Adherence to Treatment Guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aimed to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS: Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart failure (HF) medication prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS: Out of 2,528 patients in the registry, 1,384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION: Prescription rates and target dose achievement are suboptimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.

Low-cost transcriptional diagnostic to accurately categorize lymphomas in low- and middle-income countries.

Inadequate diagnostics compromise cancer care across lower- and middle-income countries (LMICs). We hypothesized that an inexpensive gene expression assay using paraffin-embedded biopsy specimens from LMICs could distinguish lymphoma subtypes without pathologist input. We reviewed all biopsy specimens obtained at the Instituto de Cancerología y Hospital Dr. Bernardo Del Valle in Guatemala City between 2006 and 2018 for suspicion of lymphoma. Diagnoses were established based on the World Health Organization classification and then binned into 9 categories: nonmalignant, aggressive B-cell, diffuse large B-cell, follicular, Hodgkin, mantle cell, marginal zone, natural killer/T-cell, or mature T-cell lymphoma. We established a chemical ligation probe-based assay (CLPA) that quantifies expression of 37 genes by capillary electrophoresis with reagent/consumable cost of approximately $10/sample. To assign bins based on gene expression, 13 models were evaluated as candidate base learners, and class probabilities from each model were then used as predictors in an extreme gradient boosting super learner. Cases with call probabilities < 60% were classified as indeterminate. Four (2%) of 194 biopsy specimens in storage <3 years experienced assay failure. Diagnostic samples were divided into 70% (n = 397) training and 30% (n = 163) validation cohorts. Overall accuracy for the validation cohort was 86% (95% confidence interval [CI]: 80%-91%). After excluding 28 (17%) indeterminate calls, accuracy increased to 94% (95% CI: 89%-97%). Concordance was 97% for a set of high-probability calls (n = 37) assayed by CLPA in both the United States and Guatemala. Accuracy for a cohort of relapsed/refractory biopsy specimens (n = 39) was 79% and 88%, respectively, after excluding indeterminate cases. Machine-learning analysis of gene expression accurately classifies paraffin-embedded lymphoma biopsy specimens and could transform diagnosis in LMICs.

Identificación del Virus Epstein-Barr por Hibridación in situ en pacientes con Cáncer Gástrico que asisten al Instituto de Cancerología (Incan) de Guatemala / Identification of Epstein-Barr Virus by in situ Hybridization in Gastric Cancer patients attending the Cancer Institute (Incan) Guatemala

El Virus Epstein Barr (EBV) está relacionado como agente oncogénico en el desarrollo del cáncer gástrico, atribuyéndosele el 10 % de los casos de esta neoplasia a nivel mundial. No existen estudios previos que identifiquen la presencia EBV en los pacientes con cáncer gástrico en Guatemala, por lo que en este estudio se evaluó por hibridación in situ la presencia del micro ARN EBER (Epstein Barr ­encoded RNAs) de EBV en 71 pacientes con cáncer gástrico que asistieron al Instituto de Cancerología (Incan). Se determinó una prevalencia de 21.1 % (IC 95 % [10.9, 31.3] ) (15 pacientes), mayor que la reportada en otros estudios latinoamericanos. Se determinó asociación significativa entre la expresión del EBER del EBV, y el género masculino OR = 4.9 (IC 95 % [1.4, 17.5]) p < .05. Los factores asociados fueron, el padecer diarrea OR 5.7 IC 95 % [1.5, 12.6] p = .008, y la detección del anticuerpos de Helicobacter pylori séricos, OR 7.2 (IC 95 % [1.1, 18.9]) p = .03. Aun cuando la mayoría de los pacientes que expresan el EBER de EBV desarrollaron cáncer gástrico del tipo difuso 66.67 % no existe asociación significativa p = 0.13 OR = 2.5 (IC 95 % [1.1, 8.2]).

The Epstein Barr Virus (EBV) is related, as an oncogenic agent, in the development of gastric cancer, accounting for 10 % of the cases of this neoplasm worldwide. There are no previous studies that identify the presence of EBV in patients with gastric cancer in Guatemala, so in this study the presence of the EBER micro EBV of EBV was evaluated by in situ hybridization in 71 patients with gastric cancer who attended the Cancer Institute (Incan). A prevalence of 21.1% (95 % CI [10.9, 31.3]) was determined (15 patients), higher than that reported in other Latin American studies. A significant association was found between the EBER expression of EBV, and the male gender OR = 4.9 (95 % CI [1.4, 17.5]) p < .05. The associated factors were diarrhea OR 5.7 95 % (CI [1.5, 12.6]) p = .008, and detection of Helicobacter pylori serum antibodies, OR 7.2 95 % CI [1.1, 18.9] p = .03. Although the majority of patients expressing EBV EBER developed gastric cancer of the diffuse type 66.67% there is no significant association p = 0.13, OR = 2.5 (95 % CI [1.1, 8.2]).

Measurement of pollution levels of organochlorine and organophosphorus pesticides in water, soil, sediment, and shrimp to identify possible impacts on shrimp production at Jiquilisco Bay.

This study aims to identify levels of several organochlorine and organophosphorus compounds in shrimp-raising areas of coastal El Salvador, to assess potential impacts on shrimp growth and survival that hamper the sustainability of aquaculture in the region. The paper reports the current levels of γ-HCH, 4,4'-DDT, 4,4'-DDE, 4,4'-DDD, endrin, dieldrin, heptachlor, parathion, methyl parathion, and etoprophos in soils (depth 20 cm), sediments (depth 5 cm), shrimp (Penaeus sp.), and water of three rearing ponds and also in the sediment (depth 5 cm) and water surrounding those ponds in Jiquilisco Bay. Sampling was carried out during the dry (January-March) and rainy (June-August) seasons of 2008. The presence of pesticides in the samples of water, shrimp, and sediment at shrimp ponds was not detected in either season; however, in soil samples (depth 20 cm) taken from these ponds, heptachlor, endrin, dieldrin, 4,4'-DDD, and 4,4'-DDT were identified at concentrations below the method limit of quantification (LOQ), and 4,4'-DDE was found in a concentration falling in the range from 3.85 to 19.61 ng/g. In samples of water taken at the bay water intakes to the rearing ponds, we observed dieldrin concentrations in the range between 0.085 ng/mL and 0.182 ng/mL during the dry season. In the samples of sediments taken in the surrounding areas of shrimp ponds, we found-for both seasons-that in 60 % of the samples, 4,4'-DDE was present in concentrations ranging from 3.75 ng/g to 30.97 ng/g. Additionally, in the rainy season, we observed heptachlor in sediment at concentrations below the method quantification limit. It was concluded that organochlorine compounds from pesticides are still present in Jiquilisco Bay, trapped in deep sediment, even though they have been banned since the 1980s. These were not detected in shrimp tissue, surface water, and shallow sediment in rearing ponds, and hence, we do not believe their presence has any major impact on shrimp production in sampled areas.

Evaluacion de la calidad sanitaria y detección de Salmonella spp., en cremas de leche no pasteurizadas expendidas en el eje costero Carabobo-Falcón Venezuela 2003 / Evaluation of the sanitary quality and detection of Salmonella spp., in sold unpasteurized milk creams in Carabobo-Falcon coast Venezuela 2003

Se evaluó la Calidad Sanitaria y presencia de Salmonella spp. en cremas de leche no pasteurizadas expendidas en el eje costero Carabobo-Falcón, según Metodología por la APHA. Se obtuvo 93,7 por ciento de las muestras con contajes de Bacterias Aerobias Mesófilas no aceptables de acuerdo a la normativa Venezolana (COVENIN 3046 - 93), según este indicador sólo 6,7 por ciento de las muestras estuvo dentro de los límites microbiológicos. De las cremas analizados 93,3 por ciento presentó carga de mohos fuera del rango de aceptación y según contaje de levaduras 96,7 por ciento son rechazables. Se recomiendan posteriores estudios con una muestra mayor sin embargo, las muestras de crema de leche analizadas, pueden considerarse de pobre calidad sanitaria y por ende susceptibles de sufrir alteraciones y causar enfermedades, sugiriendo posibles fallas en las condiciones sanitarias de producción

Tolerancia al nimesulide en pacientes con reacción medicamentosa a analgésicos y antiinflamatorios / Tolerance of the nimesulide in patients with analgesic reaction

El propósito del presente trabajo es plantear el uso del Nimesulide como medicamento alternativo, para los pacientes con reacciones adversas a analgésicos antiinflamatorios. Se estudiaron 46 pacientes 23 del sexo femenino y 23 del masculino en ambos grupos existían antecedentes de haber presentado síntomas de anafilaxia, urticaria, o angioedema posterior a la administración de aspirina, analgésicos y otros antiinflamatorios. A todos los pacientes se les provocó prueba de provocación con Nimesulide en tres días. El 86,96 por ciento 40 pacientes aportaron buena tolerancia al Nimesulide y 6 pacientes 13,6 por ciento presentaron síntomas de intolerancia, prurito y urticaria que cedieron a la administración de antihistamínicos. En el presente trabajo se describe una forma de estudio para descartar hipersensibilidad cruzada a esta droga, la cual resulta sencilla, libre de riesgo a reacciones alérgicas severas, además de ser útil para descartar hipersensibilidad al Nimesulide. En pacientes con reacciones adversas a la aspirina ha sido utilizado el acetaminofen y el dextropropoxifeno encontrándose reacciones cruzadas en el caso del acetaminofen se presentó en 13 de nuestros pacientes 28,26 por ciento, el dextropropoxifeno tiene el inconveniente de que se necesita récipe especial para su compra y la presentación oral no existe a disposición en el mercado nacional, es por ello que nos motivamos a buscar otras formas de tratamiento con otros medicamentos, en este caso el Nimesulide que tiene un mecanismo de acción diferente al de la aspirina fue bien tolerado por nuestros pacientes y se pudo administrar sin riesgo

Principales repercusiones socio-economicas y psicologicas en pacientes que presentaron cancer y que fueron internados en los servicios de clínica y cirugía del hospital Eugenio Espejo, en el período comprendido de febrero 20 a marzo 20 de 1986. Quito / Main repercussions partner-economicas and psicologicas in patients who presented/displayed to cancer and who were committed in the services of clinic and surgery of the hospital Eugene Mirror, in the period included/understood of February 20 to March

Cualquier médico o enfermera en el ejercicio de su profesión está familiarizado con mil preguntas, súplicas y anhelos con que acusan los pacientes o sus familiares y han vivido situaciones como las siguientes como: unas veces, llega el paciente al área hospitalaria a quejando dolor en está o aquella parte del cuerpo, manifiesta sus sospechas acerca del posible origen de su malestar y espera absolutamente concencido, que será tarea elemental para el Médico y la Enfermera el suprimir inmediatamente su sufrimiento: esto en el mejor de los casos, puesto que según el estudio que hemos realizado en su mayoría los pacientes afectados por el Cáncer ingresan en una etapa avanzada (III Grado), en cuyo caso el tratamieno de elección el Paleativo. El objetivo primordial de este trabajo es poder acercarnos a la comprensión de los problemas por los que atravieza la familia y en especial el paciente afectado por el cáncer: cuyos problemas se traducen en: Psicológicos, Socio-económicos y su deterioro físico. Es así como se inicia una larga carrera contra el tiempo para tratar de vencer los diferentes tratamientos mediante esquemas hace que el paciente y su familia se sumerga en el campo de la desesperación por tratar de obtener el dinero viendose obligados a vencer sus propiedades y bienes materiales, todos estos sacrificios banos puesto que al final del camino está la muerte...