bone diagnosed at Hospital Universitario San Ignacio in february 2018; an open biopsy allowed recognizement and description of cytologic features, forward diagnosis and treatment with combination of pre-operative embolization, local and extended curettage, local adyuvance and bone cement as described. At 18 months follow-up have found the patient remains without clinical or radiologic recurrence of CMF. We made a review of literature on chondromixoid fibroma emphasizing on pelvic bones compromise regarding diagnosis and management options.

Factors Involved in the Development of Inhibitory Antibodies in Patients with Hemophilia in Colombia: A Case-Control Study.

BACKGROUND: The appearance of inhibitory antibodies against antihemophilic factors is one of the most serious complications related to hemophilia. OBJECTIVE: The objective of this study was to identify variables and factors related to the development of inhibitory antibodies in a group of patients undergoing antihemophilic therapy in Colombia. METHODS: A case-control study in patients with hemophilia treated in Specialized Healthcare Provider Institutions (IPS-E) in 21 cities of Colombia of any age and with a diagnosis of inhibitory antibodies against factor VIII or IX during 2016. Four controls per case paired by age and type of hemophilia were used. Sociodemographic, clinical, and pharmacological variables were identified and analyzed. RESULTS: Seventeen patients with inhibitory antibodies and 68 controls with hemophilia were identified. The mean age was 28.3 ± 17.8 years. A total of 94.1% had hemophilia A, and 88.2% of the cases and 50.0% of the controls had severe hemophilia; 47.1% of the cases and 54.4% of the controls were receiving prophylaxis with coagulation factors. Multivariate analysis showed that having severe hemophilia (OR:17.0, 95%CI:1.32-219.60) and lack of knowledge of the coagulation factor with which the patient was treated before entering the care program in the IPS-E (OR:8.9, 95%CI:1.82-43.75) were significantly associated with a higher probability of developing inhibitory antibodies. CONCLUSION AND RELEVANCE: Coagulation factors associated with the development of inhibitory antibodies were severe hemophilia and lack of knowledge of the type of factor used prior to entering the follow-up cohort.

Desafíos y acciones de Terapia Ocupacional en salud mental. Tiempos de pandemia y transformación / Challenges and actions of Occupational Therapy in mental health. Times of pandemic and transformation

Aproximarnos a comprender la salud mental en la complejidad de una pandemia reafirma la necesidad de reconocerla como un conjunto de relaciones humanas y dinámicas sociales vinculadas a la garantía de los derechos fundamentales, al trabajo digno, a la justicia social, al acceso a servicios ciudadanos, al cuidado y el co-cuidado de la vida como práctica y visión personal y colectiva y, por supuesto, a las necesidades y sufrimientos subjetivos. Hay que estimular el debate de la salud y la salud mental a partir de distintas perspectivas y actores para recrear y buscar alternativas que realmente apunten a la complejidad de las necesidades percibidas por las personas y las sociedades.

Carga de enfermedad atribuible al uso de tabaco en Colombia y potenciales beneficios sanitarios y económicos del aumento del precio del cigarrillo mediante impuestos / Disease burden attributable to smoking in Colombia and potential economic and health benefits of price increase through taxes

Resumen Objetivo: estimar la carga de enfermedad asociada al consumo de tabaco en Colombia y evaluar el potencial efecto sanitario y económico del aumento de precio en los cigarrillos mediante impuestos. Materiales y métodos: se diseñó un modelo de simulación de Monte Cario de primer orden que incorporó la historia natural, los costos y la calidad de vida de enfermedades relacionadas con el consumo de tabaco en adultos. Se estimó el impacto en la prevalencia de tabaquismo y en la recaudación de diferentes escenarios de aumento de precio a través de impuestos. Resultados: en Colombia cada año mueren 32.088 personas como consecuencia del consumo de cigarrillo y pueden atribuírsele los siguientes porcentajes: el 16% de las muertes cardiovasculares, el 13% de las producidas por accidentes cerebrovasculares, el 77% de las muertes ocasionadas por enfermedad pulmonar obstructiva crónica y el 80% de las muertes por cáncer de pulmón. Las enfermedades relacionadas con el cigarrillo representan un costo directo anual al sistema de salud de más de 4,5 billones de pesos, mientras la recaudación impositiva por la venta de cigarrillos apenas logra cubrir un 10% de este gasto. Un aumento en el precio de los cigarrillos del 50% podría evitar, en un horizonte de 10 años, más de 45.000 muertes y generar recursos por 8 billones por ahorro en gastos sanitarios y aumento de recaudación. Conclusiones: la carga de enfermedad y el costo para el sistema de salud asociados al consumo de tabaco son muy elevados en Colombia. Un aumento del precio de los cigarrillos a través de los impuestos tendría importantes beneficios tanto sanitarios como económicos.

Abstract Objective: to estimate the burden of disease associated with tobacco consumption in Colombia and to evaluate the potential health and economic effect of the price increase in cigarettes through taxes. Materials and methods: to estimate the burden of disease, a first-order Monte Carlo simulation model was designed that incorporated the natural history, costs and quality of life of diseases related to tobacco consumption in adults. A tax model was designed to calculate the impact on the prevalence of smoking and on the collection of different price increase scenarios. Results: according to the proposed model, it can be estimated that in Colombia 26,464 people die every year as a result of cigarette smoking. 13% of cardiovascular deaths, 13% of those caused by strokes, 77% of deaths caused by chronic lung disease and 81 % of deaths from lung cancer can be attributed to their consumption. The diseases related to cigarettes in Colombia represent a direct annual cost of more than 4 billion pesos, while the tax collection from the sale of cigarettes barely covers 10% of this expense. An increase in the price of cigarettes of 50% could prevent more than 30,000 deaths in ten years and generate resources for 7.9 billion savings in health spending and increased collection. Conclusions: the burden of disease and the cost to the health system associated with tobacco use are very high in Colombia. An increase in the price of cigarettes through taxes would have important health and economic benefits for Colombia.

Análisis espectroscópico y morfológico de una válvula artificial para el corazón / Spectroscopic and morphologic analisis of an artificial cardiac valve

RESUMEN Los materiales que están en contacto con el sistema corporal requieren de la característica primordial que les permita su aceptación e integración en el organismo: la biocompatibilidad. De igual manera, deben exhibir excelentes propiedades mecánicas, tribológicas y topográficas para que su prestación del servicio en el tejido especificado sea el más óptimo, pudiendo esbozar estas características mediante la caracterización de estos materiales a través de técnicas espectroscópicas y microscópicas. En el presente trabajo, una válvula artificial para el corazón fabricada en titanio y recubierta con diamond-like carbon (DLC), material altamente biocompatible, fue sometida a análisis XPS, FTIR y morfológico. En estos se encontró una alta interdifusión del recubrimiento con el sustrato junto con una gran señal de enlaces sp3. Los enlaces terminales CH3 suponen una película poco compacta. La rugosidad del recubrimiento fue baja y adecuada para fines hemocompatibles.

ABSTRACT The materials that are in contact with the body system require the fundamental characteristic that allows their acceptance and integration in the organism, the biocompatibility. Likewise, they must show excellent mechanical, tribological and morphological properties, so that their provision of a service in the specific tissue is the most optimal, being able to sketch such characteristics through the characterization of these materials by spectroscopic and microscopic techniques. In this work, an artificial valve for the heart made of titanium and coated with diamond-like carbon (DLC), highly biocompatible material, was subjected to XPS, FTIR, and morphological analysis. A high interdiffusion of the coating and the substrate was found, together with a large signal of sp3 bonds. The CH3 terminal bonds represent a little compact film. The film roughness of the coating was low and adequate for hemocompatible purposes.

Formulación de una colada empleando harina de Sancha Inchi (Plukenetia Volubilis L.) proveniente del proceso de obtención de aceite / Formulation of a Porridge Using Solid Remants of Sacha Inchi Flour After the Oil Extraction Process

Resumen Antecedentes: la extracción en frío de aceite de sacha inchi presenta bajo rendimiento, lo que genera aproximadamente un 60 % de torta residual, un contenido variado de grasa y un valor elevado de proteína. Objetivo: evaluar formulaciones de colada elaborados con harina de sacha inchi producida a partir de la torta residual de la extracción del aceite (HTSI). Materiales y métodos: se obtuvo HTSI mediante el acondicionamiento de la torta, molienda y tamizado, luego se incorporó en una formulación de colada sustituyendo el almidón de maíz al 0 %, 25 % y 50 %. Las formulaciones fueron evaluadas fisicoquímica, microbiológica, reológica y sensorialmente con panelistas mayores de 45 años. Resultados: según la Resolución 333 de 2011, la HTSI es buena fuente de proteína, calcio y ácidos grasos omega 3. Las formulaciones de colada presentaron buena calidad microbiológica y fueron aceptadas sensorialmente. La formulación F1 con sustitución del 50 % de almidón de maíz por HTSI fue un líquido que aportó 2,3 % menos energía, 16,3 % menos carbohidratos, 1,4 % más grasa y 90,7 % más proteína que una porción del producto tradicional. Conclusiones: la HTSI puede ser empleada en matrices alimentarias, y aporta proteína de alta digestibilidad a la dieta.

Abstract Background: Cold extraction of sacha inchi oil presents low yield, generating approximately 60% solid residual remnants, which contain a variety of fats and high levels of protein. Objective: Evaluate porridge formulations made with the solid remnants left from the oil extraction of sacha inchi flour (HTSI). Materials and Methods: HTSI was obtained using the solids as dough, then conditioning, grinding, and sieving. The resultant product was then incorporated into a porridge formulation by substitution with corn flour at 0%, 25% and 50%. The formulations were evaluated using physical chemistry, microbiology, and rheology, and additionally were evaluated sensorially in panel with adults aged 45+ years. Results: HTSI is suitable for human consumption, and is a good source of protein, calcium and omega 3 fatty acids. The porridge formulations presented microbiological quality levels and were sensorially accepted by panel participants. Formulation with 50% substitution of cornstarch by HTSI is a liquid, and provides 2.3% less energy, 16.3% less carbohydrates, 1.4% more fat and 90.7% more protein than a portion of the traditional product. Conclusions: HTSI can be used in dietary plans to provide a high quality protein.

Current Knowledge Status on Periphyton Algae and Benthic Macroinvertebrates of The Meta Region, Colombia / Estado actual del conocimiento sobre microalgas del perifiton y macroinvertebrados bentónicos en el departamento del meta, colombia

RESUMEN El departamento del Meta cuenta con un elevado potencial hidrológico que se traduce en oportunidades para los sectores agrícola, pecuario y ambiental. Por otra parte, se han incrementado considerablemente las actividades de la industria petrolera, lo cual ha traído nuevos retos y amenazas a la región. En consecuencia, los ríos del departamento se ven afectados por vertimientos de diferentes tipos, por captaciones y por modificaciones de los entornos de ribera y de los ambientes bentónicos. Sin embargo, es poco lo que se conoce acerca de estos sistemas y de las comunidades de microalgas y macroinvertebrados que los habitan, las cuales cumplen un papel fundamental en el funcionamiento ecológico de los ríos. Por esta razón se analizan las características más relevantes de dichas comunidades y se discuten las modificaciones que las actividades humanas provocan sobre la estabilidad ecológica de los ríos en un contexto regional. Adicionalmente, se presenta un listado de los taxones de microalgas perifíticas y macroinvertebrados bentónicos registrados para el departamento del Meta.

ABSTRACT Nowadays the Meta Department has a high hydrological potential, which results in an opportunity for agriculture and livestock. Moreover, activities of the oil industry have significantly increased, which have brought new challenges and threats to the region. Consequently, different types of discharges and environment modifications affect the Meta Region's rivers in their watersheds and their riparian and benthic communities. However, these systems are poorly understood, including the periphyton and macroinvertebrate communities that inhabit them. In this paper, we provide a review of the most relevant characteristics of these communities, and we discuss the changes caused by human activities on the ecological stability of the rivers in a regional context. Additionally, we presented a list of periphytic algae and benthic macroinvertebrates taxa registered in the Meta Region.