End-of-life care needs in cancer patients: a qualitative study of patient and family experiences.

BACKGROUND: Cancer is a disease that transcends what is purely medical, profoundly affecting the day-to-day life of both patients and family members. Previous research has shown that the consequences of cancer are greatly aggravated in patients at the end of life, at a time when they must also grapple with numerous unmet needs. The main objective of this study was to obtain more in-depth insight into these needs, primarily in patients with end-stage cancer nearing death. METHODS: Semi-structured interviews were conducted in Spain with cancer patients at the end of life (n = 3) and their family members (n = 12). The findings from the interviews were analyzed using qualitative thematic analysis and a grounded theory approach. RESULTS: Four major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4), needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance. CONCLUSIONS: A lack of support, information and transparency during a period of immense vulnerability makes the end-of-life experience even more difficult for patients with cancer. Our findings highlight the importance of developing a more in-depth understanding of the needs of this population, so that informed efforts can be made to improve palliative healthcare and implement more comprehensive care and support at the end of life.

High altitude pulmonary edema at 2640 m altitude associated with an acute Rhinovirus infection. First case in the literature.

High altitude pulmonary edema (HAPE) is a multifactorial condition that may occur after ascent of high altitudes, especially in genetic predisposed individuals. Diagnosis is challenging and could lead to potentially lethal complications such as acute respiratory distress syndrome (ARDS). We present one of the few reported cases of HAPE below 3000 m of altitude, and the first to our knowledge to present with a concomitant acute Rhinovirus infection, precipitating and complicating the diagnosis and clinical course. Clinical manifestations, treatment, and outcomes are shown below.

Pandoraea pnomenusa Superinfection in a Patient with SARS-CoV-2 Pneumonia: First Case in the Literature.

Pandoraea pnomenusa is a Gram-negative bacterium of the Pandoraea genus and is mainly associated with the colonization of structurally abnormal airways. During the COVID-19 pandemic, many microorganisms have been associated with coinfection and superinfection in SARS-CoV-2 pneumonia, but so far, no coinfection or superinfection by P. pnomenusa has been reported. We present the first case describing this association in a previously healthy patient. Clinical manifestations, treatment, and outcomes are shown.

Clinical, pathological and genetic characteristics of Perry disease-new cases and literature review.

BACKGROUND AND PURPOSE: Perry disease (or Perry syndrome) is an autosomal dominant neurodegenerative disorder characterized by parkinsonism, neuropsychiatric symptoms, central hypoventilation, weight loss and distinct TDP-43 pathology. It is caused by mutations of the DCTN1 gene encoding an essential component of axonal transport. The objectives were to provide the current state of knowledge on clinical, pathological and genetic aspects of Perry disease, as well as practical suggestions for the management of the disease. METHODS: Data on new patients from New Zealand, Poland and Colombia were collected, including autopsy report. Also all of the published papers since the original work by Perry in 1975 were gathered and analyzed. RESULTS: Parkinsonism was symmetrical, progressed rapidly and was poorly responsive to L-Dopa; nonetheless, a trial with high doses of L-Dopa is warranted. Depression was severe, associated with suicidal ideations, and benefited from antidepressants and L-Dopa. Respiratory symptoms were the leading cause of death, and artificial ventilation or a diaphragm pacemaker prolonged survival. Weight loss occurred in most patients and was of multifactorial etiology. Autonomic dysfunction was frequent but underdiagnosed. There was a clinical overlap with other neurodegenerative disorders. An autopsy showed distinctive pallidonigral degeneration with TDP-43 pathology. Genetic testing provided evidence of a common founder for two families. There was striking phenotypic variability in DCTN1-related disorders. It is hypothesized that oligogenic or polygenic inheritance is at play. CONCLUSIONS: Perry disease and other DCTN1-related diseases are increasingly diagnosed worldwide. Relatively effective symptomatic treatments are available. Further studies are needed to pave the way toward curative/gene therapy.

Chromobacterium violaceum Periareolar Infection, First Non-Lethal Case in Colombia: Case Report and Literature Review.

Chromobacterium violaceum is a facultative anaerobic, Gram-negative rod found in different ecosystems, especially tropical and subtropical areas. Human infections are rare, and just a few cases have been reported in literature. In this paper, we present the first non-lethal infection due to Chromobacterium violaceum, in an adult male with polycystic kidney disease in Colombia. Periareolar soft tissue infection was documented with isolation of Chromobacterium violaceum. Clinical manifestations, treatment, and outcome are shown.

Association between population distribution and urban GDP scaling.

Urban scaling and Zipf's law are two fundamental paradigms for the science of cities. These laws have mostly been investigated independently and are often perceived as disassociated matters. Here we present a large scale investigation about the connection between these two laws using population and GDP data from almost five thousand consistently-defined cities in 96 countries. We empirically demonstrate that both laws are tied to each other and derive an expression relating the urban scaling and Zipf exponents. This expression captures the average tendency of the empirical relation between both exponents, and simulations yield very similar results to the real data after accounting for random variations. We find that while the vast majority of countries exhibit increasing returns to scale of urban GDP, this effect is less pronounced in countries with fewer small cities and more metropolises (small Zipf exponent) than in countries with a more uneven number of small and large cities (large Zipf exponent). Our research puts forward the idea that urban scaling does not solely emerge from intra-city processes, as population distribution and scaling of urban GDP are correlated to each other.

Dysembryoplastic neuroepithelial tumor and temporal arachnoid cyst on a child with epilepsy. Which one to operate? Case report and literature review.

A 6 year-old male, with seizures characterized by abnormal epigastric sensation, behavioral arrest, upper extremities search automatisms and secondary tonic-clonic generalization. Magnetic resonance imaging showed a hypointense cystic extra-axial image with an increase in the thickness of the convolutions in the first and second gyri of the right frontal lobe. It was decided to resect the frontal lesion with transoperative motor mapping. Morphological and immunohistochemical findings corresponded to dysembryoplastic neuroepithelial tumor with focal cortical dysplasia. Adequate semiology, analysis of the electroencephalogram, and imaging studies allowed treating adequately the cortical dysplasia. At present, the patient is seizure-free without medication (Engel IA).

Niño de 6 años con crisis caracterizadas por sensación epigástrica, arresto conductual, automatismos de búsqueda y generalización tónico-clónica secundaria. La resonancia magnética mostró una imagen extraaxial quística y un aumento del grosor de las circunvoluciones del primer y segundo giros del lóbulo frontal derecho. Se decidió resecar primero la lesión frontal con guía por mapeo transcortical intraoperatorio. Los hallazgos morfológicos e inmunohistoquímicos mostraron un tumor neuroepitelial disembrioplásico con displasia cortical focal. La semiología, el análisis del electroencefalograma y la imagen permitieron orientar el tratamiento. Actualmente el paciente está libre de crisis y sin medicamentos (Engel IA).

[Posición de la Academia Nacional de Medicina de México con relación con el decreto presidencial por el que se reforman y adicionan diversas disposiciones de la Ley General de Salud, en específico aquella donde faculta a la Secretaría de Salud para diseñar y ejecutar políticas públicas que regulen el uso medicinal y científico de los derivados farmacológicos de la Cannabis sativa indica americana o marihuana, entre los que se encuentra el tetrahidrocannabinol, sus isómeros y variantes estereoquímicas, así como para normar la investigación y producción nacional de los mismos].

As a consequence of the Presidential Decree that reforms and additions the General Statute of Health with regard to medicinal and scientific use of tetrahydrocannabinol, its isomers and stereochemical variants, the National Academy of Medicine of Mexico declares its position in favor of regulating investigation and national production thereof.

Como consecuencia del decreto presidencial que reforma y adiciona la Ley General de Salud respecto al uso medicinal y científico del tetrahidrocannabinol, sus isómeros y variantes estereoquímicas, la Academia Nacional de Medicina de México declara su posición para normar la investigación y producción nacional de los mismos.

Medicina alternativa y complementaria: ¿Qué experiencias tienen las personas al utilizarla? / Alternative and Complementary Medicine: What experiences do people have using it?

Introducción: El incremento del uso de la Medicina Alternativa y Complementaria (MAC) se puede sustentar en la eficacia reportada y escasos efectos secundarios. Sin embargo, no hay suficientes investigaciones sobre posibles complicaciones e interacciones con los medicamentos convencionales. Objetivo: Describir las experiencias de mujeres que hayan utilizado la medicina alternativa y complementaria Metodología: Investigación cualitativa con diseño fenomenológico descriptivo. La recolección de datos se realizó a través de entrevistas a profundidad, con una guía que incluyó los temas relacionados con el fenómeno a investigar, observación y notas. El análisis se realizó según lo propuesto por Krueger: lectura, transcripción, codificación, formación de temas y sub temas, se aplicaron los criterios de rigor y el consentimiento informado. Hallazgos: Se encontró que los principales motivos por los cuales las entrevistadas acudieron a la medicina alternativa fueron por recomendación de familiares o conocidos así como la asequibilidad de la misma. Las entrevistadas admiten utilizar 1 o más métodos alternativos, de los cuales sobresale la herbolaria, para tratar patologías específicas y/o síntomas generales. Sobre sus emociones y sentimientos que les causó el uso de la MAC sobresalen la confianza y bienestar que les genera. También se identificó una creencia sobre la inocuidad de los remedios herbolarios ya que creen que son inofensivos. Conclusiones: La experiencia de las participantes con la MAC fue en lo general positiva y ninguna reportó efectos secundarios por el uso de la misma. Por esta sensación de bienestar percibida, las personas tienen una gran confianza en sus efectos sanadores.

Tumor de tritón benigno: reporte de un caso en órbita / Orbit Benign triton Tumor: Case Report

El artículo presenta el caso de una mujer de 49 años de edad sin antecedentes patológicos con proptosis axial progresiva izquierda de un año de evolución asociada a dolor ocular, sin cambios en la agudeza visual, sin limitación en los movimientos oculares ni diplopía. Con imágenes sugestivas de seudotumor versus schwannoma versus hemangioma cavernoso orbitario versus dermoide intraconal. Fue llevada a resección de masa vía orbitotomía anterior transconjuntival. Esta fue una lesión compatible histológicamente con hamartoma neuromuscular (tumor de tritón benigno).

This article shows the case of a 49-year-old woman with no medical history, developed a progressive left axial proptosis associated with ocular pain. There are no changes to visual acuity, limitation of eye movement or diplopia. The diagnostic images may suggest one of the following: pseudotumor, schwannoma, orbital cavernous hemangioma or intraconal dermoid. The resected specimen was taken via anterior transconjuntival orbitotomy. Microscopic examination of the tumor showed a neuromuscular hamartoma (benign triton tumor).

[Intracranial electrode recording prognostic value in anterior temporal lobectomy and hypocampectomy]. / Valor pronóstico de los registros intracraneales en la lobectomía temporal anterior con hipocampectomía.

UNLABELLED: The experience obtained in the Epilepsy Clinic of the General Hospital of México in regard to the use of intracraneal electrodes to determine the epileptic tissue that must be resected in an anterior temporal lobectomy with amygdalo-hippocampectomy in patients with intractable mesial temporal lobe seizures is described. The data obtained while recording the electroencephalographic activity with these electrodes to learn about its impact in the postsurgical result (seizure reduction and complications) both in the first year and long-term (up to 17 years) follow-up was analyzed. Fifty seven patients implanted between years 1993-2008 were included. Forty eight patients (84%) were seizure and medication free in the first year of postsurgical follow-up. Five patients relapsed after five years of being seizure free. There were no serious complications caused by the use of intracraneal electrodes per se and neurological deficits were barely noticeable in one patient due to the lobectomy. CONCLUSION: the use of intracraneal electrodes is a safe and effective diagnostic method that contributes to the good postsurgical long-term outcome in those patients previously excluded for a possible surgery.

Impacto de una política de restricción de uso de antibióticos en la unidad neonatal del Hospital Militar Central / Impacto de uma politica de restrição de uso de antibióticos na unidade neonatal do Hospital Militar Central de Bogota / The impact of an antibiotic restriction policy in the intensive care unit at the Hospital Militar Central

Teniendo en cuenta que el uso indiscriminado de antibióticos de amplio espectro ha favorecido la aparición de resistencia bacteriana a múltiples drogas, se realizó un estudio de intervención cuasiexperimental entre enero de 2002 y enero de 2006 en la unidad de cuidados intensivos neonatal (UCIN) del Hospital Militar Central de Bogotá (HMC), en el que se restringió el uso de cefalosporinas de 3ª generación cambiándolas por antibióticos no asociados con inducción de beta-lactamasas de espectro extendido (BLEEs), utilizando piperazilina-tazobactam y cefepime. En el estudio se hizo comparación antes y después de la política de restricción antibiótica en infecciones nosocomiales por gérmenes gram negativos, encontrándose que de 2880 pacientes que ingresaron a UCIN, el 24,5% tuvo diagnóstico de infección y de ellos, el 30,7% correspondió a infecciones hospitalarias. De los gérmenes aislados el 49% correspondió a bacterias gram negativas, con una producción de BLEEs en el 51% de los aislados de Klebsiella pneumoniae, de 28% en los de Escherichia coli, de 14% en los de Acinetobacter baumannii y de 7% en los de Serratia. En el 70% de los casos con presencia de BLEEs se habían utilizado cefalosporinas de III generación. Luego de la restricción de cefalosporinas de III generación se observó una importante disminución en los aislamientos de los gérmenes productores de resistencia betalactámica (del 20% en el primer periodo, se bajó a menos del 4% en el segundo), es decir que el riesgo producir BLEEs disminuyó casi cinco veces, con una razón de prevalencia de 4,91(IC 95%: 1,14-21,09) y un valor de p=0,031 respecto al periodo anterior, pudiéndose concluir que la adopción de una política de restricción en el uso de antibióticos tuvo un significativo efecto reductor en la incidencia de BLEEs en la UCIN de nuestro hospital, disminuyendo a su vez los costos, pues se redujo el uso de carbapenems...

Considering that the indiscriminate use of wide spectrum antibiotics has favour the appearance of bacterial resistance to multiple drugs, a quasi-experiemental intervention study was performed between January 2002 and January 2006, in the neonatal intensive care unit (NICU) of the Hospital Militar Central in Bogotá (HMC), in which the use of cephalosporins of 3th generation was restricted and changed for antibiotics non associated with the induction of beta-lactamases of extended spectrum (ESBLs), by the use of piperacillin-tazobactam and cefepime. A comparison was done before and after the restriction policy was applied in nosocomial infections produced by gram-negative bacteria. It was found that 24, 5% out of 2880 patients were diagnose with infections and among them, 30,7% were nosocomial infection. 49% of isolated germs were Gram-negative bacteria from which 51% of Klebsiella pneumoniae, 28% of Escherichia coli, 14% of Acinetobacter baumannii and 7% of Serratia isolates produced ESBLs. In 70% of the ESBLs cases, cephalosporins of 3er generation were used. After restriction of cephalosporins of 3 th generation an important decreased in the number of beta-lactamic resistance isolates were observed (from 20% during the first period to less than 4 % during the second), which means that the risk of ESBLs production decreased five times, with a ratio of prevalence of 4,91 (IC 95%: 1,14-21,09) and a p value of 0,031 with respect to the previous period. It can be conclude that the adoption of a restriction policy in the use of antibiotics had a significant reductor effect on the incidence of ESBLs in NICU of our Hospital, which implies a reduction of costs as the use of carbapenems was also reduced...

Tendo em conta que o uso indiscriminado de antibióticos de amplo espectro favoreceu a aparição de resistência bacteriana a numerosos medicamentos, realizou-se um estudo de intervenção experimental entre janeiro de 2002 e janeiro de 2006 na unidade de terapia intensivos neonatal (UTIN) do Hospital Militar Central de Bogotá, no que se restringiu o uso de cefalosporinas de III geração mudando-as por antibióticos não associados com indução de beta-lactamasas de espectro estendido (BLEEs), utilizando piperazilina-tazobactam e cefepime. No estudo se fez comparação antes e depois da política de restrição antibiótica em infecções nosocomiais por bactérias gram negativos, encontrando-se que de 2880 pacientes que ingressaram a UTIN, o 24,5% teve diagnóstico de infecção e deles, o 30,7% correspondeu a infecções hospitalares. Dos germens isolados o 49% correspondeu a bactérias gram negativas, com uma produção de BLEEs no 51% dos isolados de Klebsiella, de 28% nos de Escherichia coli, de 14% nos de Acinetobacter e de 7% nos de Serratia. No 70% dos casos com presença de BLEEs se tinham utilizado cefalosporinas de III geração. Depois da restrição de cefalosporinas de III geração se observou uma importante diminuição nos isolamentos dos germes produtores de resistência beta-lactámica (do 20% no primeiro período, baixou-se a menos do 4% no segundo), isto é que o risco produzir BLEEs diminuiu quase cinco vezes, com uma razão de prevalência de 4,91(IC 95%: 1,14-21,09) e um valor de p=0,031 com respeito ao período anterior, podendo-se concluir que a adoção de uma política de restrição no uso de antibióticos teve um significativo efeito redutor na incidência de BLEEs na UTIN de nosso hospital, diminuindo a sua vez os custos, pois se reduziu o uso de carbapenems...

Tratamiento médico y quirúrgico de la enfermedad de Parkinson: estudio a largo plazo / Medical and surgical treatment of Parkinson's disease. A long term study

Este trabajo estudia los efectos del tratamiento médico y quirúrgico sobre el curso natural de la enfermedad de Parkinson. Tres grupos de pacientes fueron estudiados: I. Pacientes tratados con levodopa/carbidopa y anticolinérgicos (n = 10). II. Pacientes tratados con talamotomía (n = 9). III. Pacientes con tratamiento médico más trasplante autólogo de médula adrenal al núcleo caudado (n = 8). Fueron evaluados antes de iniciar el tratamiento médico o de efectuar la cirugía, al mes, a los seis meses y al año. Fueron usadas las escalas clínicas: New York Parkinson's Disease Scale, Unified Parkinson's Disease Scale, Schwab and England y Hoehn and Yarth Scale. Se evaluó por separado temblor, rigidez, bradicinesia y deterioro mental. Se uso un análisis de varianza tipo Friedman. Grupo I. No hubo mejoría significativa y sí un deterioro mental significativo al año. Grupo II. Hubo mejoría significativa del temblor y la rigidez, sin embargo el deterioro mental al año determinó un empeoramiento de la escala global. Grupo III. No hubo mejoría significativa, pero el deterioro al año fue menos pronunciado que para los otros grupos