ABSTRACT
Primary anorectal melanoma is a rare malignant melanocytic neoplasm; its principal manifestation is rectal bleeding. It has an ominous prognosis with a five-year survival rate of 10%. The case of a 56-year-old woman with rectal bleeding and the sensation of a rectal mass is presented. A polypoid lesion, resected transanally, was documented in the distal rectum during the colonoscopy. The histological study confirmed a primary anorectal melanoma.
El melanoma anorrectal primario es una neoplasia melanocítica maligna poco frecuente, su principal manifestación es el sangrado rectal. Tiene un pronóstico ominoso con una tasa de sobrevida del 10% a 5 años. Se presenta el caso de una mujer de 56 años con rectorragia y sensación de masa rectal. Durante la colonoscopia se documentó una lesión polipoide en el recto distal, que se resecó por vía transanal. El estudio histológico confirmó la presencia de un melanoma anorrectal primario.
ABSTRACT
Traditionally, the initiation of enteral nutrition after a percutaneous endoscopic gastrostomy (PEG) is performed between 12 and 24 hours. Different research suggests that early initiation might be a safe option. Our aim was to determine whether starting enteral nutrition 4 hours after performing PEG is a safe practice in terms of risk of intolerance, complications, or death, compared to starting it at 12 hours. We carried out a prospective, randomized, multicenter study in third and fourth level institutions in Bogotá and Cundinamarca, between June 2020 and May 2022, 117 patients were included who were randomized into 2 groups, group A with early nutrition initiation (4 hours), and standard group B (12 hours). The most frequent mechanism of dysphagia was cerebrovascular disease (43%), followed by complications of COVID19 infection (26%). There were no statistically significant differences between the groups evaluated regarding the percentage of intolerance to nutrition, RR = 0.93 (CI 0.30-2.90), there were also no differences in terms of postoperative complications, (RR) = 0.34 (CI 0.09-1.16), and no differences were found in mortality between the evaluated groups, (RR) = 1.12 (CI 0.59-2.15). In conclusion, early initiation of nutrition through the gastrostomy, 4 hours after performing the PEG, is a safe behavior that is not related to greater intolerance to nutrition, complications, or death, compared to later initiation.
Subject(s)
Enteral Nutrition , Gastrostomy , Humans , Gastrostomy/adverse effects , Prospective Studies , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Time FactorsABSTRACT
Tradicionalmente, el inicio de nutrición enteral, luego de una gastrostomía endoscópica percutánea (GEP) se realiza entre 12 a 24 horas. Diferentes investigaciones sugieren que iniciarla más temprano podría ser una opción segura. El objetivo es determinar si el inicio de nutrición enteral a las 4 horas después de realizar GEP es una conducta segura en cuanto al riesgo de intolerancia, complicaciones o muerte, comparado con iniciarla a las 12 horas. Realizamos un estudio prospectivo, aleatorizado, multicéntrico en instituciones de tercer y cuarto nivel de Bogotá y Cundinamarca, entre junio de 2020 y mayo de 2022, se incluyeron 117 pacientes que fueron aleatorizados en 2 grupos, el grupo A de inicio temprano de nutrición (4 horas), y el grupo B de inicio estándar (12 horas). El mecanismo más frecuente de disfagia fue la enfermedad cerebrovascular (43%), seguido por complicaciones de infección por COVID-19 (26%). No hubo diferencias estadísticamente significativas entre los grupos evaluados respecto al porcentaje de intolerancia a la nutrición, RR = 0,93 (IC 0,30-2,90), tampoco hubo diferencias en términos de complicaciones posoperatorias, (RR) = 0,34 (IC 0,09-1,16), y no se encontraron diferencias en la mortalidad entre los grupos evaluados, (RR) = 1,12 (IC 0,59 - 2,15). En conclusión, el inicio de nutrición a través de la gastrostomía de forma temprana, 4 horas después de la realización de la GEP es una conducta segura que no se relaciona con una mayor intolerancia a la nutrición, complicaciones o muerte, en comparación con un inicio más tardío.
Traditionally, the initiation of enteral nutrition after a percutaneous endoscopic gastrostomy (PEG) is performed between 12 and 24 hours. Different research suggests that early initiation might be a safe option. Our aim was to determine whether starting enteral nutrition 4 hours after performing PEG is a safe practice in terms of risk of intolerance, complications, or death, compared to starting it at 12 hours. We carried out a prospective, randomized, multicenter study in third and fourth level institutions in Bogotá and Cundinamarca, between June 2020 and May 2022, 117 patients were included who were randomized into 2 groups, group A with early nutrition initiation (4 hours), and standard group B (12 hours). The most frequent mechanism of dysphagia was cerebrovascular disease (43%), followed by complications of COVID19 infection (26%). There were no statistically significant differences between the groups evaluated regarding the percentage of intolerance to nutrition, RR = 0.93 (CI 0.30-2.90), there were also no differences in terms of postoperative complications, (RR) = 0.34 (CI 0.09-1.16), and no differences were found in mortality between the evaluated groups, (RR) = 1.12 (CI 0.59-2.15). In conclusion, early initiation of nutrition through the gastrostomy, 4 hours after performing the PEG, is a safe behavior that is not related to greater intolerance to nutrition, complications, or death, compared to later initiation.
ABSTRACT
Abstract Streptococcus constellatus is a member of the group now called Streptococcus anginosus. This microorganism is part of the normal oropharyngeal, gastrointestinal and genitourinary microbiota. However, it may cause serious infections such as pharyngitis, bacteremia and invasive pyogenic infections in immunocompromised patients. We report the first case in Colombia of an adult male with no relevant medical history and with an unusual presentation of infection by S. constellatus and whose laboratory results showed an important systemic inflammatory response and radiographic evidence of abdominal involvement with poor response to medical and surgical management. Since there are few reports in international medical journals about intra-abdominal infection by S. constellatus and taking into consideration the need of a multidisciplinary intervention, this report may be of interest for both clinical and surgical practitioners.
Resumen Streptococcus constellatus es un miembro del grupo ahora llamado Streptococcus anginosus. Este microorganismo es parte de la microbiota orofaríngea, gastrointestinal y genitourinaria normal. Sin embargo, puede causar infecciones graves como faringitis, bacteriemia e infecciones piógenas invasivas en pacientes inmunocomprometidos. Presentamos el primer caso en Colombia de un hombre adulto sin antecedentes médicos relevantes y con una presentación inusual de infección por S. constellatus, dada por una gran respuesta inflamatoria sistémica y evidencia radiográfica de afectación abdominal con mala respuesta al tratamiento médico y quirúrgico. Dado que hay pocos informes en revistas médicas internacionales sobre la infección intraabdominal por S. constellatus y teniendo en cuenta la necesidad de intervenciones multidisciplinarias, este reporte puede ser de interés tanto para los médicos clínicos como para los quirúrgicos.
Subject(s)
Humans , Female , Middle Aged , Streptococcus anginosus , Streptococcus constellatus , Intraabdominal Infections , Shock, Septic , Gram-Positive Bacterial Infections , Abdominal Abscess , InfectionsABSTRACT
SUMMARY OBJECTIVE: To determine the prescription pattern of riluzol and the variables associated to its use in a population of patients with motor neuron disease affiliated to the Colombian General Social Security Health System (SGSSS) in 2017. METHOD: Descriptive cross-sectional study. Through a systemized data base of approximately 3,5 million members to the Colombian SGSSS; patients who had been given riluzol uninterruptedly between April 1 and June 30 of 2017, were selected. Sociodemographic, pharmacological variables and comorbidities were analyzed. Defined daily dose (DDD) was estimated for 1.000 inhabitants/day and its costs. RESULTS: There were found 81 patients with motor neuron disease receiving riluzol, with an average age of 60,8+12,6 years. 48.1% were male. The prevalence of motor neuron disease was 29/100.000 individuals. Patients received riluzol in 50 mg tablets and the doses was estimated in 0,016 DDD for 1.000 inhabitants/day 63% were receiving medicines that reflect comorbidity or could interact with riluzol. The total cost of riluzol dispensed in 2017 was USD 85.348 and per prescribed daily dose on average was USD 2,3. CONCLUSIONS: The use of riluzol in patients with motor neuron disease in Colombia was carried by the recommended doses by the WHO and with a direct cost lower than reported in other countries. Studies are recommended in order to determine the effectiveness of riluzol in real-life conditions.
RESUMEN OBJETIVOS: Determinar el patrón de prescripción de riluzol y las variables asociadas a su utilización en una población de pacientes con enfermedad de neurona motora afiliados al Sistema General de Seguridad Social en Salud de Colombia (SGSSS) en 2017. METODOLOGÍA: Estudio descriptivo de corte transversal. Mediante una base de datos sistematizada de aproximadamente 3,5 millones de afiliados al SGSSS de Colombia; se seleccionaron pacientes a quienes se les haya dispensado riluzol de manera ininterrumpida entre 1 abril y 30 junio de 2017. Se analizaron variables socio-demográficas, farmacológicas y las comorbilidades. Se estimaron la dosis diaria definida (DDD) por 1.000 habitantes/día y los costos. RESULTADOS: Se encontraron 81 pacientes con enfermedad de neurona motora recibiendo riluzol, con edad promedio de 60,8+12,6 años. El 48,1% eran hombres. La prevalencia de enfermedad de neurona motora fue 2,29/100.000 personas. Los pacientes recibieron riluzol en tabletas de 50 mg y se estimó la dosis en 0,016 DDD por 1.000 habitantes/día. El 63% recibían medicamentos que reflejan comorbilidad o pudieran tener interacción con riluzol. El costo total del riluzol dispensado en 2017 fue USD 85.348 y por dosis diaria prescrita en promedio fue USD 2,3. CONCLUSIONES: El uso de riluzol en pacientes con enfermedad de neurona motora en Colombia se realizó a las dosis recomendadas por la OMS y con un costo directo menor al reportado en otros países. Se recomienda realizar estudios que permitan determinar la efectividad del riluzol en condiciones de la vida real.
Subject(s)
Transit-Oriented DevelopmentABSTRACT
BACKGROUND: Giardiasis is one of the most common intestinal infections in the world. There have been no national studies on the morbidity of giardiasis in Colombia. In this study, incidence rates of giardiasis were estimated for the years 2009-2013. METHODS: An observational, retrospective study of the giardiasis incidence in Colombia, 2009-2013, was performed using data extracted from the personal health records system (Registro Individual de Prestación de Servicios, RIPS). Official population estimates from the National Department of Statistics (DANE) were used for the estimation of crude and adjusted incidence rates (cases/100 000 population). RESULTS: During the period studied, 15 851 cases were reported (median 3233/year; 5-year cumulated crude national rate of 33.97 cases/100 000 population). Of these, 50.3% were female; 58.4% were <10 years old and 14.8% were 10-19 years old. By region, 17.7% were from Bogotá (10.07 cases/100 000 population, 2009), 10.9% from Antioquia (9.42, 2009), 8.6% from Atlántico (15.67, 2009), and 6.5% from Risaralda (33.38, 2009). Cases were reported in all departments (even insular areas). CONCLUSIONS: As giardiasis is neglected in many countries, surveillance is not regularly undertaken. Despite its limitations, this study is the first attempt to provide estimates of national giardiasis incidence with consistent findings regarding affected age groups and geographical distribution.
Subject(s)
Giardiasis/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Colombia/epidemiology , Female , Humans , Incidence , Infant , Male , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
Se conoce como Hashitoxicosis a la Tiroiditis de Hashimoto que coexiste conepisodios de hipertiroidismo; se debe a la liberación excesiva de hormonatiroidea en un paciente con diagnóstico previo de enfermedad de Hashimoto.Puede ser más común de lo que se pensaba, debido al aparente aumento depacientes con Tiroiditis de Hashimoto y/o avances en su diagnóstico.Se presenta el caso de un paciente femenino de 12 años de edad, que porhallazgos clínicos se le diagnostica un hipertiroidismo por enfermedad deGraves Basedow. Sin embargo, los estudios iniciales y la evolución posterior de la paciente, orientan el diagnóstico hacia una etiología diferente...
Subject(s)
Humans , Hyperthyroidism , Congenital HypothyroidismABSTRACT
BACKGROUND: Despite efforts in prevention and control of dengue, it is still a public health problem in the region. There are estimations of 13 million people affected in the Americas, therefore, it is of outmost importance to research it. An assessment on the Latin- American contributions on dengue was done. METHODS: Bibliometric study at SCI (1980- 2013), MEDLINE/GOPUBMED (1802-2013), Scopus (1959-2013), SCIELO (2004-2013), LILACS (1980- 2013). Different study types, characterized by years, city/country of origin, journals and more productive authors, by country, cites and H index have been conducted. RESULTS: At SCI, 2598 articles were retrieved (21% of the total). Brazil was found to be the highest contributor (31.2%), then Puerto Rico (12.9%) and Mexico (10.7%). At Scopus, there are 2646 articles (16.7% of the total), 31.2% Brazil, 11.1% Mexico, 9.3% Cuba; the region received 41881 citations, 25.4% from Brazil (H index=45), 14.4% Cuba (H index=35) and 12.88% Puerto Rico (H index=38); 9.1% in Brazil were from Fundação Oswaldo Cruz; 1.6% of Mexico corresponded to Instituto Nacional de Salud Publica, 4.9% of Cuba are from Instituto de Medicina Tropical Pedro Kouri. At Medline, there are 2799 records (33.9% from Brazil). At SciELO there are 825 records (46.6% Brazil). At LILACS, there are 1178 records (46.8% Brazil). CONCLUSIONS: Brazil is the best producer in the region. In Puerto Rico and Brazil, there observed the epidemiologic burden of the disease. Scientific production in bibliographical data bases, particularly regional, is low, as compared to the high impact of the disease of in urban zones of the region.
Subject(s)
Biomedical Research/statistics & numerical data , Dengue Virus , Dengue , Infectious Disease Medicine/statistics & numerical data , Neglected Diseases , Antiviral Agents/therapeutic use , Bibliometrics , Dengue/diagnosis , Dengue/drug therapy , Dengue/epidemiology , Dengue/prevention & control , Dengue/virology , Dengue Virus/drug effects , Dengue Virus/pathogenicity , Humans , Latin America/epidemiology , Neglected Diseases/diagnosis , Neglected Diseases/drug therapy , Neglected Diseases/epidemiology , Neglected Diseases/prevention & control , Neglected Diseases/virology , Prognosis , PubMedABSTRACT
Chagas disease, considered a parasitic neglected disease, is endemic in Latin America. Although, its mortality rate has decreased over time, it still represents a public health problem in the region. A bibliometric evaluation of the Latin American contributions on this disease was done. This study used SCI (1980-2013), MEDLINE/GOPUBMED (1802-2013), Scopus (1959-2013), SCIELO (2004-2013), and LILACS (1980-2013). Different study types have been characterized by years, origin city/country, journals and most productive authors, by country, cites and H-index. 2988 articles were retrieved from SCI (30.85% of total). Brazil was found to be the highest producer (31.22%), followed by Argentina (18.14%) and México (9.57%); the region received 47241 citations, 28.60% for Brazil (H-index=52), 18.26% of Argentina (Hindex= 43), 11.40% Bolivia (H-index=37). 4484 were retrieved from Scopus (30.20% of the total), 38.58% of which were from Brazil, 12.40% from Argentina and 8.90% from Mexico. From Medline, 6647 records were retrieved (45.58% Brazil). From SciELO, 917 articles (47.66% Brazil). From LILACS, 2165 articles (60.05% Brazil). Brazil has the highest output in the region. Despite advances in controlling Chagas disease, scientific production is low, particularly for regional bibliographic databases, which calls for more research on this disease.
Subject(s)
Biomedical Research/statistics & numerical data , Chagas Disease , Infectious Disease Medicine/statistics & numerical data , Neglected Diseases , Trypanosoma cruzi , Bibliometrics , Caribbean Region/epidemiology , Chagas Disease/diagnosis , Chagas Disease/drug therapy , Chagas Disease/epidemiology , Chagas Disease/parasitology , Chagas Disease/prevention & control , Humans , Latin America/epidemiology , Neglected Diseases/diagnosis , Neglected Diseases/drug therapy , Neglected Diseases/epidemiology , Neglected Diseases/parasitology , Neglected Diseases/prevention & control , Prognosis , PubMed , Time Factors , Trypanocidal Agents/therapeutic use , Trypanosoma cruzi/drug effects , Trypanosoma cruzi/pathogenicityABSTRACT
Introducción: el diagnóstico y tratamiento del cáncer de mama son acontecimientos estresantes que producen en las pacientes dificultades psicopatológicas y un detrimento de su calidad de vida. Métodos: se realizó un estudio cuantitativo descriptivo transversal en 58 mujeres entre 35 y 65 años, diagnosticadas con cáncer de mama que recibían tratamiento enOncólogos del Occidente S.A., Pereira. Se aplicó una encuesta que evaluó: saludfísica, psicológica, relaciones sociales y vida sexual. Se realizaron distribucionesde frecuencias y análisis univariados y bivariados para las variables demográficas, y prueba de hipótesis para el puntaje global del test. El cuestionario fue validado a través de una prueba piloto y un análisis de confiabilidad interna, cuando se incluía y excluía la pregunta de actividad sexual en las respuestas (Alfa deChrombach=0.703 y 0.77 respectivamente). Resultados: la mayoría de las mujeres reportaban una calidad de vida buena (T= 24.9 y significancia estadística <0.0001). Los puntajes variaron según la actividad sexual. El 20,06% de las mujeres sexualmente activas tenían una calidadde vida muy buena, 52,9% buena y 23,5% regular; mientras que en la población sexualmente inactiva se evidenció que el 29,2% es muy buena, en el 54,2% es buena y en el 12,5% es regular. El mayor deterioro fue en la actividad física máxima, donde el 41.4% respondió: actividad ligera.Conclusión: más de la mitad de las pacientes en tratamiento para cáncer de seno sexualmente activas e inactivas de la institución Oncólogos de Occidente S.A, tienen una calidad de vida en el rango Buena.
Introduction: breast cancer diagnosis and treatment are stressing occurrences that generate psychopathological difficulties in patients and a detriment in their quality of life.Methods: a cross-sectional study was performed in 58 women ages 35 to 65 who were diagnosed with breast cancer. The women received treatment at "Oncologos de Occidente S.A" in Pereira. The information was gathered using a survey that asked about: physical and psychological health, social relations and sexual behavior. Data was tabulated using "Microsoft Excel 2007" and analyzed with "SPSS version 17.0." Frequency distributions, univariate and bivariate analysis for demographic variables were performed; hypothesis testing was done over the mean score obtained in the tests. The questionnaire was validated through a pilot test and the analysis of its internal reliability when including or not the question about sexual activity (Chrombach's alpha= 0.703 and 0.77 respectively).Results: most of the women reported their quality of life as "good" (T = 24.9 and statistical significance <0.0001). Scores varied depending on the sexual behavior, 20.06 % of sexually active women revealed a "very good" life's quality, 52.9 % reported as "good" and 23.5 % as "regular" whereas the sexually inactive women population statistical analysis revealed life's quality as "very good" for a 29.2 %, "good" for the 54.2 % and "regular" for a 12.5 %. The most deteriorated aspect was "physical activity" reported in a 41.4% as "light activity".Conclusion: quality of life for active and inactive sexual life patients of the institution "Oncologos de Occidente S.A" was reported as "good".
Introdução: o diagnóstico e tratamento do câncer de mama são acontecimentos estressantes que produzem dificuldades psicopatológicas nos pacientes e um detrimento em sua qualidade de vida.Métodos: realizou-se um estudo comparativo descritivo transversal em 58 mulheres entre 35 e 65 anos, diagnosticadas com câncer de mama, que recebiam tratamento em "Oncólogos do Ocidente S.A., Pereira". Aplicou-se uma pesquisa que avaliou saúde física, psicológica, relações sociais e vida sexual. Foram realizadas distribuições de frequências e nálises univariadas e bivariadas para as variáveis demográficas, e prova de hipótese para a pontuação global do teste. O questionário foi avaliado através de uma prova piloto e uma análise de confiabilidade interna, quando se incluía e excluía a pergunta de atividade sexual nas respostas (Alfa de Chrombach=0.703 e 0.77 respectivamente).Resultados: a maioria das mulheres reportavam uma qualidade de vida "boa" (T=24.9 e significancia estatística <0.0001). As pontuações variaram segundo a atividade sexual. Os 20.06% das mulheres sexualmente ativas tinham uma qualidade de vida muito boa; 52.9% boa e 23.5% regular. Já na população sexualmente inativa, evidenciou-se que 29,2% é muito boa, para 54,2% é boa e para 12,5%, é regular. A maior deterioração foi na atividade física máxima, onde 41,4% respondeu: atividade ligeira.Conclusão: mais da metade das pacientesem tratamento para câncer de seio sexualmente ativas e inativas da instituição Oncólogos de Ocidente S.A., tem uma qualidade de vida na categoria "Boa".