Effectiveness and safety of pembrolizumab monotherapy in patients with locally advanced or metastatic non-small-cell lung cancer.

INTRODUCTION: Immunotherapy has become a standard treatment for lung cancer; the objective of this study was to evaluate the effectiveness, safety of pembrolizumab monotherapy in patients with advanced or metastatic non-small-cell lung cancer used in real-world clinical practice. MATERIAL AND METHODS: Retrospective observational study of every patient treated with pembrolizumab in our centre from January 2017 to June 2019. Outcomes collected: sex, age, Eastern Cooperative Oncology Group, programmed death receptor 1 level, previous metastatic line therapies, adverse events and smoking status. RESULTS: A total of 62 patients were reviewed. The median age was 62.34 ± 10.62 years, 48 (77.41%) were men and 91.93% of patients had Eastern Cooperative Oncology Group 0. The median dose administered was 170.5 mg (108 - 240 mg) and the median follow-up was 3 months (range: 1 - 38). A median of four cycles of pembrolizumab (range: 1 - 56) were administered as monotherapy. The reason for treatment discontinuation was mainly due to disease progression in 38.70% of patients or death in 30.64%. As first-line pembrolizumab monotherapy, median progression-free survival was 7.7 months (95% CI: 3.66 - 11.73) (N = 33). With respect to patients who were treated in second-third-line treatment, median progression-free survival was 3.5 months (95% CI: 2.40 - 4.59) (N=29). As to overall survival, pembrolizumab-treated patients as first-line treatment reached 19 months median OG (95% CI: 13.36 - 24.63) (N = 33) and those treated in second-third-line treatment got 11 months (95% CI: 3.4 - 18.5). A total of 64.51% of patients presented some adverse events to pembrolizumab however, only, 9.38% of them were grade 3. CONCLUSION: Pembrolizumab represents an effective and feasible alternative in terms of progression-free survival. It is a well-tolerated treatment option.

Impact of telephone follow-up on COPD outcomes in pulmonary rehabilitation patients: A randomized clinical trial.

Background: The educational component is a comprehensive part of Pulmonary Rehabilitation (PR), and telephone follow-up (TFU) is an alternative to reinforce face-to-face education. The objective was to determine the effect of telephone follow-up on educational needs, dyspnea, quality of life and functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients undergoing PR. Methods: Double-blind randomized controlled clinical trial in patients with COPD in a PR program in Cali-Colombia, allocation by randomization tables. All patients received 24 sessions of PR, which included face-to-face education sessions. In addition, the experimental group received telephone calls twice a week to reinforce the face-to-face educational content. The Lung Information Needs Questionnaire (LINQ) was used to measure disease knowledge, the Saint George's Respiratory Questionnaire to measure quality of life, the modified Medical Research Council (mMRC) scale to measure dyspnea, and the 6-minute walking test (6MWT) to measure functional capacity. Results: Thirty-four patients were randomized and 31 were analyzed. PR group with conventional education (PRTE) n=15 and PR group with education plus telephone follow-up (PRTETFU) n=16. Significant improvement from baseline to endpoint in both groups: LINQ (PRTE 4±1.1, p=0.003, PRTETFU 5.8±10.6, p=0.000), mMRC (PRTE 1.6±0.3, p=0.000, PRTETFU 0.6±0.3, p=0.036) and functional capacity (PM6M: PRTE 45.9m±16.1, p=0.013, PRTETFU 62.8m±21.4, p=0.010). Analysis showed differences between groups for changes in LINQ knowledge domain after intervention, with greater improvement for PRTETFU (p=0.018). Discussion: The TFU is an alternative to reinforce the education. This study demonstrated greater positive effects for the autonomous management of the pathology. Conclusion: Adding educational reinforcement through phone calls to patients with COPD during PR leads to improved knowledge and skills for managing the disease.

Hospital 360°.

There are forces that are greater than the individual performance of each hospital institution and of the health system structural of each country. The world is changing and to face up to the future in the best possible way, we need to understand how contexts and emerging trends link up and how they affect the hospital sector. The Columbian Association of Hospitals and Clinics, ACHC, has thus come up with the Hospital 360° concept which uses hospitals capable of anticipating changing contexts by means of the transition between present and future and takes on board the experience of global, socio-economic, demographic, political, environmental and technological fields as its model. Hospital 360° is an invitation to reinvent processes and institution themselves allowing them to adapt and incorporate a high degree of functional flexibility. Hospital 360° purses goals of efficiency, effectiveness and relevance, but also of impact and sustainability, and is coherent with the internal needs of hospital institutions and society for long-term benefits.

Prevalence of Anti-SARS-CoV-2 Antibodies and Associated Factors Among Health Care Workers in Santiago De Cali, Colombia.

Purpose: This study aims to determine the seroprevalence of coronavirus disease (COVID-19) among health care workers and describe the associated sociodemographic and labor features. Patients and Methods: An observational study with an analytical component was conducted at a clinic in Cali, Colombia. The sample size was 708 health workers and they were selected by stratified random sampling. A Bayesian analysis was developed to determine the raw and adjusted prevalence. A Poisson regression model was used to estimate the prevalence ratios. Results: Overall seroprevalence of COVID-19 among healthcare workers was 29%. Miscellaneous services workers, healthcare, and administrative workers, was 38%, 33%, and 32%, respectively. Factors related to seropositivity were having a contact with a COVID-19 patient for >120 minutes and being diagnosed with COVID-19 by laboratory tests. Conclusion: The present study shows a adjusted seroprevalence of 29% in health workers, indicating a high level of disease transmission and an increased risk of infection in this population group.

Interrater Reliability of the Spanish (Colombia) Version of the Post-COVID-19 Functional Status Scale.

Background: COVID-19 has been one of the most critical public health challenges of recent decades. This disease develops severely in one in five patients, and approximately 5% require admission to a critical care unit. Due to the impact of the sequelae, the Post-COVID-19 Functional Status Scale (PCFS) was developed. This study is aimed at determining the interrater reliability of the Spanish (Colombia) version of the PCFS in adult patients with post-COVID-19 infection. Methods: This is an observational study performed with patients diagnosed with COVID-19. Two evaluators repeated the test-retest of the PCFS scale with knowledge and clinical experience in the care of patients with COVID-19 and had previously applied the test. The PCFS assesses functional limitations at discharge and can be used at 4 and 8 weeks to evaluate practical consequences and determine the degree of disability these patients may have. For interrater reliability, Cronbach's alpha was applied with its respective confidence interval and the Bland-Altman method. A 95% confidence interval (CI) was taken as the basis for the interpretation of the Intraclass Correlation Coefficient (ICC). Results: A total of 112 adult patients participated in the study, aged 51.46 ± 15.94 years. It was evidenced that the survival, constant care, and activities of daily living questions have an ICC of one (1.000) with an ICC (1.000-1.000), demonstrating excellent reliability, while those close to one were instrumental activities, role participation, symptoms, and final score with an ICC 0.918 to 0.984 and an ICC (0.881-0.989). Thus, a homogeneous distribution of the interrater data was evident. Conclusions: Excellent interobserver reliability of the Spanish (Colombia) version of the PCFS in patients with different degrees of functional status was reported.

NEUROCANTRIAL: study protocol for a randomised controlled trial of a pain neuroscience education programme in adults with cancer pain.

INTRODUCTION: Pain is the second most frequent symptom reported in patients with cancer among the main reasons for consultation. The incorporation of educational modalities in pain intervention processes has been suggested. This study aims to examine the efficacy of neuroscience pain education (PNE) in relation to pain, biopsychosocial variables and functional capacity in comparison with conventional treatment. It is hypothesised that an intervention based on PNE achieves better outcomes than conventional management, in terms of pain, biopsychosocial variables and functional capacity in adults with oncological pain. METHODS AND ANALYSIS: This will be a single-blind, controlled clinical trial in which two groups will be compared using changes in pain as the primary measure. The first group will receive conventional treatment in addition to PNE, and participants will undergo an intervention of nine sessions (one session per week, for a total of 9 weeks), each lasting 30-40 min. Specifically, these sessions will teach biophysiological elements using metaphors that allow the adoption of these concepts related to pain. The second group will receive conventional treatment (pharmacological treatment). For this study, a sample size calculation was made based on the background, where 80 adults with oncological pain were required. An initial evaluation will be made to establish the baseline characteristics, and then, according to the randomisation, the assignment to the PNE group or the control group will be made and the two groups will be summoned again. Ten weeks later, for the intervention evaluation, the statistical analysis plan will be established by protocol and by intention-to-treat. ETHICS AND DISSEMINATION: This protocol complies with all ethical considerations. The authors commit to presenting the study's results. This study was approved by the ethics committees of the Universidad Santiago de Cali, Clínica de Occidente/Angiografía de Occidente. The authors commit to presenting the study's results. TRIAL REGISTRATION NUMBER: NCT05581784.

Effectiveness and Safety of Palbociclib plus Endocrine Therapy in Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer: Real-World Results.

BACKGROUND: Real-world data are critical to demonstrate the reproducibility of evidence and the external generalizability of randomized clinical trials. Palbociclib is an oral small-molecule inhibitor of cyclin-dependent kinases 4/6 that has been shown to improve progression-free survival when combined with letrozole or fulvestrant in phase 3 clinical trials. OBJECTIVE: To evaluate real-world outcomes in patients with metastatic breast cancer who received palbociclib in combination with endocrine therapy in routine clinical practice. METHODS: In this retrospective observational multicentre study, data were evaluated for all women with metastatic breast cancer who were treated with palbociclib from April 2017 to September 2019. Treatment response was assessed through progression-free survival according to the Response Evaluation Criteria in Solid Tumors, version 1.1. RESULTS: Fifty-three patients were included in the study, with median age 57 years (range 31-87 years). For all patients treated with palbociclib, median progression-free survival by the end of the study period was 14.4 months (95% confidence interval [CI] 6.2-22.2 months). Twenty-three women who received palbociclib as a first-line treatment did not experience progression-free survival; for these patients, the median treatment duration was 12.1 months (95% CI 1.4-28.0 months). For the 23 patients who received palbociclib as second-line therapy for metastatic breast cancer, median progression-free survival was 13.3 months (95% CI 4.1-22.4 months). Among the 7 women who received palbociclib as third-line therapy, median progression-free survival was 6.0 months (95% CI 0.9-11.1 months). The most common adverse events were hematologic, with grade 3 or 4 neutropenia occurring in 20 (38%) of the 53 patients. CONCLUSIONS: This study provides data from a real-world setting that match the results of previous studies in terms of effectiveness (i.e., progression-free survival) when palbociclib plus endocrine therapy was used as second- or third-line treatment. Palbociclib had appropriate tolerability and a profile of easily manageable adverse effects, with none of the patients suspending their treatment because of toxic effects.

CONTEXTE: Les données du monde réel sont essentielles pour démontrer la reproductibilité des éléments probants et la « généralisabilité ¼ externe des essais cliniques randomisés. Il a été démontré qu'en association avec le létrozole ou le fulvestrant dans les essais cliniques de phase 3, le palbociclib (un inhibiteur oral à petite molécule des kinases dépendantes des cyclines 4/6) améliorait la survie sans progression. OBJECTIF: Évaluer les résultats réels des patientes atteintes d'un cancer du sein métastatique qui ont reçu du palbociclib en association avec un traitement endocrinien dans le cadre d'une pratique clinique de routine. MÉTHODES: Dans cette étude observationnelle rétrospective multicentrique, les données ont été évaluées pour toutes les femmes atteintes d'un cancer du sein métastatique et qui ont été traitées avec du palbociclib d'avril 2017 à septembre 2019. La réponse au traitement a été évaluée par la survie sans progression au moyen des critères RECIST d'évaluation de la réponse des tumeurs solides, version 1.1. RÉSULTATS: Cinquante-trois patientes (âge médian : 57 ans; extrêmes 31­87 ans) ont été incluses dans l'étude. Pour toutes les patientes traitées avec le palbociclib, la survie moyenne sans progression à la fin de la période d'étude était de 14,4 mois (intervalle de confiance à 95 % [IC] 6,2­22,2 mois). Vingt-trois femmes ayant reçu du palbociclib en guise de traitement de première ligne n'ont pas connu de survie sans progression; pour ces patientes, la durée moyenne du traitement était de 12,1 mois (IC à 95 % 1,4­28 mois). Pour les 23 patientes ayant reçu le palbociclib en guise de traitement de deuxième ligne pour le cancer du sein métastatique, la survie moyenne sans progression était de 13,3 mois (IC à 95 % 4,1­22,4 mois). Parmi les 7 femmes ayant reçu le palbociclib en guise de traitement de troisième ligne, la survie moyenne sans progression était de 6,0 mois (IC à 95 % 0,9­11,1 mois). Les effets indésirables les plus fréquents étaient d'ordre hématologique, avec une neutropénie de grade 3 ou 4 survenant chez 20 (38 %) des 53 patientes. CONCLUSIONS: Cette étude fournit des données provenant d'un contexte réel. Elles correspondent aux résultats d'études précédentes en termes d'efficacité (c'est-à-dire « survie sans progression ¼) lorsque le palbociclib, associé à un traitement endocrinien, était utilisé comme traitement de deuxième ou de troisième ligne. Le seuil de tolérance du palbociclib est approprié et son profil d'effets indésirables est facilement gérable : aucune des patientes n'a en effet suspendu son traitement en raison d'effets toxiques.

Annexin A2 associates to feline calicivirus RNA in the replication complexes from infected cells and participates in an efficient viral replication.

Cellular proteins have been identified to participate in calicivirus replication in association with viral proteins and/or viral RNAs. By mass spectrometry from pull-down assays, we identified several cellular proteins bound to the feline calicivirus (FCV) genomic RNA; among them the lipid raft-associated scaffold protein Annexin (Anx) A2. AnxA2 colocalizes with FCV NS6/7 protein and with the dsRNA in infected cells; moreover, it was found associated with the viral RNA in the membrane fraction corresponding to the replication complexes (RCs), suggesting its role during FCV replication. AnxA2-knockdown from CrFK cells prior to infection with FCV caused a delay in the cytopathic effect, a strong reduction of viral non-structural proteins and dsRNA production, and a decrease of FCV yield in both cell-associated and supernatant fractions. Taken together, these results indicate that AnxA2 associates to the genomic RNA of FCV and is required for an efficient FCV replication.

Strict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: a randomised clinical trial.

INTRODUCTION: Critically ill patients can develop hyperglycaemia even if they do not have diabetes. Intensive insulin therapy decreases morbidity and mortality rates in patients in a surgical intensive care unit (ICU) and decreases morbidity in patients in a medical ICU. The effect of this therapy on patients in a mixed medical/surgical ICU is unknown. Our goal was to assess whether the effect of intensive insulin therapy, compared with standard therapy, decreases morbidity and mortality in patients hospitalised in a mixed ICU. METHODS: This is a prospective, randomised, non-blinded, single-centre clinical trial in a medical/surgical ICU. Patients were randomly assigned to receive either intensive insulin therapy to maintain glucose levels between 80 and 110 mg/dl (4.4 to 6.1 mmol/l) or standard insulin therapy to maintain glucose levels between 180 and 200 mg/dl (10 and 11.1 mmol/l). The primary end point was mortality at 28 days. RESULTS: Over a period of 30 months, 504 patients were enrolled. The 28-day mortality rate was 32.4% (81 of 250) in the standard insulin therapy group and 36.6% (93 of 254) in the intensive insulin therapy group (Relative Risk [RR]: 1.1; 95% confidence interval [CI]: 0.85 to 1.42). The ICU mortality in the standard insulin therapy group was 31.2% (78 of 250) and 33.1% (84 of 254) in the intensive insulin therapy group (RR: 1.06; 95%CI: 0.82 to 1.36). There was no statistically significant reduction in the rate of ICU-acquired infections: 33.2% in the standard insulin therapy group compared with 27.17% in the intensive insulin therapy group (RR: 0.82; 95%CI: 0.63 to 1.07). The rate of hypoglycaemia (< or = 40 mg/dl) was 1.7% in the standard insulin therapy group and 8.5% in the intensive insulin therapy group (RR: 5.04; 95% CI: 1.20 to 21.12). CONCLUSIONS: IIT used to maintain glucose levels within normal limits did not reduce morbidity or mortality of patients admitted to a mixed medical/surgical ICU. Furthermore, this therapy increased the risk of hypoglycaemia. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: 4374-04-13031; 094-2 in 000966421.

Variaciones fenotípicas relacionadas a respuestas hipóxicas entre andinos a distintas altitudes / Phenotypic variations related to hypoxic responses among Andeans at different altitudes

Introducción. La adaptación a grandes altitudes implica cambios evolutivos que conllevan respuestas adaptativas, como a la hipoxia. Los andinos desarrollaron fenotipos eritroides diferentes en relación con otras poblaciones a gran altitud que pueden variar dependiendo la altitud. Objetivo. Determinar las variaciones fenotípicas de hemoglobina (Hb), saturación de oxígeno (SpO2), P50 y lactato en andinos bolivianos con radicatorias entre 400, 4000 y 5000 msnm. Material y métodos. Estudio descriptivo transversal de tipo prospectivo. Se recolectó sangre venosa periférica de andinos bolivianos (n=124) nacidos a 4000 m, pero con radicatoria en altitudes diferentes (400 m, 4000 m, 5000 m), así como de aquellos con eritrocitosis patológicas. Adicionalmente, se recolectó muestras de europeos residentes a 4000 m (n=11). Se realizó estudios de hemograma, oximetría y gasometría. La P50 fue calculada con fórmula de Lichtman. Resultados. Los andinos sanos, comparados entre distintas altitudes, reflejaron aumento de Hb al ser mayor la altitud (p: 0,001), empero disminución de SpO2 (p: 0,001) y P50 (p: 0,001); sin variaciones en lactato. Los europeos a 4000 m, en relación con andinos a la misma altitud, presentaron Hb incrementada (p: 0,01), SpO2 y P50 sin variaciones, pero lactato significativamente aumentado (p: 0,001). Los pacientes con eritrocitosis comparados con sujetos sanos, a 4000 m y 5000 m respectivamente, presentaron Hb aumentada (p: 0,001); SpO2 disminuida (p: 0,001); P50 sin variaciones, pero lactato incrementado (p: 0,01). El lactato elevado en sujetos a 5000 m con eritrocitosis fue llamativo (1,7 mmol/L). Conclusiones. Las variaciones fenotípicas observadas entre andinos en diferentes altitudes constituyen una expresión de una adaptación parcial a la altura.

Introduction. Human adaptation to high altitude involves evolutionary changes leading adaptive responses, such as to hypoxia. Andeans developed different erythroid phenotypes in relation to other populations at high altitude, which can vary depending on the altitude. Objective. To determine the phenotypic variations of hemoglobin (Hb), oxygen saturation (SpO2), P50 and lactate in Bolivian Andeans residing between 400, 4000 or 5000 masl. Material and methods. Prospective cross-sectional descriptive study. Peripheral venous blood from Bolivian Andeans (n=124) born at 4000 m, but residing at different altitudes (400 m, 4000 m, 5000 m), likewise from those with pathological erythrocytosis were collected. Additionally, samples from Europeans residing at 4000 m (n=11) were collected. CBC, oximetry and blood gas studies were performed. P50 was calculated using the Lichtman formula. Results. Healthy Andeans, compared between different altitudes, reflected an increased Hb (p: 0.001), but a decreased SpO2 (p: 0.001) and P50 (p: 0.001) as the altitude was higher; without variations in lactate. Europeans at 4000 m, related to Andeans at the same altitude, presented increased Hb (p: 0.01), SpO2 and P50 without variations, but significantly increased lactate (p: 0.001). Patients with erythrocytosis compared to healthy subjects, at 4000 m and 5000 m respectively, depicted increased Hb (p: 0.001); decreased SpO2 (p: 0.001); P50 without changes, but increased lactate (p: 0.01). Increased lactate in subjects with erythrocytosis at 5000 m was remarkable (1.7 mmol/L). Conclusion. The phenotypic variations observed among Andeans residing at different altitudes constitute an expression of partial adaptation to altitude.

Economic evaluation of the GENESIS-SEFH report of olaratumab with doxorubicin in soft tissue sarcoma in advanced stages.

OBJECTIVE: The economic evaluation of the drug olaratumab is carried out in the treatment of soft tissue sarcoma. METHOD: The data were analyzed following the recommendations contained in  the MADRE program of the GENESIS-SEFH report model. RESULTS: Progression free survival and overall survival results published in the  pivotal clinical trial; Tap, WD. et al. (2016) were improvement of 2.5 months in  median progression free survival (primary endpoint) HR = 0.672; IC95%  (0.442-1.021) and gain of 11.8 months in median OS (secondary endpoint) HR  = 0.463; IC95% (0.301-0.710). A cost-effectiveness analyses was performed  considering 2 scenarios; scenario 1: with use of whole vials and scenario 2: use  of whole vials and associating non-pharmacological costs (day hospital visits,  mucositis, neutropenia and dexrazoxane use). In both cases we considered the  cost of drugs and the efficacy data of the pivotal clinical trial. In Scenario 1, we  would have an Incremental-Cost-Effectiveness-Ratio of €28,443.81/month of  progression-free survival and €72,560.74 per year of life gained and in scenario  2 we would have an incremental-cost-effectivenessratio of €30,879.79/  progression-free survival and €78,774.99/ year of life gained. The budgetary  impact of this drug would range from €61,759.592 to €92,639.388 estimated to  be 800 to 1,200 patients likely to receive treatment in Spain. CONCLUSIONS: Olaratumab is a drug that provides a significant benefit in overall  survival but not in progression free survival. To be used in soft tissue sarcoma  and to be cost-effective, the acquisition cost of the 500 mg vial should be  between €101.91 and €506.54 and that of the 190 mg vial between €39.31 and  €195.37.

Objetivo: Desarrollar la evaluación económica del fármaco olaratumab en el  tratamiento del sarcoma de partes blandas.Método: Los datos se analizaron siguiendo las recomendaciones contenidas en  el programa MADRE del modelo de informe GENESIS-SEFH.Resultados: Los resultados de supervivencia libre de progresión y supervivencia global publicados en el ensayo clínico pivotal: Tapm WD. et al.  (2016) fueron: la ganancia en supervivencia libre de progresión (variable  principal) en términos absolutos fue de 2,5 meses, HR = 0,672; IC95% (0,442- 1,021). La ganancia absoluta en supervivencia global (variable secundaria) fue  de 11,8 meses, HR = 0,463; IC95% (0,301-0,710). Se realizó un análisis coste- efectividad considerando dos escenarios; escenario uno: sin aprovechamiento de viales; y escenario dos: sin aprovechamiento de viales y asociando costes no  farmacológicos. En ambos casos se consideraron los costes de adquisición de los medicamentos y los datos de eficacia del ensayo clínico pivotal. En el primero  determinamos una ratio coste-efectividad-incremental de 28.443,81 euros/mes  libre de progresión ganado y 72.560,74 euros/año de vida ganado. En el  segundo obtenemos una ratio coste-efectividad incremental de 30.879,79 euros libre de progresión ganado y 78.774,99 euros/año de vida ganado. El  impacto económico estatal, por tanto, se situaría entre 61.759.592 millones de  euros y 92.639.388 de euros, considerando una población diana de 800-1.200  pacientes a nivel nacional.Conclusiones: Olaratumab es un fármaco que aporta un beneficio significativo  en la supervivencia global, no así en la supervivencia libre de progresión. Para  poder utilizarse en el sarcoma de partes blancas y que resultase costeefectivo, el coste de adquisición del vial de 500 mg debería situarse entre 101,91 y 506,54  euros y el del vial de 190 mg entre 39,31 y 195,37 euros.

Rehabilitación cardíaca integral en un caso de paciente con miocardiopatía por SARS-COV-2 / Comprehensive Cardiac Rehabilitation in a Case of a Patient with SARS-CoV-2 Cardiomyopathy

Introducción: Una complicación reportada en la infección por SARS-CoV-2 es la miocardiopatía. Se ha descrito que los pacientes pueden presentar un deterioro significativo de la clase funcional, que limita el desempeño en las actividades de la vida diaria, sociales, familiares y laborales. La rehabilitación cardíaca como componente integral es una alternativa de tratamiento no farmacológica en el manejo de secuelas cardiovasculares ocasionadas por SARS-CoV-2. Objetivo: Describir el impacto de la rehabilitación cardíaca integral en un caso de paciente con miocardiopatía por SARS-CoV-2. Caso clínico: Se presenta el caso de un hombre de 56 años de edad con miocardiopatía por SARS-CoV-2 quien realizó rehabilitación cardíaca integral. Conclusiones: La rehabilitación cardíaca con un componente de intervención integral multidisciplinar permitió al paciente mejorar la capacidad aeróbica, sintomatología, calidad de vida relacionada con la salud y reincorporarse a las actividades sociales, familiares y laborales(AU)

Introduction: A reported complication of SARS-CoV-2 infection is cardiomyopathy. It has been described that patients may present with significant impairment of functional class, limiting performance in activities of daily living, social, family and work. Cardiac rehabilitation as an integral component is a non-pharmacological treatment alternative in the management of cardiovascular sequelae caused by SARS-CoV-2. Objective: To describe the impact of comprehensive cardiac rehabilitation in a case of a patient with cardiomyopathy due to SARS-CoV-2. Case report: We present the case of a 56-year-old patient with SARS-CoV-2 cardiomyopathy who underwent comprehensive cardiac rehabilitation. Conclusions: Cardiac rehabilitation with a comprehensive multidisciplinary intervention component allowed the patient to improve aerobic capacity, symptomatology, health-related quality of life and reincorporation to social, family and work activities(AU)

Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Abstract Background: Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement. Objective: To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection. Methods: This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level. Results: This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4-24.5. Conclusions: Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.

Eritrocitosis patológicas con niveles de eritropoyetina baja e incrementada: características clínicas y laboratoriales / Pathological erythrocytosis with low and increased erythropoietin levels: clinical and laboratory characteristics

RESUMEN: Introducción: Los pacientes con eritrocitosis patológicas en la altura, Eritrocitosis Secundaria o Eritrocitosis Patológica de Altura, ocasionalmente suelen presentar niveles de eritropoyetina (EPO) con variaciones notables respecto de los parámetros normales, reflejando ya sea concentraciones muy bajas o muy altas de EPO. Objetivo: Analizar la prevalencia de las eritrocitosis con EPO disminuida y de las eritrocitosis con EPO incrementada, así como, las características laboratoriales y clínicas inmiscuidas entre ellas. Material y Métodos: Se realizó un estudio descriptivo transversal de tipo retrospectivo. Se analizó historias clínicas de 44 pacientes eritrocíticos; de estos, 22 pacientes (5 mujeres, 17 varones) con registros de EPO sérica disminuida (100 mUI/ml) que constituyeron el Grupo 2. Todos ellos residentes a una altura >3650 m s. n. m. Se recolectó datos demográficos, clínicos y laboratoriales; asimismo, datos referentes a los tratamientos administrados, seguimiento y respectivas respuestas en ambos grupos. Resultados: La frecuencia de las eritrocitosis patológicas con EPO disminuida representó 5 % y de aquellas con EPO elevada 5 %.: Se debe considerar estudios específicos en pacientes eritrocíticos con EPO baja para descartar Policitemia Vera, asimismo, los pacientes con EPO incrementada implican mayor complejidad en el manejo médico.

ABSTRACT: Introduction: Patients with pathological erythrocytosis at high altitude, Secondary Erythrocytosis or High Altitude Pathological Erythrocytosis, occasionally present notable variations of erythropoietin (EPO) levels regarding normal parameters, reflecting either very low or very high EPO concentrations. Objective: To analyze the prevalence of erythrocytosis with decreased EPO and erythrocytosis with increased EPO, as well as the laboratory and clinical characteristics involved between them. Material and methods: A retrospective cross-sectional descriptive study was conducted. Clinical records of 44 patients with erythrocytosis were analyzed; of these, 22 (5 women, 17 men) with records of decreased serum EPO (100 mIU/ml) ml) specified as Group 2. All of them were high altitude dwellers (>3650 m a. s. l). Demographic, clinical and laboratory data were collected, including data about administered treatments, follow-up and responses in both groups. Results: Frequency of pathological erythrocytosis with decreased EPO was 5% and with elevated EPO 5%. There were no representative differences between both groups concerning the CBC variables. Patients with increased EPO showed more complications of erythrocytosis (27%) compared to those with decreased EPO (0%). Two types of treatment regimen were evidenced in each group: a) ATV+ASA, and b) ATV+ASA+HU. Erythrocytosis patients with decreased EPO receiving ATV+ASA had higher favorable responses 90% versus those with elevated EPO (80%). The ATV+ASA+HU regimen reflected better applicability in the increased EPO group. Conclusion: Specific studies should be considered in erythrocytosis patients with decreased EPO to rule out Polycythemia Vera, similarly, patients with increased EPO imply more complexity at medical management.

Condición clínica, capacidad funcional, ansiedad/depresión y calidad de vida en pacientes con EPOC con diferentes rangos de edad / Clinical Condition, Functional Capacity, Anxiety or Depression, and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Different Age Groups

Introducción: La enfermedad pulmonar obstructiva crónica genera una discapacidad progresiva en el sujeto que la padece a causa de la disnea frecuente, lo que conlleva a limitaciones y restricciones en la participación con el incremento de la edad, lo que finalmente le desencadena estados de ansiedad y depresión, secundarios a su condición clínica. Objetivo: Establecer las diferencias en la condición clínica, capacidad funcional, ansiedad/depresión y calidad de vida en un grupo de pacientes que se encuentran entre la prevejez, senectud y la ancianidad diagnosticados con enfermedad pulmonar obstructiva crónica. Métodos: Estudio descriptivo en pacientes con enfermedad pulmonar obstructiva crónica, quienes se dividieron en grupos edad. Se tuvieron en cuenta variables las clínicas: capacidad funcional, ansiedad/depresión y calidad de vida. Resultados: Se distribuyeron los pacientes en grupos de edad de la siguiente manera: 45-59 años (prevejez) n = 16; 60-79 años (senectud) n = 89; y 80 años y más (ancianidad) n = 24. Se vincularon mayor cantidad de hombres (61,3 por ciento), todos los grupos erar mayormente casados. Hubo diferencias significativas en la distacia recorrida siendo el grupo ancianidad quien presentó un peor resultado (235,25±106,8). La ansiedad y depresión no presentaron diferencias y la calidad de vida mostró mayor afección del dominio actividades. Conclusión: Los pacientes del grupo prevejez presentaron mejor desempeño en la capacidad funcional comparado con los grupos senectud y ansianidad. A su vez, la ansiedad y depresión es mayor en pacientes en prevejez, sin embargo, no resulta ser significativa entre los grupos(AU)

Introduction: Chronic obstructive pulmonary disease produces progressive disability in the person who presents the disease, because of frequent dyspnea, leading to limitations and restrictions in participation with age increase, which finally triggers anxiety and depression states secondary to their clinical condition. Objective: To establish the differences in clinical condition, functional capacity, anxiety or depression, and quality of life in a group of patients between late adulthood, senescence and old age diagnosed with chronic obstructive pulmonary disease. Methods: Descriptive study carried out in patients with chronic obstructive pulmonary disease, who were divided into age groups. Clinical variables were taken into account: functional capacity, anxiety or depression, and quality of life. Results: Patients were distributed into age groups as follows: 45-59 years (old age), n=16; 60-79 years (senescence); n=89; and 80 years and older (old age); n=24. There were significant differences in the distance traveled, with the old age group presenting the worst result (235.25±106.8). Anxiety or depression did not show differences, and quality of life showed greater repercussion in the activity domain. Conclusion: Patients in the late adulthood group presented better functional capacity compared to the senescence and old age groups. In turn, anxiety and depression were higher in patients in the late adulthood group; however, it was not significant between the groups(AU)

Efeitos da reabilitação pulmonar em homens vs. mulheres com doença pulmonar obstrutiva crônica na Colômbia / Effects of Pulmonary Rehabilitation in Men Compared to Women with Chronic Obstructive Pulmonary Disease in Colombia / Efectos de la rehabilitación pulmonar en hombres vs. mujeres con enfermedad pulmonar obstructiva crónica en Colombia

Objetivo: determinar los efectos de la rehabilitación pulmonar en hombres y mujeres con diagnóstico de EPOC en una clínica de Colombia. Método: estudio descriptivo longitudinal en 75 pacientes con EPOC que ingresaron a un programa de rehabilitación pulmonar durante el año 2018 y 2019. La población se dividió en grupos según el sexo y se evaluaron algunas características sociodemográficas, la espirometría en porcentaje del predicho, el índice de masa corporal, la disnea mMRC, la capacidad de ejercicio y algunas variables fisiológicas con el test de la caminata de los seis minutos, la ansiedad-depresión (HADS) y la calidad de vida (SGRQ). Se tuvo un valor p<0,05 como estadísticamente significativo. Resultados: el índice paquetes fumados por año fue mayor en hombres 34±29.11 (p<0,001), mientras que la exposición al humo de leña fue cinco veces mayor en las mujeres (p=0,037). Todas las variables de capacidad de ejercicio mejoraron significativamente (p<0,021), sobresaliendo la distancia recorrida 63,26±60,03 versus. 51,53±61,02 a favor de las mujeres. La disnea mMRC fue inicialmente mayor en las mujeres comparado con hombres 0,709±0,287 y evidenció un mayor cambio en las mujeres 1,294±0,415 versus hombres 0,736±0,880 al final de la rehabilitación pulmonar. Conclusión: la rehabilitación pulmonar en mujeres muestra un incremento en la distancia recorrida de 63,26 metros, disminución de 1,294 puntos en la disnea, para hombres 51,53 metros y 0,736 puntos respectivamente, y una mejoría en la calidad de vida en hombres de 11,47 puntos SGRQ con respecto con mujeres de 0,600.

Objetivo: determinar os efeitos da reabilitação pulmonar em homens e mulheres com diagnóstico de DPOC em uma clínica na Colômbia. Método: estudo descritivo longitudinal em 75 pacientes com DPOC que ingressaram em programa de reabilitação pulmonar durante os anos de 2018 e 2019. A população foi dividida em grupos de acordo com o sexo e foram avaliadas algumas características sociodemográficas, espirometria em porcentagem do previsto, índice de massa corporal, mMRC dispneia, capacidade de exercício e algumas variáveis ​​fisiológicas com o teste de caminhada de seis minutos, ansiedade-depressão (HADS) e qualidade de vida (SGRQ). Considerou-se o valor de p <0,05 como estatisticamente significativo. Resultados: a taxa de fumaça de maços por ano foi maior nos homens 34 ± 29,11 (p <0,001), enquanto a exposição à fumaça de lenha foi cinco vezes maior nas mulheres (p = 0,037). Todas as variáveis ​​da capacidade de exercício melhoraram significativamente (p <0,021), destacando-se a distância percorrida 63,26 ± 60,03 versus 51,53 ± 61,02 a favor das mulheres. O mMRC dispneia foi inicialmente maior nas mulheres em relação aos homens 0,709 ± 0,287 e evidenciou maior alteração nas mulheres 1,294 ± 0,415 versus homens 0,736 ± 0,880 ao final da reabilitação pulmonar. Conclusão: a reabilitação pulmonar em mulheres mostra um aumento na distância percorrida de 63,26 metros e uma diminuição de 1.294 pontos na dispneia, enquanto para os homens os valores obtidos foram 51,53 metros e 0,736 pontos, respectivamente, e uma melhoria na qualidade de vida nos homens de 11,47 pontos do SGRQ em relação às mulheres, onde foi de 0,600 pontos.

Objective: To determine the effects of pulmonary rehabilitation in men and women with a COPD diagnosis in a Colombian clinic. Method: A longitudinal and descriptive study was conducted with 75 COPD patients who entered a pulmonary rehabilitation program during 2018 and 2019. The population was divided into groups according to gender and some sociodemographic characteristics were assessed, such as spirometry expressed in percentage of the predicted value, body mass index, mMRC dyspnea, and capacity for physical exercise, as well as some physiological variables with the six-minute walk test, anxiety-depression (HADS) and quality of life (SGRQ). A p-value<0.05 was considered statistically significant. Results: The cigarette packs smoked per year index was higher in men, 34±29.11 (p<0.001), whereas the exposure to firewood smoke was five times higher in women (p=0.037). All the variables related to the capacity for physical exercise improved significantly (p<0.021), with distance covered standing out: 63.26±60.03 vs. 51.53±61.02 in favor of women. mMRC dyspnea was initially higher in women when compared to men, 0.709±0.287, and presented a greater change in women with 1.294±0.415 when compared to men, 0.736±0.880, at the end of pulmonary rehabilitation. Conclusion: Pulmonary rehabilitation in women shows an increase of 63.26 meters in the distance covered and a 1.294-point reduction in dyspnea; while, for men, these figures were 51.53 meters and 0.736 points, respectively, as well as an improvement in quality of life in men by 11.47 SGRQ points when compared to women: 0.600.

Factores de riesgo y síntomas de asma infantil en estudiantes de dos colegios de Cali / Risk factors and symptoms of childhood asthma in students from two schools in Cali (Colombia)

Resumen Introducción: Factores de riesgo como alergias, historia familiar, infecciones respiratorias, bajo peso al nacer, exposición a humo de tabaco y síntomas frecuentes tales como: sibilancias, disnea o tos persistente, se presentan en niños con asma. En Cali son escasos los estudios que aborden esta temática. Objetivo: Describir factores de riesgo y síntomas en estudiantes con diagnóstico de asma en dos colegios de la ciudad de Cali. Materiales y métodos: Estudio transversal. Se recolectó información a cuidadores de niños(as) en edades entre 6 y 14 años, a través del cuestionario del estudio Internacional de Asma y Alergias en la Infancia (ISAAC). Resultados: De 324 encuestas resueltas por cuidadores, 77 niños presentaban asma. Para esta población el 60% de los niños eran mayores de 9 años de edad, 56% eran niñas; 68% pertenecían al estrato socioeconómico medio-bajo. Se encontró antecedentes de enfermedades como bronquiolitis en el niño y asma y rinitis en los padres, factores de riesgo como piso inadecuado en el hogar, ausencia de lactancia materna y asistencia al jardín. El 40,3% presentaron disnea, tos y sibilancias. Conclusiones: Factores de riesgo como el sexo, piso inadecuado y síntomas como disnea, tos y sibilancias fueron los más frecuentes en niños con asma.

Abstract Introduction: Allergies, family history, respiratory infections, low birth weight, and exposure to tobacco smoke are risk factors for asthma, whose symptoms in children include wheezing, dyspnea, and persistent cough. There is a lack of studies about asthma in Cali (Colombia). Objective: To describe risk factors and symptoms in students diagnosed with asthma in two schools from the city of Cali. Materials and methods: A cross-sectional study was developed, which gathered information from caregivers of children aged between 6 and 14 years old using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Results: Out of the 324 surveys completed by caregivers, 77 children had asthma. 60% of this population were older than 9 years of age, 56% were girls, and 68% belonged to the lower-middle socioeconomic stratum. History of diseases such as child bronchiolitis and asthma and rhinitis in the parents were revealed. Some risk factors that were identified included inadequate flooring of the house, lack of breastfeeding, and attendance to kinder garden. 40.3% of children had dyspnea, cough and wheezing. Conclusions: Risk factors like gender, inadequate flooring, and symptoms such as dyspnea, cough and wheezing were the most frequent in children with asthma.

Drenaje percutáneo con catéter del neumotórax en pacientes con COVID­19 / Percutaneous catheter drainage of pneumothorax in patients with COVID-19

Introducción. La transmisión del SARS-CoV-2 principalmente se da por gotas y contacto cercano con las per-sonas infectadas, pero los aerosoles parecen ser también una fuente de infección. El neumotórax espontáneo o secundario puede presentarse en pacientes con COVID-19, ayudado por patologías de base como la enfermedad pulmonar obstructiva crónica. Es necesario garantizar procedimientos seguros para los pacientes y buscar todas las medidas posibles para la protección del personal de la salud, por eso el drenaje de neumotórax con catéter pleural en lugar de sonda de toracostomía puede ser una de ellas.El objetivo de este estudio es presentar a los cirujanos una alternativa a la toracostomía tradicional, mediante la utilización de catéteres de menor diámetro, para la resolución de la ocupación pleural.Aspectos Técnicos. Se presenta el protocolo para inserción segura de un catéter pleural para el drenaje de neumotórax, mediante un sistema completamente cerrado, y se dan recomendaciones sobre el uso de filtros virales y solución viricida en el sistema de drenaje pleural conectado al catéter. Conclusión. El estado de pandemia por COVID-19 y el riesgo que representa para los profesionales de la salud la exposición a fuentes de transmisión durante procedimientos generadores de aerosoles, hace que se deban extremar las medidas para evitar el contagio.

Introduction. The transmission of SARS-CoV-2 mainly occurs by drops and close contact with infected people, but aerosols also seem to be a source of infection. Spontaneous or secondary pneumothorax can occur in patients with COVID-19, helped by underlying pathologies such as chronic obstructive pulmonary disease. It is necessary to guarantee safe procedures for patients and to seek all possible measures for the protection of health personnel, so drainage of pneumothorax with a pleural catheter instead of a thoracostomy tube may be one of those. The objective of this study is to present surgeons with an alternative to traditional thoracostomy, using smaller diameter catheters, to resolve pleural occupancy.Technical aspects. The protocol for the safe insertion of a pleural catheter for pneumothorax drainage is presented, using a completely closed system, and recommendations are given on the use of viral filters and viricidal solution in the pleural drainage system connected to the catheter.Conclusions. The state of the COVID-19 pandemic and the risk that exposure to sources of transmission sources during aerosol-generating procedures represents for health professionals means that extreme measures must be taken to avoid contagion.

Negative effect of heat shock on feline calicivirus release from infected cells is associated with the control of apoptosis.

FCV infection causes rapid cytopathic effects, and its replication results in the induction of apoptosis changes in cultured cells. It is well established that the survival of apoptotic cells can be enhanced by the expression of heat-shock proteins (Hsp) to prevent damage or facilitate recovery. Hsps can act as molecular chaperones, but they can also have anti-apoptotic roles by binding to apoptotic proteins and inhibiting the activation of caspases, the primary mediators of apoptosis. Because apoptosis occurs during FCV infection and heat shock (HS) treatment has a cytoprotective role due to the expression of Hsps, we studied the effect of the HS response to hyperthermia during FCV infection in cultured cells. We found that FCV infection does not inhibit the expression of Hsp70 induced by HS and that non-structural and structural protein synthesis was not modified during HS treatment. However, HS caused a delay in the appearance of a cytopathic effect in infected cells, as well as a reduction in the extracellular but not in the cell-associated viral yield. This antiviral effect of HS correlates with the inhibition of caspase-3 activation. Thus, the HS-induced reduction in virus production appeared to be associated with the control of apoptosis, supporting previous data that indicate that apoptosis is necessary for FCV release.