Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country.

OBJECTIVE: To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. METHODS: A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan-Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. RESULTS: 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9-14.4), 13 months for adenocarcinoma (95% CI, 8.1-17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6-4.4) (P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9-10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076-3.082, P=.026) and (HR:14.6, 95% CI, 8.921-24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). CONCLUSIONS: Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized.

Pleural and pulmonary dissemination patterns from gastric adenocarcinoma among patients with treated primary disease in Latin America.

Purpose: Latin America is one of the regions with the highest incidence of gastric cancer. Even though, there are not reports about the patterns of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intent and the prognosis according to each dissemination pattern. Material and methods: We conducted a retrospective analysis of patients with gastric adenocarcinoma treated with curative intent at the National Cancer Institute (INC) between 2010 and 2017. Demographic variables, variables associated with the primary disease and variables associated with the presence of pleuro-pulmonary opacities and metastases were collected. A univariate and multivariate logistic regression analysis was performed and survival curves were presented using the Kaplan Meier method and compared using the log-rank test. A Cox regression model was performed for multivariate analysis for overall survival. Results: The study included 450 patients, 51.3% were male and the median age was 63 years. Intestinal adenocarcinoma was the most frequent histological subtype, in 261 cases (58.0%). Gastric cancer initial pathological stage was stage I in 23.3% of the patients, stage II in 19.3% and stage III in 53.6%. During a median follow-up of 31.9 months, 37 (8.2%) patients developed pleuro-pulmonary opacities; among those, 14 (3.1%) met the criteria for pleuro-pulmonary metastases: 6 (1.3%) had lymphangitic metastasis, 4 (0.9%) had a mixed pattern of pleural and lung nodules, 3 (0.7%) had pleural metastasis, and only one (0.2%) had hematogenous metastasis. The median OS was 114.5 months for the entire cohort and 38.2 (95%CI, 19.2-57.2) months for patients with pleuro-pulmonary metastases. Patients with pleural metastasis and lymphangitic carcinomatosis had median survival of 24.3 (95%CI, 0.01-51.0) and 26.4 (95%CI, 18.2-34.7) months, respectively. Conclusions: incidence of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intention was low. In our series, lymphangitic carcinomatosis was the main pattern of dissemination; meanwhile, hematogenous metastasis was rare and patients with pleural carcinomatosis had the lowest median survival.

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center.

Purpose: This study aimed to describe the survival outcomes and factors associated with prognosis in patients undergoing pulmonary metastasectomy with colorectal cancer (CRC) in a cancer center in South America. Material and methods: A retrospective analysis of patients that underwent lung metastasectomy due to CRC at National Cancer Institute (INC), Colombia between 2007 and 2017 was performed and Kaplan-Meier survival analysis along with log-rank test and Cox regression multivariate analysis were completed. Results: Seventy-five patients with colorectal adenocarcinoma were included in the study. Of them, 57.3% were women with a median age of 62 years [interquartile ranges (IQR): 18.5]. For 45.3% the adenocarcinoma was located in the rectum and 29.3% had stage IV at diagnosis. 56% had a history of controlled extrapulmonary metastasis and 20% of the cases had a history of the metastasis of the liver. The median follow-up was 36.8 months (IQR: 27.4). Three-year and five-year overall survival (OS) was 57.5% [95% confidence interval (CI), 47.0-70.4] and 33.2% (95% CI, 23.4-47.2), respectively. Patients with bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy carcinoembryonic antigen (CEA), history of liver metastasis, and disease-free interval (DFI) ≤12 months had worse OS. Three-year and five-year disease-free survival (DFS) was 30.1% (95% CI, 20.8-43.6) and 21.6% (95% CI, 13.0-35.9), respectively. Bilateral, more than one pulmonary metastasis, and patients with stage IV at diagnosis had the worst DFS. Multivariate analysis in the Cox regression model showed that abnormal postmetastasectomy CEA [Hazard Ratio (HR):1.97, 95% CI, 1.01-3.86, p = 0.045] and DFI ≤ 12 months (HR: 3.08, 95% CI, 1.26-7.53, p = 0.014) were independent factors for worst OS. Conclusions: The OS found falls within the wide range described in the world literature but interestingly it falls at the bottom end of this range. The factors associated with worst survival were identified as bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and DFI ≤12 months. Contribution to the field: Pulmonary metastasectomy is the standard of care in patients with metastatic CRC. However, the literature supporting this conduct is based on retrospective studies and the only randomized controlled trial conducted to date was stopped due to poor recruitment. Limited information is available in South America about survival and factors associated with prognosis in patients with metastatic CRC. While this study is another series that adds to the many studies across the world that describe the use of pulmonary metastasectomy in CRC, it presents critical data as it is one of the few studies carried out in South America. As described in a wide range of world literature, OS found falls in patients that underwent lung metastasectomy due to CRC however; interestingly, in the South American population analyzed here it falls at the bottom end of this range. This may be explained by a large number of patients included with a history of extrapulmonary metastasis as well as may reflect inadequate patient access to reference cancer centers in Colombia. Factors associated with worst survival in our population were bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and interval from diagnosis to development of pulmonary metastasis ≤12 months.

Metodología para el desarrollo de competencias profesionales ante desastres naturales en Equipos Básicos de Salud / Methodology for the development of professional skills while facing natural disasters in Basic Health Teams

RESUMEN Fundamento: el médico desempeña un importante papel ante la respuesta a desastres naturales producidos por peligros hidrometeorológicos, por lo que requiere una preparación que le permita disminuir las vulnerabilidades en la comunidad. Objetivo: diseñar una metodología que contribuya al desarrollo de competencias profesionales para la reducción de riesgos por desastres de origen natural producidos por peligros hidrometeorológicos para los Equipos Básicos de Salud. Métodos: se realizó un estudio cualitativo longitudinal y de desarrollo en los Equipos Básicos de Salud del Consejo Popular Caribe en la provincia Guantánamo en el año 2018 donde se emplearon métodos teóricos, empíricos y matemáticos. Resultados: se diseñó una metodología para el desarrollo de las competencias que deben poseer los Equipos Básicos de Salud para la reducción de riesgos por desastres de origen natural, producidos por peligros hidrometeorológicos, y se determinaron los referentes históricos para el desarrollo de este tipo de competencias. Conclusiones: el diseño de la metodología se sometió a la validación teórica por un grupo de especialistas, quienes opinaron que posee una estructura y metodología apropiadas, y es pertinente en la solución de las insuficiencias que presentan estos grupos en la asistencia primaria para enfrentar situaciones de este tipo.

ABSTRACT Background: the doctor plays an important role in the response to natural disasters caused by hydro-meteorological hazards, for which he requires preparation that allows him to reduce vulnerabilities in the community. Objective: to design a methodology that contributes to the development of professional skills for the reduction of risks due to natural disasters caused by hydro-meteorological hazards for Basic Health Teams. Methods: a qualitative longitudinal and development study was carried out in the Basic Health Teams of the Caribbean People's Council in the Guantánamo province in 2018, where theoretical, empirical and mathematical methods were used. Results: a methodology was designed for the development of the competencies that the Basic Health Teams must possess for the reduction of risks due to natural disasters, produced by hydro-meteorological hazards, and the historical references for the development of this type of competencies were determined. Conclusions: the design of the methodology was subjected to theoretical validation by a group of specialists, who considered that it has an appropriate structure and methodology, and is pertinent in solving the insufficiencies that these groups present in primary health care to face situations of this type.

A South American Experience With Postoperative Complications Following Chest Wall Reconstruction for Neoplasms.

BACKGROUND: This study aims to report postoperative complications of chest wall reconstructions due to resections of primary or secondary neoplasms in a South American cancer institution and their association with prosthesis reconstruction. MATERIALS AND METHODS: We retrospectively reviewed clinical records of patients with primary or secondary chest wall neoplasms who underwent resection and reconstruction between November 2008 and October 2018 at the Instituto Nacional de Cancerología, Bogota, Colombia. RESULTS: A total of 77 patients were analyzed, 50 were women (64.9%), and the median age was 45.8 years. There were 22(28.6%) sternal resections and 55(71.4%) costal resections. Prosthetic material was used in 14(18.2%) sternal and 37(48.1%) costal reconstructions. There were 26(33.7%) early postoperative complications and 16(20.8%) reinterventions. Infections were observed in 12(15.6%) patients and 4(5.2%) patients developed respiratory complications. 33.3% of all the early infections were presented in patients with methyl methacrylate (MMA) reconstructions and the same percentage in those with titanium plates. There were six (7.8%) late complications and five were related to prosthetic material extrusion, all required prosthetic material removal. The mean overall survival was 77,3 months (SD = 8 months), and 1-year and 5-year overall survival was 85% and 61%, respectively. CONCLUSIONS: Infections were the more frequent postoperative complications in chest wall reconstructions. The use of either MMA or titanium plates was not related to early postoperative complications, although MMA reconstructions developed higher late complications and required prosthetic material removal.

Características de los pacientes con cáncer de pulmón de célula no pequeña en el Instituto Nacional de Cancerología de Colombia / Characteristics of patients with non-small cell lung cancer at the National Cancer Institute of Colombia

Resumen Objetivos: Describir las características demográficas, histopatológicas, biología molecular tumoral y estadificación de los pacientes con cáncer de pulmón de célula no pequeña atendidos entre diciembre de 2013 y diciembre de 2018 en el Instituto Nacional de Cancerología de Colombia. Métodos: Estudio descriptivo de corte transversal. Resultados: Se incluyeron 392 pacientes con cáncer de pulmón de célula no pequeña, la mediana de edad fue 65.9 años (rango, 28,9 a 88,9 años). 198 (50,5%) pacientes fueron mujeres, obteniendo una relación hombre mujer 1:1. El 90.6% de los casos eran mayores de 50 años. Antecedente de tabaquismo se presentó en 211 (53,8%) pacientes, 75.8% de la población masculina y 32,3% de la población femenina eran fumadores. El adenocarcinoma se encontró en 293 (74,7%) pacientes y el carcinoma escamocelular en 73 (18,6%) pacientes. La estadificación patológica fue: estadio I en 22 (5,6%) pacientes, estadio II en 18 (4,6%), estadio III en 40 (10,2%) pacientes, estadio IV en 311 (79,3%) pacientes y no hubo dato en un solo paciente. Se detectó la mutación del EGFR en 21,2% de los pacientes. Los reordenamientos de ALK se identificaron en 4,6% de los pacientes y el PDL 1 solo se midió en el 9% de la población. Conclusiones: este estudio nos muestra el panorama general del cáncer de pulmón de célula no pequeña en la población colombiana, en donde la mayoría de los pacientes se diagnostican en estadios avanzados de la enfermedad y nos expone la necesidad de nuevas estrategias para la detección temprana y el acceso oportuno de los pacientes con cáncer de pulmón.

Abstract Objectives: to describe the demographic and histopathologic characteristics, tumor molecular biology and staging of patients with non-small cell lung cancer treated between December 2013 and December 2018 at the National Cancer Institute of Colombia. Methods: a retrospective cohort study based on data from medical records. Results: 392 patients with non-small cell lung cancer were included. The median age was 65.9 years (range: 28.9 to 88.9 years); 198 (50.5%) patients were women, obtaining a 1:1 male-female ratio. 90.6% of the cases were older than 50 years. History of smoking occurred in 211 patients (53.8%), 75.8% of the male population and 32.3% of the female population were smokers. Adenocarcinoma was found in 293 (74.7%) patients, while squamous cell carcinoma was present in 73 (18.6%) patients. The pathological staging was: 22 (5.6%) patients were in stage I, 18 (4.6%) had stage II, 40 (10.2%) patients were in stage III, stage IV was found in 311 (79.3%) patients, and there was no data in one patient. EGFR mutation was detected in 21.2% of patients. ALK rearrangements were identified in 4.6% of patients and PDL-1 was only found in 9% of the population. Conclusions: this study presents a general panorama of non-small cell lung cancer in the Colombian population, where most patients are diagnosed in advanced stages of the disease, and highlights the need for new strategies for early detection and better access for patients with lung cancer.

Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report.

BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.

Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection.

Since the introduction of lung nodule radio-guided localization, multiport video-assisted thoracoscopic surgery resection has been widely described. To date, only one series has reported the use of uniportal approach. Our objective is to describe the experience of a single institution of lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection. Retrospective cohort study based on data from medical records of patients between May 2012 and April 2019. Twenty-four patients were included, 13 were women (54.2%) with a median age of 59.5 years (range 19 and 81 years). Median nodule size was 7 mm (range 3-12 mm) and 19 (79.2%) patients had single lung nodule. The main indication was sub-centimetric nodule in 22 (91.6%) patients followed by a deep localization in 10 (41.6%) patients and sub-solid nodule in 9 (37.5%) patients. Median surgical time was 102.5 min (range 55-160 min). 4 (16.6%) patients had malignant neoplasm of the lung, 10 (41.7%) patients had lung metastases and 10 (41.7%) patients had benign lung lesions. The success rate found was 95.8%. Concordance analysis between palpation of the pulmonary nodule and the presence of the nodule in the histopathology was rated as poor, kappa value - 0.71 (P = 0.186) and between the resection of the pulmonary nodule according to the presence of the nodule in the pathology report was rated as good, Kappa value 0.625 (P = 0.001). Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection has a similar success rate and complications to those described by multiport video-assisted thoracoscopic surgery resections.

Etiología de nódulos pulmonares en pacientes con cáncer mamario / Etiology of pulmonary nodules in patients with breast cancer

Resumen Objetivo: Describir los diagnósticos histopatológicos a partir de los casos de las pacientes con cáncer de mama que fueron llevadas a resección de nódulos pulmonares en el Instituto Nacional de Cancerología (INC). Materiales y métodos: Se desarrolló un estudio tipo serie de casos donde se describen las características clínicas, histológicas y anatomopatológicas de un grupo de pacientes con diagnóstico confirmado de cáncer de mama de novo o que durante su enfermedad presentaron nódulos pulmonares que requirieron resección quirúrgica mediante cuña pulmonar o lobectomía en el INC, entre el 1 de enero de 2015 y el 30 de abril de 2018. Resultados: En el periodo de estudio se realizaron 225 resecciones en cuña pulmonar y lobectomías, 55 de estos pacientes tenían diagnóstico de cáncer de mama, de los cuales el 69,1% fueron de origen neoplásico, 26 pacientes fueron metástasis de cáncer mama (47,3%), 9 pacientes tenían segundo primario pulmonar (16,4%) y un paciente tenía concomitantemente cáncer primario pulmonar y una metástasis de mama (1,8%). Otras 2 pacientes tenían metástasis de otros órganos, uno de recto y uno de tiroides (3,6%), mientras que las 17 pacientes restantes presentaron reporte de lesiones pulmonares benignas en la anatomía patológica (30,9%). Conclusión: La presencia de nódulos pulmonares en pacientes con cáncer de mama no siempre son secundarias a enfermedad metastásica en pulmón; pueden existir otras etiologías como cáncer primario pulmonar, metástasis de otros órganos, tumores benignos o infecciones. Conocer la etiología de los nódulos pulmonares en pacientes con cáncer de mama es determinante para evaluar las opciones terapéuticas que pueden variar desde el manejo quirúrgico hasta el manejo sistémico.

Abstract Objectives: To describe the histopathological diagnoses of patients with breast cancer who underwent resection of pulmonary nodules at the National Cancer Institute (INC) of Bogotá. Materials and methods: A case-series study was developed to describe the clinical, histological and anatomopathological characteristics of a sample of patients with a diagnosis of de novo metastatic breast cancer or whom presented with pulmonary nodules during their disease that required surgical resection by wedge pulmonary or lobectomy in the INC, between January 1, 2015 and April 30, 2018. Results: During the study period, 225 resections were performed in lung wedge and lobectomies, 55 of these patients had a diagnosis of breast cancer, of which 69.1% were of neoplastic origin, 26 (47.3%) were metastatic of breast cancer, 9 (16.4%) second primary pulmonary and 1 (1.8%) patient had concomitantly primary lung cancer and a breast metastasis. Another 2 (3.6%) patients had metastases from other organs, one from the rectum and one from the thyroid, while the remaining 17 (30.9%) patients presented a report of benign lung lesions in the pathology. Conclusion: The presence of pulmonary nodules in patients with breast cancer are not always secondary to metastatic disease. Other etiologies may exist, such as primary pulmonary cancer, metastasis from other cancers, benign lung tumors or infections. Knowing the etiology of pulmonary nodules in patients with breast cancer is crucial to evaluate the therapeutic options that can vary from surgical management to systemic management.

Combination of complementary data mining methods for geographical characterization of extra virgin olive oils based on mineral composition.

This work explores the potential of multi-element fingerprinting in combination with advanced data mining strategies to assess the geographical origin of extra virgin olive oil samples. For this purpose, the concentrations of 55 elements were determined in 125 oil samples from multiple Spanish geographic areas. Several unsupervised and supervised multivariate statistical techniques were used to build classification models and investigate the relationship between mineral composition of olive oils and their provenance. Results showed that Spanish extra virgin olive oils exhibit characteristic element profiles, which can be differentiated on the basis of their origin in accordance with three geographical areas: Atlantic coast (Huelva province), Mediterranean coast and inland regions. Furthermore, statistical modelling yielded high sensitivity and specificity, principally when random forest and support vector machines were employed, thus demonstrating the utility of these techniques in food traceability and authenticity research.

Characterization and evaluation of phenolic profiles and color as potential discriminating features among Spanish extra virgin olive oils with protected designation of origin.

Changes in phenolic profiles and color parameters can help to differentiate between extra virgin olive oils (EVOOs) with protected designation of origin (PDO). Phenolic profile characterization and CIELAB parameters determination of 9 PDO EVOOs from Spain were developed. Both properties of EVOOs are very relevant to their commercialization and increase the product value. The Serrana de Espadán olive cultivar was characterized for the first time and showed the highest pinoresinol concentrations and clarities in these olive oils, which are important values for the product image. To detect fraudulent instrumental work and implement quality control, principal component analysis (PCA) and linear discriminant analysis (LDA) were performed. EVOO geographical origin and cultivar distributions were achieved with cumulative variances of 93.4% and 92.4%, respectively. A categorization of PDO EVOOs was proposed using the following 7 phenolic compounds: phenolic alcohols (tyrosol and hydroxytyrosol), 3,4-DHPEA-EDA, 3,4-DHPEA-EA, p-HPEA-EDA, pinoresinol and total phenolic compounds.

First non-intubated uniportal video-assisted pulmonary lobectomy in America.

The first video-assisted thoracic lobectomy in non-intubated patient in America was performed on 27th of September 2014 in Bogotá Colombia, The National Cancer Institute in Bogotá received Dr. Diego González-Rivas to make possible this kind of procedure in a 53-year-old man, with a history of papillary thyroid cancer treated with surgery and Iodine therapy, in whom two pulmonary nodules were found in the monitoring tomography. We resected the nodule located at the right upper lobe previously marked by scintigraphy, the other one required a lobectomy because it was a deep nodule with malignant radiologic appearance inside of the middle lobe. The procedure discoursed in a non-intubated patient without technical difficulties or complications, very short recovery time, minimum pain and a quiet and usual postoperative evolution. This procedure, the first reported in America was replicated after others with similar results in several countries thanks to the collaboration between surgeons, anesthesiologists, radiologists, nurses and therapists, because especially in such interventions teamwork is essential. We believe that given the benefits in terms of recovery for the patient and anesthetic time, we could go on replicating the experience in selected patients.

Material complementario para la asignatura Preparación para la Defensa III / Material in the preparation course for the Defense III

Se realizó un estudio cualitativo a partir de la observación y estudio documental, que incluye la revisión de materiales de apoyo y textos de la disciplina Preparación para la Defensa III con el objetivo de elaborar un folleto como material de estudio que proporcione a estudiantes y profesionales de las Ciencias Médicas conocimientos sobre las actividades que lleva a cabo el sector de la salud en asentamientos de evacuados o albergues temporales creados para situaciones de contingencia desarrollando en ellos habilidades para la implementación de los servicios de salud en estas instalaciones. Se constató que en el cuerpo teórico del tema no aparecen elementos importantes que necesita el estudiante conocer y recibir según programa de estudio. Se presentó una recopilación material de forma actualizada sobre cuáles deben ser las actividades salubristas dirigidas y desarrolladas por el equipo de salud en una contingencia para la reducción de desastres. Servirá de apoyo a la docencia y por su importancia en la práctica ante la amenaza constante de los diferentes desastres que azotan al país, será de mucha utilidad dentro del sector salud, al hacer de este un material de estudio y consulta (AU)

A qualitative study was carried out from observation and documentary study, which includes a review of support materials and textbooks discipline Defense Preparedness III in order to draw up a prospectus as study material that provides students and professionals Medical Sciences knowledge of the activities carried out by the health sector in settlements evacuated or temporary shelters created for contingency situations developing in them skills for the implementation of health services in these facilities. It was found that in the theoretical body of the subject does not appear important elements that students need to know and receive according to the program of study. an update on what should be the activities for health professionals and developed by the health team in a contingency for disaster reduction materials such collection was presented. It will support teaching and its practical significance to the constant threat of various disasters that plague our country, it will be very useful in the health sector, to make this a material of study and consultation(AU)

Aspectos sobre la seguridad nacional cubana en la asignatura Preparación para la Defensa para estudiantes de la salud / National security issues in Cuba for the defense preparation course for students of health

Se abordan algunos aspectos relacionados con la seguridad nacionalcubana, su influencia internacional y cómo se manejaindiscriminadamente el tema por parte del gobierno de los EstadosUnidos, sin tener en consideración las afectaciones en el campo de lasalud que estas provocan en nuestro país(AU)

This investigation is about some aspects of Cuban national security, international influence and how can be treated the subject indiscriminately by the government of the United States, without regard to the damages in the field of health that they cause in our country(AU)

Casos clinicos: sindrome de Zellweger / Clinical cases: Zellweger syndrome

Se presenta el caso de un recién nacido, sexo masculino con síndrome de Zellweger con las siguientes características: hipotonía generalizada, dificultad respiratoria, deficiente capacidad de succión, fontanelas amplias, facies plana, implantación baja de las orejas, manchas de Brushfield, persistencia del conducto arterioso, comunicación interauricular y hepatomegalia.

Encefalocele occipital gigante. A propósito de un caso clínico / Occipital encephalocele

Presentamos un recién nacido con encefalocele occipital gigante, que fue atendido en la unidad de neonatología del Hospital "Jaime Mendoza" de la Caja Nacional de Salud de la ciudad de Sucre. Se presenta este caso clínico por lo inusual de esta patología y se hace una revisión de la literatura al respecto.

We described a newborn baby with gigantic occipital encephalocele, who was attended at the neonatal ward of the Hospital "Jaime Mendoza" in the city of Sucre. This is an unusual case presentation for this pathology and we reviewed the pertinent literature.

Taponamiento cardíaco en pacientes con neoplasia primaria conocida / Cardiac tamponade in patients with primary known malignancies

Los pacientes con neoplasias están en riesgo de presentar compromiso cardíaco por derrames pericárdicos secundarios a metástasis. Aunque en la literatura se ha reportado hasta un 6 por ciento de los pacientes con neoplasias pueden tener esta complicación, no existe en nuestro medio estudios que muestren la magnitud de este problema. Con tal objeto se realizó un estudio retrospectivo de 12 casos de taponamiento cardíaco atendidos en nuestra institución durante el periodo comprendido entre enero a junio de 1999. Se evaluó el motivo de consulta, los métodos diagnósticos, el tratamiento recibido y el pronóstico. Nuestros resultados difieren a los obtenidos por otros autores a la fecha...

Displasia condroectodérmica o sindrome de Ellis-Van Creveld. A propósito de un caso / Condroectodermic dysplasia or Ellis-Van Creveld sindrome: report a case

Se presento un caso del sindrome de Ellis - Van Creveld cuyas malformaciones congenitas son: Extremidades distales cortas, polidactilia, hipoplasia de las uñas. Realizando la anamnesis a la madre se descubre que la causa se debe al alto grado de consanguinidad de los congéneres(hermanos), teniendo el antecedente de haber sido tratdo con medicación antiepiléptica, se asocia otras malformaciones como labio leporino, paladar y maxilar hendido y paabellón auricular. Poco se conoce la incidencia de estos casos en Bolivia y especialmente en Sucre, por presentarse más en sociedades cerradas como los menonitas y algunos grupos de indigenas en los que se procen incestos y el resultado de los mismos es enterrado o cremado. El trabajo de los médicos de Barrio debe llevar a cabo pesquizas más dirigidas, para realizar una consejeria genética más adecuada.

Malformaciones congénitas del sistema nervioso / Congenital malformations of nervous system

Se presenta la incidencia de las malformaciones congénitas del sistema nervioso diagnosticadas al examinar 5832 recién nacidos vivos en la maternidad del hospital "Jaime Mendoza" C.N.S. de Sucre, en el período comprendido entre Julio de 1997. Se hace una revisión actualizada de embriología del sistema nervioso y se las agrupa de acuerdo a la Clasificación Internacional de Enfermedades de la OMS