Trato digno en la atención de salud a la comunidad LGBTIQA+ / Dignity in treatment in health care to the LGBTIQA+ community

El trato digno, igualitario e inclusivo se ha constituido en un fenómeno de estudio en el contexto de la atención sanitaria, pero su abordaje es aún limitado frente al desconocimiento respecto al tema por parte del equipo de salud hacia las personas de la comunidad de la diversidad sexual, hoy conocida con la sigla que les representa como LGBTIQA+, quienes están inmersos fundamentalmente, en una sociedad heteronormada, donde la formación profesional con enfoque de género y diversidad sexual es aún limitada. El objetivo de la argumentación del escrito es presentar algunas referencias conceptuales, derechos legales, consecuencias para la salud que fundamentan una propuesta para el cambio de las instituciones de salud y de las enfermeras y enfermeros que iluminen el derecho de las personas de esta comunidad a recibir un trato digno.

Dignified, equal and inclusive treatment has become a study phenomenon in the context of health care, but its approach is still limited due to the lack of knowledge on the subject by the health team towards people from the diversity sexual, today known by the acronym that represents them as LGBTIQA+, who are fundamentally immersed in a heteronormative society, where professional training with a gender and sexual diversity approach is still limited. The objective of the argumentation of the writing is to present some conceptual references, legal rights, health consequences that support a proposal for the change of the health institutions and of the nurses that illuminate the right of people in this community to receive a decent deal.

Reacción granulomatosa de tipo sarcoideo secundaria a biopolímeros: reporte de caso y revisión de la literatura / Biopolymer sarcoid-like foreign-body granulomas: Case report and literature review

La alogenosis iatrogénica es la enfermedad causada por la aplicación de biopolímeros con fines estéticos. Sus manifestaciones clínicas pueden presentarse entre las seis horas y los 30 años posteriores a la aplicación, con síntomas locales o sistémicos. El principal rasgo de la histopatología es la presencia de granulomas por cuerpo extraño con reacción de tipo sarcoideo, la cual es difícil de Interpretar por su asociación con la sarcoidosis. Se reporta aquí el caso de una paciente con lesiones granulomatosas de tipo sarcoideo por reacción a cuerpo extraño, secundaria a la aplicación de múltiples sustancias desconocidas en cara y glúteos.

Iatrogenic allogenosis is a disease caused by the injection of biopolymers with esthetic purposes. Clinical manifestations can occur between six hours and 30 years after the procedure with local and/or systemic symptoms. The pathological findings are characterized by the presence of foreign body granulomas with a sarcoid-like reaction. Its Interpretation Is difficult given Its association with sarcoidosis. We report the clinical case of a female patient with granulomatous lesions In reaction to a foreign body secondary to the multiple application of unknown substances on the face and buttocks.

Clinical, sociodemographic, pharmacological and quality of life characterization of patients with a diagnosis of moderate to severe psoriasis treated in a specialized psoriasis clinic / Caracterización clínica, sociodemográfica, farmacológica y calidad de vida de pacientes con diagnóstico de psoriasis moderada a severa atendidos en una clínica especializada en psoriasis

Abstract Introduction: psoriasis is a systemic, inflammatory, and chronic disease with a global prevalence between 0.6-6.5 %. It is related to multiple comorbidities and generates a significant decrease in quality of life. Objective: to characterize sociodemographic, clinical, pharmacological, and quality of life variables in a population of patients with moderate-severe psoriasis. Methods: descriptive observational study the patients with a diagnosis of severe-moderate psoriasis treated in the Clínica Integral de Psoriasis-CLIPSO between May 2018 - June 2020. A collection format was designed for defined variables and a univariate analysis was performed. Results: 948 patients were identified with a median age of 50 years (IQR: 38-60) of which 51.0 % were women. 23.6 % were incidents with a median treatment time of 114 days (IQR: 98-127) and 73.9 % were prevalent with a median treatment time of 228 days (IQR: 160-371). The type of therapy used was mainly non-biological systemic and 90.9 % of the patients were adherent to the treatment. The clinical variables were similar for both groups and the most common phenotype was psoriasis vulgaris (57.1 %). The health-related quality of life in both groups was greater than 60 points and the affected dimensions were physical and psychological health. 27.3 % of the patients had comorbidities associated with cardiovascular risk and 44.7 % were overweight. Conclusion: knowing the sociodemographic, clinical, pharmacological, and quality of life characteristics of patients with moderate-severe psoriasis allows the identification of risk factors and comprehensive management of the disease.

Resumen Introducción: la psoriasis es una enfermedad sistémica, inflamatoria y crónica con una prevalencia global entre 0,6-6,5 %. Está relacionada con múltiples comorbilidades y genera una disminución significativa en la calidad de vida. Objetivo: caracterización sociodemográfica, clínica, farmacológica y calidad de vida de un grupo de pacientes con psoriasis moderada-severa. Métodos: estudio observacional descriptivo en pacientes con diagnóstico de psoriasis moderada-severa atendidos en la Clínica Integral de Psoriasis (CLIPSO) entre mayo 2018 y junio 2020. Se diseñó un formato para la recolección de las variables definidas y se realizó un análisis univariado. Resultados: se identificaron 948 pacientes con una mediana de edad de 50 años (RIC:38-60) de los cuales el 51 % eran mujeres. El 23,6 % eran incidentes, con una mediana en tiempo de tratamiento de 114 días (RIC:98-127) y 73,9 % eran prevalentes, con una mediana de tiempo de tratamiento de 228 días (RIC:160-371). El tipo de terapia utilizada fue principalmente sistémica no biológica y el 90,9 % de los pacientes eran adherentes al tratamiento. Las variables clínicas fueron similares en los incidentes y los prevalentes y el fenotipo más común fue psoriasis vulgar (57,1 %). La calidad de vida en ambos grupos fue mayor a 60 puntos y las dimensiones más afectadas en la calidad de vida fueron la salud física y la psicológica. El 27,3 % presentaban comorbilidades asociadas a riesgo cardiovascular y 44,7 % presentaban sobrepeso. Conclusión: conocer las características sociodemográficas, clínicas, farmacológicas y calidad de vida de los pacientes con psoriasis moderada-severa permite la identificación de factores de riesgo y un manejo integral de la enfermedad.

Mortality from anti-personnel mines before and during the Colombian peace process / Mortalidad secundaria a minas antipersona antes y durante el proceso de paz colombiano

Abstract Introduction: Although the peace process in Colombia resulted in a significant reduction in the number of anti-personnel mines across the country, there are no reliable data on the effects of this phenomenon on outcomes for patients who were victims of these devices. Objective: The objective of this study was to assess mortality from landmine injuries before and during the Colombian peace process. Furthermore possible associations between peace negotiations and mortality were explored. Methods: For this study, we used the "Colombian Victims of Antipersonnel Mines Injuries registry" (MAP/MUSE database) data from 2002 to 2018. This registry was launched in 2001 by the government of Colombia with the aim of prospectively and systematically collect information on all the cases of anti-personnel mine injuries in the country. The period between 2002-2012 was classified as the pre-negotiation period (período de guerra), and 2014-2018 as the peace negotiations period, with 2013 classified as a washout year. Multivariate logistic regression was used to explore the association between peace negotiations and mortality among anti-personnel landmine injured individuals. Results: A total of 10306 landmine injury cases were registered. Of these, 1180 (11.4%) occurred in the peace-negotiation period. Mortality was significantly lower during the period of peace negotiations. After adjusting for sex, age group, race, active duty soldier status, rural area, and geographic Departamentos case volumes, the peace negotiation period was found to be associated with lower risk-adjusted odds of mortality after suffering a landmine injury (OR= 0.6, 95% CI, 0.5-0.7; p<0.001). Conclusions: Our findings suggest an association between the period of peace negotiation and a lower likelihood of mortality among victims of anti-personnel landmines.

Resumen Introducción: Aunque el proceso de paz colombiano produjo una reducción en la cantidad de minas antipersona en el país, no hay estimativos sobre el efecto de este fenómeno en los desenlaces de los pacientes víctimas de estos artefactos. Objetivo: Nuestro objetivo fue evaluar la mortalidad por minas antipersona antes y durante la negociación del proceso de paz en Colombia. Además, exploramos posibles asociaciones entre las negociaciones de paz y la mortalidad. Métodos: Para este estudio utilizamos los datos del "Registro de víctimas colombianas de lesiones de minas antipersona" (base de datos MAP / MUSE) de 2002 a 2018. Este registro fue lanzado en 2001 por el gobierno de Colombia con el objetivo de recolectar información de manera prospectiva y sistemática de los casos de trauma por minas antipersona en el país. Clasificamos el período comprendido entre 2002 y 2012 como el período previo a la negociación (período de guerra), el comprendido entre 2014 y 2018 como el período de negociaciones de paz y el año 2013 como período de "depuración". Se utilizaron modelos de regresión logística multivariados para explorar las asociaciones entre las negociaciones de paz y la mortalidad. Resultados: Se registraron un total de 10306 casos de lesiones por minas antipersona. De estos, 1180 (11.4%) ocurrieron en el período de negociación de paz. La mortalidad fue significativamente menor durante el período de negociaciones de paz. El análisis de regresión logística multivariado determinó que el período de negociación de paz se asoció con una menor probabilidad de mortalidad después de sufrir una lesión por minas antipersona (OR = 0,6, IC 95%, 0,5-0,7; p <0,001). Conclusiones: Nuestros hallazgos sugieren una asociación entre el período de negociación de paz y una menor probabilidad de mortalidad entre las víctimas de las minas antipersona.

Pigmentación exógena por nitrato de plata: aspectos dermatológicos y toxicológicos, a propósito de un caso / Exogenous pigmentation by silver nitrate: Dermatological and toxicological aspects, case report

Resumen | La pigmentación exógena por nitrato de plata es una enfermedad poco frecuente, cuyas manifestaciones clínicas pueden aparecer años después del contacto, lo que en ocasiones dificulta su diagnóstico. Se caracteriza por la presencia de máculas o placas azul-grisáceas en la piel o las mucosas de la zona de contacto que, en ocasiones, son muy similares a las lesiones melanocíticas y al melanoma, sus principales diagnósticos diferenciales. Se reporta el caso de un paciente de Medellín, Colombia, con antecedentes familiares de melanoma y presencia de estas lesiones en todo el cuerpo.

Abstract | Exogenous pigmentation by silver nitrate is a rare disease whose clinical manifestations appear even years after the contact, making its diagnosis difficult on occasions. It is characterized by the presence of blue-gray macules or plaques on the skin or mucosa in the contact area, sometimes very similar to melanocytic lesions and melanoma, which constitute the main differential diagnosis. We report the case of a male patient from Medellín, Colombia, with a family history of melanoma and the presence of these lesions throughout his body.

Una introducción al enfoque del curso de vida y su uso en la investigación pediátrica: principales conceptos y principios metodológicos / An introduction to the life course approach and its use in pediatric research: main concepts and methodological principles

Resumen Desde su concepción, el enfoque del curso de vida se ha utilizado ampliamente en la investigación sociodemográfica y en los estudios sociológicos. El empleo de esta perspectiva se ha difundido desde hace algunos años en la investigación en salud. Sin embargo, su uso ha sido muy limitado en pediatría. Este trabajo presenta una exposición de los principales conceptos del enfoque del curso de vida y algunos principios metodológicos para el desarrollo de investigaciones desde esta perspectiva. Además, se incluyen una serie de proyectos de investigación que se han valido de este enfoque como fundamentación conceptual en su diseño e implementación y algunas fuentes de información que pueden ser utilizadas para el desarrollo de investigaciones desde esta conceptualización en México.

Abstract Since its inception, the life course approach has been widely used in the socio-demographic research and sociological studies. The use of this perspective in health research has spread for some years, although its use in pediatrics has been limited. This work presents the main concepts of the life course approach and some methodological principles for the development of research from this perspective. In addition, a series of research projects that have used this approach as a conceptual basis in their design and implementation are included, as well as some sources of information that can be used for the development of research since this conceptualization in Mexico.

Avaliação da ventilação não-invasiva com dois níveis de pressão positiva nas vias aéreas após cirurgia cardíaca / Assessment of noninvasive ventilation with two levels of positive airway pressure in patients after cardiac surgery

INTRODUÇÃO: A aplicação de ventilação por dois níveis de pressão positiva (BiPAP®) associada à fisioterapia respiratória convencional (FRC) no pós-operatório (PO) imediato de cirurgia cardíaca pode contribuir para a diminuição das complicações pulmonares. OBJETIVO: Avaliar a segurança e a adesão da aplicação preventiva do BiPAP® associado a FRC no PO imediato de revascularização do miocárdio. MÉTODOS: Vinte e seis pacientes submetidos a revascularização do miocárdio foram aleatoriamente alocados. O Grupo Controle (GC) foi tratado com FRC, o Grupo BiPAP (GB) foi submetido a 30 minutos de BiPAP®, duas vezes ao dia, associado à FRC. A FRC foi realizada em ambos os grupos, duas vezes ao dia. Todos os pacientes foram avaliados quanto: capacidade vital, permeabilidade das vias aéreas, pressões respiratórias máximas, saturação de oxigênio, frequência cardíaca, frequência respiratória, volume minuto, volume corrente, pressões arteriais sistólica e diastólica. As avaliações foram realizadas durante a internação no pré-operatório, imediatamente após a extubação, e na 24ª e 48ª horas após extubação. RESULTADOS: No GC, 61,5 por cento dos pacientes tiveram algum grau de atelectasias, no GB, 54 por cento (P=0,691). A capacidade vital foi estatisticamente maior no GB no PO (P<0,015). Todos os outros parâmetros de ventilometria, gasometria, manovacuometria e hemodinâmicos foram semelhantes entre os grupos. CONCLUSÃO: A cirurgia de revascularização do miocárdio leva à degradação da função respiratória no PO, e a aplicação da ventilação com pressão positiva (BiPAP®) pode ser benéfica para reestabelecer a função pulmonar mais rapidamente, principalmente a capacidade vital, de forma segura, sendo bem aceita pelos paciente, devido ao maior conforto em relação à sensação de dor durante a execução da fisioterapia respiratória.

INTRODUCTION: The application of two levels of ventilation by positive pressure (BiPAP®) associated with conventional respiratory therapy (CRT) in postoperative periord of cardiac surgery may contribute to reduction of pulmonary complications. OBJECTIVES: To evaluate the safety and compliance of preventive application of BiPAP® CRT associated with immediate postoperative myocardial revascularization. METHODS: 26 patients undergoing coronary artery bypass grafting were randomly allocated in one of the groups. Patients of the Control Group (CG) were treated only with conventional respiratory therapy, compared to BiPAP group (BG) (in addition to conventional respiratory therapy the patients were subjected to 30 minutes of ventilation by two levels twice a day). The conventional respiratory therapy was held in both groups, twice a day. All patients were evaluated for vital capacity, airway permeability, maximal respiratory pressures, oxygen saturation, heart rate, respiratory frequency, Volume Minute, tidal volume, systolic and diastolic blood pressure. Evaluations were performed during hospitalization preoperatively, immediately after extubation, 24h and 48h after extubation. RESULTS: In CG 61.5 percent of patients had some degree of atelectasias, in comparison to 54 percent of BG (P=0.691). The vital capacity was higher in the GB postoperatively (P<0.015). All the other ventilometric, gasometric, hemodynamic and manometric parameters were similar between groups. CONCLUSION: Coronary artery bypass grafting leads to deterioration of respiratory function postoperatively, and the application of positive pressure ventilation (BiPAP®) may be beneficial to restore lung function more quickly, especially vital capacity, safely, and well accepted by patients due to greater comfort with the sensation of pain during the execution of respiratory therapy.

Síndrome nefrótica primária em adultos / Primary nephrotic syndrome in adults

O conceito e os critérios clínicos e laboratoriais para o diagnóstico da Síndrome Nefrótica (SN) são revisados neste artigo, assim como a definição de resposta ao seu tratamento. São abordadas as glomerulopatias de causa primariamente renal, particularmente o seu tratamento e prognóstico. Na fase inicial da SN a abordagem está centrada no diagnóstico e tratamento das complicações do estado nefrótico, muitas vezes graves e independentes da etiologia da SN, além da utilização de “medidas gerais” como restrição de sal, uso judicioso de diuréticos e de inibidores da enzima conversora e/ou bloqueadores do receptor da angiotensina. Procede-se o diagnóstico etiológico da doença, se de causa primária ou secundária. Nas glomerulopatias primárias, esse diagnóstico necessariamente dependerá da biópsia renal, a qual definirá qual o protocolo de “tratamento específico” de um ou mais imunossupressores a ser prescrito. Uma proporção significativa de pacientes pode não responder ao tratamento e permanecer com o estado nefrótico, e a decisão por “medidas gerais” e de nefroproteção em geral é a conduta mais adequada, pela baixa probabilidade de resposta e alto potencial de efeitos colaterais dos imunossupressores a longo prazo, como os corticosteróides, agentes citotóxicos e/ou inibidores da calcineurina. Futuramente o uso de drogas mais eficientes e com menos efeitos colaterais poderá ampliar as possibilidades de tratamento específico das glomerulopatias primárias.

Clinical and laboratorial criteria for the definition of Nephrotic Syndrome (NS) are reviewed in this article, as well as characterization of response to its treatment. Primary glomerulopathies are specifically described, particularly their treatment and prognosis. In the initial phase of NS, the approach is mainly focused in the diagnosis and treatment of complications of the nephrotic state, many times severe and independent of the etiology of NS, when general measures such as salt restriction, judicious use of diuretics and angiotensin-enzyme inhibitors and/or angiotensin-receptor blockers are prescribed. Then the etiology of NS is determined, if associated to a primary or a secondary cause. In primary glomerulopathies, this diagnosis relies on renal biopsy that will define a specific immunosuppressive protocol to be prescribed. A significative proportion of these patients could not respond to treatment and remain nephrotic, when to keep general measures and nephroprotection should be the best approach, because immunosuppressors such as corticosteroids, cytotoxic agents and calcineurin inhibitors have a small probability of response and high potential for toxicity in the long term. In the future, more efficient drugs with less side-effects should broaden the options of specific treatments for primary glomerulopathies.