Factors associated with neuropathic pain in Colombian patients with spinal cord injury of traumatic origin: case-control study.

STUDY DESIGN: Case-control study. OBJECTIVES: To identify factors associated with neuropathic pain (NP) in patients with spinal cord injury of traumatic origin (TSCI). SETTING: University Hospital of Valle, Cali, Colombia. METHODS: Study participants were individuals with diagnosis of TSCI who visited a trauma referral center from January 1st, 2016, to December 31st, 2016. Information was retrospectively extracted from the Hospital's Spinal Cord Injury registry and patients' medical records. Cases were defined as patients with NP and controls were those without NP. The exposure of interest was intentional injuries. Individuals were matched by age and stratified into 11 groups of ±3 years each. RESULTS: We found 164 participants with an average age of 34 ± 13 years, of whom 95.1% were male, and 53.6% had NP. Neurogenic bladder and bowel occurred in 94.3% of NP patients. Cause of injury was not associated with NP. Older injuries were protective for NP (>10 years since injury OR = 0.10, 95% CI = 0.03-0.37, p < 0.0001) and neurogenic bladder and bowel were found as risk factors (OR = 5.89, 95% CI = 1.84-18.88; p = 0.003). CONCLUSIONS: Our study uniquely shows time since injury as a protective factor for NP and neurogenic bladder and bowel as a risk factor, while violence was not found associated. This could help guide the scope of future research about NP secondary to SCI.

Urgencias en cuidado paliativo oncológico / Emergencies in palliative oncological care

El paciente oncológico de cuidados paliativos puede presentar una variedad importante de condiciones clínicas que producen sufrimiento y disminución en la calidad de vida; esto se presenta como un reto para el clínico en la identificación y correcto abordaje de los pacientes. El dolor se ha considerado por años como el síntoma cardinal a tratar en el paciente oncológico, donde se deben considerar sus condicionantes fisiopatológicos, la farmacología de las intervenciones, los posibles efectos secundarios y los condicionantes familiares, sociales y personales del dolor, pero a pesar de su relevancia, no es el único síntoma, estando acompañado de un abanico de patologías, como las afectaciones gastrointestinales, pulmonares, vasculares, hematológicas y neurológicas, que favorecen la pérdida de capacidad del paciente y, en muchas ocasiones, la muerte. Se realizó una revisión actualizada en bases de datos como EMBASE, PUBMED, SCIELO, además de la revisión de guías de asociaciones internacionales con el objetivo de acercar a todos los médicos, sin distinguir su especialidad o área de trabajo, al abordaje y manejo del paciente oncológico en cuidado paliativo, favoreciendo la sensibilización con estas patologías y la importancia en el curso de vida de los pacientes.

The palliative care cancer patient can present a significant variety of clinical conditions that produce suffering and a decrease in the quality of life. This is a challenge for the clinician in the identification and correct approach of patients. Pain has been considered for years as the cardinal symptom to be treated in cancer patients, where its pathophysiological factors, the pharmacology of the interventions, possible side effects and the family, social and personal conditions of pain must be considered, but despite its relevance is not the onset of symptoms and is accompanied by a range of pathologies such as gastrointestinal, pulmonary, vascular, hematological and neurological affectations that favor the loss of capacity of the patient and in many cases death. An updated review was carried out in databases such as EMBASE, PUBMED, SCIELO in addition to the revision of guides from international associations with the aim of bringing all doctors without distinguishing their specialty or area of work to the approach and management of cancer patients in palliative care favoring awareness of these pathologies and their importance in the life course of patients.

Epidemiology of traumatic spinal cord injuries in Colombia.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine the incidence and characteristics of newly injured individuals admitted to a traumatic spinal cord injury (TSCI) referral center during a 4-year period. SETTING: University Hospital of Valle, Cali, Colombia. METHODS: Individuals were identified, and their data was recorded based on the International Spinal Cord Injury Core Data Set. The outcome of interest was the American Spinal Injury Association Impairment Scale (AIS) grade at the last follow-up. RESULTS: There were 491 individuals admitted in the 4-year period. The mean annual incidence of TSCI was 56.27 per million inhabitants. Considering TSCI in individuals exclusively from Cali, the mean annual incidence was 27.78 per million. The leading cause of TSCI was interpersonal violence (47.25%) and falls (33.60%). There was a strong correlation between AIS grade at admission and last follow-up. The most common AIS grade at the last follow-up was E (34.01%) caused mostly by falls (57.48%), followed by A (31.16%) caused mostly by interpersonal violence (76.27%). The reported employment rate dropped from 75.56% to 18.94% before and after TSCI (p < 0.05). AIS grade A was associated with more post-injury complications (p < 0.05). CONCLUSIONS: This is the first cohort study in Colombia describing the incidence and AIS grades of individuals with TSCI from a trauma referral center. Interpersonal violence was overrepresented in this population. Future research should include the evaluation of prevention strategies, as well as research on interventions towards quality improvement in patient care and post-discharge services especially for individuals with AIS grade A.

Histoquímica enzimática en el diagnósticode miopatías: revisión sistemática / Enzymatic histochemical in the diagnosis of myopathies: a systematic review

Introducción: Las enfermedades del músculo esquelético en las que la lesión supera la capacidad deadaptación conducen a cambios patológicos propios de las miopatías. En Colombia el diagnóstico serealiza mediante tinción con hematoxilina-eosina; sin embargo, la información brindada sobre algunosde los cambios del tejido muscular es limitada, por lo que es necesario realizar algunas técnicas de histoquímicaenzimática según la alteración. Objetivo: Describir los criterios de tinción de diferentes técnicashistoquímicas en el diagnóstico de las miopatías. Materiales y métodos: Se realizó una revisiónsistemática mediante la búsqueda de artículos en inglés y español indexados en las bases de ISI Web ofScience, Ovid Medline, PubMed, ScienceDirect y EBSCO. Los descriptores MeSH utilizados fueron:«histochemistry¼, «skeletal muscle¼, «structural and congenital myopathies¼, «fiber type fast twitch¼,«fiber type slow twitch¼ y «NADH tetrazolium reductase¼. Se asociaron a la búsqueda los términos«clinical application¼ y «diagnosis¼. Se seleccionaron los artículos originales, reportes de casos y revisionespublicadas entre 1982 y 2014 que aplicaran las técnicas de histoquímica en el diagnóstico de unamiopatía o en la investigación biomédica. Resultados: Se seleccionaron 64 publicaciones (incluidosdos libros) que fueron representativos para la redacción de este manuscrito, el cual fue complementadocon imágenes de biopsias musculares procesadas en el Laboratorio de Histología de la Universidad delValle, Colombia...

Introduction: The injuries on skeletal muscle that go beyond their capacity to adaptation result incharacteristic pathological changes of the myopathies. In Colombia for their diagnosis is usually usedthe hematoxylin-eosin stain, however, the information about many changes in muscle tissue is limited.That is why it is necessary to carry out certain enzymatic histochemical staining according to eachmyopathy. Objective: To describe the different criteria to diagnose myopathies by histochemical techniques.Material and methods: A systematic review was conducted which focused on search of all articleswritten in English and Spanish indexed in ISI Web of Science database, Ovid Medline, PubMed,ScienceDirect, and EBSCO. The MeSH descriptors used for the search were «histochemistry¼, «skeletalmuscle¼, «structural and congenital myopathies¼, «fast twitch fiber type¼, «slow twitch fiber type¼,and «NADH tetrazolium reductase¼. The terms «clinical application¼ and «diagnosis¼ were associatedto the search. All original articles, case reports, and reviews published during 1982-2014, which imple-mented histochemical techniques to the diagnosis of myopathy or to biomedical research were included.Results: From systematic search, 64 publications (including two books) were representative for thedrafting of this manuscript. The article was supplemented with images from muscle biopsies processedby the Laboratory of Histology, Universidad del Valle, Colombia...