Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries.

Objective: To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods: The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results: The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion: This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.

Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries / Normas para la atención psicosocial en el cáncer pediátrico: una propuesta adaptada para los países de América Latina y el Caribe / Padrões de atendimento psicossocial em câncer pediátrico: proposta adaptada para países da América Latina e do Caribe

[ABSTRACT]. Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization’s Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.

[RESUMEN]. Objetivo. Resaltar los objetivos, logros, desafíos y próximos pasos a seguir en el marco de la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud (GICC, por su sigla en inglés), un proyecto diseñado para mejorar la atención psicosocial (APSS) en los centros de atención oncológica pediátrica de América Latina y el Caribe. Métodos. El proyecto se inició en Perú, el primer país que puso en marcha esta iniciativa mundial, en noviembre del 2020. La fase de diagnóstico incluyó una encuesta y una entrevista semiestructurada con profesionales de la salud para evaluar las prácticas en materia de APSS en las instituciones, junto con una encuesta de evaluación de necesidades para las personas cuidadoras. En la segunda fase se elaboró un plan estratégico para abordar las necesidades reconocidas, el cual comprendió la adaptación de las normas en materia de APSS, la creación de grupos de trabajo multicéntricos, la ampliación de la propuesta y la elaboración de materiales. Resultados. En el estudio se descubrió que no se proporcionaba una APSS adecuada y conforme a las normas internacionales. Se propusieron y convalidaron 6 normas adaptadas, y más de 50 profesionales de la salud de la región participaron en las actividades en línea dirigidas a apoyar el proyecto. En estos momentos está en marcha el proceso de implementación, que incluye la creación de 5 grupos de trabajo multidisciplinarios, un comité regional y la elaboración de 16 productos técnicos. Conclusión. Este proyecto supone un gran avance para la mejora de la APSS de los pacientes pediátricos con cáncer y sus familias en los países de América Latina y el Caribe. La creación de grupos de trabajo y las intervenciones basadas en la evidencia permiten consolidar la propuesta y su implementación. Es necesario formular políticas de salud que comprendan una APSS basada en normas para lograr resultados sostenibles desde el punto de vista de la calidad de vida de los pacientes pediátricos con cáncer y sus familias.

[RESUMO]. Objetivo. Destacar os objetivos, as conquistas, os desafios e as próximas etapas da Iniciativa Global para o Câncer Infantil (GICC), um projeto criado pela Organização Mundial da Saúde para melhorar a atenção psicossocial em centros de câncer pediátrico na América Latina e no Caribe. Métodos. O projeto foi lançado no Peru, o primeiro país focal da GICC, em novembro de 2020. A fase de diagnóstico incluiu uma pesquisa e uma entrevista semiestruturada com profissionais de saúde para avaliar as práticas de atenção psicossocial nas instituições, bem como uma pesquisa para avaliar as necessidades dos cuidadores. Na segunda fase, foi desenvolvido um plano estratégico para atender às necessidades identificadas, incluindo uma adaptação de padrões de atenção psicossocial, o estabelecimento de grupos de trabalho multicêntricos, a expansão da proposta e o desenvolvimento de materiais. Resultados. O estudo constatou que, de acordo com padrões internacionais, a atenção psicossocial não estava sendo adequadamente oferecida. Seis padrões adaptados foram propostos e validados, e mais de 50 profissionais de saúde da região participaram de atividades on-line para apoiar o projeto. O processo de implementação está em andamento, com a formação de cinco grupos de trabalho multidisciplinares e um comitê regional e a produção de 16 relatórios técnicos. Conclusão. Este projeto representa um avanço substancial para melhorar a atenção psicossocial para pacientes pediátricos com câncer e suas famílias nos países da América Latina e do Caribe. A criação de grupos de trabalho e intervenções baseadas em evidências fortalecem a proposta e sua implementação. É preciso desenvolver políticas de saúde que incluam atenção psicossocial segundo padrões estabelecidos para alcançar resultados sustentáveis na qualidade de vida das crianças com câncer e de suas famílias.

Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries / Normas para la atención psicosocial en el cáncer pediátrico: una propuesta adaptada para los países de América Latina y el Caribe / Padrões de atendimento psicossocial em câncer pediátrico: proposta adaptada para países da América Latina e do Caribe

ABSTRACT Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.

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RESUMO Objetivo. Destacar os objetivos, as conquistas, os desafios e as próximas etapas da Iniciativa Global para o Câncer Infantil (GICC), um projeto criado pela Organização Mundial da Saúde para melhorar a atenção psicossocial em centros de câncer pediátrico na América Latina e no Caribe. Métodos. O projeto foi lançado no Peru, o primeiro país focal da GICC, em novembro de 2020. A fase de diagnóstico incluiu uma pesquisa e uma entrevista semiestruturada com profissionais de saúde para avaliar as práticas de atenção psicossocial nas instituições, bem como uma pesquisa para avaliar as necessidades dos cuidadores. Na segunda fase, foi desenvolvido um plano estratégico para atender às necessidades identificadas, incluindo uma adaptação de padrões de atenção psicossocial, o estabelecimento de grupos de trabalho multicêntricos, a expansão da proposta e o desenvolvimento de materiais. Resultados. O estudo constatou que, de acordo com padrões internacionais, a atenção psicossocial não estava sendo adequadamente oferecida. Seis padrões adaptados foram propostos e validados, e mais de 50 profissionais de saúde da região participaram de atividades on-line para apoiar o projeto. O processo de implementação está em andamento, com a formação de cinco grupos de trabalho multidisciplinares e um comitê regional e a produção de 16 relatórios técnicos. Conclusão. Este projeto representa um avanço substancial para melhorar a atenção psicossocial para pacientes pediátricos com câncer e suas famílias nos países da América Latina e do Caribe. A criação de grupos de trabalho e intervenções baseadas em evidências fortalecem a proposta e sua implementação. É preciso desenvolver políticas de saúde que incluam atenção psicossocial segundo padrões estabelecidos para alcançar resultados sustentáveis na qualidade de vida das crianças com câncer e de suas famílias.

Cutaneous myiasis in skin cancer and malignant wounds: a systematic review.

BACKGROUND: Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data. A subregister of reports, lack of education in the population, inadequate empirical treatments, and medical underestimation are components of a public health problem that threatens patients' lives. METHODS: We conducted a systematic review of the literature of cutaneous myiasis associated with malignant wounds and skin cancer, characterizing sociodemographic variables, risk factors, clinical and histological features, and treatment. Additionally, we present a demonstrative case with the adequate taxonomic evaluation. DISCUSSION: Cutaneous myiasis is an underestimated and poorly managed infestation, which can generate severe complications in oncological patients. This is the first systematic review in the literature about this clinical scenario, which provides information to the physician and clinical researcher about the epidemiological gaps and what has been published so far. CONCLUSIONS: Findings from the current review have helped to display the sociodemographic, epidemiological, and clinical behavior of myiasis in skin cancer and malignant wounds. Its contribution to the greater tumor tissue destruction is clear; however, more studies are required. The therapeutic management in these patients is equally clarified.

Drug reaction with eosinophilia and systemic symptoms (DRESS) and multiple organ dysfunction syndrome (MODS): one more reason for a new effective treatment against leishmaniasis.

INTRODUCTION: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced reaction associated with eosinophilia and systemic manifestations. Anticonvulsants, sulfonamides, and antivirals are the most related and described drugs in DRESS syndrome. METHODS AND CASE: We present a case of severe multiple organ dysfunction syndrome (MODS) with the risk of death associated with DRESS syndrome due to antileishmanial pentavalent antimonial drug and its simultaneous toxicity. Consequently, a comprehensive review of the main clinical problems and comparative discussion of both clinical conditions was made. DISCUSSION: The overlap of DRESS syndrome and antileishmanial pentavalent antimonial drug toxicity can be life-threatening. Both conditions represent a true clinical, diagnostic, and therapeutic challenge. We exposed specific clinical and laboratory results with rare occurrence. CONCLUSION: Any physician and dermatologists should keep in mind the broad spectrum of clinical manifestations and laboratory findings associated with the use of pentavalent antimonial drugs. The clinical suspicion, an early diagnosis, and aggressive treatment are essential to prevent complications and death.

Tratamiento quirúrgico de la endocarditis mediante cirugía mínimamente invasiva / Surgical treatment of endocarditis using minimally invasive surgery

Resumen Objetivo: Describir la experiencia del Hospital Universitario San Vicente Fundación en el manejo quirúrgico de la endocarditis por técnica mínimamente invasiva (MICS). Metodología: Estudio descriptivo, longitudinal, con toma retrospectiva de pacientes intervenidos por MICS para cirugía valvular con diagnóstico de endocarditis infecciosa entre enero de 2012 y agosto de 2015 en el Hospital Universitario San Vicente Fundación, Medellín. Resultados: En 44 meses fueron llevados a cirugía por endocarditis 15 pacientes, el 93,3% de sexo masculino, edad promedio de 46,2 años, el 40% en clase funcional III y IV (clasificación de la New York Heart Association), 2 pacientes con embolización cerebral; 1 paciente requirió manejo hibrido coronario. Se realizaron 6 plastias y 8 reemplazos valvulares, con compromiso valvular mitral en 46,6%. El tiempo de circulación extracorpórea fue de 103 minutos. El promedio de elementos sanguíneos transfundido fue de 2,5 unidades de glóbulos rojos. No hubo casos de muerte en los primeros 30 días postoperatorios. No se reportaron infecciones del sitio quirúrgico, accidentes cerebrovasculares, fibrilación auricular ni marcapasos definitivo, así como tampoco reintervención por sangrado. Conclusiones: La cirugía valvular por minitoracotomía anterior derecha para el manejo de la endocarditis, es un procedimiento seguro y con buenos resultados en nuestro centro; además reafirma las ventajas de la cirugía mínimamente invasiva.

Abstract Objective: To describe the experience of the Hospital Universitario San Vicente Fundación in the surgical management of endocarditis using a minimally invasive technique. Methodology: A descriptive, longitudinal study was conducted on a retrospective sample of patients intervened for valve surgery using a minimally invasive technique. The patients were diagnosed with infectious endocarditis between January 2012 and August 2015 in the Hospital Universitario San Vicente Fundación, Medellin. Results: A total of 15 patients had surgery due to endocarditis in the 44 months of the study. Most of them (93.3%) were male. The mean age was 46.2 years, and 40% were in functional Class III and IV (New York Heart Association classification). Two patients had cerebral embolisation, and one patient, 2 patients required hybrid coronary management. A total of 6 grafts and 8 valve replacements were performed, with mitral valve involvement in 46.6%. The mean extracorporeal circulation time was 103 minutes. The mean blood products transfused was 2.5 units of blood cells. There were no deaths in the first 30 days after the surgery. There were no reports of infections at the surgical site, cerebrovascular accidents, atrial fibrillation or definite pacemakers. Neither were there were any re-interventions due to bleeding. Conclusions: Valve surgery using a right anterior mini-thoracotomy for the management of endocarditis, is a safe procedures with good outcomes in this hospital. It also re-affirms the advantages of minimally invasive surgery.

Aortitis sifilítica: "una vieja olvidada" / Syphilitic aortitis: Old and forgotten. Report of a case

Resumen Se expone el caso de un paciente de sexo masculino, de 69 años, con antecedentes de hipertensión arterial, tabaquismo, ataque cerebrovascular, fibrilación auricular, insuficiencia aórtica y cardiopatía isquémica, quien ingresa a un hospital de alta complejidad por deterioro de la clase funcional, edema de miembros inferiores y episodios de palpitaciones. En la ecocardiografía se halló fracción de eyección normal, insuficiencia aórtica grave y dilatación de aorta ascendente con criterios quirúrgicos. Dentro de los estudios prequirúrgicos, se documentó VDRL reactivo en títulos altos y confirmación del diagnóstico de sífilis con TP-PA. Se realizó reemplazo valvular aórtico con prótesis biológica e injerto de dacrón en aorta ascendente, y el estudio patológico del material quirúrgico confirmó aortitis sifilítica. Se presenta una revisión respecto a esta patología poco frecuente en la actualidad.

Abstract The case is presented of a 69-year-old male patient with a history of arterial hypertension, smoking, stroke, atrial fibrillation, aortic regurgitation, and ischaemic heart disease, who was admitted to a tertiary hospital due to functional class deterioration, lower limb oedema, and episodes of palpitations. A normal ejection fraction, with severe aortic regurgitation and ascending aortic dilation with surgical criteria, was found on echocardiography. Within pre-surgical studies, the VDRL had high titres and confirmation of the diagnosis of syphilis with TP-PA. Aortic valve replacement was performed using a biological prosthesis and Dacron graft in the ascending aorta. The histopathology study of the surgical material confirmed syphilitic aortitis. A review is presented on the current status of this rare pathology.

Early intervention in scar management and cutaneous burns with autologous platelet-rich plasma.

Burn management options are controversial and a multiple-handled issue. However, platelet-rich plasma is gaining interest in several medical fields. Dermatologist worldwide are already publishing some reports about its benefits and personal experiences in their practices. A 40-year-old female with a second-degree burn by VASER-type liposculpture was treated with platelet-rich plasma and followed up for 10 months. After treatment, she showed rapid improvement with an adequate cicatrization results. Some studies suggest that the use of platelet-rich plasma which contains cytokines and growth factors that participate in cellular repair and cellular differentiation, thus improving healing time and re-epithelization. We present the case of a patient with a second-degree burn that rapidly improved with autologous platelet-rich plasma.

Relapsing polychondritis, an underestimated dermatological urgency: case report and literature review.

BACKGROUND: Relapsing polychondritis is an autoimmune multisystemic disease with primary chondral involvement. Its high mortality and morbidity make it a real clinical challenge. CASE DESCRIPTION: A 32-year-old woman with a history of relapsing polychondritis, refractory to multiple treatments, with multisystem compromise, imminent risk of death due to severe tracheobronchial damage and difficult ventilatory support, and successful treatment with infliximab. DISCUSSION AND EVALUATION: Several treatments have been described in the literature, such as nonsteroidal anti-inflammatory drugs, corticosteroids, dapsone, azathioprine, cyclosporine, cyclophosphamide, and methotrexate. However, the cases refractory to conventional therapy may lead to chronicity, irreversibility, and death. As a result, a third-line therapy could improve the prognosis of these patients. CONCLUSIONS: Biological therapy is a good option for disease control and quality of life improvement. In addition, the physician should consider these treatments to avoid the chronicity and risk of death of these patients.

Childhood histoplasmosis in Colombia: Clinical and laboratory observations of 45 patients.

Histoplasmosis is an important mycosis in the Americas; and in children with no immune system abnormalities, histoplasmosis is typically a self-limited process. In contrast, in children with immune problems, disease manifestations are frequently more severe and include dissemination. From 1984 to 2010, a retrospective study of paediatric patients who had been diagnosed with histoplasmosis was performed. A total of 45 pediatric cases of histoplasmosis were identified. The most important risk factor was malnutrition (37%), followed by environmental exposure (33%). The patients exhibited pulmonary infiltrates (83%), fever (76%), cough, constitutional symptoms (38%), headache (35%), and lymph node hypertrophy (33%). Concerning the clinical forms, 64% of the patients presented with the progressive disseminated form that frequently affected the central nervous system (48%). Diagnostic laboratory tests indicated that the cultures were positive for 80% of the patients, the agar gel immunodiffusion was reactive in 95%, the M band of the precipitate was more commonly observed (81%), and the complement fixation tests were reactive in 88% of the patients. The timely diagnosis of histoplasmosis is important, and for this reason, it is hoped that the results of this study will lead pediatricians toward a better understanding of this mycosis in children.

Aneurisma del seno de Valsalva disecando hacia el septo interventricular en una paciente embarazada / Sinus of Valsalva aneurysm dissecting interventricular septum in pregnant patient

El aneurisma del seno de Valsalva es una entidad rara en la población general, con una incidencia de 0,14 al 3,5% en cirugías de corazón abierto; con un espectro clínico amplio y complicaciones cardiacas mecónicas o eléctricas que pueden ser fatales. En mujeres embarazadas también ha sido reportada esta entidad en unos cuantos casos en la literatura médica publicada. Se presenta un caso de una paciente gestante con aneurisma de seno de Valsalva, sus complicaciones y las medidas terapéuticas que se llevaron a cabo, ademós de una revisión del tema.

Sinus of Valsalva aneurysm is a rare entity in the general population, with an incidence of 0.14 to 3.5% in open heart surgery; with a broad clinical spectrum and mechanical or electrical cardiac complications that can be fatal. In pregnant women this entity has also been reported in a few cases in the medical literature. We present a case of a pregnant patient with sinus of Valsalva aneurysm, its complications and the therapeutic measures that were carried out, along with a review of the subject.

Canulación alternativa para cirugía mínimamente invasiva de cavidades cardiacas derechas / Alternative cannulation for minimally invasive surgery of right heart chambers

La cirugía mínimamente invasiva pasó de ser una alternativa, a un posible método de primera elección en cirugía valvular debido a sus beneficios en cuanto a infección, sangrado, estancia hospitalaria y funcionalidad. La canulación de ambas venas cavas, sin alterar los parámetros de la mínima invasividad, puede significar una disminución efectiva de los riesgos descritos con otras opciones y permite realizar procedimientos efectivos, tanto en cavidades izquierdas como derechas.

Minimally invasive surgery became more than an alternative, but a possible first election method for valve surgery because of its benefits in terms of infection, bleeding, hospital stay and functionality. The cannulation of both cava veins without altering the parameters of the minimal invasiveness may mean an effective reduction of the risks described in other options and allows us to perform procedures in both left and right cavities effectively.

Situación actual de la vigilancia de infecciones intrahospitalarias en hospitales de Lambayeque: Propuestas de mejora / Current status of surveillance of nosocomial infections in hospital in Lambayeque: Ideas for improvement

Introducción: Las infecciones intrahospitalarias (IIH) representan un serio problema de salud pública en el Perú y el mundo, sobre todo en países en vías de desarrollo que presentan deficiencias en los servicios de salud. El 2013 se reportó 80 IIH captadas por el sistema de vigilancia de los hospitales del Ministerio de Salud; mientras que la Seguridad Social (Hospital Nacional Almanzor Aguinaga Asenjo) se encontró 52% de los servicios hospitalarios presentaron IIH (tasa de prevalencia=9,34%). Situación actual de la vigilancia infecciones intrahospitalarias en Lambayeque: Para su identificación se realizó un grupo focal con los responsables de los sistemas de vigilancia de hospitales para recoger toda la información posible sobre las percepciones del proceso de vigilancia. Problemas identificados: Recursos humanos (insuficiente cantidad recursos humanos, rotación constante, insuficiente capacitación y resistencia del personal asistencial a colaborar a la vigilancia); normas (normatividad desactualizada y desconocida); sensibilización (falta de sensibilización de autoridades del centro asistencial, percepción como actividad fiscalizadora, ausencia de conformación de comités, y los existentes no son funcionales, vigilancia incompleta de los servicios priorizados según factores de riesgo estipulado por normatividad y realización de vigilancia pasiva); logística (insuficiente capacidad resolutiva de los laboratorios para identificación de agentes causales y cantidad insumos para bioseguridad disminuidos). Propuestas de mejora: Lograr una buena gestión y apoyo a la vigilancia de las IIH, asegurar un buen desempeño del recurso humano para la vigilancia de IIH, asegurar suficiente cantidad de RR HH para las IIH y asegurar logística en recursos de laboratorio y bioseguridad.

Endocarditis: una patología para actuar con decisión / Endocarditis: a pathology to act with decision

La endocarditis se ha convertido en una entidad con grandes retos tanto para el clínico como para el cirujano, por motivos como variación etiológica con resistencias cambiantes, compromiso infeccioso de nuevos dispositivos y tecnologías, además de mayores comorbilidades que demandan pericia. Su incidencia es de 3 a 9 casos por cada 100.000 personas con factores de riesgo como enfermedad valvular, prótesis, enfermedad reumática, diabetes, inmunosupresión, uso de drogas intravenosas, hemodiálisis, edad (>65 años), entre otros; la ausencia de enfermedad valvular conocida se presenta en el 50% de los casos (1). El 80% de los casos de endocarditis son producidos por estreptococo y estafilococo, pero este último es ahora en muchos centros el organismo causal más frecuente , de acuerdo con lo que reportan Eusse y colaboradores. De otra parte, las complicaciones cerebrales (8%-15% de los pacientes, son las manifestaciones extracardíacas más comunes y tienen repercusión en el pronóstico (16,7% en el reporte). Hasta el 50% de los pacientes con accidente cerebrovascular embólico pueden sufrir transformación hemorrágica. Aunque algunos grupos describen buenos resultados con cirugía temprana , la mortalidad logra un descenso del 20% a menos del 1% luego de cuatro semanas del evento isquémico . Los datos ecocardiográficos reflejan factores de riesgo de embolia. El tamaño de la lesión, su movilidad y las válvulas comprometidas son criterios fundamentales; otros parámetros como la disfunción ventricular y los cambios en la evolución de la lesión (6), también deben ser descritos para su análisis y posible influencia en el desenlace final, lo cual no está reportado en el artículo.

Bioinformatics analyses reveal age-specific neuroimmune modulation as a target for treatment of high ethanol drinking.

BACKGROUND: Use of in silico bioinformatics analyses has led to important leads in the complex nature of alcoholism at the genomic, epigenomic, and proteomic level, but has not previously been successfully translated to the development of effective pharmacotherapies. In this study, a bioinformatics approach led to the discovery of neuroimmune pathways as an age-specific druggable target. Minocycline, a neuroimmune modulator, reduced high ethanol (EtOH) drinking in adult, but not adolescent, mice as predicted a priori. METHODS: Age and sex-divergent effects in alcohol consumption were quantified in FVB/NJ × C57BL/6J F1 mice given access to 20% alcohol using a 4 h/d, 4-day drinking-in-dark (DID) paradigm. In silico bioinformatics pathway overrepresentation analysis for age-specific effects of alcohol in brain was performed using gene expression data collected in control and DID-treated, adolescent and adult, male mice. Minocycline (50 mg/kg i.p., once daily) or saline alone was tested for an effect on EtOH intake in the F1 and C57BL/6J (B6) mice across both age and gender groups. Effects of minocycline on the pharmacokinetic properties of alcohol were evaluated by comparing the rates of EtOH elimination between the saline- and minocycline-treated F1 and B6 mice. RESULTS: Age and gender differences in DID consumption were identified. Only males showed a clear developmental increase difference in drinking over time. In silico analyses revealed neuroimmune-related pathways as significantly overrepresented in adult, but not in adolescent, male mice. As predicted, minocycline treatment reduced drinking in adult, but not adolescent, mice. The age effect was present for both genders, and in both the F1 and B6 mice. Minocycline had no effect on the pharmacokinetic elimination of EtOH. CONCLUSIONS: Our results are a proof of concept that bioinformatics analysis of brain gene expression can lead to the generation of new hypotheses and a positive translational outcome for individualized pharmacotherapeutic treatment of high alcohol consumption.

Resección de fibroelastoma papilar mitral mediante cirugía mínimamente invasiva en paciente con accidente cerebrovascular / Mitral papillary fibroeslastoma resection through minimally invasive surgery in a patient with stroke

Paciente quien consultó con síntomas neurológicos y se realizó diagnóstico de accidente cerebrovascular embólico cuya etiología consistió en un tumor cardíaco de la válvula mitral (fibroelastoma) con confirmación histológica. Fue intervenido quirúrgicamente mediante técnica mínimamente invasiva a través del tórax, con excelente evolución, sin infección ni requerimientos sanguíneos; no presentó secuelas valvulares ni neurológicas. Se reportó reincorporación temprana a la vida laboral.

We report the case of a patient who consulted with neurological symptoms and was diagnosed as embolic stroke, whose etiology was a mitral valve tumor (fibroeslastoma) histologically confirmed. The patient underwent surgery through minimally invasive technique through the chest, with excellent evolution, without infection or blood requirements; there were no valvular or neurological sequelae. An early return to working life was reported.

Análisis fenomenológico-hermenéutico de la experiencia religiosa en el mito y en la locura / Phenomenological-hermeneutical analysis of religious experience in myth and madness

Antecedentes: Es bien sabido que los pacientes psiquiátricos comunican con frecuencia experiencias religiosas. Estas constituyen el contenido de los delirios especialmente en pacientes esquizofrénicos y epilépticos. La pregunta que planteamos es la siguiente: ¿hay diferencias entre este tipo de experiencias y las que encontramos en la tradición mitológica y en los textos religiosos? Resultados: Una revisión de famosas narraciones mitológicas, como La Eneida, nos permite establecer que las divinidades se hacen reconocibles al ser humano en el momento de su partida. Así, Eneas no reconoce a su madre, Venus, cuando ella se le aparece en medio del bosque en la costa de África. Entre ambos se desarrolla un diálogo y sólo al final del encuentro, cuando ella se está alejando y ya dando la espalda a Eneas, le muestra a su hijo los signos de su divinidad: "el resplandor de rosas que emanaba de su cuello, el perfume de su cabello y la majestad de su paso". Algo análogo puede observarse en el encuentro de Moisés con Yahvé en el Monte Sinaí. Moisés le pide a Dios: "Déjame ver tu gloria, te lo ruego". Y Dios responde, entre otras cosas: "tú verás mi espalda, pero no podrás ver mi faz, pues el hombre no puede verme...". En el mismo sentido, los discípulos de Emaús no reconocen a Jesús hasta el momento de su desaparición ("pero él se había desvanecido de su vista") y Saulo de Tarso se cae de su caballo justo en el momento en que siente la presencia divina. En resumen, el encuentro directo con la divinidad no parece ocurrir en el ámbito del mito o de la tradición religiosa. En el campo de la locura es exactamente lo opuesto. Nuestra investigación sobre experiencias religiosas en pacientes esquizofrénicos y epilépticos nos llevó a la conclusión de que Dios se les aparece a ellos cara a cara y los pacientes describen a Dios Padre, Jesús o la Virgen María en íntimos detalles y siempre en un ambiente cotidiano. Así es como la divinidad es vista en el jardín, o en el dormitorio, o tal vez sobre el ropero, sin nada de esa majestad que debería caracterizarla. La cercanía a Dios puede llegar a ser tan extrema que el paciente se identifique totalmente con Dios, de modo que la luz que emana del mundo de lo divino deja de ser percibida por ellos. Conclusión: Mientras en las narraciones mitológicas Dios se le aparece al ser humano en el momento de Su partida o mostrando Su espalda, los pacientes psiquiátricos con delirios religiosos experimentan a la divinidad en una forma directa, cara a cara. Dada esta deformación de lo divino que ocurre en las proximidades de la locura, podemos entender mejor las misteriosas palabras que dice Yahvé a Moisés en el Éxodo: "porque el hombre no puede verme y seguir viviendo" (AU)

Background: It is well known how often psychiatric patients report religious experiences. These are especially frequent in schizophrenic and epileptic patients as the subject of their delusions. The question we pose is: are there differences between this kind of religious experiences and those we find in religious texts or in the mythological tradition? Results: An overview on famous mythological narratives, such as The Aeneid, allows us to establish that the divinities become recognizable to the human being at the moment of their departure. Thus, Aeneas does not recognize his mother, Venus, when she appears to him in the middle of the forest at the coast of Africa. A dialogue between the two takes place, and only at the end of the encounter, when she is going away and already with her back to Aeneas, she shows her son the signs of her divinity: the rose-flus hemanating from her neck, her hair perfume and the majesty of her gait. Something analogous can be observed in the encounter of Moses with Yahweh on Mount Sinai. Moses asks God: "Show me your glory, I beg you". And God replies, among other things: ”you shall see the back of me, but my face is not to be seen”. In the same sense, the Emmaus disciples do not recognise Jesus till the moment of his disappearance ("but he had vanished from their sight"), and Saul of Tars falls off his horse just in the moment when he feels the divine presence. In short, the direct encounter with the divinity seems not to occur in the realm of myth or in religious tradition. The realm of madness is exactly the opposite. Our research on religious experiences in schizophrenic and epileptic patients leads us to conclude that God appears to them face to face, and the patient describes God the father, Jesus or the Virgin Mary in intimate detail, always in an everyday setting. So, the divinity is seen in the garden, or in the bedroom, or maybe above the wardrobe, without any of its majesty. The nearness to God also tends to be so extreme that even an identification of patient and God can occur. That light emanating from the world of the divine ceases to be perceived by them. Conclusions: While in mythological narratives God appears to the human being at the moment of His departure or showing His back, psychiatric patients with religious delusions experience the divinity in a direct way, face to face. Given the deformation of the divine occurring on the edge of madness we can better understand the mysterious words from Yahweh to Moses in Exodus: "for man cannot see me and live" (AU)

La cooperación internacional en salud I: Tunupa o la arquitectura de los caminos de la solidaridad y el desarrollo / The international cooperation in helth I: Tunupa or the architecture of links with development

En los últimos años la cooperación internacional o ayuda internacional en salud, ha tomado un rol relevante en la reforma de los servicios de salud, en las políticas de equidad y disminución de la pobreza y en general en nuestro desarrollo social. Sin embargo, tanto su conocimiento como su gestión son aún limitados; por lo que el presente artículo es un aporte para su conocimiento, focalizando en su arquitectura y filosofía, los elementos que la constituyen; así como los hilos conductores de su desenvolvimiento. A través del proceso de repensamiento, se plantea su probable origen, se detallan los conceptos básicos que la nutren y que recorren su concepción y evolución, analizándolos a través de siete paradigmas, que en la actualidad distorsionan su aproximación, dificultan su adecuada evolución y su mejor gestión. Se concluye en la elaboración de un marco conceptual de la cooperación internacional en salud.

In the last years International cooperation or international aid in health, has been taken a relevant role in the accomplishment of health services reform, on the equality and poverty alleviation policies and in general promoting the social development of our country. Nevertheless, its knowledge and its management are still limited, reason why the present revision tries to contribute to its knowledge, focusing on its architecture, structure, philosophy and links with development. For it through a rethinking process, its probable origin is mentioned, detailing the basic concepts that nourish it and that cross their conception and evolution, analyzing them through seven paradigms that distort approaches, difficult its own evolution and its better management. It concludes in an analytical framework of the international cooperation in health.