Aproximación a la distribución de los costos directos de la diabetes tipo 2 en Colombia.

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Extracorporeal membrane oxygenation for tuberculosis pneumonia with empyema.

Acute respiratory distress syndrome (ARDS) caused by Mycobacterium Tuberculosis (TB) is a rare entity. Extracorporeal membrane oxygenation (ECMO) therapy had been used as an effective therapy for this cases, but the evidence is scarce. We present a case that took place in the middle of SARS-CoV2 pandemic. A 33-year-old female presented with ARDS due to pulmonary TB infection (pneumonia with empyema and pneumothorax), which required invasive mechanical ventilation with poor response. Long term veno-arterio-venous (VAV) ECMO, overlapped with veno-venous ECMO, was used as a salvage therapy with a good response for a total of 26 days. This is an example of the effectiveness of this therapy in this scenario, never described before. The fact that this therapy was used in the middle of SARS-CoV2 pandemic, with limited resources available, was remarkable, but it was encouraged by previous successful experiences.

Phenotypical, Clinical, and Molecular Aspects of Adults and Children With Homozygous Familial Hypercholesterolemia in Iberoamerica.

OBJECTIVE: Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. Approach and Results: In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the LDLR. True HoFH due to LDLR variants had higher total (P=0.015) and LDL (low-density lipoprotein)-cholesterol (P=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (P=0.051) and had a greater frequency of xanthomas (P=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular events were present in 25 (48%) of 52 children (missing information in 2 cases), and in 43 (67%) of 64 adults with LDLR variants. Children who are true HoFH had higher frequency of major cardiovascular events (P=0.02), coronary heart (P=0.013), and aortic/supra-aortic valve diseases (P=0.022) than compound heterozygous familial hypercholesterolemia. In adults, no differences were observed in major cardiovascular events according to type of LDLR variant. From 118 subjects with LDLR variants, 76 (64%) had 2 likely pathogenic or pathogenic variants. In 89 subjects with 2 LDLR variants, those with at least one null allele were younger (P=0.003) and had a greater frequency of major cardiovascular events (P=0.038) occurring at an earlier age (P=0.001). CONCLUSIONS: There was a high frequency of cardiovascular disease even in children. Phenotype and cardiovascular complications were heterogeneous and associated with the type of molecular defect.

Síndrome de apnea/hipopnea obstructiva del sueño y su asociación con las arritmias cardíacas. Una revisión narrativa de la literatura / Obstructive sleep apnoea / hypopnoea syndrome and its relationship with cardiac arrhythmias. A narrative review of the literature

Resumen El Síndrome de apnea - hipopnea obstructiva del sueño es una enfermedad con compromiso multisistémico, con especial repercusión en el sistema cardiovascular y por tanto con alto impacto en la morbimortalidad general. Se han demostrado múltiples mecanismos fisiopatológicos que explican y sugieren una asociación directa y proporcional al daño generado por esta entidad, en especial para las taquiarritmias, específicamente para fibrilación auricular y también para las bradiarrimias, con mejoría demostrada tras el tratamiento con presión positiva continua de la vía aérea. La asociación con aleteo auricular y arritmias ventriculares ha mostrado resultados contradictorios en algunos estudios, por lo que aún no es tan clara.

Abstract Obstructive sleep apnoea / hypopnoea syndrome is a disease of multisystemic involvement, with particular repercussions on the cardiovascular system, and thus a high impact on morbidity and mortality. Several pathophysiological mechanisms have been demonstrated that explain and suggest a direct and proportional relationship to the damaged caused by the condition, especially for tachyarrhythmias, specifically for atrial fibrillation, and also for bradyarrhythmias, with a demonstrated improvement with continuous positive airway pressure. As the association with atrial flutter and ventricular arrhythmias has shown contradictory results in some studies, the relationship is still not clear.

Revisiones sistemáticas para la evaluación de intervenciones que incluyen estudios no aleatorizados. Consideraciones metodológicas / Systematic reviews for the evaluation of interventions that include non-randomized studies. Methodological considerations

Resumen Las revisiones sistemáticas para evaluar intervenciones que incluyan la evidencia aportada por los estudios no aleatorizados (ENA), pueden ser muy útiles para soportar decisiones clínicas en temas que no estén bien cubiertos por experimentos clínicos aleatorizados (ECA), como la evaluación de los efectos de un tratamiento a largo plazo, sus efectos adversos o la evaluación de intervenciones en salud pública u organizacionales. El desarrollo de estas RSL requiere una serie de ajustes metodológicos para la búsqueda y selección de los estudios primarios, la evaluación de la calidad de los mismos y la combinación de la evidencia. Especial cuidado debe tenerse para identificar y manejar adecuadamente el mayor riesgo de sesgos, en especial los derivados de un inadecuado control de los factores de confusión. El presente artículo presenta las particularidades a tener en cuenta a la hora de realizar RSL para evaluar intervenciones que incluyan ENA, las herramientas que se han desarrollado para facilitar su desarrollo, y las consideraciones importantes para reportar y discutir los hallazgos. El desarrollo de este tipo de RSL requiere un alto nivel de experiencia por parte del grupo desarrollador y una mayor cantidad de recursos económicos y de tiempo. Sin embargo, cuando han sido bien diseñadas, conducidas y analizadas, pueden ser de gran utilidad en la toma de decisiones clínicas, y pueden ser integradas en el desarrollo de las recomendaciones presentadas en las guías de práctica clínica. (Acta Med Colomb 2018; 43: 100-106).

Abstract Systematic reviews to evaluate interventions including the evidence provided by non-randomized studies (NRS), can be very useful to support clinical decisions in subjects that are not well covered by randomized clinical trials (RCTs), such as the evaluation of the effects of long-term treatment, its adverse effects or the evaluation of public health or organizational interventions. The development of these RSLs requires a series of methodological adjustments for the search and selection of the primary studies, the evaluation of their quality and the combination of the evidence. Special care must be taken to identify and appropriately manage the increased risk of bias, especially those derived from inadequate control of confounding factors. This article presents the particularities to take into account when performing RSL to evaluate interventions that include NRS, the tools that have been developed to facilitate their development, and the important considerations to report and discuss the findings. The development of this type of RSL requires a high level of experience by the developer group and a greater amount of economic resources and time. However, when they have been well designed, conducted and analyzed, they can be very useful in clinical decision-making, and can be integrated into the development of the recommendations presented in the clinical practice guidelines. (Acta Med Colomb 2018; 43: 100-106).

The different methods of assessing glycemic variability, quality of glycemic control and glycemic risk cannot be interpreted as equivalent in clinical practice.

OBJECTIVE: Several methods are available to calculate glycemic variability (GV), quality of glycemic control (QGC) and glycemic risk (GR). However, clinicians do not easily interpret these data. This study evaluates whether the results of the different methods can be interpreted as equivalent. METHODS: A prospective study was performed including outpatients with DMT2 evaluated at the San Ignacio Hospital and the Colombian Diabetes Association in Bogotá, Colombia. From six-day continuous glucose monitoring data, GV (SD, CV, IQR, MODD, MAGE), QGC (M-value, J-index) and GR (LBGI, HBGI) were calculated. Reference values ​​were generated, classifying the patients according to GV control quartiles (excellent, good, fair or poor). The concordance between the different indices was evaluated. RESULTS: In total, 140 patients (68.9 ±â€¯11.2 years) were included. The agreement levels (Kappa) between GV indices were moderate, 0.40 (CI 95%:0.29-0.51), 0.42 (CI 95%:0.31-0.53) and 0.39 (CI 95%:0.28-0.50), for CV versus SD, IQR and CONGA respectively. The levels of agreement between GV and QGC indices were minimal (Kappa CV vs. M-value, 0.15CI 95%:0.046-0.26) and weak between the GV and GR indices (Kappa CVvs.LBGI 0.37CI95%:0.26-0.48). The estimators did not improve significantly when the analysis was performed with linearly weighted or quadratic weighted Kappa. CONCLUSIONS: The present study demonstrates that the concordance between the clinical interpretation of the different GV, QGC and GR indices is poor, suggesting that they cannot be assumed as equivalent, so different indices evaluating different concepts, must be evaluated simultaneously to analyze adequately each patient. New studies are needed to evaluate which of the methods better predicts hypoglycemia and microvascular or macrovascular complications.

Concordancia entre los modelos de SCORE y ramingham y las ecuaciones AHA/ACC como evaluadores de riesgo cardiovascular / Concordance between the SCORE and Framingham models and ACC/AHA equations as cardiovascular risk indicators

Resumen Objetivo: Diferentes modelos de evaluación de riesgo cardiovascular están actualmente en uso en Colombia. El objetivo de este estudio es analizar la concordancia entre las ecuaciones AHA/ACC 2013, SCORE y Framingham ajustado, así como el impacto de usar una u otra en la cantidad de pacientes clasificados como de alto riesgo y en la cantidad de pacientes que requerirían manejo farmacológico. Métodos: Se evaluaron 800 pacientes entre 40 y 74 años, de la clínica de prevención primaria del Hospital militar Central en Bogotá (Colombia), libres de eventos cardiovasculares. Se estimaron el riesgo a 10 años de enfermedad arterioesclerótica cardiovascular según las ecuaciones propuestas por las guías AHA/ACC 2013, el riesgo de muerte cardiovascular según la función SCORE de la guía europea y el riesgo coronario según la función de Framingham ajustada, recomendada por la guía colombiana. Se consideró como indicación de manejo farmacológico un cálculo de riesgo AHA/ACC o Framingham ajustado > 7,5%. Un riesgo de Framingham > 20% o SCORE > 5% definía el riesgo alto. Resultados: Según el Framingham había un 5,9% de pacientes de alto riesgo, según las ecuaciones de SCORE para países de bajo riesgo un 18,7% y según las ecuaciones de SCORE para países de alto riesgo, un 31,2%. El coeficiente Kappa mostró baja concordancia entre Framingham ajustado y cada una de las ecuaciones de SCORE (0,28 y 0,22 respectivamente). Según las recomendaciones de la guía AHA/ACC, el tratamiento hipolipemiante estaría indicado en un 40,8% de los pacientes, frente a un 50,6% según la guía colombiana (Framingham ajustado). El coeficiente kappa fue de 0,5735. Conclusiones: En la actualidad existe pobre acuerdo entre las diferentes escalas de evaluación del riesgo cardiovascular usadas en Colombia, hecho que conlleva incertidumbre para la toma de decisiones terapéuticas. Los datos de este estudio demuestran la necesidad de validar los modelos de SCORE y AHA/ACC en Colombia y Latinoamérica.

Abstract Motivation: In Colombia, different models of cardiovascular risk assessment are currently being used. The motivation of this study is to analyse the concordance between the ACC/AHA 2013 equation, SCORE and adjusted Framingham, as well as the impact of using one or another in the amount of patients classified as high risk and the amount of patients requiring pharmacological management. Methods: 800 patients between 40 and 74 years old were assessed, from the primary prevention clinic of the Hospital Militar Central in Bogotá (Colombia), who were free of cardiovascular events. 10-year risk for atherosclerotic vascular disease was estimated according to the equations proposed by ACC/AHA 2013 guides, the risk of cardiovascular death according to the SCORE function of the European guide and the coronary risk according to the adjusted Framingham function recommended by the Colombian guide. The indication of pharmacological management was considered with an ACC/AHA or adjusted Framingham risk of > 7.5%. A >20% Framingham or a >5% SCORE risk were considered high risk. Results: According to Framingham there was a 5.9% of high-risk patients, according to SCORE equations for low-risk countries an 18.7% and according to SCORE equations for high-risk countries, a 31.2%. The Kappa coefficient showed a low concordance between adjusted Framingham and each of the SCORE equations (0.28 and 0.22 respectively). According to the ACC/AHA guide recommendations, hypolipidemic treatment would be indicated in 40.8% of patients, versus a 50.6% following the Colombian guide indications (adjusted Framingham). Kappa coefficient was 0.5735. Conclusions: Nowadays there is a poor agreement between the different cardiovascular risk assessment scales used in Colombia, thus generating uncertainty when it comes to making therapeutic choices. Data from this study show the need to validate the validate the SCORE and ACC/AHA models in Colombia and Latin America.

Microorganismos en lengua y saliva de pacientes edéntulos y con periodontitis crónica y su posible conexión con la Proteína C reactiva / Microorganisms in the Tongue and Saliva of Edentulous and Chronic Periodontal Disease Patients and the Possible Relation to the C-Reactive Protein

Antecedentes: Existe evidencia clínica y experimental que la proteína C reactiva (PCR) es un marcador de inflamación sistêmica asociado a periodontitis crónica. Esta enfermedad es la principal causa de cdcntulismo y ambas condiciones presentan, en algunos casos, los mismos microorganismos. Objetivo : Identificar microorganismos periodontopatógenos presentes en pacientes cdéntulos y en pacientes con periodontitis moderada/avanzada y establecer su relación con la PCR ultrasensible (PCR-us). Métodos: Se realizó un estudio de corte transversal en 61 pacientes mayores de 30 años de edad, divididos en dos grupos: con periodontitis crónica y cdcntulos. A cada paciente se le tomó una muestra de saliva y del dorso de la lengua, para identificación microbiológica de microorganismos, y muestra sérica, para evaluación de PCR-us. Se analizó la asociación entre microorganismos, PCR-us y por grupo de pacientes. Resultados: La PCR-us mostró un valor máximo de 1,12 mg/1 en el grupo de cdéntulos sin mostrar diferencia estadísticamente significativa con el grupo de periodontitis crónica (p = 0,29). Sin embargo, valores mayores de PCR-us se observaron en pacientes con microorganismos como Candida albicans, Porphiromona gingival is, Actinomyces nacslundii (A. nacslundii), Capnocytophaga sp., Streptococcus intermedius (S. intermedius) y Bactcroidcs thctaiotaomicron. Conclusión: De acuerdo con los resultados de este estudio, no hay diferencia en PCR-us entre pacientes cdéntulos y aquellos con enfermedad periodontal. Se encontraron periodontopatógenos en cdéntulos principalmente Capnocytophaga sp., A. nacslundii y S. intermedius, tanto en lengua como en saliva.

Background: Ihcrc is clinical and experimental evidence that C-Rcactivc Protein (CRP) is a systemic inflammation marker associated to the chronic periodontal disease. This disease is the main cause of cdcntulousncss and, in some eases, both conditions involve the same microorganisms. Objective: To identify the pcriodontopathic microorganisms appearing in both edentulous patients and patients with moderate/advanced periodontal disease and to determine how they relate to the ultrasensible CRP (US-CRP). Methods: A cross-sectional study was carried out in 61 patients with ages above 30 years divided into two groups: patients with chronic periodontal disease and edentulous patients. Each patient was taken a saliva sample from the tongue dorsum for microbiologic identification of microorganisms, and scrum samples for US-CRP evaluation. The relation between microorganisms and US-CRP was analyzed and described per group. Results: Ihc US-CRP showed a maximum value of 112 mg/L in the edentulous group without any statistically significant difference as compared to the periodontal chronic disease group (p = 029). However, higher values of US-CRP were observed in patients with microorganisms such as Candida albicans, Porphiromona gingivalis, Actinomyces nacslundii (A. nacslundii), Capnocytophaga sp., Streptococcus intermedius (S. intermedius) and Bactcroidcs thctaiotaomicron. Conclusion: Based on the results herein, no difference is observed for che US-CRP between edentulous patients and chronic periodontal disease patients. 'Ihc main periodontal pathogens found in the edentulous subjects include Capnocytophaga sp., A. nacslundii and S. intermedius, both in the tongue and the saliva.

Comparación de valores de proteína C-reactiva ultrasensible en pacientesedéntulos totales y pacientes con enfermedad periodontal crónica moderada y avanzada en la Facultad de Odontología de la Pontificia Universidad Javeriana de Bogotá / Comparison of values of C-reactive protein in edentulous patients and patients with chronic moderate-to-advanced periodontal disease at the Pontificia Universidad J averiana Dental School in Bogotá

Antecedentes: La enfermedad periodontal (EP) es un factor de riesgo para desarrollar enfermedadescardiovasculares. Puede influir e iniciar una reacción autoinmune, aumentandola inflamación sistémica y acelerando la progresión de placas ateroescleróticas prexistentes.Ante inflamación aumenta la concentración de proteína C-reactiva (medida por PCR-us),que está relacionada con ateroesclerosis y riesgo cardiovascular. Se ha encontrado queel valor de PCR-us es significativamente mayor en pacientes con periodontitis. Objetivo:Determinar si existen diferencias significativas en los valores de PCR-us de pacientes conEP crónica entre moderada y avanzada no tratada y pacientes edéntulos totales comomarcador de ausencia de EP. Métodos: El diseño fue de casos y controles con una muestrade 60 pacientes mayores de 30 años de edad (30 casos con periodontitis crónica moderadaa avanzada y 30 controles edéntulos totales). Se tomó una muestra de sangre a todos lospacientes (cuadro hemático, colesterol, triglicéridos, glucemia, PCR-us) y se analizaron loshallazgos. Resultados: El promedio de PCR-us en los pacientes con periodontitis fue 2,19mg/L, y en los pacientes edéntulos, de 4,12 mg/L. Existe una tendencia a hallar valoresde PCR-us más elevados en pacientes edéntulos, al considerar que se encontró mayorexposición al riesgo en los pacientes con periodontitis. Los resultados no fueron estadísticamentesignificativos. Conclusión: La PCR-us se presentó más aumentada en los pacientesedéntulos totales y los valores de PCR-us en pacientes con periodontitis no se observaroncomo un factor de riesgo elevado para enfermedad cardiovascular...

Background: Periodontal disease (PD) is a risk factor for cardiovascular disease. It caninitiate an autoimmune reaction, increase systemic inflammation, and accelerate the progressionof preexisting atherosclerotic plaques. In presence of inflammation, PD increasesthe concentration of C-reactive protein (measured through hs-CRP) that is associated withatherosclerosis and cardiovascular risk. It has been found that the value of hs-CRP is significantlyhigher in patients with periodontitis. Objective: Determine if there are significantdifferences in the values of hs-CRP among patients with untreated moderate-to-advancedchronic PD and edentulous patients (marker of absence of PE). Methods: A case-controlstudy was carried out with a sample of 60 patients older than 30 years of age (30 cases withmoderate-to-advanced chronic periodontitis diagnosed and 30 edentulous controls). Bloodsamples were taken from all patients (complete blood count, cholesterol, triglycerides, glucose,hs-CRP) and the results were compared. Results: The average hs-CRP in patients withperiodontitis was 2.19 mg/L and 4.12 mg/L in edentulous patients. There is a tendency tofind values higher of hs-CRP in edentulous patients, given that there was higher exposure inpatients with periodontitis. The results were not statistically significant. Conclusion: hs-CRPwas higher in edentulous patients and hs-CRP values in patients with periodontitis were notseen as a high risk factor for cardiovascular disease..

Presentaciones efectivas en medicina El arte de comunicar y transmitir: diez recomendaciones / Effective Presentations in Medicine. The Art of Communication and Transmission: Ten Recommendations

Para lograr una comunicación efectiva durante una conferencia o presentación, es necesario seguir reglas simples, que incluyen la preparación de la conferencia con el auditorio en mente y con la definición de un mensaje específico para dejar a la audiencia. Debe capturarse pronto la atención del público y todas las acciones posteriores deben ir encaminadas a mantenerla. Los textos deben ser precisos y con tamaños fácilmente visibles, las diapositivas deben ofrecer buen contraste, con fondos sólidos y simples y deben evitarse las animaciones excesivas. Al cierre de la conferencia, las conclusiones y la sesión de preguntas ofrecen la oportunidad invaluable de reforzar el mensaje que se quería dejar.

To communicate effectively during a lecture or presentation it is necessary to follow simple rules, including the preparation of the conference with the audience in mind and with the definition of a specific message to leave the audience. The public's attention should be quickly captured and all subsequent actions should aim to keep it. The text must be accurate and sizes easily visible, the slides should provide good contrast with solid and simple backgrounds and should avoid excessive animations. At the close of the conference, the conclusions and question session offers the invaluable opportunity to reinforce the desired message.

[Effective Presentations in Medicine. The Art of Communication and Transmission: Ten Recommendations]. / Presentaciones efectivas en medicina El arte de comunicar y transmitir: diez recomendaciones.

To communicate effectively during a lecture or presentation it is necessary to follow simple rules, including the preparation of the conference with the audience in mind and with the definition of a specific message to leave the audience. The public's attention should be quickly captured and all subsequent actions should aim to keep it. The text must be accurate and sizes easily visible, the slides should provide good contrast with solid and simple backgrounds and should avoid excessive animations. At the close of the conference, the conclusions and question session offers the invaluable opportunity to reinforce the desired message.

Uso de la mamografía de tamizaje en las pacientes con diagnóstico con cáncer de seno en el Hospital Universitario San Ignacio, Centro Javeriano de Oncología / Use of screening mammograms in patients diagnosed with breast cancer at Hospital Universitario San Ignacio, Centro Javeriano de Oncología

Introducción. Actualmente el cáncer de seno ha logrado trascender en la salud de las mujeres colombianas, por ser una enfermedad con alta mortalidad. Hoy por hoy, se ofrece tamizaje de oportunidad con mamografía para mujeres mayores de 50 años, pero aún es escasa la información sobre cómo se están detectando los nuevos casos en Colombia. Objetivo. Determinar el uso de la mamografía de tamizaje en mujeres diagnosticadas con cáncer de seno que acudieron a su primera consulta con el especialista en el Hospital Universitario San Ignacio de Bogotá, Colombia, entre el 2004 y 2007. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo, retrospectivo, de 232 nuevos casos de cáncer de seno, de los cuales se recolectaron los siguientes datos: edad en el momento del diagnóstico, motivo de consulta, tiempo de evolución de la sintomatología, tamaño del tumor al examen físico, adenopatías, tipo histológico y estadio clínico. Para el análisis de inferencias, se aplicaron las pruebas t de student y ×2 al cuadrado, según fuera apropiado, estableciendo como significativo un valor p menor de 0.05. Resultados. En nuestra población, sólo 18,1% de las pacientes fueron remitidas por hallazgos anormales en mamografías de tamizaje; la mayoría consultó por síntomas mamarios asociados a estadios más avanzados de la enfermedad. Aquellas que consultaron por masa, en comparación con las que lo hicieron por anormalidades en la mamografía de tamizaje, tuvieron tumores más grandes (5,1 cm versus 3,3 cm p<0,05), con mayor compromiso linfático (46,1% versus 14,3%, p<0,05) y tendencia hacia estadios localmente avanzados (estadio III, 43,3% versus 9,5%, p<0.05). Las mujeres mayores de 50 años tuvieron poco uso de la mamografía de tamizaje (24,7%) y se demoraron dos veces más tiempo en consultar que las menores de 50 años (p<0,05)...

Introduction: Breast cancer has currently become a health issue amongst Colombian women due its high mortality rate. Nowadays opportunity screening is offered with mammograms for women over 50, nonetheless little information is available on how new cases are being detected in Colombia. Objective: Determine the use of screening mammograms in women with breast cancer who had an initial consultation with breast surgeons at Hospital Universitario San Ignacio in Bogotá, Colombia, between 2004 and 2007. Methods: A retrospective, descriptive observational study of 232 newly diagnosed breast cancer cases was carried out in which the following data were collected: age at time of diagnosis, chief complaint, duration of symptoms, tumor size on clinical breast examination, lymph nodes, histological type, and clinical stage. For inferential analysis student´s T and chi square test were used. Significance was set at p<0.05. Results: In this population, only 18.1% of the patients were referred due to abnormal findings on screening mammograms, while the vast majority had breast symptoms as a consequence of advanced disease. Those who had lumps, in comparison to asymptomatic patients, had larger tumors (5.1 cm versus 3.3 cm, p<0.05), larger lymph node involvement (46.1% versus 14.3%, p<0.05), and had a stronger tendency of locally advanced disease (stage III 43.3% versus 9.5%, p<0.05). Women over 50 had a low use of screening mammograms (24.7%) and waited twice as much before having an appointment with a specialist, when compared to those less than 50 (p<0.05). Conclusions: The majority of breast cancer cases were symptomatic, and early detection was small in this population; as a consequence, advanced disease was diagnosed in a larger proportion. These results contribute to support the growing need to develop strategies to teach women and health professionals about the benefits of mammograms, breast self exam, and clinical breast exam as tools for early detection.

Experimentos clínicos aleatorizados, o cómo evaluar las intervenciones / Randomized Clinical Trials in the Evaluation of Interventions

Introducción: Para la evaluación de una intervención (medicamento, terapia, técnica quirúrgica) se utilizan los experimentos clínicos aleatorizados, estudios que controlan de manera automática muchas fuentes de sesgos. Desarrollo: Deben tener siempre un grupo control; la asignación a los grupos de tratamiento debe hacerse mediante el azar, e idealmente, para la evaluación, debe cegarse al sujeto de estudio, al evaluador y a quien hace el análisis. Tanto la intervención experimental como la de control deben haber sido seleccionados con bases sólidas, y debe haber una incertidumbre genuina en relación con su efectividad y seguridad. Debe procurarse que las variables de medición del desenlace sean sólidas y objetivas (duras) o variables blandas que hayan sido obtenidas o transformadas mediante métodos ya definidos. Si no es posible cegar al sujeto o cegar la intervención, puede recurrirse a utilizar el método de doble simulación o a variables de desenlace duras...

Randomized Clinical Trials are used to evaluate interventions (drugs, therapies or surgical techniques), since they control for many possible sources of bias. Development: Clinical Trials must have a control group, assignation to treatment groups must be at random and it is ideal to blind the study subject, the researcher and the analyst for the evaluation. Both the experimental and the control interventions must be selected with solid bases, and there should be a genuine uncertainty about their effectiveness and safety. Outcome variables should be hard and objective, and if soft variables are used, they must be transformed using predefined methods to make them as objective as possible. If it is not possible to mask the subject or the intervention, double dummy methods should be employed or hard outcomes used. Key words: Randomized clinical trial, double-blind, hard outcomes, soft outcomes, assignation, ramdomization...