¿Los pacientes odontológicos están dispuestos a pagar por medidas de bioseguridad ante COVID-19? Variaciones en el tipo de tratamiento y la presencia de comorbilidades / ¿Are dental patients willing to pay for biosecurity measures against COVID-19? Variations in the type of treatment and the presence of comorbidities

Resumen Objetivo: Estimar si los pacientes odontológicos están dispuestos a pagar (DAP) más por sus citas sabiendo que la clínica donde asisten implementó medidas de bioseguridad para evitar el contagio del COVID-19. De igual manera, si dicho pago varía dependiendo del tipo de tratamiento odontológico, así como si el paciente presenta algún tipo de comorbilidad. Materiales y métodos: Desarrollo y aplicación de encuestas en línea a una muestra de 423 pacientes odontológicos en México con diferentes tratamientos y presencia de comorbilidad si estuvieran dispuestos a pagar por su atención ante la emergencia COVID por las medidas de bioseguridad utilizando un análisis estadístico de medias. La encuesta se aplicó en los meses de septiembre a noviembre de 2020. Resultados: Se estimó que aproximadamente el 32% cancelaría sus citas dentales por miedo a contraer COVID-19; sin embargo, casi un 45% estarían DAP un monto extra en la cita, si el consultorio o clínica implementa estrictas medidas de bioseguridad. Estos porcentajes, tanto de la cancelación de cita, como de la disponibilidad a pagar adicional, se incrementa si el paciente presenta alguna comorbilidad. Conclusiones: Los pacientes de la muestra están dispuestos a pagar un monto excedente por sus citas sabiendo que los consultorios implementaron medidas de bioseguridad, y más si son pacientes que presentan alguna comorbilidad. Así mismo, dichos consultorios podrían recibir algún apoyo del Gobierno para el bienestar de toda la sociedad.

Abstract Objective: Estimate whether dental patients are willing to pay (DAP) more for their appointments knowing that the clinic where they attend implemented biosecurity measures to prevent the spread of COVID-19. Similarly, if said payment varies depending on the type of dental treatment, as well as if the patient has some type of comorbidity. Materials and methods: Development and application of online surveys to a sample of 423 dental patients in Mexico with different treatments and presence of comorbidity if they were willing to pay for their care in the face of the COVID emergency for biosecurity measures using a statistical analysis of means . The survey was applied in the months of September to November 2020. Results: It was estimated that approximately 32% would cancel their dental appointments for fear of contracting COVID-19; however, almost 45% would be DAP an extra amount in the appointment, if the office or clinic implements strict biosecurity measures. These percentages, both for appointment cancellation and willingness to pay additional, are increased if the patient has any comorbidity. Conclusions: The patients in the sample are willing to pay an excess amount for their appointments knowing that the offices have implemented biosafety measures, and more so if they are patients with some comorbidity. Likewise, these clinics could receive some support from the Government for the well-being of the entire society.

Respiratory pathogens in children with acute lower respiratory infection detected through multiplex real-time PCR / Patógenos respiratorios en niños con infección respiratoria aguda baja detectados mediante PCR multiplex en tiempo real

Abstract Introduction: Acute respiratory infection in children has a high burden of disease. Detection of multiple micro -organisms through molecular testing of nasopharyngeal swab samples could change the paradigm of a single pathogen being the cause of respiratory disease in children and prove its usefulness in clinical practice. Objective: To characterize the pathogens identified in nasopharyngeal swab samples by means of multiplex realtime polymerase chain reaction (RT-PCR), as well as clinical variables and laboratory findings in children <5 years diagnosed with acute lower respiratory tract infection (ALRTI) and hospitalized in Bogotá D.C., Colombia. Materials and methods: Cross-sectional study conducted in 81 children hospitalized between September 2019 and March 2020 at the Clínica Cafam and in whom nasopharyngeal swab samples were collected for microbiological identification using the Allplex™ multiplex RT-PCR assay. Correlations between the number of pathogens and blood cells and C-reactive protein levels were determined by Spearman's rank correlation coefficient. Results: Patients' mean age was 17.23 months (±14.44), 54.32% were males, and 51.85% were young infants. A total of 149 microorganisms (60.40% viruses) were identified in 63 children (77.78%). Mixed infection and coinfection were reported in 48.15% and 11.11% of children, respectively. Regarding clinical findings, shortness of breath, upper airway obstruction, cough, fever and pharyngitis were the most common clinical signs and/or symptoms in patients with mixed infection (32.97%), coinfection (64.40%), mixed infection (29.78%), and absence of microorganism (22.00%), respectively. A negative correlation was observed between the number of leukocytes and the number of neutrophils and the number of microorganisms detected in the preschoolers group (r=-0.46; p =0.058 and r=-0.51; p =0.033, respectively). Furthermore, a positive correlation was found between monocyte count and the number of microorganisms detected (r=0.53; p =0.0096). Conclusion: Multiplex RT-PCR assay allowed the identification of microorganisms in most children, as well as cases of mixed infection and coinfection in more than half of the sample. In addition, clinical findings in these children were highly heterogeneous as per the assay result..

Resumen Introducción. La infección respiratoria aguda en niños tiene una alta carga de enfermedad. La detección de múltiples microorganismos a través de pruebas moleculares en hisopados nasales podría cambiar el paradigma de patógeno único causal de enfermedad respiratoria en niños y ser de utilidad en la práctica clínica. Objetivo. Caracterizar los patógenos identificados mediante la técnica de reacción en cadena de polimerasa multiplex en tiempo real (RT-PCR) en hisopado nasal, así como las variables clínicas y los resultados de laboratorio en niños <5 años diagnosticados con infección respiratoria aguda baja (IRAB) y hospitalizados en Bogotá D.C., Colombia. Materiales y métodos. Estudio transversal realizado en 81 niños hospitalizados entre septiembre de 2019 y marzo de 2020 en la clínica Cafam y en quienes se hizo hisopado nasal para realizar la identificación microbiològica mediante la prueba RT-PCR multiplex Allplex. Las correlaciones entre el número de patógenos y los niveles de células del hemograma y el nivel de proteína C reactiva se determinaron mediante el coeficiente de correlación de Spearman. Resultados. La edad promedio fue 17.23 meses (±14.44), 54.32% fueron varones y 51.85%, lactantes menores. Se identificaron 149 microorganismos (60.40% virus) en 63 niños (77.78%). Hubo infección mixta en el 48.15% y coinfección en 11.11% de los niños. Respecto a los hallazgos clínicos, la dificultad respiratoria, la obstrucción de la vía respiratoria alta, la tos, la fiebre y la faringitis fueron más comunes en los casos de infección mixta (32.97%), ausencia de microorganismo (16.00%), coinfección (64.40%), infección mixta (29.78%) y ausencia de microorganismo (22.00%), respectivamente. Se observó una correlación negativa entre el número de leucocitos y neutrófilos y el número de microorganismos detectados en preescolares (r=-0.46; p=0.058 y r=-0.51; p=0.033) y una positiva entre el recuento de monocitos y el número de microorganismos detectados (r=0.53; p =0.0096). Conclusión. La prueba RT-PCR multiplex permitió identificar microorganismos en la mayoría de niños, así como casos de infección mixta y coinfección en más de la mitad de la muestra. Además, los hallazgos clínicos fueron altamente heterogéneos entre los niños según el resultado de la prueba.

Análisis estadístico de los factores de riesgo asociados a las patologías de la columna lumbar para la población empleada / Statistical analysis of risk factors associated with lumbar spine pathologies for the employed population

Objetivo: Determinar los factores de riesgo de patologías lumbares en pacientes empleados y afiliados al sistema de salud, a partir de la exploración física, hábitos, antecedentes personales y factores de riesgo laborales. Material y Métodos: El diseño del estudio es retrospectivo, transversal. En una muestra de 668 adultos trabajadores del Ecuador, se aplicó y evaluó el modelo predictivo de respuesta binaria logit para identificar factores de riesgo y se usaron métodos de aprendizaje supervisado (árboles de clasificación) para clasificar a los pacientes según el grado de patología lumbar. Resultados: El modelo predictivo logístico presentó una sensibilidad del 62,5%, una especificidad del 63,7%, el área bajo la curva ROC fue 0,63 y se determinó una precisión del 63,4%.Conclusión: Los factores que aumentan el riesgo de la patología de columna lumbar más frecuente (lumbalgia) y en orden de importancia en los pacientes son: menor edad, sexo femenino, tienden a exponerse a factores de riesgo psicosocial en su trabajo

Objective: Determine the risk factors of lumbar pathologies in patients employed and affi-liated with the health system, based on physical examination, habits, personal history, and occupational risk factors.Materials and Methods: The study design is retrospective, cross-sectional. In a sample of 668 adult workers from Ecuador. The binary logit response predictive model was applied to identify risk factors and supervised learning methodology (classification trees) was used to classify patients according to the degree of lumbar pathology.Results: The logistic predictive model has a sensitivity of 62.5%, a specificity of 63.7%, the area under the ROC curve was 0.63, and precision of 63.4% was determined.Conclusion: The factors that increase the risk of the most frequent lumbar pathology (low back pain) in order of importance in patients are: younger age, female sex, tend to be expo-sed to psychosocial risk factors at work, and lower risk of having mechanical factors.

Evaluación y análisis del índice de severidad tomográfico y clasificación de Atlanta 2012 en pancreatitis aguda severa / Evaluation and analysis of the tomographic severity index and Atlanta 2012 classification in patients with severe acute pancreatitis

Introducción. En el paciente con pancreatitis aguda severa, la presencia de necrosis infectada y falla multiorgánica se asocian con una mortalidad del 20-40 %. La tomografía computarizada con contraste intravenoso y la clasificación del Consenso de Atlanta 2012 son importantes herramientas de diagnóstico para el tratamiento oportuno. En esta investigación, se analizó la relación del índice de severidad tomográfico y los cambios morfológicos locales según dicha clasificación, con la estancia hospitalaria, intervención, infección y mortalidad de los pacientes. Métodos. Estudio de cohorte retrospectiva realizado entre los años 2015 y 2019, donde se incluyeron pacientes mayores de 15 años con pancreatitis aguda severa diagnosticado por tomografía computarizada con contraste, y se evaluó el índice de severidad tomográfico y los cambios morfológicos según la clasificación de Atlanta 2012, en relación con los desenlaces clínicos de los pacientes. Resultados. Se incluyeron 56 pacientes, en el 82,1 % (n=46) de los casos la causa fue litiásica. La falla orgánica fue principalmente pulmonar 53,6 % (n=30) y cardiovascular 55,4 % (n=31). Según la tomografía, se clasificó como severa (7-10 puntos) en el 91,1 % (n=51) de los pacientes. En pacientes con necrosis amurallada infectada la estancia hospitalaria media fue mayor (78,5 días); en todos los pacientes con pancreatitis severa se encontró infección y fueron sometidos a algún tipo de intervención. La mortalidad fue menor del 10 % (n=5).Discusión. El índice de severidad tomográfica para la categorización de severo se correlacionó en un 90 % con pancreatitis aguda severa. Una tomografía de control a la cuarta semana podría identificar complicaciones tardías para un manejo precoz

Introduction. In patients with severe acute pancreatitis, the presence of infected necrosis and multiple organ failure are associated with a mortality of 20-40%. Computed tomography with intravenous contrast and the 2012 Atlanta Consensus classification are important diagnostic tools for timely treatment. In this research, the relationship between the tomographic severity index and the local morphological changes according to that classification, with the hospital stay, intervention, infection and mortality of the patients was analyzed.Methods. Retrospective cohort study carried out between the years 2015 and 2019, which included patients older than 15 years with severe acute pancreatitis diagnosed by contrast computed tomography, the tomographic severity index and morphological changes according to the Atlanta 2012 classification were evaluated, in relationship with the clinical outcomes of the patients. Results. Fifty-six patients were included, in 82.1% (n=46) of the cases the cause was lithiasis. Organ failure was mainly pulmonary 53.6% (n=30) and cardiovascular 55.4% (n=31). According to the tomography, it was classified as severe (7-10) in 91.1% (n=51) of the patients. In patients with infected walled necrosis, the mean hospital stay was longer (78.5 days); infection was found in all patients with severe pancreatitis and they underwent some type of intervention. Mortality was less than 10% (n=5).Discussion. The tomographic severity index for the categorization of severity is 90% correlated with severe acute pancreatitis. A control tomography at the fourth week could identify late complications for early management

Adherencia a medicamentos orales en pacientes con artritis reumatoide, una experiencia colombiana / Adherence to oral disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis: a Colombian experience

RESUMEN Introducción: El uso de los fármacos modificadores de la enfermedad (FAME) en pacientes con artritis reumatoide (AR) es esencial para alcanzar y mantener un control adecuado de la enfermedad y prevenir un daño funcional irreversible. Sin embargo, la tasa de adherencia a la terapia farmacológica varía entre el 20% y el 107%. Esta variabilidad puede deberse a los métodos de medición utilizados en los diferentes estudios. Objetivo: Evaluar la adherencia global al tratamiento oral con FAME en pacientes con AR mediante el autodiligenciamiento del cuestionario Compliance Questionnaire on Rheumatology (CQR) y la actividad de la enfermedad e identificar los factores potenciales asociados con la baja adherencia. Métodos: Estudio descriptivo transversal que incluyó pacientes mayores de 18 años con AR clasificados por criterios ACR-EULAR 2010, con prescripción de FAME durante al menos 3 meses y control con reumatólogo en el último año. Los participantes llenaron el cuestionario CQR y se les indagó acerca del conocimiento de la enfermedad, la percepción sobre el tratamiento, los efectos adversos, el índice de comorbilidad de Charlson, el índice global de apoyo social, el número de medicamentos y FAME prescritos, el acceso a los servicios de salud y la actividad de la enfermedad por DAS 28 o CDAI. Se definió como buena adherencia un punto de corte de CQR >80 y ausencia de actividad (remisión o actividad baja). Para la búsqueda de factores asociados con adherencia se analizaron los datos por medio de mediana y rango intercuartílico, así como frecuencias y proporciones. La comparación entre los grupos de adherentes y no adherentes se hizo con comparaciones absolutas, por medio de test de Mann-Whitney para las variables continuas y chi-cuadrado (para valores esperados > 5), o Fisher (para valor esperado < 5) para variables categóricas, tomando como nivel de significancia un valor de p<0,05. Se utilizaron OR y sus respectivos intervalos de confianza al 95% (IC95%). Resultados: De los 170 participantes incluidos, el 50% (n = 85) tuvo un valor de CQR mayor de 80 (buena adherencia). La mayoría de los pacientes se encontraba en remisión (60,6%) o baja actividad de la enfermedad (17%). El análisis posterior únicamente encontró asociación estadísticamente significativa entre adherencia medida por CQR y el número de amigos (p = 0,0012) y entre adherencia medida por actividad de la enfermedad y el índice de soporte social global (p = 0,004). Conclusiones: Este estudio muestra un nivel de adherencia similar al reportado en otras poblaciones, lo cual puede deberse a comportamientos propios de nuestra población, aunque los autores percibieron dificultades reportadas por los pacientes para entender los enunciados del instrumento en todos los niveles de escolaridad. Únicamente las variables de soporte social tuvieron una asociación estadísticamente significativa con la adherencia, asociación descrita en la literatura. Se requieren más estudios para evaluar las características operacionales del CQR en nuestra población.

ABSTRACT Introduction: The use of disease modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) is essential in order to achieve and maintain adequate disease control, and thus preventing irreversible functional damage. However, the rate of adherence to drug therapy has been reported to be between 20% and 107%. This variability may be due to the measurement methods used in the different studies. Objective: To test the overall medication adherence to oral treatment with DMARD in patients with RA using the self-report Spanish version Compliance Questionnaire on Rheumatology (CQR) and to identify potential factors associated with non-adherence. Methods: A cross-sectional descriptive study was conducted that included patients older than 18 years with RA diagnosed according to the ACR-EULAR 2010 criteria. They also had to have been prescribed oral DMARD for the previous 3 months, and had been seen by a rheumatologist in the last year. Patients completed the CQR to assess adherence, and were asked about disease knowledge, perception about treatment, side effects, Charlson Comorbidity Index, global index of social support, number of medications and DMARD prescribed, access to health resources, and disease activity measured by DAS 28 or CDAI. Good adherence was defined as a cut-off point of CQR > 80 or non-activity (remission or low activity). In the search for factors associated with adherence, the data were analysed using means of median and interquartile range, as well as frequencies and proportions. The comparison between adherent and non-adherent groups was performed using absolute comparisons, with the Mann-Whitney test for continuous, and chi-squared (for expected values > 5), or Fisher (for expected values < 5) tests for categorical variables, taking as a level of significance a value of P < .05. OR and their respective 95% confidence intervals (95% CI) were used. Results: Of 170 participants included, 50% (n = 85) had a value greater than 80% (good drug adherence). Most patients had remission (60.6%) or low disease activity (17%). The subsequent analysis showed statistically significant association between adherence measured by CQR and the number of friends (P = .0012). An association was also found between disease activity as an indirect indicator of adherence and the global social support index (P = .004). Conclusions: This study found a similar level of adherence to that reported in other populations, which could be due to the behaviour of our population, although the authors perceived difficulties reported by patients in understanding the statements of the questionnaire at all levels of education. Only the social support variables had a statistically significant relationship with adherence, which had also been described in the literature. Further studies are required to evaluate the operational characteristics of the CQR in our population.

Formulation and Validation of Recombinant Antigens CFP10 and ESAT6 for Tuberculosis Diagnosis

Abstract The rapid and accurate diagnosis of tuberculosis (TB), especially considering limited resources, is still a challenge. Development of new methodologies and tests are needed to overcome several disadvantages of the available standard tests. We evaluated the diagnostic potential of two antigens specific for Mycobacterium tuberculosis, the CFP10 and ESAT6 recombinant proteins, and developed stable formulations thereof. Sensitivity and specificity of the delayed-type hypersensitivity (DTH) skin testing and the induction of gamma interferon production (IFN-γ) by lymphocytes, as a non-invasive test, were evaluated using the CFP10 and ESAT6 protein formulations. The recombinant proteins produced by our group presented a high DTH response and the ability to differentiate between tuberculosis infection, BCG vaccination, and the contact with non-tuberculous mycobacteria (NTM). The production of IFN-γ by stimulation with individual and combined proteins was detected in a panel of 40 individuals and showed a specificity of 100% and a sensitivity of 90% when the two proteins were used together. Lyophilized formulations were stable under all conditions, while soluble formulations were stable under freezing at -20 ºC and -80 ºC. The proposed formulations containing the ESAT6 and CFP10 recombinant antigens constitute satisfactory tools for TB testing, suitable to be developed and implemented in a large-scale trial.

Colombian Association of Rheumatology. Consensus on recommendations to decrease and discontinue biological therapy in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis / Asociación Colombiana de Reumatología. Consenso sobre recomendaciones para disminución y descontinuación de la terapia biológica en pacientes con artritis reumatoide, espondilitis anquilosante y artritis psoriásica

A B S T R A C T Objective: The objective of this study was to establish recommendations for the reduction and discontinuation of biological disease-modifying antirheumatic drugs, with the aim of becoming a guide document for health professionals involved in the management of patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Materials and methods: The recommendations were established through consensus by a panel of experts in rheumatology, and based on the analysis of available scientific evidence obtained from systematic reviews and the clinical experience of the panellists. Results: A total of 33 rheumatoid arthritis related studies were included, with 6 psoriatic arthritis related, and 9 ankylosing Spondylitis related. The recommendations for the reduction of biological therapies were made by establishing a plan to determine when and how to reduce the biological disease-modifying antirheumatic drugs in patients with these 3 diseases, and in some cases lead to the discontinuation of these treatments. Conclusion: The recommendations established in this document will serve as a guide to improve the efficiency of biological therapy in these diseases, reduce the variability in clinical practice, and establish an adequate risk/benefit ratio.

RESUMEN Objetivo: El objetivo de este estudio fue establecer recomendaciones para la disminución y descontinuación de la terapia biológica con el fin de que se convierta en un documento guía para los profesionales de la salud involucrados en el manejo de pacientes con artritis reumatoide, espondilitis anquilosante y artritis psoriásica. Materiales y métodos: Las recomendaciones fueron establecidas mediante consenso desarrollado a través de un panel de expertos en reumatología, basado en el análisis de la evidencia científica disponible obtenida de revisiones sistemáticas y sobre la experiencia clínica de los panelistas. Resultados: Se incluyeron 33 estudios relacionados con artritis reumatoide, 6 de artritis psoriásica y 9 de espondilitis anquilosante. Las recomendaciones para la disminución de las terapias biológicas se realizaron estableciendo un plan para determinar cuándo y cómo reducir los fármacos biológicos modificadores de enfermedades reumáticas en pacientes con estas 3 enfermedades y en algunos casos conducir a la descontinuación de estos tratamientos. Conclusión: Las recomendaciones establecidas en este documento servirán de guía para mejorar la eficiencia de la terapia biológica en estas enfermedades, reducir la variabilidad en la práctica clínica y establecer de manera adecuada una relación riesgo/beneficio.

Foot health and quality of life among university students: cross-sectional study

ABSTRACT BACKGROUND: Foot problems are believed to reduce quality of life and are increasingly present. Even among young adults of university age, untreated foot problems can lead to postural and mobility problems. Accordingly, our aim here was to determine the relationship between foot health and quality of life and general health among male and female university students. DESIGN AND SETTING: Observational cross-sectional quantitative study conducted at the Podiatric Medicine and Surgery Clinic of the University of Coruña, Ferrol, Spain. METHODS: A sample of 112 participants of median age 22 years came to a health center, where self-reported data were registered, including professional activity, and scores obtained through the Foot Health Status Questionnaire (FHSQ) were compared. RESULTS: In Section One of the FHSQ, the university students recorded lower scores of 66.66 in the footwear domain and 60 in the general foot health domain and higher scores of 84.37 in the foot pain domain and 93.75 in the foot function domain. In Section Two, they obtained lower scores of 60 in the overall health domain and 62.50 in the vigor domain and higher scores of 100 in the physical activity and 87.50 in the social capacity domain. Differences between males and females were evaluated using the Wilcoxon rank-sum test, which showing statistical significance (P < 0.05) regarding the dimensions of footwear and general foot health. CONCLUSIONS: These university students' quality of life relating to foot health was poor. This appears to be associated with the university period, regardless of gender.

Alternativas terapéuticas al manejo farmacológico con estatinas en adultos con dislipidemia. Revisión sistemática de la literatura y recomendaciones generales / Therapeutic alternatives to pharmacological management with statin drugs in adults with dyslipidemia. Systematic literature review and general recommendations

Objetivo: Evaluar el impacto sobre la incidencia y recurrencia de eventos cardiovasculares y cerebrovasculares (prevención primaria y secundaria), los niveles de las fracciones lipídicas y la incidencia de efectos secundarios en personas con hipercolesterolemia intolerantes al tratamiento con las estatinas. Métodos: Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. Población Población adulta, con diagnóstico de dislipidemia, o en riesgo de desarrollarla, intolerantes al manejo con las estatinas. Recomendaciones: Se formulan recomendaciones a favor del uso de diferentes medicamentos (los fibratos, la niacina, los ácidos omega 3, las resinas secuestradoras de ácidos biliares, el ezetimibe), según su efectividad hipolipemiante y reducción de eventos cardiovasculares, como propuesta adaptada al contexto social colombiano.

Objective To evaluate the impact on the incidence and recurrence of cardiovascular and cerebrovascular events (primary and secondary prevention), the levels of lipid fractions and the incidence of side effects in people with hypercholesterolemia intolerant to statin therapy. Methods: A clinical practice guideline was developed following the guidelines of the methodological guidance of the Ministry of Health and Social Protection to systematically collect the evidence and make recommendations using the GRADE methodology. Population: Adult population, diagnosed with dyslipidemia or at risk of developing, intolerant to management with statin drugs. Recommendations: Recommendations for the use of different medications (fibrates, niacin, omega 3 acids, bile acid binding resins, ezetimibe) are formulated according to their lipid-lowering effectiveness and reduction of cardiovascular events, a proposal adapted to the Colombian social context.

Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

To evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.

Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

Purpose There is little information in the literature on health-related quality of life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy monotherapy for prostate cancer. Materials and Methods We conducted a prospective study of HRQOL changes due to HDR brachytherapy monotherapy for low risk or favorable intermediate risk prostate cancer. Sixty-four of 84 (76%) patients who were treated between February 2011 and April 2013 completed 50 questions comprising the Expanded Prostate Cancer Index Composite (EPIC) before treatment and 6 and/or 12 months after treatment. Results Six months after treatment, there was a significant decrease (p<0.05) in EPIC urinary, bowel, and sexual scores, including urinary overall, urinary function, urinary bother, urinary irritative, bowel overall, bowel bother, sexual overall, and sexual bother scores. By one year after treatment, EPIC urinary, bowel, and sexual scores had increased and only the bowel overall and bowel bother scores remained significantly below baseline values. Conclusions HDR brachytherapy monotherapy is well-tolerated in patients with low and favorable intermediate risk prostate cancer. EPIC urinary and sexual domain scores returned to close to baseline 12 months after HDR brachytherapy. .

A Comparison of Cell Disruption Procedures for the Recovery of Intracellular Carotenoids from Sporobolomyces Ruberrimus H110.

Carotenoids are intracellular pigments produced by microorganisms, including some species of yeasts, in the stationary phase of growth by the secondary metabolic pathways. In the present study, different methods of Sporobolomyces ruberrimus H110 yeast cell lysis were evaluated with the objective of optimizing the recovery of intracellular pigments. Three extraction methods were used: vortex (glass beads and quartz stones), planetary mill (glass beads and quartz stones) and dimethyl sulfoxide. For each one of the lysis agents studied, factorial designs were developed considering as independent variables the agitation speed and lysis agent concentration. A central composite planning was defined considering as independent variables the lysis agent concentration and agitation speed, analyzing as response the estimated total number of extracted carotenoids. From the methods studied, a better extraction of total carotenoid (1.74 mg.g-1 of cells and of 1.57 mg.g-1 of cells) using the planetary mill method with 135 mg of glass beads or irregular quartz stones, with an agitation speed of 200 rpm. As to the cell lysis, the analysis indicated that the mechanical methods studied showed to be efficient in regards to cell laceration.

Guía de práctica clínica para la prevención, detección temprana, diagnóstico, tratamiento y seguimiento de las dislipidemias: tratamiento farmacológico con estatinas / Clinical practice guidelines for prevention, early detection, diagnose, treatment and follow-up of dyslipidemias: farmacological treatment with statins

Objetivo: Evaluar el impacto del tratamiento con estatinas sobre la incidencia y la recurrencia de los eventos cardiovasculares y los cerebrovasculares (prevención primaria y secundaria), los niveles de las fracciones lipídicas y la incidencia de efectos secundarios (el cáncer y la diabetes mellitus) en personas con hipercolesterolemia. Métodos: Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. Resultados: Se evidenció un efecto benéfico del tratamiento farmacológico con estatinas tanto en población de prevención primaria como en prevención secundaria, logrando reducciones clínica y estadísticamente significativas en la mortalidad y en los eventos cardiovasculares y cerebrovasculares. Adicionalmente, el tratamiento intensivo con estatinas mostró mayor reducción en los eventos cardiovasculares y cerebrovasculares ateroscleróticos al compararlo con el tratamiento de intensidad moderada. No se encontraron diferencias significativas en el riesgo de desarrollar cáncer al comparar estatinas frente a placebo pero sí se encontró un incremento de nueve por ciento en el riesgo de presentar diabetes mellitus asociado al tratamiento con estatinas. Conclusiones: Se formulan recomendaciones a favor del uso de estatinas como primera línea de tratamiento de hipercolesterolemia, y se establecen criterios para definir la intensidad de la terapia (alta o moderada respuesta) según el riesgo cardiovascular a 10 años, el nivel de colesterol LDL (cLDL), la edad y los antecedentes personales y los familiares.

Objective: To evaluate the impact of statin therapy on the incidence and recurrence of cardiovascular and cerebrovascular events (primary and secondary prevention), the levels of lipid fractions and the incidence of side effects (cancer and diabetes mellitus) in people with hypercholesterolemia. Methods: A clinical practice guideline was developed following the guidelines of the methodological guidance of the Ministry of Health and Social Protection to systematically collect the evidence and make recommendations using the GRADE methodology. Results: A beneficial effect of pharmacological treatment with statins in both primary prevention and secondary prevention was evident, achieving clinically and statistically significant reductions in mortality and cardiovascular and cerebrovascular events. Additionally, intensive statin therapy showed greater reduction in atherosclerotic cardiovascular and cerebrovascular events as compared to the treatment of moderate intensity. No significant differences in the risk of developing cancer by comparing statins versus placebo were found, but a 9% increase in the risk of diabetes mellitus associated with statin therapy was found. Conclusions: Recommendations for the use of statins as first-line treatment of hypercholesterolemia are formulated, and criteria to define the intensity of therapy (high or moderate response) as cardiovascular risk at 10 years, level of LDL (LDLc), age and personal and family history were established.

External beam radiation therapy and a low-dose-rate brachytherapy boost without or with androgen deprivation therapy for prostate cancer

Purpose To assess outcomes with external beam radiation therapy (EBRT) and a low-dose-rate (LDR) brachytherapy boost without or with androgen deprivation therapy (ADT) for prostate cancer. Materials and Methods From January 2001 through August 2011, 120 intermediate-risk or high-risk prostate cancer patients were treated with EBRT to a total dose of 4,500 cGy in 25 daily fractions and a palladium-103 LDR brachytherapy boost of 10,000 cGy (n = 90) or an iodine-125 LDR brachytherapy boost of 11,000 cGy (n = 30). ADT, consisting of a gonadotropin-releasing hormone agonist ± an anti-androgen, was administered to 29/92 (32%) intermediate-risk patients for a median duration of 4 months and 26/28 (93%) high-risk patients for a median duration of 28 months. Results Median follow-up was 5.2 years (range, 1.1-12.8 years). There was no statistically-significant difference in biochemical disease-free survival (bDFS), distant metastasis-free survival (DMFS), or overall survival (OS) without or with ADT. Also, there was no statistically-significant difference in bDFS, DMFS, or OS with a palladium-103 vs. an iodine-125 LDR brachytherapy boost. Conclusions There was no statistically-significant difference in outcomes with the addition of ADT, though the power of the current study was limited. The Radiation Therapy Oncology Group 0815 and 0924 phase III trials, which have accrual targets of more than 1,500 men, will help to clarify the role ADT in locally-advanced prostate cancer patients treated with EBRT and a brachytherapy boost. Palladium-103 and iodine-125 provide similar bDFS, DMFS, and OS. .

Lipiodol as a Fiducial Marker for Image-Guided Radiation Therapy for Bladder Cancer

Purpose To evaluate Lipiodol as a liquid, radio-opaque fiducial marker for image-guided radiation therapy (IGRT) for bladder cancer.Materials and Methods Between 2011 and 2012, 5 clinical T2a-T3b N0 M0 stage II-III bladder cancer patients were treated with maximal transurethral resection of a bladder tumor (TURBT) and image-guided radiation therapy (IGRT) to 64.8 Gy in 36 fractions ± concurrent weekly cisplatin-based or gemcitabine chemotherapy. Ten to 15mL Lipiodol, using 0.5mL per injection, was injected into bladder submucosa circumferentially around the entire periphery of the tumor bed immediately following maximal TURBT. The authors looked at inter-observer variability regarding the size and location of the tumor bed (CTVboost) on computed tomography scans with versus without Lipiodol.Results Median follow-up was 18 months. Lipiodol was visible on every orthogonal two-dimensional kV portal image throughout the entire, 7-week course of IGRT. There was a trend towards improved inter-observer agreement on the CTVboost with Lipiodol (p = 0.06). In 2 of 5 patients, the tumor bed based upon Lipiodol extended outside a planning target volume that would have been treated with a radiation boost based upon a cystoscopy report and an enhanced computed tomography (CT) scan for staging. There was no toxicity attributable to Lipiodol.Conclusions Lipiodol constitutes a safe and effective fiducial marker that an urologist can use to demarcate a tumor bed immediately following maximal TURBT. Lipiodol decreases inter-observer variability in the definition of the extent and location of a tumor bed on a treatment planning CT scan for a radiation boost.

Algunas reflexiones sobre el aborto no punible / Some thoughts on non-punishable abortion

A fines de 2012 los protocolos de aborto no punible brotaron apoyados sobre el dictamen de la Corte al respecto. La situación en que se ponía al médico, la falta de diálogo y una serie de cuestionamientos morales expuestos por el Dr. Daniel O. Fernández en nota elevada a la Comisión Directiva del Distrito IV del Colegio de Médicos de la Provincia de Buenos Aires, generaron la editorial del número anterior. A continuación,reexamina el tema

ANP: Consulta de la Comisión de Bioética al asesor legal del distrito IV / NPA: Consultation of the Bioethics Commission to District IV Legal Counsel

La violación constituye un delito contra la integridad y la libertad sexual según la ley 25087/99)y aunque no medie fuerza, acción coercitiva o violencia de cualquier tipo contra la víctima, vulnera la autonomía del sujeto. Se considera que las acciones que contrarían la integridad sexual dependen de instancias privadas, conforme con el inciso 1º del artículo 72 del Código Penal, por lo cual sólo procede formar causa por acusación o denuncia del agraviado o de su tutor, guardador o representante legal si fuera incapaz. La Corte postuló que cualquier mujer que quedara embarazada en razón de una violación tiene derecho a solicitar la realización del aborto en los servicios del sistema de salud y así plantea las discusiones sobre el aborto no punible (ANP)

La patologización del deseo: apuntes críticos en torno a la coerción de la identidad y del placer / A patologização do desejo: anotações críticas sobre a coerção da identidade e do prazer / The pathologization of desire: critic notes regarding the coercion of identity and pleasure

El presente artículo busca determinar las principales propiedades teóricas y prácticas que se derivan del discurso patológico contemporáneo, asociado al dispositivo del "hacer psi", así como sus concomitantes consecuencias para la sociedad. En este sentido, se desarrolla una reflexión en torno a los ejes esenciales en los que se enmarca la sección de "Trastornos Sexuales" del Manual Diagnóstico y Estadístico de los Trastornos Mentales de la Asociación Americana de Psiquiatría (DSM-IV-TR), específicamente en lo que se refiere a la patologización de las identidades no heterosexuales en un término amplio y las llamadas parafilias. De este modo, el propósito del artículo consiste en llevar a cabo una discusión respecto al valor diagnóstico de las categorías nosológicas actuales sobre la sexualidad, procurando así desentrañar la lógica que les es inherente. Dicha lógica busca regular el deseo y estandarizar el placer, de forma algunas veces subrepticia, pero muy persistente.

The present article refers to the main theoretical and practical properties that are derived from the contemporaneous pathological discourse, regarding the "psy" apparatus, and their concomitant consequences for society. In these sense, a reflection is developed around the essential axes of the "Sexual Disorders" section from The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV-TR), concerning specifically the pathologization of the nonheterosexual identities in a wide term, and the so called paraphilias. Therefore, the purpose of this article is to discuss the value of the current nosological categories about sexuality. In order to do so, the main focus is to unravel their inherent logic that tries to regulate desire and standardize pleasure, in a hidden, but persistent manner.

O presente artigo procura determinar as principais propriedades teóricas e práticas derivadas do discurso patológico contemporâneo, associado ao dispositivo do "fazer psi", assim como suas concomitantes consequências para a sociedade. Neste sentido, se faz uma reflexão dos eixos essenciais que estruturam a seção de "transtornos sexuais" do Manual Diagnóstico e Estatístico dos Transtornos Mentais da Associação Americana de Psiquiatria (DSM-IV-TR), especificamente no que se refere à patologização das identidades não heterossexuais num termo amplo e as chamadas parafilias. Desta maneira, o propósito do presente artigo consiste em efetuar uma discussão a respeito do valor diagnóstico das categorias nosológicas atuais sobre a sexualidade, procurando assim desentranhar a lógica inerente a elas. Tal lógica busca regular o desejo e padronizar o prazer de forma às vezes sub-reptícia, mas muito persistente.

The effect of rearing temperature in larval development of pejerrey, Odontesthes bonariensis: morphological indicators of development

It is well known that in pejerrey water temperature not only affects growth rates but also directs the sexual differentiation process. This fact rise the question of how different the development of pejerrey larvae of the same age is when reared at different temperatures. A description of developmental stages for the embryonic and larval periods of the pejerrey, Odontesthes bonariensis, and the influence of rearing temperature on larval development are presented. Then, larval development was studied at three rearing temperatures, and changes in general morphology, fin morphology, and caudal fin structure have been taken into consideration within the thermal range involved in the temperature sex determination of this species. Fin fold reabsorption, caudal fin formation, and body shape were selected to follow the events leading to the acquisition of the juvenile morphology. The juvenile phenotype was defined when the fin fold was reabsorpted and the caudal fin acquired its definitive homocercal structure. The moment at which the juvenile phenotype was achieved, was evaluated in relation to larval age, size and, shape. The size resulted as the best indicator of development in pejerrey.

A temperatura da água não afeta apenas as taxas de crescimento no peixe-rei, mas também direciona o processo de diferenciação sexual. Este fato levanta o questionamento de quão diferente é o desenvolvimento de larvas do peixe-rei da mesma idade quando criadas em temperaturas diferentes. Este trabalho teve como objetivo apresentar uma descrição do de desenvolvimento de embriões e larvas do peixe-rei, Odontesthes bonariensis, e a influência da temperatura de criação no desenvolvimento das larvas. Neste trabalho, o desenvolvimento das larvas foi estudado em três temperaturas diferentes de cultivo. Foram consideradas as alterações ocorridas na morfologia geral, assim como na morfologia e na estrutura da nadadeira caudal dentro da variação termal da temperatura de determinação sexual desta espécie. A taxa de reabsorção da membrana embrionária, a formação da cauda e o formato do corpo foram selecionados para acompanhar os eventos que levam à aquisição da morfologia juvenil. O fenótipo juvenil foi definido quando a nadadeira caudal foi reabsorvida e a cauda adquiriu a estrutura homocerca. O momento no qual o fenótipo juvenil foi atingido, foi avaliado quanto à idade, tamanho e formato da larva, sendo que o tamanho resultou no melhor indicador do desenvolvimento do peixe-rei.