[Prevalence of myasthenia gravis in Colombia]. / Prevalencia de la miastenia grave en Colombia.

TITLE: Prevalencia de la miastenia grave en Colombia.

Prevalence of systemic lupus erythematosus in Colombia: data from the national health registry 2012-2016.

INTRODUCTION: Registries are essential to keep track of systemic lupus erythematosus (SLE) epidemiology and to provide better care to patients. The Colombian Ministry of Health has adopted a registry (SISPRO) to gather comprehensive information coming from the Colombian health system, which provides close to universal coverage (around 95%). The information collected from SISPRO is available for scientific analysis. OBJECTIVES: We used data collected by SISPRO to estimate prevalence and specific characteristics of patients with SLE registered from January 2012 to December 2016. METHODS: This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to SLE, based on SISPRO data. Criteria for diagnosis are not explicitly addressed in each individual case. RESULTS: National records report 41,804 patients with a diagnosis of SLE for an estimated prevalence of 91.9/100,000 subjects (based on a total population of 47,663,162), being more frequent in women (89% cases). When adjusted, female and male prevalences were 204.3 and 20.2 per 100,000 (ratio 10.1) with a 7.9:1 female:male ratio, and were highest in the 45-49-year age group. CONCLUSIONS: This is the first study that describes demographic characteristics of SLE in Colombia, with useful information for decision makers. It also suggests a similar prevalence to other countries.

International experiences in multicriteria decision analysis (MCDA) for evaluating orphan drugs: a scoping review.

Introduction: Orphan diseases are low-prevalence conditions with chronically debilitating or life-threatening consequences. Their treatments are generally called orphan drugs (OD). Health-technology assessment processes have traditionally considered cost-effectiveness analysis (CEA), when making reimbursement and pricing decisions for health-care plans. Valuing OD with standard CEA raises important issues due to uncertain evidence, inability to meet cost-effectiveness thresholds for reimbursement and high budget impact, among others. Multi-criteria decision analysis (MCDA) allows to overcome these issues and improve the technical and ethical quality of decisions regarding prioritization, coverage, and reimbursement of OD. Areas covered: A scoping review was conducted in order to characterize MCDA frameworks for assessing OD and implementation experiences. We reviewed electronic databases (Medline, Embase, Cochrane Library, EBSCO, CINAHL, EconLit, Web of Science, LILACS, Google Scholar) key journals (Orphanet Journal of Rare Diseases and Value in Health) and organization repositories. Expert opinion: The theoretical framework for MCDA considers areas related to characteristics of orphan diseases and their technologies' clinical and economic impact. Participation processes are critical in incorporating societal values in weighting different dimensions and constructing decision rules. Local implementation pilots considering different stakeholders are necessary in order to pinpoint specific barriers and opportunities.

Risk factors associated with drug use before imprisonment in Peru.

OBJECTIVE: To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. MATERIALS AND METHODS: A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. RESULTS: Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). CONCLUSIONS: In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime.

Factores de riesgo asociados al consumo de drogas antes del ingreso a las penitenciarías del Perú / Risk factors associated with drug use before imprisonment in Peru

Objetivo: Determinar la prevalencia del consumo de drogas previo al ingreso penitenciario e identificar los factores de riesgo sociodemográficos y familiares asociados, según el sexo, en penitenciarías del Perú. Materiales y métodos: Se realizó un análisis secundario de los datos del Primer Censo Nacional Penitenciario 2016, que empleó un cuestionario de 173 preguntas que fue aplicado a toda la población carcelaria del Perú. Se describieron los tipos de drogas consumidas antes del ingreso según las características de la población penitenciaria, y se utilizaron modelos lineales generalizados para calcular razones de prevalencia con intervalos de confianza al 95% para identificar los posibles factores asociados al consumo de drogas. Resultados: De 76.180 presidiarios, 71.184 (93,4%) respondieron la encuesta (hombres 67.071; 94,2%). La prevalencia global de consumo de drogas previo a la reclusión fue del 24,4% (25,3% en hombres y 9,1% en mujeres), mayor en el grupo de 18 a 29 años (36,3% en hombres y 14,9% en mujeres). Las drogas de mayor consumo fueron la marihuana (58,2%), la pasta básica/cocaína o crack (40,3%), y los inhalantes (1%). Los factores más fuertemente asociados al consumo fueron haber tenido en la niñez un miembro del núcleo familiar que consumiera drogas (59,8%), historia de reclusión anterior (59,1%), desempleo (48,4%), relaciones en el colegio con compañeros que tuvieron problemas con la ley (46,9%), antecedentes de un familiar con ingreso a una penitenciaría (38,4%) e historia de fuga o huida de casa (35,9%). Conclusiones: En Perú, el consumo de drogas es más alto en población penitenciaria que en población general, y existen diferencias según sexo en la prevalencia de consumo de drogas y sus factores asociados antes del ingreso a un centro penitenciario. Se encontró que eventos sucedidos en la niñez, como maltrato, o tener un miembro de la familia encarcelado o consumidor de drogas, o haber consumido alcohol previamente, son factores asociados al consumo de drogas en la población penitenciaria. Algunos de estos factores de riesgo son modificables, por lo cual es importante que se tomen en cuenta en el diseño de políticas sociales y sanitarias enfocadas en subpoblaciones específicas para prevenir el consumo de drogas y la comisión de delitos (AU)

Objective: To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. Materials and methods: A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. Results: Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3% in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). Conclusions: In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime (AU)

Correction of craniodorsal coxofemoral luxation in cats and small breed dogs using a modified Knowles technique with the braided polyblend TightRope systems.

OBJECTIVES: To report the surgical technique and short-term radiographic and functional outcome data for a series of client owned, small breed dogs and cats treated for traumatic craniodorsal coxofemoral luxation using open reduction and internal fixation with the Arthrex Mini TightRope (mTR) and TightRope (TR) systems. METHODS: Data were collected retrospectively from the clinical case records, including the initial clinical and radiographic findings, surgical technique, and postoperative short-term clinical and radiographic data. Functional data collected after the six weeks reassessment were obtained via owner questionnaire. RESULTS: Four cats (mTR = 4) and five small breed dogs (mean weight 15 kg; TR = 4, mTR = 1) were included. Median time to postoperative weight bearing was one day. Median lameness score at six weeks postoperatively was 0 out of 5. Coxofemoral joint congruity was radiographically confirmed at the six weeks postoperative visit. Telephone follow-up (at a median of 16 weeks) revealed all animals had returned to their previous level of activity. Complications were minor, and limited to postoperative swelling (n = 1). CLINICAL SIGNIFICANCE: Clinical use of the Arthrex Mini TightRope and TightRope systems can be recommended for traumatic craniodorsal coxofemoral luxation in this novel application as short-term results are at least comparable to existing surgical techniques. Long-term follow-up studies are needed.

Intoxicación por Averrhoa carambola en un paciente en diálisis crónica / Intoxication with Averrhoa carambola in a patient on chronic dialysis

No disponible

No disponible

[Phineas Gage, 'Tan' and the importance of case reports]. / Phineas Gage, 'Tan' y la importancia de los casos clínicos.

INTRODUCTION: The original descriptions of the frontal lobe injury of Phineas Gage (1848) and the slowly growing tumor of 'Tan', Broca's famous patient (1861), are examples of how a simple case report can teach important lessons, some of them still discussed a century and a half later. DEVELOPMENT: In this article, the original sources of both of these seminal cases, in Boston and Paris, have been reviewed and are briefly summarized. The lessons learned from them in the effort to localize brain functions are explained and set in the context of modern evidence-based medicine.

Phineas Gage, ‘Tan’ y la importancia de los casos clínicos / Phineas Gage, ‘Tan’and the importance of case reports

Introducción. Las descripciones originales de la lesión frontal de Phineas Gage (1848) y del tumor de crecimiento lento de ‘Tan’, el famoso paciente de Broca (1861), son ejemplos de cómo un sencillo caso clínico puede enseñar valiosas lecciones, algunas de ellas discutidas todavía siglo y medio después. Desarrollo. En este artículo se revisan y resumen las fuentes originales de estos dos casos primigenios, en Boston y París. Se analizan las lecciones que estos dos pacientes dejaron sobre la localización de funciones cerebrales y se ubican en el contexto de la moderna medicina basada en evidencias

Introduction. The original descriptions of the frontal lobe injury of Phineas Gage (1848) and the slowly growing tumor of ‘Tan’, Broca’s famous patient (1861), are examples of how a simple case report can teach important lessons, some of them still discussed a century and a half later. Development. In this article, the original sources of both of these seminal cases, in Boston and Paris, have been reviewed and are briefly summarized. The lessons learned from them in the effort to localize brain functions are explained and set in the context of modern evidence-based medicine

[Estimating the supply of medical specialists in Colombia by using the capture-recapture method]. / Estimación de la oferta de médicos especialistas en Colombia con el método de captura-recaptura.

OBJECTIVE: Given that it is not known how many medical doctors there are in Colombia and that, without that datum, studies of demand are simply theoretical exercises, we proposed to estimate the supply of 12 medical specialties in Colombia, using the capture-recapture technique, which was developed by zoologists to estimate wild-animal populations. METHODS: Three lists, or "captures," were used: 1) university degrees obtained abroad and graduates of postgraduate programs in Colombia, 2) members of medical societies, and 3) specialists in the principal health care enterprises. To estimate the total population we used the CAPTURE software program. RESULTS: A total of 24,910 records were obtained: 8,397 from the university records, 6,561 from the scientific societies, and 9,952 from the health care businesses. More than half of the physicians have entered the labor market during the last decade. The estimated number of physicians (with the 95% confidence interval) for each specialty was: anesthesiology, 1,753 (1,727 to 1,789); cardiology, 607 (598 to 624); dermatology, 517 (514 to 525); obstetrics and gynecology, 2,338 (2,290 to 2,400); pulmonary disease, 304 (297 to 320); neurosurgery, 324 (319 to 334); neurology, 321 (296 to 369); ophthalmology, 1,049 (1,042 to 1,061); orthopedics, 1,217 (1,212 to 1,227); otolaryngology, 634 (628 to 645); psychiatry, 855 (838 to 879); and urology, 452 (452 to 458). CONCLUSIONS: The capture-recapture technique is useful in the study of human resources. In Colombia the number of specialists doubled in less than a decade. There are specialties that are already oversupplied, such as neurosurgery. All the other specialties show growth rates that indicate a future over-supply for the health care system.

Smoking in Colombian medical schools: the hidden curriculum.

BACKGROUND: Tobacco companies are focusing their interest in less developed countries. In the absence of governmental opposition, physicians are expected to lead tobacco control efforts. We studied Colombian medical students' smoking prevalence and tobacco attitudes. METHODS: First- and fifth-year students from 11 medical schools in seven Colombian cities answered anonymous, self-administered, 38-item questionnaires. Additionally, smokers answered the Fagerström Test for Nicotine Dependence (FTND). RESULTS: Two thousand twenty-one students (males 50.6%; age 15-44, median 19) completed the survey; average response rate was 89.9%. Globally 25.9% of students were current smokers (males 27.9%, females 24.0%). Living at higher altitude and attending private universities were associated with higher prevalence (P < 0.001). Males had a higher chance of having given up smoking (P < 0.05); 91.3% of current smokers would like to quit; 67.3% of all smokers and 44.8% of daily smokers scored 0 in the FTND. Prevalence was similar among first- and fifth-years, but fifth-year students were more complacent with smoking in health centers and showed a lesser desire to quit. CONCLUSIONS: Medical students' smoking prevalence is similar to that of the general population. Tobacco control strategies need to be included in the curriculum. Nicotine addiction does not seem to be the main perpetuating factor.

Handedness in Colombia: some associated conditions.

As part of a national neuroepidemiological study a population-based sample of 6941 subjects, 10 years of age or older, was selected in five different regions in Colombia (South America). Overall, 91.65% of the participants (90.6%) of the males; 92.7% of the females) considered themselves as right-handers. Handedness was significantly correlated with education in men but not in women. Handedness was not associated with age. Prevalence of history of loss of consciousness, tremors, difficulties with speech, and traumatic head injury was observed to be higher in non-handers than in right-handers. This finding was particularly evident in men. Implications of current results are analysed.

[The Mini-Mental State Examination as a selected diagnostic test for dementia: a Colombian population study. GENECO]. / El examen mental abreviado (Mini-Mental State Examination) como prueba de selección para el diagnóstico de demencia: estudio poblacional colombiano. GENECO.

INTRODUCTION: Folstein's Mini Mental State Examination (MMSE) is widely used as screening test for cognitive impairment. OBJECTIVE: To test a Spanish version of the MMSE in a population of high illiteracy rate. MATERIAL AND METHODS: Population-based survey of a stratified random sample of urban and rural residents of five regions of Colombia, followed by neurological and neuropsychological evaluation of suspect cases (phase 2). Dementia was diagnosed using DSM-IV criteria. RESULTS: 1,611 subjects age 50 or older filled out both the WHO Protocol for Epidemiologic Studies of Neurological Disorders and a Spanish version of the MMSE; 55.2% of them had three or less years of schooling; 536 individuals with scores below cutoff points were sent to phase 2. Of the population with satisfactory scores in MMSE 366 (34.0%) were evaluated by neurologists to exclude other neurological conditions. Twelve cases of dementia were diagnosed among individuals with scores below cutoff point and one among subjects with high scores. Age-adjusted prevalence was 8.1 per thousand subjects age 50 or over (95% CI: 3.7-12.5); and 34.2 per thousand for ages 75 or over (95% CI: 12.2-56.2). Sensitivity and specificity were 92.3 and 53.7%; 16 of the 19 questions show significant differences (p < 0.001) according to educational level. A gender gap is significant in low educational levels (p < 0.001) but not in subjects with more than five years of schooling. CONCLUSIONS: MMSE scores correlated closely with level of education. Low specificity leads to many non-demented subjects with low educational status requiring further investigation.

[Neurology and the reform of the health care system in Colombia]. / Neurología y reforma del sistema de salud en Colombia.

INTRODUCTION AND OBJECTIVES: Despite the magnitude of the Colombian health system reform, introduced in 1993, changes in specialized medical practice have not been evaluated. This paper is the follow-up of a similar study on the practice of neurology done by the authors before the reform. MATERIAL AND METHODS: Of the 62 members of the Colombian Association of Neurology living in Bogotá, 47 (76%) of them responded an anonymous survey inquiring on the characteristics of their medical practice and registering all the medical encounters during one week in October 1998. RESULTS: Two thirds of the total working time is devoted by neurologists to clinical work. Half of the neurologists in the sample have invested in diagnostic equipment. There was no significant change in the total number of patients attended during the week, as compared with the 1993 study, and the diagnostic profile was similar. The proportion of private patients was significantly lower, while patients from prepaid medical schemes increased. Patients belonging to the Obligatory Health Plan, designed to cover lowest income population, and to prepaid medicine are not distributed homogeneously throughout all ages. The first year of life is particularly uncovered by the Obligatory Health Plan, while prepaid schemes do not address the problems of individuals age 60 or more. CONCLUSIONS: There has been a significant reduction in private practice compensated by an increase in prepaid medicine. There is no evidence of increased coverage for neurological disorders.

[Brief history of dreams]. / Breve historia de los sueños.

Throughout history dreams have played a crucial role. Dreams have inspired great works of art, solved scientific problems and, because of the premonitory value attached to them, have influenced transcendental decisions. This paper reviews some of the dreams that have been a part of the world's literature and historical tradition.

Neurología y reforma del sistema de salud en Colombia / Neurology and reform of the healthcare system in Colombia

Introducción y objetivos. La reforma del sistema de salud en Colombia, iniciada en 1993, introdujo importantes cambios cuyos efectos sobre el ejercicio médico no se han evaluado. En este trabajo se recoge el seguimiento de un análisis de la práctica neurológica realizado por los autores antes de la proclamación de la reforma. Material y métodos. De los 62 neurólogos afiliados a la Asociación Colombiana de Neurología y residentes en Bogotá, 47 de ellos (76 por ciento) aceptaron participar en el estudio. Estos neurólogos respondieron preguntas sobre el perfil de su ejercicio profesional y llevaron un registro de pacientes atendidos durante una semana. Resultados. De su tiempo laboral total, los neurólogos dedican dos terceras partes al trabajo clínico. La mitad de ellos complementan sus ingresos con la inversión en equipos de diagnóstico neurológico. Con respecto al estudio anterior, realizado en 1993, no encontramos variación significativa en el número de consultas practicadas ni en los tipos de diagnósticos en los pacientes atendidos. Evidenciamos una disminución significativa en la proporción de enfermos particulares y un aumento en la de pacientes de medicina prepagada. Los pacientes afiliados tanto al Plan Obligatorio de Salud (POS) como a la medicina prepagada no se distribuyen de manera homogénea en todos los grupos etáreos. Hace falta afiliación al POS en el primer año de vida, mientras que en la tercera edad es menor la proporción de pacientes en los sistemas prepagados. Conclusiones. El cambio más significativo es la reducción en los pacientes privados, compensado con un incremento de la medicina prepagada. No se observan cambios compatibles con una mayor cobertura del sistema (AU)