La escritura como intervención en salud mental y salud pública: revisión a 25 años del abordaje phaedrus para el autismo / Writing as an intervention in Mental Health and Public Health: revision 25 years after the Phaedrus Approach to autism

RESUMEN INTRODUCCIÓN: El tratamiento del autismo resultó un desafío desde su descripción, sobre todo en personas sin habla (SH) o con habla mínima (HM), generalmente relegadas de la literatura científica y de alto costo sanitario. En 2022 se cumplieron 25 años de un abordaje para el autismo SH/HM rediseñado en Argentina, realizado a través de la escritura tipeada sincrónica (Abordaje Phaedrus). El objetivo fue revisar y describir por primera vez los cambios clínicos (CC) tras esta intervención. MÉTODOS: Se realizó una revisión sistemática descriptiva de los reportes de los CC mencionados en una serie de casos que fueron abordados con la intervención en estudio. RESULTADOS: Se describieron los reportes de los 10 CC más frecuentes de la muestra, que se presentaron en promedio a los 13,8 meses de tratamiento. Cada caso presentó 7,5 CC, con resultados similares entre diagnósticos previos al tratamiento y con alguna diferencia en favor del género femenino, de menores de 10 años al inicio del tratamiento y de personas SH. El 100% accedió a la escritura tipeada independiente y, luego de ello, el 71% logró o mejoró el habla. DISCUSIÓN: Los 7 CC más frecuentes representan aspectos claves del tratamiento del autismo. Aunque se requieren más estudios, los resultados son muy auspiciosos y representan un aporte sustancial a la evidencia científica. Este abordaje podría resultar costo-efectivo para el trastorno del espectro autista SH/HM y ser de interés para otras problemáticas en la intersección entre salud mental y salud pública.

ABSTRACT INTRODUCTION: The treatment of autism was a challenge since its description, especially in non-speaking (NS) or minimally speaking (MS) people, who receive little attention from scientific literature and represent a high health care cost. The year 2022 marked the 25th anniversary of an approach to NS/MS autism redesigned in Argentina and carried out through synchronous typewriting (Phaedrus Approach). The objective of this work was to review and describe for the first time the clinical changes (CC) after intervention. METHODS: A systematic descriptive review of the CC reports was carried out, based on a series of cases addressed with the intervention under study. RESULTS: The reports of the 10 most frequent CC in the sample were described, which appeared on average after 13.8 months of treatment. Each case presented 7.5 CC, with similar results between diagnoses prior to treatment and with some differences in favor of female gender, those under 10 years of age at the start of treatment, and NS people. While 100% acceded to independent typewriting, 71% achieved or improved speech afterwards. DISCUSSION: The 7 most frequent CC represent key aspects of autism treatment. Although more studies are required, the results are very promising and represent a substantial contribution to the scientific evidence. This approach could be cost-effective for NS/MS autism spectrum disorder and could be of interest for other problems at the intersection of mental health and public health.

Técnicas de Intervención educativa nutricional en el consumo de alimentos fuentes de hierro en preescolares / Nutritional intervention techniques in the consumption of foods that are sources of iron in preschoolers

Introducción: La ingesta deficiente de alimentos fuentesde hierro, es un factor de riesgo para el desarrollo de anemiaferropénica infantil, es necesario identificar la estrategia deintervención educativa nutricional más efectiva en un entornocomunitario urbano y dinámico. Objetivo: Comparar el efecto de la intervención educativanutricional a través de dos técnicas, en el consumo de alimentos fuentes de hierro en preescolares residentes en unazona urbana.Materiales y Métodos: Se realizó un estudio de enfoquecuantitativo, aplicada, diseño experimental de tipo ensayo nocontrolado, realizado en 80 preescolares de 3 a 5 años edad.Se seleccionaron dos grupos de 40 (madre e hijo) para unaintervención educativa nutricional sincrónica y presencial respectivamente: antes y después de la intervención educativanutricional; se evaluó a ambos grupos el consumo de hierrode los preescolares, a través de un cuestionario de frecuenciade consumo de alimentos fuentes de hierro. Para el análisisestadístico, se aplicó la prueba estadística T de Student.Resultados: El consumo de hierro promedio de la dietafue de1,25 ± 0,29 mg/día y después de la intervención nutrición sincrónica fue de 1,35 + 0,19 mg/día. En el grupo deintervención presencial, antes fue de 1,17 ± 0,27 mg/día ydespués de la intervención fue de 2,63 ± 0,35 mg/día. Existediferencia del consumo de hierro antes y después de la intervención educativa nutricional en ambas técnicas de intervención nutricional, sincrónica y presencial (p<0,001).Conclusión: La técnica de intervención nutricional, bajo lamodalidad presencial fue la más efectiva en aumentar el consumo de alimentos fuentes de hierro en preescolares residentes en una zona urbana.(AU)

Introduction: Deficient intake of food sources of iron is arisk factor for the development of iron deficiency anemia inchildren, it is necessary to identify the most effective nutritional educational intervention strategy in an urban and dynamic community environment. Objective: To compare the effect of the nutritional educational intervention through two techniques, on the consumption of foods that are sources of iron in preschoolers residingin an urban area.Materials and Methods: A study with a quantitative approach, applied, experimental design of the uncontrolled trialtype, carried out in 80 preschoolers from 3 to 5 years of age, was carried out. Two groups of 40 (mother and son) were selected for a synchronous and face-to-face nutritional educational intervention respectively. Before and after the nutritional educational intervention, the iron consumption of thepreschoolers was evaluated in both groups, through a questionnaire on the frequency of consumption of foods that aresources of iron. For the statistical analysis, the Student’s Tstatistical test was applied.Results: Before the intervention, the average dietary ironintake was 1,25 ± 0,29 mg (synchronous nutritional intervention) and 1,17 ± 0,27 mg (face-to-face nutritional intervention). After the intervention it was 1,35 ± 0,19 mg (synchronous nutritional intervention) and 2,63 ± 0,35 mg(synchronous nutritional intervention). There is a differencein iron consumption before and after the nutritional educational intervention of the synchronous and face-to-facetechnique (p<0,001).Conclusion: The nutritional intervention technique, underthe face-to-face modality, was the most effective in increasing the consumption of foods that are sources of iron inpreschoolers residing in an urban área.(AU)

Adrenalectomía laparoscópica bilateral sincrónica: técnica quirúrgica y resultados perioperatorios en 13 años de experiencia / Synchronous bilateral laparoscopic adrenalectomy: Surgical technique and perioperative results of a 13-years’ experience

Introducción y objetivos: La cirugía laparoscópica se ha convertido en el abordaje estándar para el tratamiento de las glándulas suprarrenales. Debido a que la adrenalectomía bilateral sincrónica no se realiza con frecuencia, la evidencia sobre este procedimiento es limitada. Nuestro objetivo es reportar nuestra experiencia de 13 años con la adrenalectomía bilateral laparoscópica sincrónica, evaluando su viabilidad, seguridad y resultados perioperatorios.Pacientes y métodos: Un total de 23 pacientes consecutivos sometidos a adrenalectomía laparoscópica bilateral sincrónica entre 2007 y 2020 en un único centro académico fueron incluidos en el estudio. Las variables evaluadas fueron el tiempo quirúrgico, la pérdida media estimada de sangre, la conversión a cirugía abierta, las complicaciones postoperatorias, la mortalidad y la duración de la estancia postoperatoria.Resultados: El tiempo operatorio medio fue de 189,3±48,9min. La media de pérdida de sangre estimada fue de 163,0±201,3ml. No hubo conversiones a cirugía abierta. Cinco pacientes tuvieron complicaciones postoperatorias y 3 de estas fueron graves. Ningún paciente falleció durante el periodo perioperatorio. La mediana del tiempo de estancia postoperatoria fue de 3 días (rango 1-30). En el análisis patológico 15 pacientes tenían hiperplasia suprarrenal bilateral, 2 hiperplasia suprarrenal unilateral y un tumor benigno contralateral, uno hiperplasia suprarrenal unilateral y glándula contralateral normal, otro adenoma unilateral, 3 feocromocitomas bilaterales y uno mielolipoma bilateral.Conclusión: La adrenalectomía laparoscópica bilateral sincrónica es una técnica factible y segura. Se requiere un equipo multidisciplinar y experimentado que incluya anestesistas y endocrinólogos. (AU)

Introduction and objectives: Laparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes.Patients and methods: A total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay.Results: Mean operative time was 189.3±48.9min. Mean estimated blood loss was 163.0±201.3ml. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1-30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma.Conclusion: Synchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required. (AU)

Synchronous bilateral laparoscopic adrenalectomy: Surgical technique and perioperative results of a 13-years' experience.

INTRODUCTION AND OBJECTIVES: Laparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes. PATIENTS AND METHODS: A total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay. RESULTS: Mean operative time was 189.3 ±â€¯48.9 min. Mean estimated blood loss was 163.0 ±â€¯201.3 mL. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1-30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma. CONCLUSION: Synchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required.

Aplicación y evaluación de la eficacia del protocolo unificado transdiagnóstico con estudiantes universitarios españoles / Application and evaluation of the effi cacy of the Unifi ed Transdiagnostic Protocol with Spanish college students

Resumen Se presenta aplicación y evaluación del Protocolo Unificado Transdiagnóstico para los trastornos emocionales grupal, online sincrónico a estudiantes universitarios que solicitaron atención al Servicio de Atención Psicológica de la Universidad de Cádiz. Se implementó el Protocolo Unificado de ocho módulos desarrollado en 12 sesiones semanales con el objetivo de examinar su eficacia en un formato grupal online. Los objetivos específicos fueron los siguientes: Incrementar la calidad de vida, el optimismo y el afecto positivo y disminuir la sintomatología depresiva y ansiosa, el afecto negativo, las conductas rumiativas, el malestar psicológico y la evitación experiencial. La investigación tuvo un enfoque cuantitativo, exploratorio, descriptivo e interactivo, con un diseño cuasi-experimental, pre-post test para muestras pareadas. Los instrumentos de evaluación fueron los siguientes: OASIS, ODSIS, QLI-Sp, COP, PANAS, RRS, CORE-OM, BEAQ, ficha sociodemográfica ad hoc y una Escala de satisfacción/opinión. Participaron nueve estudiantes con una edad promedio de 21.11. Se hallaron diferencias estadísticamente significativas entre las mediciones pre y pos test en afecto negativo (t = 3.250; p < .012) y en la escala Riesgo del CORE OM (t = 2.401; p < .043). La aplicación del PU en formato grupal online resultó eficaz en el contexto no clínico aplicado: los participantes evidenciaron un progreso en el tratamiento y mejoras en las variables en estudio.

Abstract: This study presents the results of the application of the Unified Transdiagnostic Protocol Treatment of Emotional Disorders in a group format in a non-clinical context, with university students who have asked for therapy at the University Psychological Services. The standardized eight modules-UP was implemented and it was administered in twelve group sessions. Synchronous online weekly and 90-minute long sessions were carried out. UP is an evidence-based cognitive behavioral intervention program to address a wide range of emotional disorders. The general target was to examine the efficacy of UP for the Transdiagnostic Treatment of Emotional Disorders in an online group format. The specific targets were: (a) to increase quality of life, optimism and positive affect; and (b) to reduce depressive and anxious symptoms, negative affect, ruminant behaviors, psychological distress and experiential avoidance. This study was carried out with a quantitative, exploratory, descriptive and interactive approach. A quasi-experimental design, pre- and posttest for paired samples was used. Instruments: OASIS, ODSIS, QLI-Sp, COP, PANAS, RRS, CORE-OM, BEAQ, ad hoc socio-demographic file and Opinion Scale. A total of 9 students voluntarily participated in the study (Mean age = 21.11 years). After the intervention, statistically significant diffe- rences were found between the pre- and posttest measurements in negative affect (t = 3.250; p < .012) and in the CORE OM´ Risk Scale (t = 2.401; p < .043). The UP application in a group format with students that asked for therapy has proven to be effective in a non-clinical context, participants have shown progress in the treatment as well as in some psychological areas.

Linfoma de Hodgkin anal primario y tumor neuroendocrino intestinal sincrónicos: a propósito de un caso y revisión de la literatura / Primary rectal Hodgkin's lymphoma and synchronous small bowel neuroendocrine tumor: Case report and literature review

Resumen La localización extranodal gastrointestinal del linfoma de Hodgkin comprende el 5% de todos los linfomas. Dentro de este grupo, el linfoma anal primario representa menos del 0,05%, siendo por tanto una entidad extremadamente rara. Por otro lado, los tumores neuroendocrinos son un grupo heterogéneo de neoplasias relativamente poco frecuentes, pero de localización fundamentalmente digestiva. La asociación entre un linfoma de Hodgkin de localización anal y un tumor neuroendocrino intestinal no ha sido descrita previamente en la literatura, pero no es en absoluto raro que los tumores neuroendocrinos puedan coexistir con otro tipo de neoplasias. Los autores presentan el caso infrecuente de presentación de linfoma Hodgkin de localización anal asociado a un tumor neuroendocrino intestinal en una paciente mujer de 74 años, describiéndose la clínica, resultados de pruebas complementarias y tratamiento recibido.

Abstract Extranodal gastrointestinal Hodgkin's lymphoma comprises 5% of all lymphomas. In this group, primary rectal lymphoma represents less than 0.05%; thus, it is an extremely rare entity. On the other hand, neuroendocrine tumors are a heterogeneous group of infrequent neoplasms, mainly of digestive location. The association between a rectal Hodgkin's lymphoma and an intestinal neuroendocrine tumor has not been previously described in the literature, but it is not at all uncommon for neuroendocrine tumors to coexist with other types of neoplasms. The authors present a rare case of rectal Hodgkin's lymphoma associated with an intestinal neuroendocrine tumor in a 74-year-old female patient, describing the symptoms, complementary test results, and treatment.

Neoplasia primaria sincrónica de estómago, colon y recto: reporte de un caso / Synchronous stomach, colon and rectum primary neoplasias: a case report

Presentamos el caso de un paciente masculino de 40 años de edad, con estreñimiento de un año de evolución y antecedentes de enfermedad por reflujo gastroesofágico, se realiza endoscopia digestiva alta y baja y se realiza diagnóstico sincrónico de adenocarcinoma de estómago, recto y colon descendente, realizamos tomografía por emisión de positrones con tomografía computarizada pre quirúrgico y cirugía como tratamiento primario. Mostramos una descripción del caso y una revisión de la bibliografía.

We present the case of a 40-year-old man with a one year evolution constipation and a history of GERD. An upper and lower digestive endoscopy was performed and a synchronous diagnosis of adenocarcinoma of the stomach, rectum and descending colon was established. A PET-CT pre-surgical was performed and the surgery was carried out as primary treatment. We show a description of the case and a bibliographic review.

Cáncer de colon con metástasis hepáticas sincrónicas / Colon Cancer with Synchronous Hepatic Metastases

Introducción: El cáncer de colon constituye un grave problema sanitario debido a su alta incidencia y mortalidad. Objetivo: Describir algunos aspectos epidemiológicos, etiopatogénicos, diagnósticos, terapéuticos y evolutivos del cáncer de colon con metástasis hepáticas. Métodos: Revisión documental en bases de datos bibliográficos biomédicas sobre el tema durante el período 2015-2020. Se seleccionaron 31 artículos relacionados con el objetivo propuesto. Desarrollo: Los pacientes con cáncer de colon con metástasis hepáticas sincrónicas son tratados mediante tres estrategias: la tradicional o clásica consiste en la resección quirúrgica del tumor primario y posteriormente, quimioterapia, radioterapia o ambas, para proceder a la resección de las lesiones hepáticas tres a seis meses después; la simultánea, consistente en la resección de la lesión tumoral primaria y de las metástasis hepáticas en un mismo acto quirúrgico, seguida de quimioterapia, radioterapia o ambas y la inversa, que administra de tres a seis ciclos de quimioterapia sistémica, seguidos por la resección de las metástasis hepáticas y en un segundo tiempo resecar el tumor primario, todo esto con quimioterapia durante el intervalo entre ambas cirugías. Conclusiones: El único tratamiento con potencial curativo en los pacientes con metástasis hepáticas debe ser la resección de todo el volumen tumoral hepático con márgenes adecuados y la suficiente preservación del parénquima sano (25 - 30 por ciento), según criterios oncológicos y anatómicos establecidos, lo que incide en la calidad de vida y la supervivencia de estos enfermos(AU)

Introduction: Colon cancer is a serious health concern due to its high incidence and mortality. Objective: To describe some epidemiological, etiopathogenic, diagnostic, therapeutic and evolutionary aspects of colon cancer with hepatic metastases. Methods: Documentary review about the subject carried out in biomedical bibliographic databases, during the period 2015-2020. Thirty-one articles related to the proposed objective were selected. Development: Colon cancer patients with synchronous hepatic metastases are treated using three strategies: the traditional, or classic, strategy consists in surgical resection of primary tumor and, subsequently, chemotherapy, radiotherapy or both, before proceeding then to resection of liver lesions three to three six months later; the simultaneous strategy consists in resection of primary tumor lesion and hepatic metastases in the same surgical procedure, followed by chemotherapy, radiotherapy or both; and the reverse strategy, in which three to six cycles of systemic chemotherapy are administered, followed by resection of hepatic metastases and, in a second stage, resection of primary tumor, all this with chemotherapy during the interval between both surgeries. Conclusions: The only treatment with curative potential in patients with hepatic metastases should be the resection of the entire hepatic tumor volume with adequate margins and sufficient preservation of the healthy parenchyma (25-30 percent), according to established oncological and anatomical criteria, which has an incidence on the quality of life and survival of these patients(AU)

Especificidades clínico-epidemiológicas y diagnósticas del cáncer de colon con metástasis hepáticas sincrónicas / Clinical-Epidemiological Specificities of Colon Cancer Diagnosed with Synchronic Metastasis

Introducción: El cáncer de colon se erige como la neoplasia del tubo digestivo más frecuente en la presente centuria. Objetivo: Identificar algunos factores clínicos, epidemiológicos y diagnósticos en pacientes operados de cáncer de colon con metástasis hepática sincrónica. Métodos: Se realizó un estudio observacional, descriptivo y transversal de una muestra de 31 pacientes operados con diagnóstico definitivo de cáncer de colon con metástasis hepática sincrónica, en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el periodo comprendido entre 2010 y 2019. Resultados: La edad promedio fue de 63,2 años. Existió predominio de la enfermedad inflamatoria intestinal como antecedente patológico personal, y del alcoholismo como factor de riesgo. La sintomatología predominante fue dolor abdominal y cambios del hábito intestinal, así como el tumor palpable al examen físico del abdomen. La ecografía abdominal y el colon por enema fueron los procederes de diagnóstico más utilizados. Prevalecieron los tumores en el colon izquierdo a nivel del descendente. Todos los tumores malignos fueron adenocarcinomas a predominio de los moderadamente diferenciados. Conclusiones: Las edades avanzadas de la vida, así como la presencia de tabaquismo y alcoholismo son factores epidemiológicos característicos de la población de enfermos aquejados de cáncer de colon con metástasis hepática. Los elementos clínicos identificados constituyeron los habitualmente descritos en la literatura médica, aunque los estudios imaginológicos utilizados preoperatoriamente resultaron limitados para el diagnóstico del cáncer de colon con metástasis hepática sincrónica, precisándose el hallazgo de las lesiones metastásicas durante la intervención quirúrgica(AU)

Introduction: Colon cancer is the most frequent digestive-tract neoplasm in the present century. Objective: To identify some clinical, epidemiological and diagnostic factors in patients operated on for colon cancer and synchronic hepatic metastasis. Methods: An observational, descriptive and cross-sectional study was carried out in a sample of 31 patients operated on with a definitive diagnosis of colon cancer and synchronic hepatic metastasis, in the general surgery service of Saturnino Provincial Teaching Hospital in Santiago de Cuba, during the period between 2010 and 2019. Results: The average age was 63.2 years. There was a predominance of inflammatory intestinal disease as a personal pathological antecedent, as well as alcoholism as a risk factor. The predominant symptoms were abdominal pain and changes in intestinal habits, as well as a tumor palpable on physical abdominal examination. Abdominal ultrasound and lower barium enema were the most used diagnostic procedures. Tumors prevailed at the level of the left descending colon. All malignant tumors were adenocarcinomas, predominantly moderately differentiated ones. Conclusions: Advanced ages of life, as well as smoking and alcoholism are characteristic epidemiological factors among the population of patients suffering from colon cancer with hepatic metastases. The clinical elements identified were those usually described in the medical literature, although the imaging studies used preoperatively were limited for the diagnosis of colon cancer with synchronic hepatic metastasis, a fact that required finding metastatic lesions during surgery(AU)

Telepsychiatry: A Successful Experience in Antioquia, Colombia. / Telepsiquiatría: una experiencia exitosa en Antioquia, Colombia.

OBJECTIVE: To describe the experience of physicians and patients in the Telepsychiatry programme at the University of Antioquia's Faculty of Medicine in the first 12 months after its implementation in eight towns across Antioquia. METHODOLOGY: A descriptive study involving the evaluation of 111 patients during the programme's first year. An instrument was designed to evaluate patients' satisfaction and the Technology Acceptance Model (TAM) was used to evaluate the health professionals' satisfaction. RESULTS: 111 patients were seen on 340 occasions. 70 out of the 111 patients (63.1%) were seen by Telepsychiatry at least twice in the first year of implementation. A sample of 38 patients (34%) was used to evaluate their experience, of which 94.7% said their problem had been solved and 100% were highly satisfied. Nine health professionals took part in the programme, who agreed that the technology was useful and easy to use. They also stated that they wanted to continue using it. CONCLUSION: Health systems across the globe have failed to provide an adequate response to the mental health burden. Therefore, strategies such as telepsychiatry are considered an ideal treatment modality to give patients living in remote locations the specialised attention that they need.

Telepsiquiatría: una experiencia exitosa en Antioquia, Colombia

Objetivo: Describir la experiencia que han tenido los médicos y pacientes del programa de Telepsiquiatría de la Facultad de Medicina de la Universidad de Antioquia en los primeros 12 meses de su implementación en 8 municipios del departamento. Métodos: Estudio descriptivo, que incluyó a 111 pacientes atendidos durante el primer año. Se diseñó un instrumento para evaluar la satisfacción de los pacientes y se empleó el instrumento de aceptación de tecnología para evaluar la de los profesionales de la salud. Resultados: Se realizaron 340 atenciones durante ese periodo a 111 pacientes; 70 (63,1%) de ellos recibieron al menos 2 atenciones por telepsiquiatría en el primer año. Se evaluó la experiencia en una muestra de 38 pacientes (34%), quienes manifestaron la resolución del problema (94,7%) y una satisfacción alta (100%). En el programa participaron 9 profesionales de la salud, que estuvieron de acuerdo en que la tecnología es útil y fácil de usar y tienen la intención de seguir usándola. Conclusiones: Los sistemas de salud de todo el mundo no han dado una respuesta adecuada a la carga de trastornos mentales; por esto, estrategias como la telepsiquiatría se consideran una modalidad de atención ideal para personas que viven en lugares remotos y tienen dificultad de acceso a los servicios de salud especializados, con adecuada aceptación.

Objective: To describe the experience of physicians and patients in the Telepsychiatry pro gramme at the University of Antioquia's Faculty of Medicine in the first 12 months after its implementation in eight towns across Antioquia. Methodology: A descriptive study involving the evaluation of 111 patients during the programme's first year. An instrument was designed to evaluate patients' satisfaction and the Technology Acceptance Model (TAM) was used to evaluate the health professionals' satisfaction. Results: 111 patients were seen on 340 occasions. 70 out of the 111 patients (63.1%) were seen by Telepsychiatry at least twice in the first year of implementation. A sample of 38 patients (34%) was used to evaluate their experience, of which 94.7% said their problem had been solved and 100% were highly satisfied. Nine health professionals took part in the programme, who agreed that the technology was useful and easy to use. They also stated that they wanted to continue using it. Conclusion: Health systems across the globe have failed to provide an adequate response to the mental health burden. Therefore, strategies such as telepsychiatry are considered an ideal treatment modality to give patients living in remote locations the specialised attention that they need.

Hallazgo de Tumor Maligno/Premaligno Insospechado en Estudios 18 F-FDG PET/TC en Pacientes Oncológicos: Incidental Malignant/Premalignant Tumor Detection in Oncological Patients / 18 f-fdg pet/ct

Objetivo Determinar la frecuencia y el tipo de tumor maligno/premaligno insospechado como hallazgo en estudios 18 F-FDG PET/TC en pacientes oncológicos. Material y Métodos Se revisaron retrospectivamente (de enero de 2014 a marzo de 2017), informes de estudios 18 F-FDG PET/TC de pacientes oncológicos, identificando aquellos pacientes con hallazgo de lesión sospechosa de otro tumor maligno como hallazgo incidental. La información fue obtenida a partir de determinadas "palabras clave" en la base de datos del Centro. Los hallazgos se confirmaron mediante histopatología y/o seguimiento clínico y paraclínico de como mínimo seis meses. Resultados De 4.086 pacientes oncológicos estudiados con 18 F-FDG PET/TC, se encontró lesión sospechosa de otro tumor maligno en 130 (3,2%), de los cuales 72 eran mujeres y 58 hombres, con edad media de 61 años. Los tumores primarios más frecuentes (aquellos que motivaron el pedido del examen PET/CT inicialmente), fueron de mama (n = 27), pulmón (n = 27) y colo-recto (n = 20). Se confirmaron por histopatología 49 (1,2%) nuevos tumores malignos/premalignos y dos lesiones metastásicas. La localización del segundo tumor primario correspondió a: colon (n = 18), pulmón (n = 6), mama (n = 6), linfoma (n = 3), ovario (n = 2), endometrio/cuello uterino (n = 2), tiroides (n = 2) y otros (n = 10). Resultaron 28 hallazgos falsos positivos, 31 pacientes no se estudiaron por progresión lesional y 20 pacientes se perdieron de seguimiento. Discusión La prevalencia de neoplasia primaria maligna múltiple (NPMM) es variable entre 0,7 y 11,7%. En nuestra serie, se encontró lesión sospechosa de segundo tumor en 130 casos (3,2%), de los cuales se confirmaron 49 segundos tumores (1,2%), similar a Conclusiones La tasa de detección de tumor maligno insospechado confirmado histológicamente fue de 1,2%. Todo hallazgo incidental sospechoso de malignidad en 18 F-FDG PET/TC debe ser estudiado, ya que puede corresponder a un segundo tumor maligno no sospechado con posibilidad de tratamiento curativo.

Purpose To determine the frequency and type of unexpected malignant/ premalignant tumor as a finding in 18 F-FDG PET/CT studies in oncological patients. Material and Methods Reports of 18 F-FDG PET/CT studies of oncological patients were reviewed retrospectively (from January 2014 to March 2017), with the finding of suspicious lesion of another malignant tumor. The information was obtained from certain "keywords" in the Center's database. The findings were confirmed by histopathology when possible and with clinical and paraclinical follow-up for at least six months. Results Of 4086 oncological patients, studied with 18 F-FDG PET/CT, a suspicious lesion of another malignant tumor was found in 130 (3.2%), 72 female and 58 male sex, average age 61 years. The most frequent primary tumors were: breast (n = 27), lung (n = 27) and colo-rectum (n = 20). 49 (1.2%) new malignant/premalignant tumors and two metastatic lesions were confirmed by histopathology. The location of the second primary tumor was: colon (n = 18), lung (n = 6), breast (n = 6), lymphoma (n = 3), ovary (n = 2), endometrium/cervix (n = 2), thyroid (n = 2) and others (n = 10). There were 28 false positive findings, 31 patients were not studied for progression and 20 patients were lost to follow-up. Discussion The prevalence of multiple malignant primary neoplasia (MMPN) is variable between 0.7 and 11.7%. In our series, a suspicious second tumor lesion was found in 130 cases (3.2%), of which 49 second tumors (1.2%) were confirmed, similar to that reported by other authors. Conclusions The detection rate of unsuspected malignant tumor was 1.2%, coincident with the literature. Any incidental finding suspicious of malignancy in 18 F-FDG PET/CT should be studied since in most cases it corresponds to early diagnosis with the possibility of curative treatment.

Gastrointestinal stromal tumour and second tumours: A literature review. / El tumor del estroma gastrointestinal y la aparición de segundos tumores: revisión de la bibliografía.

There are several tumours associated with gastrointestinal stromal tumour (GIST), most of them without an apparent family relationship; only 5% of them occur within the context of a family syndrome. In this article the corresponding literature about the former has been reviewed. A search in Pubmed was carried out, the methodology of which is described in detail in the body of the article. A total of 88 articles have been chosen for the review, next to the application of limits as well as a manual review. GIST patients have a twofold risk of developing a second tumour than the general population (4-33% of them develop a second neoplasm, either synchronic or metachronic). Most incident tumours associated with GIST are gastrointestinal and genitourinary tumours. In addition, patients with second tumours have a worse survival rate than those without second tumours.

Tres cánceres primarios simultáneos: reporte de caso y revisión de la literatura / Three simultaneous primary cancers: Case report and literature review

Resumen La presencia de un segundo o tercer cáncer primario después del diagnóstico inicial de malignidad es un evento cada vez más frecuente asociado con la mejor sobrevida y seguimiento de pacientes con cáncer a nivel mundial. Sin embargo, la presencia de tres neoplasias primarias simultáneas sigue siendo un evento singular. Presentamos el caso de una mujer de 76 años con tumor neuroendocrino del intestino delgado, adenocarcinoma de colon sigmoide y adenocarcinoma mucinoso de ovario de manera simultánea, manejada quirúrgicamente. Reali zamos una revisión de la literatura.

Abstract The presence of a second or third primary cancer after the initial diagnosis of malig nancy is an increasingly frequent event associated with the improved survival and monitoring of cancer patients worldwide. However, the presence of three simultaneous primary neoplasms remains a singular event. The case is presented of a 76-year-old woman with a neuroendo crine tumour of the small intestine, sigmoid colon adenocarcinoma, and a mucinous ovarian adenocarcinoma, simultaneously surgically managed. A literature review on the topic was also conducted.

Surgical treatment of lung cancer with synchronous adrenal metastases: Adrenalectomy first. / Tratamiento quirúrgico de metástasis suprarrenal sincrónica de cáncer de pulmón: adrenalectomía primero.

INTRODUCTION: The aim of this study is to present our patients with lung cancer and synchronous adrenal metastases treated with a reversal approach: starting with adrenalectomy and doing the lung resection second. METHODS: A total of 108 laparoscopic adrenalectomies were performed, and we analyze a consecutive serie of 10 patients with isolated adrenal synchronous metastases from the lung, surgically treated in a sequential way. All patients underwent staging mediastinoscopy, and patients with positive lymph nodes were primary treated with chemotherapy. We analyze: postoperative morbidity, length of stay, time between the 2surgeries, suvival free progression and global survival. Survival analysis was performed by the Kaplan-Meier method. RESULTS: Mean age: 56.8 (41-73) years old. Of the total, 8 patients were surgically performed by laparoscopy. Metastases average size: 5.9 (3-10) cm. Days between the 2surgeries were 28 (12-35) days. No morbidity after adrenalectomy. Length of stay was 4.3 (3-5) days. Disease-free survival at 2 years was 60%, the 5-year overall survival was 30%, with a median survival of 41.5 (0-98) months. CONCLUSIONS: Adrenalectomy involves no significant morbidity and can be performed safely without delaying lung surgery, and allows us to operate the primary lung tumor successfully as long as we ensure complete resection of the adrenal gland. A multidisciplinary oncology committee must individualize all cases and consider this therapeutic approach in all patients with resectable primary tumor and resectable adrenal metastases.

Metástasis hepática sincrónica de cáncer colorrectal / Synchronous liver metastases of colorectal cancer

El cáncer colorrectal representa 9,7% de todos los cánceres con 1,4 millones de nuevos casos diagnosticados cada año en el mundo 19-31% de los pacientes desarrollan metástasis hepáticas de cáncer colorrectal y 23-38% desarrollan enfermedad extrahepática1 15-25% se presentarán de forma sincrónica y 25-40% serán metacrónicas2.La resección quirúrgica es el único tratamiento potencial-mente curativo, en el caso de las metástasis sincrónicas, se debate si se deben resecar simultáneamente, antes o después del tumor primario.

Colorectal cancer (CRC) accounts for 9.7% of all cancers with 1.4 million new cases diagnosed each year. 19–31% of CRC patients develop colorectal liver metastases, and 23–38% develop extra-hepatic disease1 . 15-25% will be presented synchronously and 25-40% will metachronously2 . Surgical resection is the only potentially curative treatment and, in the case of synchronous metastases, the debate is whether to resect simultaneously, before or after the primary tumor.

[Additional primary malignancies in patients with gastrointestinal stromal tumors. Proposal for a new classification]. / Asociación de tumores del estroma gastrointestinal con otros tumores primarios. Propuesta de una nueva clasificación.

Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST) is not only common but of growing interest in the scientific literature. This association is of great importance in terms of clinical challenge, diagnosis and therapy as well as for the prognosis impact it implies. In the published series there is a tendency to group these patients to determine the specific and distinguishable characteristics of GIST associated with other malignancies. On the other hand, there is no general consensus or unified classification. This classification would be of great interest, as it would unify criteria, agree groups to compare different series and demonstrate whether the aetiology underlying both tumours and the GIST's own characteristics really vary according to the type in question. We undertook a medical literature review and proposed a new classification for patients with GIST associated with other tumours.

Incidental focal uptake in colorectal location on oncologic ¹8FDG PET and PET/CT studies: histopathological findings and clinical significances.

PURPOSE: Unexpected focal colonic or rectal radiotracer activity is an usual finding in patients subjected to a PET study. The aim of this work has been to evaluate the clinical significance of this finding in the prediction of an existing colorectal malignancy. MATERIAL AND METHODS: During the last three years, all patients studied with (18)F-FDG PET/CT and PET for oncologic work-up purposes were prospectively surveyed for focal colorectal radiotracer activity. Colonoscopy was performed in all patients with this incidental finding in order to exclude colonic malignancy. CEA level, maximum standardized uptake value (SUVmax), CT findings, colonoscopy findings and histopathological results were prospectively analyzed in all patients. RESULTS: A total of 2290 patients were evaluated, 158 of whom were studied with PET and the remainder with a hybrid PET/CT. Focal FDG colorectal activity was incidentally detected in 27 patients with no previous history of colorectal cancer. Colorectal adenocarcinoma was diagnosed in seven (25.9%) patients. A pre-cancerous lesion was found in eleven patients (40.7%). Eight patients (29.6%) had no macroscopic lesions. One patient was diagnosed with a benign lesion. Any focal activity found in the colon by (18)F-FDG PET/CT examination predicts a probability greater than 50% of an underlying malignant or premalignant lesion in the histopathological analysis (logistic regression, p=0.01), independently of the calculated SUVmax. CONCLUSION: According to the results of the present study, we recommend the performance of a colonoscopy and biopsy of any suspicious lesions, in all patients with unexpected focal FDG activity found in colon or rectum during a (18)F-FDG PET/CT examination.

Dinámica del daño foliar en plántulas de Drimys granadensis (Winteraceae) y Clusia multiflora (Clusiaceae) en el bosque altoandino de la Cordillera Oriental colombiana

Leaf damage dynamics of Drimys granadensis (Winteraceae) and Clusia multiflora (Clusiaceae) seedlings in the High-Andean Forest. Because of their slow growth, shade-tolerant species remain exposed to foliar damage long before reproductive age. Foliar damage can be controlled through synchronous leaf production and specialized phytochemical strategies. in this study, the dynamics of foliar damage in different cohorts of seedlings were evaluated to determine if the High-Andean species, Clusia multiflora (Clusiaceae) and Drimys granadensis (Winteraceae) appeal to the synchronous leaf production for controlling the herbivory and pathogenical damage, and to establish the possible relations between the healthy state, growth and mortality of seedlings. Since a recently-emerged seedling could not supply the physiological costs of specialized strategies, we expected the highest synchronous leaf production in the youngest individuals, and differences between cohorts in foliar damage. Four variables were measured to evaluate the health state along time, in three cohorts of seedlings: Proportion of predated leaves (Pp), proportion of healthy leaves (Ps), proportion of leaves with symptoms of disease or punctual damage (Pe) and growing (% increment of height). Both species showed significant differences between periods in the proportion of healthy leaves, but there was not an effect of time-cohort interaction, therefore synchronic production of leaves was not a strategy more used for any particular cohort. Foliar damage oscillated along time, fact that can be explained by the pulses of leaf production. However, this strategy had little efficiency to control the pathogen attack. in general, the unified behavior of all variables was affected by cohort, time, species an all the different interactions. Association between growing and foliar damage were conditioned by climate. The highest mortality ocurred during the dry season, and one fourth of the D. granadensis deaths were caused by the joint action of herbivory and drought. Results suggest that in spite of the synchronous leaf production in all cohorts, this strategy quickly loses the efficiency for controlling foliar damage, because the means of Ps were below of 0.25 at the end of the monitoring period. The differences between species in the dynamics of health state should explain partially their coexistence in the High-Andean forest. Rev. Biol. Trop. 56 (3): 1087-1100. Epub 2008 September 30.

Además de las estrategias fitoquímicas especializadas, las plantas pueden usar la producción sincrónica de hojas como un método de saciado de patógenos y herbívoros. Con el fin de determinar si las especies del bosque altoandino colombiano Clusia multiflora (Clusiaceae) y Drimys granadensis (Winteraceae) recurren a la producción sincrónica de hojas para controlar los efectos de la herbivoría y el ataque microbiano, y establecer que relación existe entre el estado de salud, el crecimiento y la mortalidad de plántulas, se evaluó la dinámica del daño foliar sobre diferentes cohortes. Dado que una plántula tolerante a la sombra recientemente emergida no puede suplir los costos fisiológicos de una estrategia especializada, se esperaba una alta sincronía en la producción de hojas en las plántulas más jóvenes, y diferencias en el daño foliar entre cohortes. Se midieron cuatro variables que evaluaban el estado de salud a lo largo del tiempo, en tres cohortes de plántulas: Proporción de hojas predadas, proporción de hojas sanas, proporción de hojas enfermas o con daño puntual y crecimiento. Ambas especies mostraron diferencias significativas entre épocas, en la proporción de hojas sanas; pero no hubo un efecto de la interacción tiempo-cohorte, por lo tanto la producción sincrónica de hojas no fue una estrategia más usada por alguna cohorte en particular. El daño foliar osciló a través del tiempo, lo cual puede ser explicado por los pulsos en la producción de hojas. Sin embargo, ésta estrategia tuvo poca eficiencia para controlar el ataque por patógenos. En general, el comportamiento unificado de todas las variables fue afectado por la cohorte, el tiempo, la especie y todas las diferentes interacciones. La relación entre crecimiento y daño foliar fue condicionado por el clima. La mayor mortalidad se dio durante la estación seca, y un cuarto de las muertes en D. granadensis fueron causadas por la acción conjunta de herbivoría y sequía. Los resultados sugieren que a pesar de la producción sincrónica de hojas en todas las cohortes, fue poca la eficiencia para controlar el daño foliar, ya que las medias de Ps estuvieron por debajo de 0.25 al final del seguimiento. Las diferencias en la dinámica del estado de salud entre especies podrían explicar parcialmente la coexistencia en el bosque altoandino.