Desenlaces maternos y neonatales en gestantes con cardiopatía con evaluación única vs. evaluación semiestructurada por un equipo cardio-obstétrico / Maternal and neonatal outcomes in pregnant women with heart disease with single evaluation vs. semi-structured evaluation by a cardio-obstetric team

Resumen Introducción: Las enfermedades cardiovasculares en las gestantes son desafiantes, con alta morbimortalidad materna y perinatal, por lo que se recomienda un equipo cardio-obstétrico para su atención. Aun así, pocos datos evalúan el impacto de estos equipos. Por lo tanto, el presente estudio tiene como objetivo comparar los resultados obstétricos, maternos y neonatales del seguimiento semiestructurado (SSE) en una clínica cardio-obstétrica con respecto a un seguimiento usual o seguimiento no estructurado (SNE) en gestantes con enfermedad cardiaca. Métodos: Se realizó un registro prospectivo de gestantes con cardiopatías. Se compararon las pacientes con SSE por un equipo cardio-obstétrico, contra aquellas con evaluación única o SNE. Se calculó el riesgo de eventos según la clasificación de la Organización Mundial de la Salud modificado (OMSm) y la escala del Cardiac Disease in Pregnancy Study II (CARPREG-II) y se evaluaron los desenlaces cardiacos, obstétricos y neonatales. Resultados: Se evaluaron 168 pacientes, 37 con SSE y 131 con evaluación única (SNE). Los principales diagnósticos fueron cardiopatía congénita, arritmias y valvulopatías. La media del CARPREG-II en pacientes de SNE fue 2.48 (DE: 2.3) y en pacientes de SSE fue 3.37 (DE: 2.45; p = 0.041). La media de la OMSm en pacientes de SNE fue 2.1 (DE: 1.6) y con SSE fue 2.65 (DE: 0.95; p = 0.0052). No hubo diferencias significativas en los desenlaces cardiacos primarios (13.8% en SNE vs. 5.4% en SSE; p = 0.134), cardiacos secundarios (5.3 en SNE vs. 2.7 en SSE; p = 0.410), obstétricos (10% en SNE vs. 16.2% en SSE; p = 0.253) y neonatales (35.9% en SNE y 40.5% en SSE; p = 0.486) a pesar de que las pacientes con SSE tenían un riesgo mayor que las pacientes con SNE según las escalas de la OMSm y el CARPREG-II. Conclusiones: En gestantes con cardiopatía, un SSE comparado con un SNE por un equipo cardio-obstétrico no mostró diferencias estadísticamente significativas en los desenlaces cardiovasculares, obstétricos y neonatales, a pesar de que las pacientes con SSE tenían un riesgo significativamente más alto de desenlaces adversos por las escalas de la OMSm y el CARPREG-II. Esto sugiere que el SSE logra al menos equiparar los desenlaces a pesar del mayor riesgo de eventos adversos que tenían las pacientes de este grupo.

Abstract Introduction: Cardiovascular diseases in pregnant women are challenging, with high maternal and perinatal morbidity and mortality, so a cardio-obstetric team is recommended for their care. Even so, little data evaluates the impact of these teams. Therefore, the present study aims to compare the obstetric, maternal, and neonatal outcomes of semi-structured follow-up (SSF) in a Cardio-obstetric clinic concerning regular or unstructured follow-up (USF) in pregnant women with heart disease. Methods: A prospective registry of pregnant women with heart disease was carried out. Patients with SSF by a cardio-obstetric team were compared with those with single evaluation or USF. The risk of events was calculated according to the modified World Health Organization (mWHO) classification and the CARPREG-II scale, and cardiac, obstetric, and neonatal outcomes were evaluated. Results: One hundred sixty-eight patients were evaluated, 37 with SSF and 131 with single evaluation (USF). The primary diagnoses were congenital heart disease, arrhythmias, and valve disease. The average CARPREG-II in USF patients was 2.48 (SD 2.3); in SSF patients, it was 3.37 (SD 2.45; p = 0.041). The average of the mWHO in patients with USF was 2.1 (SD 1.6), and with SSF, it was 2.65 (SD 0.95; p = 0.0052). There were no significant differences in primary cardiac outcomes (13.8% in USF vs. 5.4% in SSF; p = 0.134), secondary cardiac (5.3% in USF vs. 2.7% in SSF; p = 0.410), obstetric (10% in USF vs. 16.2% in SSF; p = 0.253) and neonatal (35.9% in USF and 40.5% in SSF; p = 0.486) even though patients with SSF had a higher risk than patients with USF according to the mWHO and CARPREG-II scales. Conclusions: In pregnant women with heart disease, an SSF compared with a USF by a cardio-obstetric team did not show statistically significant differences in cardiovascular, obstetric, and neonatal outcomes. However, patients with SSF had a significantly higher risk of adverse outcomes due to the mWHO and CARPREG-II scales. This result suggests that the SSF achieves at least equal outcomes despite the higher risk of adverse events that patients in this group had.

Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus

Abstract The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Sex differences regarding the impact of a standardized adaptation session in Colombian patients with obstructive sleep apnea and poor adherence to positive airway pressure devices / Diferencias por sexo respecto al impacto de una sesión de adaptación en pacientes colombianos con apnea obstructiva del sueño y mala adherencia a dispositivos de presión positiva

Abstract Introduction: Positive airway pressure (PAP) is the most effective treatment for obstructive sleep apnea (OSA) but adherence to this device is poor. The Sleep and Breathing Disorders Clinic of Fundación Neumológica Colombiana (FNC) has a standardized adaptation session (SAS) aimed at patients with difficulties in using PAP devices. Objective: To evaluate the impact of a SAS in short-term adherence to PAP therapy in patients with OSA, and to determine differences by sex. Materials and methods: Before-and-after single cohort study conducted in 40 people aged >18 years with an apnea-hypopnea index >15/hour and treated at the FNC, Bogotá D.C. (Colombia) between 2015 and 2017, who attended a SAS due to poor adherence to PAP therapy (defined as <4 hours use in 70% of nights). Data on the hours of use of the PAP device and the percentage of days in which it was used >4 hours were recorded before and after the intervention to evaluate changes in patients' adherence. Descriptive statistics were used for data analysis. The paired samples t-test was used for the comparison of variables before and after the intervention. Results: A significant increase was observed in PAP device use (1.8 hours, 95%CI: 1.3-2.3; p<0.001) and in the percentage of days it was used >4 hours (35.6%, 95%CI: 26.0-45.3; p<0.001). Among men, the increase was higher in both cases (2.3 hours, 95%CI: 1.7-2.9; p=0.029 and 47.8%, 95%CI: 32.9-62.8; p=0.029). Conclusion: The SAS offered by the FNC, which includes education strategies and the identification and solving of barriers hindering the use of PAP devices, significantly increased the hours of PAP device use and the percentage of days in which it was used >4 hours in the study population, particularly in men.

Resumen Introducción. La terapia de presión positiva en la vía aérea (PAP) es el tratamiento más efectivo de la apnea obstructiva del sueño (AOS); sin embargo, la adherencia no es óptima. La clínica de trastornos respiratorios del sueño de la Fundación Neumológica Colombiana (FNC) tiene una sesión de adaptación estandarizada (SAE) dirigida a pacientes con dificultades en el uso de equipo PAP. Objetivo. Evaluar el impacto de una SAE en la adherencia a corto plazo a la terapia de PAP en pacientes con AOS y determinar diferencias por sexo. Materiales y métodos. Estudio de cohorte única de antes y después realizado en 40 pacientes >18 años con un índice de apnea-hipopnea >15/hora atendidos en la FNC, en Bogotá D.C., Colombia, entre 2015 y 2017 y que asistieron a una SAE debido a una pobre adherencia a la terapia de PAP (<4 horas de uso el 70% de las noches). Se registraron los datos de uso en horas del equipo de PAP y el porcentaje de días en que se usó más de 4 horas antes y después de la intervención. Los datos se analizaron mediante estadística descriptiva y se empleó la prueba T de muestras emparejadas para comparar las variables antes y después de la intervención. Resultados. Se observó un aumento significativo después de la SAE en las horas de uso del equipo de PAP (1.8 horas, IC95%: 1.3-2.3; p<0.001) y del porcentaje de días en que su uso fue >4 horas (35.6%, IC95%: 26.0-45.3; p<0.001); el incremento fue mayor en los hombres en ambos casos (2.3 horas, IC95%: 1.7-2.9; p=0.029, y 47.8%, IC95%: 32.9-62.8; p=0.029). Conclusión. La SAE que brinda la FNC, la cual incluye estrategias educativas y la identificación y solución de barreras que dificultan el uso del equipo de PAP, aumentó de forma significativa las horas de uso de los dispositivos de PAP y el porcentaje de días con uso >4 horas en la población de estudio, en particular en los hombres.

Impacto clínico de un grupo de discusión multidisciplinaria en el diagnóstico de fibrosis pulmonar idiopática en Colombia / Clinical impact of a multidisciplinary discussion group on the diagnosis of idiopathic pulmonary fibrosis in Colombia

Resumen Introducción: la fibrosis pulmonar idiopática (FPI) es una enfermedad pulmonar intersticial (EPID) de mal pronóstico, considerada huérfana en Colombia. Un diagnóstico correcto tiene implicaciones para el paciente y los costos de atención. Los grupos de discusión multidisciplinaria (GDM) se consideran el estándar de oro en el diagnóstico. No hay estudios previos en Colombia de la experiencia de un GDM. Objetivos: evaluar el impacto de un GDM en una institución de cuarto nivel en Bogotá en cambio de diagnóstico de pacientes con EPID y la concordancia entre el diagnóstico inicial y final de FPI. Material y métodos: pacientes con EPID evaluados entre 2015-2018 por el GDM conformado por neumólogos, radiólogo, patólogo y reumatólogos. Criterios ATS/ERS/JRS/ALAT de diagnóstico de FPI. Descripción del cambio en el diagnóstico y concordancia entre el diagnóstico inicial y del GDM en FPI. Resultados: de 165 pacientes con EPID se cambió el diagnóstico en 35.2%. En 77.3% pacientes con diagnóstico inicial de FPI y en 6.7% con diagnóstico inicial diferente a FPI el GDM confirmó FPI. Al descartar FPI, los principales diagnósticos fueron neumonitis de hipersensibilidad en fase crónica (29.4%) y neumonía intersticial no específica (23.5%). El índice kappa entre el diagnóstico inicial y final de FPI fue 0.71 (0.60-0.82). Conclusiones: el GDM en EPID tuvo un importante impacto clínico demostrado por un alto porcentaje de cambió del diagnóstico de remisión. Se descartó el diagnóstico inicial de FPI en un porcentaje significativo de pacientes y se ratificó en un grupo menor sin esta sospecha clínica inicial. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2017).

Abstract Introduction: idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease (ILD) with a poor prognosis, considered an orphan disease in Colombia. An accurate diagnosis has implications for the patient and healthcare costs. Multidisciplinary discussion groups (MDGs) are considered the gold standard for diagnosis. There are no prior studies in Colombia on the experience of an MDG. Objectives: to evaluate the impact of an MDG in a quaternary care institution in Bogotá on the change in the diagnosis of patients with ILD and the concordance between the initial and final diagnosis of IPF. Materials and methods: patents with ILD evaluated from 2015-2018 by the MDG made up of pulmonologists, a radiologist, a pathologist and rheumatologists. The ATS/ERS/JRS/ALAT diagnostic criteria for IPF. A description of changes in the diagnosis and the agreement between the initial diagnosis and the MDG diagnosis of IPF. Results: out of 165 patients with ILD, the diagnosis was changed in 32.5%. The MDG confirmed IPF in 77.3% of patients with an initial diagnosis of ILD and 6.7% of those with a different initial diagnosis. When IPF was ruled out, the main diagnoses were chronic hypersensitivity pneumonitis (24.8%) and nonspecific interstitial pneumonia (23.5%). The Kappa index between the initial and final IPF diagnoses was 0.71 (0.60-0.82). Conclusions: the MDG on ILD had a significant clinical impact evidenced by a high percentage of change in the referral diagnosis. The initial diagnosis of IPF was ruled out in a significant percentage of patients and confirmed in a smaller group which did not have this initial clinical suspicion. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2017).

Visita a exposições artísticas: considerações acerca da recepção estética / Visiting art exhibitions: considerations about the aesthetic reception

O artigo apresenta alguns resultados da pesquisa intitulada "Narrativas de vida de usuários do Núcleo de Apoio Psicossocial: a recepção estética e a experiência de visitar exposições artísticas", que explora a recepção estética e a experiência de visitar exposições de arte com usuárias de um Núcleo de Apoio Psicossocial de Santos. É uma pesquisa-intervenção que utilizou diários de campo elaborados pela pesquisadora que acompanhou uma das participantes a duas exposições artísticas. Para a análise foram construídos os seguintes analisadores: A quem serve a arte do museu? e Recepção estética: uma experiência singular. Embora as exposições visem afetar o público, a recepção estética se produz de modo singular para cada sujeito de acordo com suas histórias de vida, experiências, conhecimento, entre outros. Este artigo explicita alguns dos efeitos dessa recepção estética em uma das usuárias participantes impulsionada pelo contato com as artes, que se fez por aproximações com o seu cotidiano de vida e suas experiências, produzindo sensações e encontros.(AU)

This article presents results of the research titled "Life Narratives of Users of the Psychosocial Support Center: The aesthetic reception and the experience of visiting artistic exhibitions" that explores the aesthetic reception and the experience of visiting two art exhibitions of an user of a Center of Psychosocial Support of Santos. An intervention research that used field diaries prepared by the researcher who accompanied one of the user participants to two artistic exhibitions. For analysis, the following analyzers were built: Who does the art of the museum serve? and Aesthetic Reception: a unique experience. Although the exhibitions aim to cause an impression on the audience, the aesthetic reception is produced in a unique way for each subject according to their life stories, experiences, knowledge, among others. This article explains some of the effects of this aesthetic reception, by one of the users participating in the research driven by the contact with arts, which was made by approximations with her daily life and her experiences producing sensations and encounters.(AU)

El artículo presenta algunos resultados de la investigación titulada "Narrativas de vida de usuarias del Centro de Apoyo Psicosocial: La recepción estética y la experiencia de visitar exposiciones artísticas" que explora la recepción estética y la experiencia de visitar exposiciones de arte con dos usuarias de un Centro de Apoyo Psicosocial de Santos en São Paulo - Brasil. El presente artículo trata de una investigación de intervención que utilizó diarios de campo elaborados por la investigadora que acompañó a una de las usuarias participantes a dos exposiciones artísticas. Para el análisis, fueron establecidos los siguientes analizadores: ¿A quién sirve el arte del museo? y Recepción Estética: una experiencia única. Aunque las exposiciones pretenden afectar al público, la recepción estética se produce de manera única para cada sujeto según sus historias de vida, experiencias, conocimientos, entre otros. Este artículo explica algunos de los efectos de esta recepción estética, por parte de una de las usuarias participantes de la investigación a partir del contacto con las artes, que se realizó a través de aproximaciones con su cotidianidad y sus vivencias, produciendo sensaciones y encuentros.(AU)

Factores asociados a la percepción de competencias gerenciales en médicos peruanos recién egresados / Factors associated with the perception of managerial competencies in recently graduated Peruvian doctors

Introducción: Las competencias gerenciales le permiten al médico en formación prepararse para la inserción en el sistema de salud. Objetivo: Identificar factores asociados a la percepción de competencias gerenciales en médicos egresados de los Establecimientos de Salud del Perú que participaron en el proceso SERUMS 2018-I. Material y Métodos: Estudio observacional, analítico de corte transversal. Se aplicó el cuestionario "How Dutch medical specialists perceive the competencies and training needs of medical residents in healthcare management" a los médicos postulantes al SERUMS 2018-I. Se midió el grado de asociación entre variables con la razón de prevalencia (RP). Resultados: De los 289 médicos encuestados, el 13,8% reportó haber realizado entrenamiento previo que potencialmente contribuye a su desempeño como gestor. El 35.5% se encontraba en el nivel bajo de la percepción de competencias gerenciales, el 74,8% reportó tener interés en desarrollar actividades de gerencia y un 97,2% tiene necesidad de formación en gerencia médica. El sexo y la capacitación previa que contribuye al desempeño como gerente está asociado significativamente con la percepción del desempeño de funciones gerenciales efectivas con una RP=1,66. Conclusiones: La percepción de desarrollar funciones gerenciales efectivas está asociada al sexo y a la capacitación previa.

Background: The managerial competences allow the doctor in training to prepare for the insertion in the health system. Objetive: To identify factors associated with the perception of managerial competencies in doctors graduated from the undergraduate medical programs in who participated in the SERUMS 2018-1 process. Material and Methods: Observational analytical cross-sectional study. The questionnaire "How Dutch medical specialists perceive the competencies and training needs of medical residents in healthcare management" was applied to the doctors applying for SERUMS 2018-1. The prevalence ratio (PR) to measure the degree of association between variables was used. Results: Of the 289 doctors surveyed, 13.8% reported having undergone previous training that potentially contributes to their performance as a manager. 35.5% were at the Iow level of the perception of managerial competencies, 74.8% reported having an interest in developing management activities and 97.2% need training in medical management. Sex and previous training that contributes to performance as a manager is significantly associated with the perception of performance of effective managerial functions with a PR 1.66. Conclusions: The perception of developing effective managerial functions associated with sex and previous training.

Association between high blood pressure and fitness and fatness in adolescents / Presión arterial alta asociada con condición física y adiposidad en adolescentes

Abstract Introduction: Excess adiposity is considered the most important risk factor for high blood pressure (HBP) in children and adolescents. Objectives: To explore the association between HBP and overweight (OW) and abdominal obesity (AO), mediated by cardiorespiratory fitness (CRF). To analyze the combined effect of excess adiposity and CRF on HBP among a sample of school-aged children from Montería, Colombia. Materials and methods: Cross-sectional study conducted in a sample of 546 adolescents aged between 11 and 18 years from 14 randomly selected schools in Montería. Blood pressure, anthropometric, and fitness measures were evaluated by trained personnel using standardized protocols and instrumentation. The association of HBP with fitness and fatness was analyzed using logistic regression models. Results: HBP was associated with OW, AO and low CRF. The inclusion of CRF in this model did not attenuate the association between HBP and OW and between HPB and AO. Adolescents with higher adiposity and low CRF were more likely to have HBP compared with those with lower adiposity and high CRF. Moreover, it was found that excess adiposity and low CRF had an additive effect on the risk for HBP among the sample. Conclusion: HBP is a prevalent condition in children and adolescents from Montería, Colombia. HBP is significantly associated with OW, AO, and low CRF; therefore, it is necessary to implement initiatives to promote healthy habits aimed at this population in order to reduce the incidence rate of HBP in Colombian adolescents.

Resumen Introducción. El exceso de adiposidad es considerado como el factor de riesgo más importante para la presión arterial alta (PAA) en niños y adolescentes. Objetivos. Explorar la asociación entre PAA y sobrepeso (SP) y obesidad abdominal (OA), mediada por condición física cardiorrespiratoria (CFC), y analizar el efecto combinado de la adiposidad excesiva y la CFC en la PAA en una muestra de escolares de Montería, Colombia. Materiales y métodos. Estudio transversal realizado en 546 adolescentes con edades entre 11 y 18 años de 14 escuelas seleccionadas aleatoriamente en Montería. Se evaluó la presión arterial, los indicadores antropométricos y la condición física; las mediciones fueron realizadas por personal capacitado mediante el uso de protocolos e instrumentos estandarizados. La asociación de PAA con condición física y adiposidad fue analizada a través de modelos de regresión logística. Resultados. Se encontró una asociación entre PAA y SP, OA y baja CFC. La inclusion de la CFC en el modelo no atenuó la asociación entre PAA y SP y entre PAA y OA. Los adolescentes con mayor adiposidad y baja CFC fueron más propensos a presentar PAA que aquellos con menor adiposidad y alta CFC. Además, se observó que la presencia de adiposidad excesiva y baja CFC aumenta el riesgo de desarrollar PAA. Conclusión. La PAA es una condición prevalente en niños y adolescentes de Montería, además se encontró una asociación estádisticamente significativa entre PAA y SP, OA, y baja CFC, por lo que es necesario que en el país se implementen estrategias que promuevan hábitos saludables en escolares y permitan reducir la tasa de incidencia de PAA en esta población.

Small airway disease in COPD associated to biomass exposure

Abstract Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous entity that may result from different causative agents and risk factors and may follow diverse clinical courses, including COPD secondary to biomass smoke exposure. At present, this phenotype is becoming more important for two reasons: first, because at least almost half of the world’s population is exposed to biomass smoke, and second, because the possibility of it being diagnosed is increasing. Biomass smoke exposure COPD affects primarily women and is related with insults to the airways occurred during early life. Although constituents of biomass smoke and tobacco smoke are similar, the physiopathological changes they induce differ depending not only on the chemical composition (related with the type of fuel used) but also on the particle size and the inhalation pattern. Evidence has shown that biomass smoke exposure affects the airway, predominantly the small airways causing anthracofibrosis and peribronchiolar fibrosis changes that will clinically translate into chronic bronchitis symptoms, with a high impact on the quality of life. In this review, we focus especially on the main epidemiological and clinical differences between COPD secondary to biomass exposure and COPD caused by tobacco exposure.

Manejo del mesotelioma peritoneal maligno con citorreducción quirúrgica más quimioterapia hipertérmica intraperitoneal en el Instituto Nacional de Cancerología, Colombia: reporte de un caso y revisión bibliográfica / Peritoneal malignant mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at the National Cancer Institute, Colombia: case report and literature review

El mesotelioma peritoneal es una neoplasia que se origina en las células mesoteliales del peritoneo. Histórica-mente, la supervivencia de los pacientes con mesotelioma peritoneal maligno sin tratamiento, es menor de 12 meses y se considera una neoplasia resistente a la quimioterapia. La citorreducción quirúrgica y la quimioterapia regional administrada como quimioterapia hipertérmica intraperitoneal (Hyperthermic Intraperitoneal Chemothe-rapy, HIPEC) se asocia con mejor supervivencia a largo plazo.Se presenta el caso de un paciente con antecedentes de exposición al asbesto y con diagnóstico de mesotelioma peritoneal maligno de tipo epitelioide, que fue tratado con cirugía citorreductora más quimioterapia hipertérmica intraperitoneal en el Instituto Nacional de Cancerología con una supervivencia de un año libre de enfermedad

Peritoneal mesothelioma is originated at the mesothelial cells of the peritoneum. Historically the survival of patients with this disease is less than 12 months without treatment and it is considered a neoplasm resistant to chemotherapy. Citorreductive surgery with hiperthermic intraperitoneal chemotherapy (HIPEC) is associated with an increased long-term survival. Here we present the case of a patient who had a past history of asbestos exposure and who was diagnosed with peritoneal mesothelioma of the epithelioid subtype. The patient was treated with cytoreductive surgery and HIPEC at the Instituto Nacional de Cancerología (Bogotá, Colombia) and has had a 12 month disease free survival

Diabetes mellitus en pacientes atendidos en el hospital universitario: Caracterización epidemiológica / Diabetes mellitus in patients of the Guayaquil university hospital: Epidemiological characterization

Introducción. La diabetes mellitus es una enfermedad metabólica que se caracteriza por la elevación de la glicemia en sangre; la misma que se ha observado un incremento en el número de pacientes adultos. Objetivo. Determinar la frecuencia de diabetes mellitus y los factores epidemiológicos importantes en los pacientes atendidos en el Hospital Universitario de Guayaquil, entre 2014-2015. Metodología. Diseño observacional de tipo transversal descriptivo en los pacientes de la consulta externa, en la que se utilizó un formulario de recolecciónde datos. Resultados. Se obtuvo diabetes mellitus no insulinodependiente el 45,16 %, diabetes insulinodependiente 39,87 %, diabetes mellitus no especificada 14,15 %; mayormente afectados el adulto intermedio (41 a 64 años de edad) con el 60,31 %; en el sexo femenino el 52,14 % comparado con el masculino con el 47,86 %; presentaron comorbilidad en aproximadamente 8,99 %, mayormente complicaciones de tipo circulatorias con el 10,75 %. Conclusiones. Existe mayormente diabetes mellitus no insulinodependiente, con predisposición en el sexo femenino, y en el grupo de adultas intermedias comparados con los masculinos; que quizá la tendencia presentada se deba a otros factores, como la falta de ejercicio, dieta no saludable, sobrepeso, historia familiar; fomentando la prevención y control de la diabetes mellitus mediante campañas integrales de información, educación y comunicación en todos los sectores de la sociedad.

Introduction. Diabetes Mellitus is a metabolic disease characterized by elevated blood glucose levels; the same has been observed an increase in the number of adult patients. Objective. To determine the frequency of Diabetes Mellitus and the important epidemiological factors in the patients treated at the University Hospital of Guayaquil between 2014-2015. Methodology. Observational design of descriptive transversal type; in the patients of the external consultation, in which a form of data collection was used. Results. Non-insulin dependent Diabetes Mellitus (NID) was obtained 45.16%, Insulin Dependent Diabetes (ID) 39.87%, Diabetes Mellitus Unspecified 14.15%; Mainly affected Intermediate Adult (41 to 64 years old) with 60.31%; In the female sex 52.14% compared to the male with 47.86%; Presented comorbidity in approximately 8.99%, mostly circulatory type complications with 10.75%. Conclusions. There is mainly Diabetes Mellitus Non-insulin dependent, predisposed in the female sex, and in the group of intermediate adults compared to the male; That the tendency presented may be due to other factors, such as lack of exercise, unhealthy diet, overweight, family history; Promoting the prevention and control of Diabetes Mellitus through comprehensive campaigns of information, education and communication in all sectors of society.

Cardiorespiratory performance of coronary artery disease patients on land versus underwater treadmill tests: a comparative study

OBJECTIVE: To compare responses to a cardiopulmonary exercise test on land versus on an underwater treadmill, to assess the cardiorespiratory performance of coronary artery disease patients while immersed in warm water and to compare with the performance of healthy individuals. METHODS: The sample population consisted of 40 subjects, which included 20 coronary artery disease patients aged 63.7±8.89 years old, functional class I and II, according to the New York Hearth Association, and 20 healthy subjects aged 64.7±7.09 years old. The statistical significances were calculated through an ANOVA test with a (1 - β) power of 0.861. ClinicalTrials.gov: NCT00989248 (22). RESULTS: Significant differences were uncovered in coronary artery disease group regarding the variables heart beats (HB), (p>0.01), oxygen consumption (VO2), (p>0.01) and carbon dioxide production (VCO2) (p<0.01). Also, for the same group, in relation to the environment, water versus on land for HB, VO2, VCO2 and oxygen for each heart beat (VO2/HB) all of than (p<0.01). The stages for data collected featured the subject's performance throughout the experiment, and within the given context, variables rating of perceived exertion (RPE), HB, VO2, VCO2 and VO2/HB (p<0.01) showed significant interactions between test stages and environment. Additionally, there was a significant interaction between the etiology and the test stages for the variables HB, VO2 and VCO2 (p<0.01). Electrocardiographic changes compatible with myocardial ischemia or arrhythmia were not observed. The subjects exhibited lower scores on Borg's perceived exertion scale in the water than at every one of the test stages on land (p<0.01). CONCLUSION: This study show that a cardiopulmonary exercise test can be safely conducted in subjects in immersion and that the procedures, resources and equipment used yielded replicable and reliable data. Significant differences observed in water versus on land allow us to conclude that coronary artery disease patients are able to do physical exercise in water and that the physiological effects of immersion do not present any risk for such patients, as exercise was well tolerated by all subjects.

Caracterización clínica del dengue con signos de alarma y grave, en hospitales de Guayaquil / Clinical characterization of dengue with signs of alarm and severe, in hospitals of Guayaquil

Introducción. El dengue es una infección vírica transmitida por mosquitos cuya infección va desde síntomas leves que en ocasiones evolucionan hasta un cuadro clínico llamado dengue grave. Objetivo. Caracterizar clínicamente los casos con diagnóstico de dengue con signos de alarma y dengue grave entre las semanas epidemiológicas 19 al 26 del 2014 ingresados en el Hospital de Niños Francisco de Icaza Bustamante y en adultos del hospital de Infectología de la ciudad de Guayaquil. Metodología. No experimental de tipo descriptivo, comparativo, de corte transversal; donde se comparan sus características clínicas, antecedentes y valores en pruebas hemáticas. Resultados. La fiebre re registró en el total de los pacientes, que se acompañan en los niños con nausea o vómito, dolor abdominal, artralgias, mialgias, cefaleas, entre otros, con variedad sintomática, mientras que en los adultos concuerda con la definición de casos. En las pruebas de laboratorio se detectaron casos con hemoconcentración y plaquetopenia mayormente en adultos; TGO y TGP elevadas por encima del 70 % de los casos; presencia de IgM en aproximadamente 1 de cada 2 en niños y adultos al momento de su ingreso, con anticuerpos IgG en 2 de cada 3 niños que revela una previa exposición al dengue. Conclusiones. Mayor afectación en los niños con variedad sintomática, entre 3 a 7 días de evolución, acompañados de hemoconcentración y plaquetopenia; así como, leucopenia, linfocitosis, neutropenia y las enzimas hepáticas elevadas en gran número de casos. Las pruebas serológicas específicas para dengue demuestran la infección reciente y antecedentes de infección pasada.

Introduction. Dengue is a viral infection transmitted by mosquitoes; whose infection ranges from mild symptoms that sometimes evolve to a clinical condition called severe dengue. Objective. Clinically characterize the cases with diagnosis of dengue with signs of alarm and severe dengue among the epidemiological weeks 19 to 26 of 2014 admitted to the Hospital of children Francisco de Icaza Bustamante and in adults of the Hospital of Infectología of the city of Guayaquil. Methodology. Non-experimental descriptive, comparative, cross-sectional type; where their clinical characteristics, antecedents and values are compared in blood tests. Results. Fever had the total number of patients, who were accompanied in children with nausea or vomiting, abdominal pain, arthralgia, myalgias, headaches, among others, with symptomatic variety, while in adults it was consistent with the definition of cases. In laboratory tests cases with hemoconcentration and thrombocytopenia were detected mainly in adults; TGO and TGP elevated above 70% of the cases; Presence of IgM in approximately 1 in 2 in children and adults at the time of admission, with IgG antibodies in 2 of 3 children revealing a previous exposure to Dengue. Conclusions. Major affectation in children with symptomatic variety, between 3 and 7 days of evolution, accompanied by hemoconcentration and thrombocytopenia; As well as leukopenia, lymphocytosis, neutropenia and elevated liver enzymes in a large number of cases. Specific serological tests for dengue demonstrate recent infection and history of past infection.

Cinema, subjetividade e sociedade: a sétima arte na produção de saberes. Uma experiência de extensão na Universidade Federal de São Paulo / Cinema, subjectivity, and society: the seventh art in the production of knowledge. An experience at the Federal University of São Paulo

O projeto de extensão "Cinema, Subjetividade e Sociedade: a sétima arte na produção de saberes", no campus Baixada Santista da Universidade Federal de São Paulo, utiliza a linguagem cinematográfica na investigação de fenômenos ligados à constituição das diferentes configurações subjetivas presentes na contemporaneidade. As atividades se desenvolvem em parcerias com diversos projetos da universidade e iniciativas existentes na cidade. As ações abordam temas relevantes, entendendo o cinema como importante dispositivo que pode propiciar o questionamento de concepções que o sujeito tenha de si e de seu meio sociocultural e político. São diversas as técnicas utilizadas: construção participativa de estratégias de ensino, pesquisa e extensão, de natureza qualitativa; pesquisa filmográfica; exibição de filmes e a realização de debates com convidados; produção de material audiovisual. Este artigo pretende abordar como as atividades propostas têm conseguido atingir seus objetivos e os resultados evidenciam preocupação com temáticas sociais, tais como educação pública, direitos humanos e movimentos sociais, em uma vertente transdisciplinar e em parcerias com iniciativas comunitárias. As conclusões apontam para a possibilidade de novos modos de produção epistêmica em articulação com a linguagem audiovisual, atestando a potência do cinema na produção de saberes e sua capacidade de mobilização em torno de múltiplas temáticas.

The extension project "Cinema, Subjectivity and Society: the seventh art in the production of knowledge", on the campus Santos, in Federal University of São Paulo, uses the cinematic language in the investigation of phenomena connected with the different subjective configurations present in contemporary times. Activities are developed in partnership with several projects of the university and devices in town. The project seeks to address relevant issues, understanding cinema as an important methodological tool in questioning of concepts that the subject has of itself and its socio-cultural and political environment. There are several techniques: participatory construction of teaching strategies, qualitative research and extension; filmic research; film screenings and debates with guests; production of audiovisual. This article aims to address how the proposed activities have been able to achieve their goals and the results show concern for social issues such as public education, human rights and social movements, in a cross-disciplinary dimension and partnerships with community initiatives. The findings point to the possibility of new epistemic production methods in conjunction with the audiovisual language, attesting the power of cinema in the production of knowledge and its ability to mobilize around multiple themes.

Segunda citorreducción más quimioterapia hipertérmica intraperitoneal por recaída de seudomixoma peritoneal / Second cytoreduction plus intraperitoneal hyperthermic chemotherapy in recurrence of pseudomyxoma peritonei

Introducción. El seudomixoma peritoneal es una condición rara caracterizada por la presencia de ascitis mucinosa e implantes peritoneales, en la mayoría de los casos, provenientes de tumores mucinosos del apéndice. El tratamiento primario de esta enfermedad es quirúrgico, y la citorreducción más quimioterapia hipertérmica intraperitoneal es el estándar de tratamiento actual, con supervivencia global a 5 y 10 años hasta de 96 y 68 %, respectivamente. No obstante, es una cirugía con alta morbilidad y considerable mortalidad, que apenas se está introduciendo en Colombia y la experiencia es incipiente. El porcentaje de recaída es de 28 a 44 % y existen pocos reportes sobre su manejo; la segunda citorreducción más quimioterapia hipertérmica intraperitoneal parece tener resultados aceptables en cuanto a supervivencia, morbilidad y mortalidad. Resultados. No hay estudios de segundas intervenciones por recaída peritoneal del seudomixoma en Colombia y, por esta razón, se decidió reportar la experiencia de dos casos del Instituto Nacional de Cancerología, donde, después de una primera citorreducción más quimioterapia hipertérmica intraperitoneal, los pacientes presentaron recaída peritoneal diagnosticada con imágenes durante el seguimiento y fueron sometidos a una nueva cirugía con buen resultado quirúrgico. Conclusión. La citorreducción secundaria más quimioterapia hipertérmica intraperitoneal es un procedimiento complejo con morbilidad considerable, que debe practicarse en lugares con experiencia y que proporciona al paciente un tratamiento radical y, posiblemente, se convierta en el manejo estándar de la recaída

Introduction: Peritoneal pseudomyxoma is a rare condition characterized by mucinous ascitis and peritoneal implants, originating from mucinous tumors of the apendix in the majority of cases. Primary treatment is surgical resection, with cytoreduction surgery plus hiperthermic intraperitoneal chemotherapy as the current standard of care, with 96% and 68% 5 and 10 year overall survival rates. Nonetheless, it is a surgical procedure associated with high morbidity and considerable mortality, with initial experience in Colombia. Recurrence is estimated between 28% and 44% and few reports address the management of recurrence peritoneal pseudomyxoma; second cytoreduction surgery plus hiperthermic intraperitoneal chemotherapy (CRS + HIPEC) seems to have acceptable results in terms of survival, morbidity and mortality. No studies of second CRS + HIPEC have been reported in Colombia; this is why we decided to publish two cases treated at the Instituto Nacional de Cancerología, Bogotá, Colombia, who had recurrence after a fist CRS + HIPEC, diagnosed by follow up images and who were taken to a second surgical treatment with good results. Conclusion: Second CRS + HIPEC is a technically challenging procedure with considerable morbidity that should only be performed in specialized and experienced centers, a radical form of treatment that could possibly become the standard of choice for recurrence.

Tumor filoide. Estado del arte / Phyllodes tumour. State of the art

El tumor filoide (TF) es una neoplasia fibroepitelial con una baja incidencia a nivel mundial, lo que limita el poder contar con estudios prospectivos acerca de su abordaje diagnóstico y terapéutico. Se hace una revisión actualizada de su presentación, diagnóstico y tratamiento. Con las características histopatológicas disponibles actualmente se puede subdividir el TF en: de histología benigna, limítrofe y maligna. Esta subclasificación permite establecer el abordaje quirúrgico, que es la base del manejo terapéutico, la indicación de terapias adyuvantes, y finalmente establecer el pronóstico de la paciente.

Phyllodes tumour is a fibroepithelial neoplasm of the breast, with a low world incidence, and with few prospective trials on its diagnosis and treatment. A review is presented of the available world medical literature on this topic. Phyllodes tumours can currently be classified as benign, borderline and malign. This classification helps to determine the surgical treatment, which is the cornerstone of the treatment of Phyllodes tumour, as well as the adjuvant treatment, and finally it helps to determine the patient's prognosis.

Comportamiento clínico de cáncer de mama en hombres en una población latinoamericana / Clinical behavior of breast cancer in men in a Latin American population

El cáncer de mama en hombres es una enfermedad poco frecuente, en Colombia la incidencia estimada anual es de 1 caso por cada 1.000.000 de habitantes, lo cual es significativamente menor que en otros países. Objetivo: Describir la presentación clínica, histopatológica, tratamiento inicial y recaídas de pacientes de sexo masculino con diagnóstico de cáncer de mama en el Instituto Nacional de Cancerología entre el periodo 1996 a 2011. Resultados: La población del estudio fue de 27 pacientes. Los principales síntomas reportados por los pacientes fueron masa y dolor. La mayoría de los pacientes (89%) presentaban un estadio clínico localmente avanzado (IIIB y IV). El tipo histológico ductal NOS fue el más predominante (82%). Se encontró resultado de receptores hormonales en 22 de los 27 pacientes, de los cuales 19 (86%) eran positivos. El porcentaje de pacientes llevados a cirugía fue del 71% (20 pacientes), la técnica quirúrgica utilizada en 17 de los 20 pacientes fue la mastectomía radical modificada. En todos los pacientes sometidos a tratamiento quirúrgico fue realizado vaciamiento axilar y resección del CAP. La mediana de seguimiento de los pacientes fue de 8,9 meses. Dos pacientes presentaron recaída sistémica. Ninguno de los pacientes presentó recaída locorregional. Conclusión: Presentamos una serie de pacientes con cáncer de mama en hombres, lo cual es una entidad de baja incidencia. Nuestros pacientes se presentaron principalmente en estadio avanzado, en una proporción mayor a lo descrito en otras series latinoamericanas. Aunque la biología tumoral encontrada representa factores de buen pronóstico, no concuerda con el hecho de que la mayoría de tumores sean avanzados.

Breast cancer in men is a rare disease in Colombia, with an estimated annual incidence of 1 case per 1,000,000 habitants, which is significantly lower than in other countries. Objective: To describe the clinical presentation, histopathology, initial treatment and relapse of male patients diagnosed with breast cancer at the National Cancer Institute between 1996 and 2011. Results: The study population was 27 patients. The main symptoms reported by patients were mass and pain. Most patients (89%) had locally advanced clinical stage (IIIB and IV). NOS ductal histological type was the most prevalent (82%). Hormone receptor was found in 22 of 27 patients, of whom 19 (86%) were positive. The percentage of patients undergoing surgery was 71% (20 patients), and the surgical technique used in 17 of the 20 patients was modified radical mastectomy. Axillary dissection and resection of the CAP was performed on all patients who underwent surgical treatment. The median follow up of patients was 8.9 months. Two patients had systemic relapse. None of the patients had locoregional relapse. Conclusion: A case series is presented of male patients with breast cancer, which is a disease of low incidence. Our patients are mainly presented in advanced stages, a greater proportion than that described in other Latin American series. Although tumour biology found good prognostic factors, it is not consistent with the fact that most tumours are advanced.

Tumores retroperitoneales: experiencia de 11 años en un centro de referencia en cáncer en un país latinoamericano (2000-2011) / Retroperitoneal tumors: 11 years experience in a cancer reference center in a Latin-American country (2000-2011)

Objetivo: Describir las características clínico-patológicas, evolución postoperatoria y desenlaces oncológicos de los pacientes con diagnóstico de tumor retroperitoneal operados en el Instituto Nacional de Cancerología en un periodo de 11 años. Métodos: Se realizó un estudio descriptivo retrospectivo, incluyendo los pacientes operados en el INC entre los años 2000 y 2011. Resultados: En total fueron 101 pacientes. La mediana de la edad fue de 52 años con un 56,4% de mujeres. Entre los pacientes operados, 60,4% presentaban enfermedad primaria, el 23,8% enfermedad recurrente y 15,8% (n = 16) eran remitidos como irresecables. El principal método de imagen fue la tomografía abdominal helicoidal con doble contraste (89,1%). El tipo histológico más frecuente fue el liposarcoma bien diferenciado. Se alcanzó resección completa en el 74,3%, con resecciones viscerales en bloque en 68,3% de los pacientes. Se presentaron complicaciones intraoperatorias en 55,4% de los pacientes, siendo la más frecuente el sangrado. La mediana de seguimiento fue de 549 días, con una supervivencia global de 41,1% a 5 años. La recaída local fue de 54,2% y la progresión sistémica de 25%. Conclusión: Los tumores retroperitoneales son tumores raros que se suelen diagnosticar en estadio avanzado, tienen pobre pronóstico oncológico principalmente por alto porcentaje de recaída local. El manejo óptimo tiene como pilar la cirugía idealmente en centros de referencia. Inicia desde la sospecha diagnóstica e incluye el uso racional de imágenes, el análisis histológico por patólogos con experiencia, la planeación preoperatoria y la decisión de terapias neoadyuvantes o adyuvantes de acuerdo al tipo y estadio tumoral.

Objective: To describe the clinical-pathological features, postoperative and oncological outcomes of patients diagnosed with retroperitoneal soft tissue tumors operated at the National Cancer Institute (NCI), over a period of 11 years. Methods: A retrospective and descriptive study was performed that included patients operated in the NCI between years 2000 and 2011. Results: In total there were 101 patients. The median age was 52 years, with 56.4% of them women. Among the operated patients, 60.4% had primary disease, 23.8% recurrent disease, and 15.8% (n = 16) were submitted as unresectable. The main method of imaging was abdominal helical double-contrast tomography (89.1%). The most common histological type was well differentiated liposarcoma. Complete resection was achieved in 74.3%, with en bloc resections of involved structures in 68.3% of patients. Intraoperative complications occurred in 55.4% of patients, the most frequent being bleeding. Median follow-up was 549 days, with an overall survival of 41.1% at 5 years. Local recurrence was 54.2% and the systemic progression was 25%. Conclusion: Retroperitoneal tumors are rare tumors that are usually diagnosed in advanced stages. They have a poor prognosis, mainly due to a high rate of local relapse. The mainstay of optimal management is surgery, and starts from the suspected diagnosis, encompassing the rational use of images, histological analysis by experienced pathologists, preoperative planning, and the decision of neoadjuvant or adjuvant therapies according to the type and tumor stage.

Mortalidad y recaída en pacientes con cáncer de mama infiltrante sometidas a cirugía conservadora / Mortality and relapse after conservative surgery in breast cancer patients

El tratamiento quirúrgico del cáncer de mama ha evolucionado, desde cirugías radicales que incluían la pared torácica hasta cirugías conservadoras de resección tumoral con margen oncológico seguro complementadas con radioterapia; estas se consideran alternativa a la cirugía radical. La supervivencia es similar en ambos procedimientos. Metodología: Estudio de cohorte retrospectivo que evaluó las características demográficas, patológicas y desenlaces clínicos, como recaída y mortalidad, en mujeres con cáncer invasivo, sometidas a cirugía conservadora entre 1998 y 2007 en el INC. Resultados: Se incluyeron 358 pacientes con edad promedio de 53 años y estados tumorales tempranos en su mayoría. Con mediana de seguimiento de cuatro anos se presentaron 40 recaídas entre locales, regionales y sistémicas con una tasa de recaída de 2,6 recaídas por 100 pacientes/año. Se presentó un mayor porcentaje de recaídas en estado clínico avanzado (p=0,022), tamaño tumoral mayor de 2 centímetros (p=0,02) y a mayor número de ganglios comprometidos en el vaciamiento axilar (p=0,004). La tasa de mortalidad fue 1,2 muertes por 100 pacientes/año. Los márgenes positivos se relacionaron con estado clínico avanzado (p=0,010) y las pacientes con márgenes positivos que recibieron manejo no quirúrgico presentaron un porcentaje mayor de recaída, comparado con las llevadas a cirugía (p=0,023). Esta diferencia se conservó al comparar manejo quirúrgico con no quirúrgico en márgenes positivos invasivos (p=0,037). Conclusiones: El estado clínico avanzado, se relacionó con márgenes positivos y recaída tumoral. El compromiso ganglionar axilar y el manejo no quirúrgico de los márgenes positivos determinaron un mayor porcentaje de recaída.

Surgical treatment for breast cancer has improved from radical surgery involving the chest wall, to conservative tumor resection surgery with oncologically safe margins. This latter, when supplemented with radiotherapy, is considered an alternative to radical surgery with similar survival for both procedures. Methodology: Retrospective observational study was performed to assess the clinical response in women older than 18 years with invasive cancer undergoing conservative surgery between 1998 and 2007. Results: A total 358 patients, with the majority in early tumor states were included for final revision. The mean age was 53 years. During a four year follow-up there were 40 local, regional and systemic relapses, with a progression rate of 2.6 relapses per 100 patients / year. There was a higher percentage of recurrence in advanced clinical status (P=.022), tumor size greater than 2 cm (P=.02), and greater number of lymph node involvement in the axillary clearance. Mortality rate was 1.2 deaths per 100 patients / year. Positive margins were associated with advanced clinical status (P=.010), and patients who received non-surgical management had a higher relapse rate compared with patients who had surgery (P=.023). This difference was maintained when comparing surgery with non-surgical management in invasive positive margins (P=.037). Conclusions: Advanced clinical stage was associated with positive margins and tumor relapse. Axillary lymph node involvement, and non-surgical management of surgical margins, resulted in a higher percentage of recurrence.

Experiencia clínica en el tratamiento adyuvante de los pacientes con melanoma de tronco y extremidades estado III en un hospital del Tercer Mundo / Clinical experience with adjuvant treatment of patients with Stage III melanoma of the trunk and extremities in a developing country

Objetivos: describir la experiencia del uso de interferón adyuvante en altas dosis en pacientes con melanoma de tronco y extremidades estadio III y establecer las causas por las que los pacientes con indicación del tratamiento adyuvante no lo recibieron, así como la toxicidad y los principales desenlaces. Materiales y métodos: se trata de una cohorte retrospectiva de pacientes con diagnóstico de melanoma de tronco y extremidades, que fueron llevados a tratamiento quirúrgico de la lesión primaria y vaciamiento ganglionar durante 10 años en el INC (1999-2009) y que tenían indicación de tratamiento adyuvante con interferon. Resultados: se identificaron 88 pacientes con melanoma de tronco y extremidades estado clínico ni, de los cuales 50 (56,8%) recibieron tratamiento adyuvante con Interferón. Entre las principales razones por las cuales los 38 pacientes restantes no lo recibieron se encontraban la edad y comorbilidades asociadas (21), consulta diferida a oncología (5), decisión del oncólogo clínico (5). Solo el 36% (18) pacientes recibió el interferón por más de 10 meses y el 62% (N = 31) de los pacientes suspendió el tratamiento por progresión de la enfermedad (N = 16, 51,6%) y 25 pacientes (28,4%) presentaron toxicidad grado III. Se encontró una menor tasa de incidencia de recaídas en el grupo que recibió el medicamento. Conclusión: en esta cohorte se encontró que los pacientes con melanoma estado III que recibieron tratamiento adyuvante con interferón tenían una menor tasa de recaída y una mejor supervivencia libre de enfermedad, lo cual se relaciona con lo reportado en la literatura.

Objectives: To describe the experience with the use of adjuvant high-dose interferon in patients with stage III melanoma of the trunk and extremities, establishing the causes why patients with an indication of adjuvant treatment did not receive it, as well as major toxicity and outcomes. Materials and Methods: This is a retrospective study of a cohort of patients diagnosed with melanoma of the trunk and extremities, who were subjected to surgical treatment of the primary lesion and lymph node dissection in the INC over a ten-year period (1999-2009), and who had an indication for Interferon adjuvant treatment. Results: A total 88 patients were diagnosed with Stage III melanoma of the trunk and extremities, of whom 50 (56.8%) were identified to have received adjuvant treatment with interferon. Among the main reasons why the remaining 38 patients did not receive it were, age and associated comorbidities (21), delayed oncology consultation (5), and decision of medical oncologist (5). Only 36% (18) patients received interferon for more than 10 months, and 62% of patients (N = 31) discontinued treatment. The main reason for suspending treatment was disease progression (N = 16, 51.6%), and 25 patients had grade III toxicity. A lower incidence of relapse was found in the group receiving the drug. Conclusion: In this cohort it was found that patients with stage III melanoma receiving adjuvant interferon therapy had a lower relapse rate and better disease-free survival, which is in agreement with that reported in the literature.

Anestesia peridural em paciente portadora de esclerose lateral amiotrófica - relato de caso / Epidural anesthesia in patient with amyotrophic lateral sclerosis - case report

Justificativa e objetivos: a esclerose lateral amiotrófica (ELA) é uma doença degenerativa progressiva do neurônio motor, de causa desconhecida, com padrão genético frequente. Quando os músculos responsáveis pela ventilação são acometidos, o paciente evolui para o óbito em alguns anos em decorrência da insuficiência respiratória. O objetivo deste trabalho é relatar o caso de uma paciente com ELA que foi submetida à gastrostomia e colostomia no Hospital Belo Horizonte sob anestesia peridural contínua e sedação consciente. Conclusão: as evidências têm demonstrado que a administração do bloqueio no neuroeixo associado à dexamedetomidina parece ser segura em pacientes com ELA, pois evita a manipulação das vias aéreas e as complicações respiratórias.

Justification and objectives: Amyotrophic Lateral Sclerosis (ALS) is a progressive degenerative disease of the motor neuron, of unknown cause, with a frequent genetic pattern. When the muscles responsible for ventilation are affected, the patient progresses to death in a few years as a result of respiratory failure. The aim of this study is to report the case of a patient with ALS who underwent gastrostomy and colostomy in Belo Horizonte Hospital under continuous epidural anesthesia and conscious sedation. Conclusion: Evidence has shown that the neuraxial block administration associated with dexmedetomidine seems to be safe in patients with ALS, since it avoids manipulation of the respiratory airways and complications