A Contextualization of Transgender Women and Condom Use Using the HIV Syndemic Framework: Scoping Review.

Objective: To contextualize condom use in the transgender women population utilizing the HIV syndemic framework. Methods: Studies reporting condom use frequency and syndemic factors associated with HIV risk in transgender women were systematically searched. We followed the Scoping Reviews (PRISMA-ScR) checklist. Results: Social factors have a proven relationship with using condoms and HIV among transgender women. Syndemic factors, defined as co-occurring adverse factors that interact to contribute to risk behaviors, deserve a specific analysis to develop strategies to face HIV among transgender women. Conclusions: A syndemic perspective allows to generate specific health intervention and prevention policies to protect transgender women.

Pelvic lymph node involvement and risk of recurrence in HPV-associated endocervical adenocarcinoma stage IA2-IB1 according to Silva's system in two Colombian cancer centers.

OBJECTIVE: To compare the pelvic lymph node involvement and risk of recurrence in patients with human papillomavirus (HPV)-associated endocervical adenocarcinoma stage IA2-IB1 undergoing hysterectomy and/or trachelectomy plus lymphadenectomy, according to Silva's classification system. METHODS: A retrospective cohort study was performed in two Colombian cancer centers. The cases were classified according to the Silva classification system. Clinical, surgical, and histopathological variables were evaluated. Recurrence risk was analyzed by patterns A, B, or C. A logistic regression model was performed for tumor recurrence. The Kaplan-Meier method was used to estimate overall survival and disease-free survival (DFS). A weighted kappa was performed to determine the degree of concordance between pathologists. RESULTS: A total of 100 patients were identified, 33% pattern A, 29% pattern B, and 38% pattern C. The median follow-up time was 42.5 months. No evidence of lymph node involvement was found in patients classified as A and B, while in the C pattern was observed in 15.8% (n = 6) of cases (P < 0.01). There were 7% of cases with recurrent disease, of which 71.5% corresponded to type C pattern. Patients with Silva pattern B and C had 1.22- and 4.46-fold increased risk of relapse, respectively, compared with pattern A. The 5-year DFS values by group were 100%, 96.1%, and 80.3% for patterns A, B, and C, respectively. CONCLUSION: For patients with early-stage HPV-associated endocervical adenocarcinoma, the type C pattern presented more lymph node involvement and risk of recurrence compared to the A and B patterns. The concordance in diagnosis of different Silva's patterns by independents pathologists were good.

Adherence to Oral Pre-Exposure Prophylaxis Intervention by Transgender Women: A Systematic Review.

Prevalence of human immunodeficiency virus (HIV) is higher in transgender populations. Pre-exposure prophylaxis (PrEP) intervention is successful in reducing HIV acquisition. We aimed to investigate the adherence to oral PrEP by HIV-negative transgender women (TW). We followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement. We searched in WoS, OVID, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials databases. Participation and adherence to the intervention were low for TW compared to cisgender men who have sex with men (cMSM), and it was measured mostly by self-report (72.7%) or tenofovir-diphosphate/emtricitabine triphosphate dried blood spot (45.5%). Awareness should increase and the effect of oral PrEP on gender-affirming hormone therapy should be explained to TW at the beginning of the trials. One limitation is that our sample size was dominated by two Thai studies with TW sex workers. Future studies should evaluate adherence to new PrEP modalities.

Comparative Virucidal Activities of Essential Oils and Alcohol-Based Solutions against Enveloped Virus Surrogates: In Vitro and In Silico Analyses.

The large-scale use of alcohol (OH)-based disinfectants to control pathogenic viruses is of great concern because of their side effects on humans and harmful impact on the environment. There is an urgent need to develop safe and environmentally friendly disinfectants. Essential oils (EOs) are generally recognized as safe (GRAS) by the FDA, and many exhibit strong antiviral efficacy against pathogenic human enveloped viruses. The present study investigated the virucidal disinfectant activity of solutions containing EO and OH against DENV-2 and CHIKV, which were used as surrogate viruses for human pathogenic enveloped viruses. The quantitative suspension test was used. A solution containing 12% EO + 10% OH reduced > 4.0 log10 TCID50 (100% reduction) of both viruses within 1 min of exposure. In addition, solutions containing 12% EO and 3% EO without OH reduced > 4.0 log10 TCID50 of both viruses after 10 min and 30 min of exposure, respectively. The binding affinities of 42 EO compounds and viral envelope proteins were investigated through docking analyses. Sesquiterpene showed the highest binding affinities (from -6.7 to -8.0 kcal/mol) with DENV-2 E and CHIKV E1-E2-E3 proteins. The data provide a first step toward defining the potential of EOs as disinfectants.

Cytotoxic Activity of Amaryllidaceae Plants against Cancer Cells: Biotechnological, In Vitro, and In Silico Approaches.

Cancer is a major cause of death and an impediment to increasing life expectancy worldwide. With the aim of finding new molecules for chemotherapeutic treatment of epidemiological relevance, ten alkaloid fractions from Amaryllidaceae species were tested against six cancer cell lines (AGS, BT-549, HEC-1B, MCF-7, MDA-MB 231, and PC3) with HaCat as a control cell line. Some species determined as critically endangered with minimal availability were propagated using in vitro plant tissue culture techniques. Molecular docking studies were carried out to illustrate binding orientations of the 30 Amaryllidaceae alkaloids identified in the active site of some molecular targets involved with anti-cancer activity for potential anti-cancer drugs. In gastric cancer cell line AGS, the best results (lower cell viability percentages) were obtained for Crinum jagus (48.06 ± 3.35%) and Eucharis bonplandii (45.79 ± 3.05%) at 30 µg/mL. The research focused on evaluating the identified alkaloids on the Bcl-2 protein family (Mcl-1 and Bcl-xL) and HK2, where the in vitro, in silico and statistical results suggest that powelline and buphanidrine alkaloids could present cytotoxic activity. Finally, combining experimental and theoretical assays allowed us to identify and characterize potentially useful alkaloids for cancer treatment.

Vasoplegic Syndrome During Cardiopulmonary Bypass in a Twin Pregnancy.

Introduction: The most severe form of hemodynamic instability is vasoplegic syndrome. Case Presentation: This case report presents a case of vasoplegic syndrome in a patient with a twin pregnancy during cardiopulmonary bypass. Conclusions: In this case, we managed vasoplegia by maintaining high flows of the cardiopulmonary bypass, reducing the use of volatile anesthetics, administering vasoactive drugs, and optimizing hemoglobin levels above normal thresholds.

Essential Oils from Colombian Plants: Antiviral Potential against Dengue Virus Based on Chemical Composition, In Vitro and In Silico Analyses.

Currently, there are no therapies to prevent severe dengue disease. Essential oils (EOs) can serve as primary sources for research and the discovery of phytomedicines for alternative therapy. Fourteen EOs samples were obtained by distillation from six plants used in Colombian folk medicine. GC/MS analysis identified 125 terpenes. Cytopathic effect (CPE) reduction assays revealed differences in antiviral activity. EOs of Lippia alba, citral chemotype and carvone-rich fraction; Lippia origanoides, phellandrene chemotype; and Turnera diffusa, exhibited strong antiviral activity (IC50: 29 to 82 µg/mL; SI: 5.5 to 14.3). EOs of Piper aduncum, Ocimum basilicum, and L. origanoides, carvacrol, and thymol chemotypes, exhibited weak antiviral activity (32 to 53% DENV-CPE reduction at 100 µg/mL; SI > 5.0). Cluster and one-way ANOVA analyses suggest that the strong antiviral activity of EOs could be attributed to increased amounts of non-phenolic oxygenated monoterpenes and sesquiterpene hydrocarbons. Docking analyses (AutoDock Vina) predicted binding affinity between the DENV-2 E protein and terpenes: twenty sesquiterpene hydrocarbons (−8.73 to −6.91 kcal/mol), eight oxygenated monoterpenes (−7.52 to −6.98 kcal/mol), and seven monoterpene hydrocarbons (−7.60 to −6.99 kcal/mol). This study reports for the first time differences in the antiviral activity of EOs against DENV, corresponding to their composition of monoterpenes and sesquiterpenes.

Coping and adaptation of adults with cancer: the art of nursing care / Afrontamiento y adaptación del adulto con cáncer: el arte del cuidado de enfermería / Enfrentamento e adaptação do adulto com câncer: a arte do cuidado de enfermagem

Objective: To determine the coping and adaptive capabilities in patients with cancer undergoing treatment. Methodology: This was a quantitative and descriptive cross-sectional study; the sample consisted of 100 patients with a cancer diagnosis who received chemotherapy and/or radiotherapy treatment between June and August 2019, meeting the inclusion criteria. The Coping and Adaptation Processing Scale (CAPS) was used. Results: 53 % of the patients participating in the study presented high coping and adaptive capabilities; 40 % presented medium capabilities, and 7 % presented low capabilities. Conclusion: Continuous follow-up is extremely important throughout the disease process; having a romantic partner becomes a protective factor since patients feel heard and cared for, which motivates them to follow through with the treatment. In the nursing field, knowing the experience of those who live with an illness allows for transcending and impacting care by providing holistic attention to patients.

Objetivo: determinar la capacidad de afrontamiento y adaptación en personas con cáncer en tratamiento. Metodología: estudio cuantitativo y descriptivo de corte transversal; la muestra fue conformada por 100 pacientes con diagnóstico de cáncer que asistieron a tratamiento de quimioterapia y/o radioterapia entre junio y agosto del 2019, cumpliendo los criterios de inclusión. Se utilizó la Escala de Medición del Proceso de Afrontamiento y Adaptación (ESCAPS). Resultados: 53% de los pacientes estudiados poseen una capacidad de afrontamiento y adaptación alta; 40% obtuvo capacidad media y 7% una capacidad baja. Conclusión: el acompañamiento continuo es de gran importancia en todo el proceso de la enfermedad; tener una pareja sentimental se convierte en un factor protector pues los pacientes se sienten escuchados y atendidos, lo cual los motiva a continuar con el tratamiento. En el área de enfermería, conocer la experiencia de quienes viven una enfermedad permite trascender e impactar el cuidado brindando una atención holística.

Objetivo: determinar a capacidade de enfrentamento e adaptação em pessoas com câncer em tratamento. Materiais e método: estudo quantitativo e descritivo, de corte transversal; a amostra foi conformada de 100 pacientes com diagnóstico de câncer que passaram por tratamento de quimioterapia e/ou radioterapia entre junho e agosto de 2019, cumprindo com os critérios de inclusão. Foi utilizada a Escala de Medição do Processo de Enfrentamento e Adaptação. Resultados: 53 % dos pacientes estudados apresentaram capacidade de enfrentamento e adaptação alta; 40 % obtiveram capacidade média e 7 %, capacidade baixa. Conclusões: o acompanhamento contínuo é de grande importância em todo o processo da doença; ter um parceiro(a) sentimental se torna um fator protetor, pois os pacientes se sentem escutados e atendidos, o que os motiva a continuar com o tratamento. Na área de enfermagem, conhecer a experiência de quem vive uma doença permite transcender e impactar o cuidado, oferecendo uma atenção holística.

Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis.

INTRODUCTION: Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy. METHODS: We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models. RESULTS: A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8-201.2) in the laparoscopic group and 52.6 months (range, 0.4-166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09-2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05-4.37; P=0.03). CONCLUSION: In this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

FLABRA, frontline approach for BRCA testing in an ovarian cancer population: a Latin America epidemiologic study.

Aim: FLABRA evaluated the prevalence of BRCA mutations, genetic counseling and management approaches in patients with ovarian cancer in Latin America. Patients & methods: Patients with ovarian cancer from six Latin-American countries were enrolled. Tumor samples were tested for BRCA mutations (BRCAmut). In cases with BRCAmut, blood samples were analyzed to determine germline versus somatic mutations. Medical records were reviewed for counseling approach and treatment plan. Results: From 472 patients enrolled, 406 samples yielded conclusive results: 282 were BRCA wild-type (BRCAwt), 115 were BRCAmut and nine were variants of uncertain significance. In total, 110/115 were tested for germline mutations (77 germline and 33 somatic). Conclusion: Tumor testing to identify mutations in BRCA1/2 in ovarian cancer can help optimize treatment choices, meaning fewer patients require germline testing and genetic counseling, a scant resource in Latin America. Clinical trial registration: NCT02984423 (ClinicalTrials.gov).

Consideraciones especiales de bioseguridad en ortodoncia durante pandemia (SARS COV-2) / Special biosecurity considerations in orthodontics during pandemic (SARS COV-2) / Considerações especiais de biossegurança em ortodontia durante pandemia (SARS-COV-2)

Resumen El control periódico en un tratamiento de Ortodoncia permite establecer una buena secuencia de tratamiento sin riesgos para el paciente. Un tratamiento sin la vigilancia adecuada puede llegar a generar daños irreversibles. Sin embargo, por la pandemia de COVID-19 que enfrenta el mundo actualmente y los riesgos en el área de la salud, se han suspendido temporalmente los servicios no vitales y potencialmente expuestos a contagios como lo son los servicios odontológicos de consulta programada. Teniendo en cuenta esta situación, y que este virus puede llegar a ser endémico en la población humana, se hace necesario establecer protocolos de bioseguridad que permitan reactivar las prácticas odontológicas, y a su vez genear garantías para operadores, personal de apoyo, pacientes y el entorno de los mismos. En este contexto, es de gran importancia desarrollar un protocolo con profesionales expertos en tratamientos ortodóncicos y en el manejo de la pandemia, para delinear procesos de calidad que garanticen un ambiente seguro y minimicen los riesgos de contagio.

Abstract Periodic control in an Orthodontic treatment allows establishing a good treatment sequence without risks for the patient. Treatment without proper monitoring can lead to irreversible damage. However, due to the COVID-19 pandemic facing the world today and the risks in the health area, non-vital and potentially contagious services such as scheduled consultation dental services have been temporarily closed. Taking into account this situation, and that this virus will end up being endemic, it is necessary to establish biosafety protocols that allow reactivating dental practices, and in turn generate guarantees for operators, support staff, patients and the environment of the themselves. In this context, it is of great importance to develop a protocol carried out with expert professionals in orthodontic treatments and in the pandemic, to outline the quality protocol that guarantees a safe environment and minimizes the risks of infection.

Resumo O controle periódico em um tratamento ortodôntico permite estabelecer uma boa sequência de tratamento sem riscos para o paciente. O tratamento sem monitoramento adequado pode levar a danos irreversíveis. No entanto, devido à pandemia do COVID-19 que o mundo enfrenta atualmente e aos riscos na área da saúde, serviços não vitais e potencialmente contagiosos foram temporariamente suspensos, como serviços odontológicos agendados para consultas. Considerando essa situação e que esse vírus pode se tornar endêmico na população humana, é necessário estabelecer protocolos de biossegurança que permitam reativar as práticas odontológicas e, por sua vez, gerar garantias aos operadores, pessoal de apoio, pacientes e meio ambiente. Dos mesmos. Nesse contexto, é de grande importância o desenvolvimento de um protocolo com profissionais especialistas em tratamentos ortodônticos e no manejo da pandemia, para delinear processos de qualidade que garantam um ambiente seguro e minimizem os riscos de infecção.

Emergency Embolization of Pelvic Vessels in Patients With Locally Advanced Cervical Cancer and Massive Vaginal Bleeding: A Case Series in a Latin American Oncological Center.

PURPOSE: Locally advanced cervical cancer may present with uncontrollable vaginal bleeding in up to 70% of cases. Pelvic vessel embolization has been used as an urgent maneuver for achieving fast hemostatic control. This report describes outcomes of selective pelvic vessel embolization in patients with severe bleeding due to a locally advanced cervical cancer. METHODS: In this retrospective study, technical aspects, clinical variables, and bleeding-related morbidity were described. The frequency of recurrent disease and the vital status at 1 year of follow-up were determined. Analysis was performed with statistical software R, version 3.6.2. The setting was Instituto Nacional de Cancerología- Bogotá, Colombia, between January 2009 and July 2017. RESULTS: A total of 47 patients were included. Median age was 44 years (range, 26-70 years). The pre-embolization median hemoglobin level was 7.9 g/dL (range, 5.0-11.3 g/dL). Blood transfusions were administered to 41 women (87.2%). Bleeding control was achieved in 95.7% of cases in the first 24 hours after the embolization. There were no major complications. In 17 cases (36.2%), minor complications were reported; the most common was pelvic pain. In 17.1% of cases, a second embolization was required. After 12 months of follow-up, 27.7% of patients were alive without disease, 44.7% were alive with disease, and 25.5% of them have died of cervical cancer progression. CONCLUSION: Selective pelvic vessel embolization is a useful alternative in patients with locally advanced cervical cancer and life-threatening bleeding. Its impact on recurrent disease and death due to oncologic cause is not clear.

Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey.

OBJECTIVE: To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID-19 pandemic among Latin American gynecological cancer specialists. METHODS: Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. RESULTS: A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post-cancer treatment follow-up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo-oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). CONCLUSION: Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID-19 pandemic, which may reflect the region's particularities. The COVID-19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.

Prevention and control of HPV infection and HPV-related cancers in Colombia- a meeting report.

The Human Papillomavirus (HPV) Prevention and Control Board is an independent multidisciplinary board of international experts that disseminates relevant information on HPV to a broad array of stakeholders and provides guidance on strategic, technical and policy issues in the implementation of HPV control programs. In response to drastic drop of vaccine coverage following the adverse event crisis in Carmen del Bolivar, Colombia, the HPV Prevention and Control Board in collaboration with the Colombian National Cancer Institute and Colombian League Against Cancer convened a meeting in Bogota, Columbia (November 2018). The goal of the meeting was to bring together national and international group of experts to report the disease burden, epidemiology and surveillance of HPV and HPV-related cancers, to discuss the successes and especially the challenges of HPV vaccination and screening in Colombia, as well as the lessons learnt from neighbouring countries. The meeting provided a platform to confer various stakeholder's perspectives, including the role of the Colombian healthcare system and to catalyse various parts of the public health community in Colombia into effective action. The conclusion of the meeting included following suggestions to strengthen HPV prevention and control: 1) Re-introducing school-based vaccine programs, 2) Integrating primary and secondary prevention programs, 3) Developing an innovative crisis communication plan targeting healthcare workers, teachers and general population, 4) Building trust through efficient and timely communication, 5) Building strong relationship with media to ensure a stable vaccination campaign support, and 6) Promoting empathy among healthcare professionals towards patients to build trust and communicate effectively.

Supervivencia de pacientes con cáncer epitelial de ovario en el Instituto Nacional de Cancerología, resultados a partir del registro hospitalario de cáncer (2005-2014) / Survival of patients with epithelial ovarian cancer, results of the hospital-based cancer registry of the National Cancer Institute (2005-2014)

Resumen Objetivo: Proporcionar características demográficas y clínicas, así como estimaciones de supervivencia global a tres años de pacientes con cáncer epitelial de ovario (CEO) tratadas entre 2005 y 2014 en el Instituto Nacional de Cancerología de Colombia (INC). Métodos: Se incluyeron 783 pacientes diagnosticadas y tratadas por primera vez en el INC por CEO en los periodos 2005-2008, 2009-2011 y 2012-2014 sin un diagnóstico previo de otro cáncer. Se cruzaron datos del registro hospitalario de cáncer con bases de datos gubernamentales para obtener información de seguimiento. Utilizando el método Kaplan-Meier se estimó la probabilidad de sobrevivir a 36 meses a partir de la fecha de ingreso, evaluando diferencias en supervivencia entre grupos con la prueba de rango logarítmico. Se utilizaron modelos multivariados de riesgos proporcionales de Cox para evaluar: el efecto relativo de edad, el estadio clínico, el subtipo histológico y el tipo de tratamiento inicial en la supervivencia. Resultados: La probabilidad de supervivencia global a 36 meses fue de 56,5% (IC 95%: 53,0; 60,0), que se mantuvo estable en los tres periodos. La edad avanzada, el estadio clínico y el subtipo histológico afectaron significativamente la supervivencia global a tres años: 49,5% (IC 95%: 43; 55,6) para mujeres >59 años; 21,9% (IC 95%: 14,7; 29,2) para la enfermedad en estadio IV y 56,3% (IC 95%: 37,5; 54,3) para los tumores serosos. Las estimaciones de hazard fueron significativamente más altas en pacientes de 59 años o más (HR 1,54 (IC del 95%: 1,04 a 2,27)) y en cánceres con estadio avanzado (HR 13,47 (IC 95%: 7,92-22,92)); la cirugía más quimioterapia tuvo una reducción en el riesgo en comparación con otros tratamientos (HR 0,84 (IC 95% 0,52-1,36). Conclusiones: La supervivencia del cáncer epitelial de ovario se mantuvo estable con el tiempo. La variación se presentó en factores como: la edad, el estadio clínico y el primer tratamiento.

Abstract Aims: To provide demographical and clinical characteristics and estimations of 3-year overall survival of epithelial ovarian cancer (EOC) patients treated at the Colombian National Cancer Institute (INC) between 2005 and 2014. Methods: All 783 patients first treated at INC for EOC in the three periods: (2005-2008, 2009-2011, 2012-2014), without a prior cancer diagnosis, were included in this study. Follow-up was realized by cross-linkage with governmental databases using person identification numbers. Probability of surviving 36 months since the date of entry at INC was estimated using Kaplan-Meier methods, using the log-rank test to evaluate differences between groups. We used multivariate Cox proportional hazard models to evaluate the relative effect of age, clinical stage, histological subtype and treatment first on survival. Results: The overall survival probability at 36 months was 56.5% (95% CI: 53.0, 60.0), which was stable over time. Advanced age and clinical stage significantly affected 3-year overall survival, being 49.5°% (95°% CI: 43.4, 55.6) for age > 59, 21.9°% (95°% CI: 14.7, 29.2) for stage IV disease and 56.3% (95% CI: 37.5, 54.3) for serous tumors. Hazard ratios were significantly higher for patients aged 59 and over (HR 1.54 (95%CI 1.04-2.27)) and advanced stage cancers (HR 13.47 (95%CI 7.92-22.92)), whereas patients with surgery plus chemotherapy had a strongly reduced risks compared to other treatments (HR 0.84 (95%CI 0.52-1.36)). Conclusions: Survival of epithelial ovarian cancer was stable over time, with a variation according to age, clinical stage and first treatment.

Informe de Circulación Viral. A la semana epidemiológica 40 de 2019.

Vigilancia de virus respiratorios y tosferina, Bogotá

Salud sexual reproductiva en estudiantes universitarios: conocimientos y prácticas / Sexual and reproductive health in university students: beyond knowledge and practices / Saúde sexual reprodutiva em estudantes universitários: conhecimentos e práticas

Objetivo: Describir el conocimiento y las prácticas relacionadas con la salud sexual y reproductiva en los estudiantes de una Universidad del suroccidente colombiano. Materiales y métodos: Investigación cuantitativa, descriptiva y prospectiva de corte transversal realizada con estudiantes matriculados en I y II semestre en el primer periodo académico 2016. El cálculo de la muestra se obtuvo utilizando la fórmula de varianza desconocida y población total conocida (3.489), obteniendo un tamaño de muestra de 415 estudiantes. Se utilizó un instrumento tipo encuesta estructurado a partir del formato de consejería del programa de salud sexual y reproductiva universitario. Los datos se procesaron a través de Excel y el paquete estadístico SPSS versión 22. Para determinar la significación de la asociación se utilizó la prueba Chi cuadrado con una confiabilidad de 95 %. Resultados: En la población estudiada se encontró un predominio masculino del 50,7 %, la edad promedio fue de 19 años, encontrando que el 81 % está en una etapa de adolescencia tardía, el 62 % tiene un nivel de conocimientos defi cientes sobre salud sexual y reproductiva, el 78 % inició vida sexual con edad promedio de 16 años, un gran porcentaje de estos estudiantes tiene entre 1 y 3 compañeros(as) sexuales al año. El 70 % utilizó condón en su primera relación sexual y el 12,3 % de la población utilizó la píldora de emergencia. Conclusiones: El nivel de conocimiento acerca de salud sexual y reproductiva es deficiente. La mayoría de los estudiantes encuestados utiliza al menos un método de planificación familiar en sus relaciones sexuales.

Objective: To describe the knowledge and practices related to Sexual and Reproductive Health in the students of a University of the Suroccidente Colombiano. Materials and methods: Quantitative descriptive prospective cross-sectional study; was carried out in students enrolled in I and II semester in the first academic period 2016; the calculation of the sample was obtained using the formula of unknown variance and known total population (3,489), obtaining a sample size of 415 students. A structured survey-type instrument was developed based on the counseling format of the university's sexual and reproductive health program. Data were processed through Excel and the SPSS version 22 statistical package, to determine the significance of the association was used Chi square test with a reliability of 95%. Results: A male prevalence of 50.7% was found in the study population, the mean age was 19 years, and 81% were in the late teens, 62% had a poor level of knowledge about sexual health and reproductive, 78% start sexual life with average age of 16 years, a large percentage of these students have between 1 and 3 sexual partners a year. Seventy percent used a condom at their first sexual intercourse and 12.3% of the population used the emergency pill. Conclusions: The level of knowledge about sexual and reproductive health is deficient. Most students surveyed use at least one method of family planning in their sexual relationships.

Objetivos: Descrever os conhecimentos e práticas relacionados com a saúde sexual e reprodutiva em estudantes de uma Universidado sudoeste Colombiano. Materiais e Métodos: A pesquisa quantitativa transversal descritiva prospectiva; foi realizado em estudantes matriculados em I e II, semestre 2016; cálculo da amostra foi obtida utilizando a fórmula de variância desconhecida e a população total conhecido (3489), obtendo-se um tamanho de amostra de 415 estudantes. Foi utilizado um tipo de instrumento de pesquisa estruturada. Os dados foram processados pelo pacote estatístico Excel versão 2010 e SPSS versão 22, para determinar o significado do teste foram utilizados do qui-quadrado de associação com uma confiabilidade de 95%. Resultados: Na população estudada predominância do sexo masculino de 50,7%, a idade média dos alunos era de 19 anos, descobrindo que 81% estão em uma fase de adolescência tardia, 62% têm um nível de conhecimentos regulares saúde sexual e reprodutiva, 78% inicio vida sexual com uma idade média de 16 anos, uma grande porcentagem desses estudantes estão entre 1 e 3 parceiro (s) ano sexual. 70% usam preservativo em sua primeira relação sexual e 12,3% da população usava a pílula de emergência. Conclusões: O nível de conhecimento sobre a saúde sexual e reprodutiva é regular. A maioria dos estudantes pesquisados usar pelo menos um método de planejamento familiar em suas relações sexuais.

Müllerian adenosarcoma of the uterine cervix with sarcomatous overgrowth: A case report of aggressive disease in a young patient.

INTRODUCTION: Müllerian adenosarcoma of the cervix with sarcomatous overgrowth and lymphovascular invasion is a rare and aggressive disease. We report a case of a young patient with Müllerian adenosarcoma with sarcomatous overgrowth in the uterine cervix and pelvic lymph node involvement. The patient received radical surgery but not adjuvant treatment, and the disease was aggressive with rapid relapse. PRESENTATION OF CASE: A 39-year-old woman was diagnosed with Müllerian adenosarcoma of the cervix with sarcomatous overgrowth, International Federation of Gynecology and Obstetrics (FIGO) stage IB2. She underwent abdominal radical hysterectomy and resection of the left external iliac lymph nodes for suspected metastatic involvement detected during surgical exploration but undetected via imaging. She refused adjuvant treatment, and the disease recurred 8 months after primary oncologic surgery, with rapid local, regional, and bone relapse. DISCUSSION: Our report suggests that sarcomatous overgrowth, a high mitotic index, a rhabdomyoblastic component, and lymphovascular compromise are risk factors for aggressive recurrence. Positron emission tomography-computed tomography (PET-CT) was used to identify relapse locations in addition to those detected via clinical examination of the vaginal vault. However, whether PET-CT is indicated for the initial detection of lymph node and bone metastases in FIGO stage IB tumors with surgical indication is unclear. CONCLUSION: A young woman with Müllerian adenosarcoma of the cervix with sarcomatous overgrowth presenting the risk factors for its recurrence experienced a rapid relapse after receiving radical surgery but not adjuvant therapy. Control of this aggressive disease via sequential radiotherapy and chemotherapy are recommended.

Cáncer y embarazo: Experiencia de seis años en un centro de referencia en cáncer en un país latinoamericano (2007-2013) / Cancer and pregnancy: Six years of experience in a cancer reference centre in a Latin-American country (2007-2013)

Objetivo: Describir las características sociodemográficas, epidemiológicas, clínico-patológicas, de tratamiento y complicaciones de las pacientes con diagnóstico de cáncer que se embarazaron y aquellas que estando en embarazo fueron diagnosticadas con cáncer. Métodos: Serie de casos. Pacientes atendidas en el Instituto Nacional de Cancerología (Bogotá, Colombia) entre agosto de 2007 a julio de 2013. Se revisaron datos epidemiológicos, clínicos, tratamientos y complicaciones de las historias clínicas. Se describió la adherencia al tratamiento y se realizó análisis descriptivo de la información. Resultados: Durante el periodo de estudio se incluyeron 38 pacientes, de las cuales 28 ya contaban con el diagnóstico de cáncer. El principal diagnóstico fue cáncer de cérvix. La mediana de edad gestacional al final del embarazo fue 35 semanas (rango intercuartílico 12 semanas). La principal vía de nacimiento fue vaginal (60%), seguida de cesárea (40%). Con respecto al tratamiento, el 55,5% requirió su suspensión, 38,9% tuvo cambios y en 5,6% se modificó la dosis del tratamiento. Las complicaciones presentadas durante el embarazo fueron parto pretérmino, abortos, hemorragia, óbitos fetales, oligohidramnios y anemia. Se describen los casos de pacientes que durante su estado de embarazo fueron diagnosticadas con enfermedad neoplásica. La adherencia al tratamiento fue buena en 26 pacientes y 8 no la tuvieron. Conclusiones: La paciente con cáncer y embarazo representa un reto diagnóstico y terapéutico para el obstetra y el grupo oncológico. Se debe resaltar la consejería en anticoncepción y en salud sexual y reproductiva.

Objective: To describe the socio-demographic, epidemiological, clinical and pathological characteristics, as well as the treatment and complications of patients diagnosed with cancer who became pregnant and those that were diagnosed with cancer when pregnant. Methods: Case series study. Patients treated in the National Cancer Institute (Bogotá, Colombia) from August 2007 to July 2013. The epidemiological, clinical, treatment, and complications were reviewed in the medical records. Adherence treatment was recorded. A descriptive data analysis was performed. Results: The study included 38 patients, of whom 28 already had a cancer diagnosis. The main diagnosis was cervical cancer. The median gestational age at the end of pregnancy was 35 weeks (interquartile range 12 weeks). The main route was vaginal birth (60%), followed by caesarean section (40%). Treatment had to be suspended in 55.5% of cases, 38.9% had changes, and the therapeutic dose was modified in 5.6%. The complications presented during pregnancy were preterm birth, abortions, bleeding, stillbirths, oligohydramnios, and anaemia. A description is presented of the cases of patients who were diagnosed with neoplastic disease during their pregnancy. Adherence to treatment was good in 26 patients and not good in 8 cases. Conclusions: The patient with cancer and pregnancy represents a diagnostic and therapeutic challenge to the obstetrician and the oncology group. Counselling on contraception and sexual and reproductive health should be emphasised.

Evaluación de seguridad de la vacuna contra el virus del papiloma humano / Safety assessment of the human papillomavirus vaccine

Introducción: el cáncer de cuello uterino es en Colombia el segundo cáncer con mayor frecuencia y mortalidad en mujeres. Las vacunas contra el virus del papiloma humano (VPH) han mostrado efectividad para prevenir la infección por el virus y las lesiones precancerosas asociadas, sin embargo, se han reportado eventos negativos en salud, posiblemente asociados con la aplicación de la vacuna. Objetivo: examinar la seguridad del uso de la vacuna profiláctica contra el VPH. Metodología: se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database, IBECS, LILACS y fuentes complementarias. La selección de estudios se realizó por dos revisores independientes de acuerdo con criterios de elegibilidad predefinidos. Se incluyeron estudios experimentales, observacionales analíticos y observacionales descriptivos que reportaran desenlaces de seguridad y efectividad de la vacuna contra el VPH. La calidad de los estudios analíticos fue valorada mediante herramientas previamente definidas, de acuerdo a cada diseño. Los estudios descriptivos fueron considerados con alta probabilidad de sesgo. La calidad de la evidencia fue evaluada para cada desenlace reportado mediante la etodología Grading of Recommendations Assessment, Development and Evaluation (GRADE). Los resultados por cada desenlace fueron reportados de forma narrativa y presentados en perfiles de evidencia GRADE (estudios analíticos) y tablas de evidencia genéricas (estudios descriptivos). Resultados: fueron seleccionados 112 estudios que reportaron 305 resultados de desenlaces de seguridad reportados \r\nposterior a la aplicación de la vacuna contra el VPH, que incluyeron desenlaces para los cuales la vacunación mostró asociación estadísticamente significativa como factor de riesgo, desenlaces para los cuales la vacunación no mostró asociación como factor de riesgo, y desenlaces para los cuales la vacunación mostró resultados inconsistentes. La calidad de la evidencia fue baja y muy baja para la mayoría de los resultados reportados. Discusión y conclusión: Las principales debilidades de la evidencia identificada fueron falta de periodos adecuados de seguimiento para eventos de aparición tardía, falta de precisión de los resultados, y limitaciones en la medición de los desenlaces, verificación del periodo de latencia de \r\nlos mismos y control de los potenciales factores de confusión. Los determinantes más relevantes de \r\nla calidad fueron la falta de precisión de los resultados, probablemente por la baja frecuencia de los \r\neventos, y el carácter observacional de los estudios que evaluaron la mayor parte de los desenlaces \r\nreportados. Los resultados de asociación reportados no permiten establecer causalidad entre los \r\neventos y la vacunación. La baja calidad de la evidencia no implica que los resultados no sustenten \r\nla existencia, o no, de las asociaciones evaluadas; ni que los resultados no sean suficientes para \r\norientar decisiones; sino que es probable que estudios con mayor rigor metodológico muestren \r\nresultados diferentes. La mejor evidencia disponible hasta la fecha sustenta un adecuado perfil de \r\nseguridad de la vacuna contra el VPH, similar al reportado por la OMS para otras vacunas, que apoya \r\nsu utilización teniendo en cuenta los beneficios reportados en la literatura; sin que sea posible descartar la ocurrencia de eventos adversos graves raros, por lo cual es recomendable la \r\nimplementación de un sistema de vigilancia posvacunación, que garantice un apropiado reporte, \r\ndiagnóstico, seguimiento, análisis y retroalimentación a los usuarios, de los posibles eventos adversos de la vacunación, con enfoque en los eventos descritos en esta evaluación. (AU)