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Background: Non-pharmacological interventions (NFI) or preventive actions (PA) are the best alternatives to control future pandemics, especially in vulnerable populations, such as semi-urban areas. Objective: To describe the predominant health behavior groups (HBG) and associated factors during the third wave of COVID-19 in a semi-urban area. Material and methods: A survey which included characteristics, factors related to COVID-19, perceptions of health behavior and PA was applied in a probabilistic sample in a first-level hospital in the State of Mexico. People of both sexes over 18 years of age were included. Using a hierarchical cluster analysis, HBGs were obtained and characterized with a descriptive and multivariate statistical analysis. Results: In a probabilistic sample (n = 260), 4 HBGs were identified: 2 of high-risk (HRG) and 2 of low-risk (LRG), and the proportions were 43.5% y 56.5%, respectively. The sociodemographic characteristics of both groups were similar. Perceptions of severity and COVID-19-related barriers significantly influenced health behaviors in LRG. In HRG, low security played a significant role, highlighting the importance of comorbidities as a clinical factor. Conclusions: In a semi-urban area, 2 crucial health behaviors were identified: one associated with low risk and the other with high risk. In the HRG, the perception of insecurity was particularly relevant, emphasizing the importance of comorbidities as a clinical factor.
Introducción: las intervenciones no farmacológicas (INF) o acciones preventivas (AP) contra enfermedades son la mejor alternativa para controlar futuras pandemias, en especial en poblaciones vulnerables, como las zonas semiurbanas. Objetivo: describir los grupos predominantes de conductas de salud (GCS) y los factores asociados durante la tercera ola de la COVID-19 en una zona semiurbana. Material y métodos: se aplicó una encuesta que incluyó las características, los factores relacionados con COVID-19, las percepciones de conductas de salud y las AP, en una muestra probabilística en un hospital de primer nivel del Estado de México. Se incluyeron personas de ambos sexos, mayores de 18 años. Mediante un análisis de conglomerados se caracterizaron los GCS con un análisis estadístico descriptivo y multivariado. Resultados: en una muestra probabilistica (n = 260), se identificaron cuatro GCS: 2 de riesgo alto de contagio por la COVID-19 (GRA) y 2 de riesgo bajo (GRB) y las proporciones fueron 43.5% y 56.5%, respectivamente. Las características sociodemográficas de los grupos fueron similares. Para los GRB los factores significativos fueron las percepciones sobre la severidad y las barreras relacionadas con la COVID-19. En los GRA fue la seguridad baja y destacó la importancia de la comorbilidad como factor clínico. Conclusiones: en una zona semiurbana se identificaron 2 conductas de salud de importancia: una de bajo riesgo y otra de alto riesgo. En el GRA, la percepción de seguridad baja fue especialmente relevante, lo cual resalta la importancia de las comorbilidades como factor clínico.
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COVID-19 , Conductas Relacionadas con la Salud , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , Femenino , Masculino , México/epidemiología , Adulto , Persona de Mediana Edad , Estudios Transversales , Adulto Joven , Anciano , Población Suburbana , Adolescente , Encuestas y CuestionariosRESUMEN
Nimodipine, an L-type cerebroselective calcium channel antagonist, is the only drug approved by the US Food and Drug Administration for the neuroprotection of patients with aneurysmal subarachnoid hemorrhage (aSAH). Four randomized, placebo-controlled trials of nimodipine demonstrated clinical improvement over placebo; however, these occurred before precision medicine with pharmacogenomics was readily available. The standard enteral dose of nimodipine recommended after aSAH is 60 mg every 4 h. However, up to 78% of patients with aSAH develop systemic arterial hypotension after taking the drug at the recommended dose, which could theoretically limit its neuroprotective role and worsen cerebral perfusion pressure and cerebral blood flow, particularly when concomitant vasospasm is present. We investigated the association between nimodipine dose changes and clinical outcomes in a consecutive series of 150 patients (mean age, 56 years; 70.7% women) with acute aSAH. We describe the pharmacogenomic relationship of nimodipine dose reduction with clinical outcomes. These results have major implications for future individualized dosing of nimodipine in the era of precision medicine.
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Bloqueadores de los Canales de Calcio , Nimodipina , Farmacogenética , Hemorragia Subaracnoidea , Humanos , Nimodipina/administración & dosificación , Nimodipina/efectos adversos , Hemorragia Subaracnoidea/tratamiento farmacológico , Hemorragia Subaracnoidea/genética , Hemorragia Subaracnoidea/complicaciones , Persona de Mediana Edad , Femenino , Masculino , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Anciano , Farmacogenética/métodos , Resultado del Tratamiento , Relación Dosis-Respuesta a Droga , Adulto , Medicina de Precisión/métodos , Vasoespasmo Intracraneal/tratamiento farmacológicoRESUMEN
Resumen Introducción: La disfunción inmunológica en el paciente críticamente enfermo es un compromiso de un sistema muy poco estudiado; adicionalmente, en la población infantil aún faltan guías que orienten la evaluación del sistema inmunológico. Objetivo: Determinar la asociación de disfunción inmunológica y los desenlaces en los pacientes que ingresan a la unidad de cuidado intensivo pediátrico. Materiales y método: Estudio observacional, con componente analítico, llevado a cabo durante cuatro años, en el que se revisaron los expedientes de todos los pacientes pediátricos consecutivos con estancia en la unidad de cuidados intensivos a quienes, por criterios médicos, se les realizó perfil inmunológico. Resultados: Durante el período de estudio se reportaron 188 pacientes quienes cumplieron con los criterios de inclusión. Se presentó disfunción inmunológica en el 83% de los casos y enfermedad cardiaca en el 65%. La disfunción inmunológica se asoció con peores desenlaces medidos en mortalidad (37 vs. 9%; p = 0.0021), tiempo de estancia mayor a 14 días (46 vs. 14%; p < 0.0001) y disfunción multiorgánica (72 vs. 25%; p < 0.0001). Conclusión: La disfunción inmunológica es frecuente en los pacientes que ingresan a la unidad de cuidado intensivo pediátrico y se asocia con un aumento de la mortalidad, la duración de la ventilación mecánica invasiva y la duración de la estancia en la unidad de cuidado intensivo pediátrico. Muchos factores se asociaron con el desarrollo de disfunción inmunológica en esta población. Se necesitan estudios prospectivos para dilucidar el manejo óptimo de la disfunción inmunológica en el paciente crítico.
Abstract Introduction: Immune dysfunction in critical patients has not been clearly defined and has been insufficiently researched, particularly in pediatrics. Guidelines to standardize the immune system assessment and for routine use in clinical practice are lacking. Objective: To determine the association between immune dysfunction (here understood as the reduction of immunoglobulins and/or of the absolute count or populations of lymphocytes) and the outcome of patients admitted to the pediatric intensive care unit. Materials and method: This was an observational, analytical, descriptive, retrospective study, conducted over four years. The records of all patients who were admitted to the pediatric intensive care unit and had an immunity profile done were included in the database. Demographic and clinical variables were compared between patients with and without immune dysfunction. Results: A total of 188 patients with an immune profile were identified; 83% of patients had immune dysfunction and 65% had heart disease. The presence of immune dysfunction was associated with worse outcomes measured in mortality (37 vs. 9% p = 0.0021), length of stay greater than 14 days (46 vs. 14%; p < 0.0001) and multiple organ dysfunction syndrome (72 vs. 25%; p < 0.0001). Conclusion: Immune dysfunction is frequent in patients with a difficult disease course and in our study sample. It was found to be associated with increased mortality, duration of invasive mechanical ventilation and length of stay in the pediatric intensive care unit. Further prospective studies with other biomarkers are needed to determine the immune compromise and its impact on outcomes in the critically ill children.
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The aim of this report is to describe TransOrbital NeuroEndoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus (CS) biopsy. We describe this technique in a patient with a diffuse large B cell lymphoma mimicking Tolosa-Hunt's syndrome. Articles were gathered querying PubMed, Embase, and Scopus databases with terms related to a "transorbital neuroendoscopic approach." The literature search was performed by two independent authors (N.L.F. and J.R.), with inconsistencies resolved by the senior author (M.M.D.V.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for 2 months. A brain magnetic resonance imaging revealed an infiltrative lesion at the left CS. A presumptive diagnosis of Tolosa-Hunt syndrome was made, but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report, the TONES approach was safe, effective for tissue diagnosis, and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.
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Cassava is a staple food used in many countries around the world, despite deficiencies in micronutrients such as provitamin A carotenoids. Unfortunately, improvement of the cassava nutritional content by use of conventional breeding is slow and difficult. Therefore, there is an urgent need to develop and standardize protocols using biotechnological tools to improve cassava. The Alliance of Biodiversity International and the International Center for Tropical Agriculture (CIAT) have worked on cassava genetic transformation over the last 30 years. Here, we describe, step by step, the procedures used for genetic transformation of cassava variety TMS60444, to improve carotenoids and other traits. This protocol includes stock setup, reagents, media preparation, materials, and equipment, for the genetic transformation of embryogenic tissues. The main expected output in publishing this protocol is to provide the basis for a reproducible and reliable method to genetically modify and/or gene edit Latin American and Asian cassava varieties.
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Manihot , Biotecnología , Carotenoides , Manihot/genética , Ingeniería Metabólica , FitomejoramientoRESUMEN
KEY MESSAGE: The overexpression of RXam2, a cassava NLR (nucleotide-binding leucine-rich repeat) gene, by stable transformation and gene expression induction mediated by dTALEs, reduce cassava bacterial blight symptoms. Cassava (Manihot esculenta) is a tropical root crop affected by different pathogens including Xanthomonas phaseoli pv. manihotis (Xpm), the causal agent of cassava bacterial blight (CBB). Previous studies have reported resistance to CBB as a quantitative and polygenic character. This study sought to validate the functional role of a NLR (nucleotide-binding leucine-rich repeat) associated with a QTL to Xpm strain CIO151 called RXam2. Transgenic cassava plants overexpressing RXam2 were generated and analyzed. Plants overexpressing RXam2 showed a reduction in bacterial growth to Xpm strains CIO151, 232 and 226. In addition, designer TALEs (dTALEs) were developed to specifically bind to the RXam2 promoter region. The Xpm strain transformed with dTALEs allowed the induction of the RXam2 gene expression after inoculation in cassava plants and was associated with a diminution in CBB symptoms. These findings suggest that RXam2 contributes to the understanding of the molecular basis of quantitative disease resistance.
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Manihot , Xanthomonas , Leucina , Manihot/genética , Nucleótidos , Enfermedades de las Plantas/microbiologíaRESUMEN
BACKGROUND: Adequate testing is critically important for control of the SARS-CoV-2 pandemic. Antibody testing is an option for case management and epidemiologic studies, with high specificity and variable sensitivity. However, characteristics of local populations may affect performance of these tests. For this reason, the National Institute of Health (INS) and regulatory agencies in Colombia require verification of diagnostic accuracy of tests introduced to the Colombian market. METHODS: We conducted a validation study of the Abbott SARS-CoV-2 test for qualitative detection of IgG using the Abbott Architect i2000SR. Participants and retrospective samples were included from patients with suspected SARS-CoV-2 infection, age ≥18 years, and ≥8 days elapsed since initiation of symptoms. Pre-pandemic plasma samples (taken before October 2019) were used as controls. We estimated the sensitivity, specificity and agreement (kappa) of the Abbott IgG test compared to the gold standard (RT-PCR). RESULTS: The overall sensitivity was 83.1% (95% CI: 75.4-100). Sensitivity among patients with ≥14 days since the start of symptoms was 85.7%, reaching 88% in samples collected from patients with COVID-19 symptoms onset >60 days. Specificity was 100% and the kappa index of agreement was 0.804 (95% CI: 0.642-0.965). CONCLUSIONS: Our findings show high sensitivity and specificity of the Abbott IgG test in a Colombian population, which meet the criteria set by the Colombian INS to aid in the diagnosis of COVID-19. Data from our patient groups also suggest that IgG response is detectable in a high proportion of individuals (88.1%) during the first two months following onset of symptoms.
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Anticuerpos Antivirales/sangre , Prueba Serológica para COVID-19/instrumentación , COVID-19/sangre , Inmunoglobulina G/sangre , Pandemias , SARS-CoV-2/metabolismo , Adulto , Anciano , COVID-19/epidemiología , Colombia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Resumen: Introducción: El objetivo de este estudio es determinar los procedimientos quirúrgicos más frecuentemente realizados en el Centro Médico Naval, un Centro Médico de Tercer Nivel. Material y métodos: Se realizó un estudio observacional, exploratorio, descriptivo, trasversal y retrospectivo incluyendo todas las cirugías realizadas del 01 de enero de 2015 al 31 de julio de 2019, consultando los registros del quirófano y los expedientes electrónicos. Resultados: Se registraron 25,114 cirugías, con un promedio anual de 5,527 procedimientos y de 16 procedimientos diarios (rango de 2 a 25). Las especialidades que más cirugías realizaron fueron cirugía general, ortopedia, ginecoobstetricia y oftalmología. Las principales cirugías realizadas fueron la facoemulsificación de catarata con colocación de lente intraocular, endoscopías, cesáreas, colecistectomía laparoscópica, atención del trabajo de parto, reducción abierta con fijación interna de fracturas, apendicectomía abierta, hernioplastía inguinal y lavados quirúrgicos. El 59% de las cirugías se realizó en mujeres. El rango de edad de los pacientes fue desde recién nacido hasta los 101 años, estando la mayoría entre los 53 y 72 años. Conclusiones: El Centro Médico Naval destina la mayoría de los recursos de su quirófano para la atención obstétrica (cesárea y trabajo de parto), la atención de padecimientos crónico-degenerativos (cirugía de catarata, y endoscopías), atención de accidentes (reducción de fracturas y lavados quirúrgicos) y la resolución de padecimientos abdominales agudos como la apendicitis y la colecistitis.
Abstract: Introduction: The study objective was to determine the most frequently surgical procedures at the Naval Medical Center, a third level medical center. Material and methods: An observational, exploratory, descriptive, cross-sectional and retrospective study was conducted including all surgeries performed from January 1, 2015 to July 31, 2019, reviewing the surgical records and patient electronic files. Results: 25,114 surgeries were registered, with an annual average of 5,527 procedures and 16 daily procedures (range from 2 to 25). General surgery, orthopedics, gynecoobstetrics and ophthalmology were the specialties with the most amount of surgeries. The main surgeries were cataract phacoemulsification with intraocular lens placement, endoscopies, caesarean sections, laparoscopic cholecystectomy, labor delivery, open reduction with internal fracture fixation, open appendectomy, inguinal hernioplasty and surgical washes. 59% of the surgeries were performed in women. The age range of the patients was from newborn to 101 years, with most patients between 53 and 72 years. Conclusions: The naval medical center spend surgical resources for obstetric care (caesarean section and labor), care of chronic degenerative diseases (cataract surgery, and endoscopy), accident care (fracture reduction and surgical washes) and the resolution of acute abdominal conditions such as appendicitis and cholecystitis.
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CASE: A 40-year-old Colombian woman presented with a 7-year history of progressive lower-limb pain. Sclerosis of the diaphyseal tibia and femur was observed in her latest x-ray images. A narrowing of the medullary canal is observed in Camurati-Engelmann disease (CED), a rare and progressive diaphyseal dysplasia that was confirmed in this patient by genetic testing. Medical treatment was unsuccessful; thus, surgical treatment consisted of decompression by drilling of the medullary canal was performed, achieving successful pain release. CONCLUSION: Surgical treatment should be considered for patients with CED when the medical treatment is unsuccessful because doing so reduces bone overgrowth, leading to pain relief.
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Síndrome de Camurati-Engelmann , Adulto , Síndrome de Camurati-Engelmann/diagnóstico por imagen , Síndrome de Camurati-Engelmann/genética , Síndrome de Camurati-Engelmann/cirugía , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Extremidad InferiorRESUMEN
BACKGROUND: The justification for this consensus is the absence of local protocols on Medication-Related Osteonecrosis of the Jaws (MONJ), for prevention, evaluation, and treatment, involving physicians and dentists, leading to suspension of antiresorptive treatments, despite their benefit in the prevention of fragility fractures (40-70%). These fractures cause disability and mortality (80% and 20-30%, respectively), as opposed to the low risk associated with MONJ in osteoporotic (0.01-0.03%) and oncological patients (1.3-1.8%). PURPOSE: To provide management recommendations through algorithms that guide health professionals to prevent, diagnose, and treat MONJ in different clinical scenarios. METHOD: A technical multidisciplinary team composed of specialists with extensive experience in osteoporosis or osteonecrosis of the jaw from Fundación Santa Fé (Bogotá, Colombia) and the Asociación Colombiana de Osteoporosis y Metabolismo Mineral was selected. Three rounds were carried out: definition of questions, answers using Delphi methodology, and the discussion of questions in order to have an agreement. The whole group participated in two phases, and the developer group in the total number of rounds. A literature review was conducted to obtain academic support to design questions with clinical relevance. RESULTS AND CONCLUSIONS: The consensus group generated definitions and recommendations useful for doctors and dentists, following clinical algorithms involving four scenarios: osteoporosis patient who requires dental procedures and has not received antiresorptives, osteoporosis patient who are under treatment with antiresorptives, cancer patients, and MONJ-instituted patients. The therapeutic approach in osteoporosis and cancer patients, in invasive dental procedures, must be relied on the risk-benefit treatment.
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Osteonecrosis , Algoritmos , Conservadores de la Densidad Ósea/efectos adversos , Colombia , Denosumab , Difosfonatos , Humanos , Enfermedades Maxilomandibulares , Osteonecrosis/inducido químicamente , Osteonecrosis/terapiaRESUMEN
This study describes the median average intake of calcium in a population in Bogota, Colombia. Approximations on the possible reasons of low intake are listed. INTRODUCTION: The International Osteoporosis Foundation (IOF) published in 2017 the Calcium Map. It is a review of the calcium intake of 74 countries, placing Colombia in the bottom three countries of the world, with a daily calcium intake of 297 mg per day. The present study determined the actual median average calcium intake of a sample from Bogota and described it using sociodemographic variables. METHODS: In 2019, 450 anonymous volunteers who agreed to fill out the IOF Calcium Calculator survey were recruited. Measures of frequencies and percentage for qualitative variables were used, along with measures of central tendency with averages and dispersion for quantitative variables. Insufficient daily calcium intake was determined according to age, gender, and overall. RESULTS: The median average intake was 726 mg/day. Population between 18 and 30 years old had the highest intake per day. There were no significant differences between genders: women had a median average calcium intake of 731 mg/day, and for men it was 717.5 mg/day. Intake was directly correlated with socioeconomic status. CONCLUSIONS: Calcium intake in Colombia is low according to the age requirements and it is proportional to the socioeconomic status. Medical societies and national government should create policies in order to educate the general public and increase the intake of calcium based on diet.
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Calcio/farmacología , Osteoporosis , Adolescente , Adulto , Calcio de la Dieta , Colombia/epidemiología , Dieta , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND: Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. METHODS: We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. RESULTS: The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40-94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were - 3.02 (1.23) at the lumbar spine and - 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. CONCLUSIONS: This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.
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Conservadores de la Densidad Ósea/uso terapéutico , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/epidemiología , Posmenopausia , Teriparatido/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Dolor de Espalda/tratamiento farmacológico , Densidad Ósea , Brasil/epidemiología , Colombia/epidemiología , Comorbilidad , Femenino , Glucocorticoides/uso terapéutico , Humanos , América Latina , México/epidemiología , Persona de Mediana Edad , Osteoporosis/epidemiología , Osteoporosis/etiología , Fracturas Osteoporóticas/etiología , Dimensión del Dolor , Prevalencia , Estudios Prospectivos , Calidad de Vida , Historia Reproductiva , Factores de Riesgo , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/etiología , Escala Visual AnalógicaRESUMEN
RESUMEN INTRODUCCIÓN: La ausencia congénita de vagina es una condición poco común, algunas causas son el síndrome de Mayer-Rokitansky-Kuster-Hauser y la insensibilidad periférica a los andrógenos. Múltiples técnicas quirúrgicas y no quirúrgicas se han descrito para el manejo de esta condición, siendo el objetivo principal la creación de un canal vaginal de diámetro y longitud adecuada que permitan restaurar la función coital. El objetivo de este estudio es detallar la experiencia del procedimiento de neovagina con la técnica quirúrgica de McIndoe en pacientes con Mayer-Rokitansky-Kuster-Hauser realizados en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. METODOLOGÍA: Reporte de 5 casos de pacientes con agenesia de vagina secundarios al síndrome de Mayer-Rokitansky-Kuster-Hauser, a las cuales se les realizó neovagina con la técnica de McIndoe con algunas modificaciones en el molde para el implante de piel. RESULTADOS: Se incluyeron cinco pacientes con diagnóstico de Mayer-Rokitansky-Kuster-Hauser, todas tenían desarrollo de características sexuales secundarias, perfil hormonal normal, y un cariotipo XX. Se utilizó la técnica quirúrgica de McIndoe para la realización de la neovagina sin complicaciones intraoperatorias asociadas y con adecuada evolución posoperatoria, con una longitud vaginal entre 7-9 cm y 3 pacientes con vida sexual activa. El tiempo de estancia hospitalaria fue 7 a 9 días. CONCLUSIÓN: La técnica quirúrgica de McIndoe es una opción para restaurar la función sexual en mujeres con agenesia vaginal con resultados favorables. El tiempo para decidir su realización es electivo, sin embargo, se debe contar con madurez física y emocional para ser llevado a cabo. Las pacientes de nuestro reporte tenían una edad promedio de 18 años.
SUMMARY INTRODUCTION: The congenital absence of the vagina is an uncommon condition, some causes are the Mayer-Rokitansky-Küster-Hauser syndrome and peripheral insensitivity to androgens. Multiple surgical and non-surgical techniques have been described for the management of this condition, being the main objective the creation of a vaginal canal of adequate diameter and length to restore coital function. The objective of this study is to detail the experience of the neovagina procedure with the McIndoe surgical technique performed in patients with Mayer-Rokitansky-Küster-Hauser syndrome at the Clinica Universitaria Bolivariana. METHODOLOGY: Report of five cases of patients with vaginal agenesis secondary to the Mayer-Rokitansky-Kuster-Hauser syndrome, who underwent neovagina with the McIndoe technique and some modifications in the mold for the skin implant. RESULTS: Five patients with diagnosis of Mayer-Rokitansky-Kuster-Hauser were included, all had development of secondary sexual characteristics, normal hormonal profile, and a XX karyotype. The McIndoe surgical technique was used to perform the neovagina without associated intraoperative complications and with adequate postoperative evolution, with a vaginal length between 7-9 cm and three patients with active sexual life. The length of hospital stay was 7 to 9 days. CONCLUSION: The McIndoe surgical technique is an option to restore sexual function in women with vaginal agenesis with favorable results. The time to decide its realization is elective, however, they must have the physical and emotional maturity to be carried out. The patients in our report have an average age of 18 years.
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Humanos , Femenino , Adolescente , Adulto , Anomalías Congénitas/cirugía , Anomalías Congénitas/diagnóstico , Anomalías Congénitas/genética , Vagina/cirugía , Procedimientos Quirúrgicos Ginecológicos , Vagina/anomalías , Estructuras Creadas Quirúrgicamente , Trastornos del Desarrollo Sexual 46, XX/cirugía , Conductos Paramesonéfricos/anomalíasRESUMEN
Abstract Background: Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. Methods: We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. Results: The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40-94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were - 3.02 (1.23) at the lumbar spine and - 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. Conclusions: This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Osteoporosis/tratamiento farmacológico , Posmenopausia , Teriparatido/uso terapéutico , Conservadores de la Densidad Ósea/uso terapéutico , Fracturas Osteoporóticas/epidemiología , Osteoporosis/etiología , Osteoporosis/epidemiología , Argentina/epidemiología , Calidad de Vida , Dimensión del Dolor , Brasil/epidemiología , Densidad Ósea , Comorbilidad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/epidemiología , Dolor de Espalda/tratamiento farmacológico , Historia Reproductiva , Colombia/epidemiología , Fracturas Osteoporóticas/etiología , Escala Visual Analógica , Glucocorticoides/uso terapéutico , América Latina , México/epidemiologíaRESUMEN
Introducción: la prevalencia de la osteoporosis aumenta con la edad, así como la morbimortalidad secundaria a fracturas por fragilidad impactando los costos en salud. Las estrategias creadas han mejorado la detección y manejo de las fracturas. Objetivo: describir las características clínicas de los pacientes con fracturas por fragilidad y su manejo en el Hospital de San José de Bogotá de febrero 2015 a julio 2016, luego de establecer un programa de identificación y prevención de fracturas. Métodos: estudio descriptivo de corte transversal. Se evaluaron las historias clínicas con diagnóstico de osteoporosis severa, analizando las características demográficas, clínicas y tratamiento recibido. Resultados: de 621 pacientes con diagnóstico de osteoporosis y fracturas asociadas, 184 cumplieron los criterios de inclusión. La edad media fue de 71.5 años (DE: 11,6). Las localizaciones más frecuentes fueron radio distal 36%, vertebrales 34%, fémur proximal 18% y otras 11%. El 30% tenían diagnóstico de osteoporosis, de ellos 30% recibieron tratamiento completo antes de la fractura y 57,6% posterior. Conclusión: las fracturas por fragilidad son frecuentes en osteoporosis, aunque hay subdiagnóstico y subtratamiento. La prevención de la segunda fractura se refleja en el aumento del número de pacientes que recibieron tratamiento adecuado, demostrando la necesidad de crear programas de educación.
Introduction: the prevalence of osteoporosis increases with aging, as well as, morbidity and mortality secondary to fragility fractures, impacting costs of healthcare. New strategies have enhanced fragility fractures detection and management. Objective: to describe the clinical features of patients with fragility fractures and their management at Hospital de San José, Bogotá, from February 2015 to July 2016, after establishing a fracture identification and prevention program. Methods: a cross sectional descriptive study. Clinical records of patients diagnosed with severe osteoporosis were reviewed. Demographic and clinical characteristics and treatment outcomes were analyzed. Results: out of 621 patients with osteoporosis-related fractures, 184 met the inclusion criteria. Mean age was 71.5 years (SD: 11.6). Fractures affected the distal radius in 36%, vertebrae in 34%, proximal femur in 18% and other sites in 11%. Osteoporosis was diagnosed in 30% of patients of which 30% received complete treatment for osteoporosis prior to fracture and 57.6% after fracture. Conclusions: fragility fractures are usually associated with osteoporosis, although there is underdiagnosis and under-treatment. Prevention of a future fracture is reflected in the increasing number of patients who received appropriate treatment, demonstrating the need to create education programs.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Fracturas Óseas , Fracturas Osteoporóticas , Osteoporosis , Deficiencia de Vitamina D , HuesosRESUMEN
INTRODUCTION: The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients.Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. PATIENTS AND METHOD: Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen. RESULTS: 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) < 90 mmHg at admission (p = 0.0126; RR = 5.19), drop in hemoglobin (Hb) > 2 g/dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. CONCLUSIONS: Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP < 90 mmHg at admission, an Hb fall > 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.
Asunto(s)
Tratamiento Conservador , Hígado/lesiones , Bazo/lesiones , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/terapia , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Pronóstico , Estudios Retrospectivos , Insuficiencia del Tratamiento , Heridas no Penetrantes/fisiopatologíaRESUMEN
Introducción: El manejo no operatorio (MNO) es el manejo estándar del trauma cerrado esplénico y hepático en el paciente pediátrico. Se han identificado como fallas a este manejo inestabilidad hemodinámica y transfusiones masivas. Pocos trabajos evalúan si existen factores que permitan una anticipación a estos eventos. El objetivo fue determinar la existencia de factores asociados a la falla en MNO de las lesiones esplénicas y/o hepáticas secundarias al trauma abdominal cerrado. Pacientes y Método: Análisis retrospectivo 2007 a 2015 de los pacientes que ingresaron al servicio de Cirugía infantil del Hospital Universitario San Vicente Fundación con trauma hepático y/o esplénico cerrado. Resultados: Ingresaron 70 pacientes con trauma cerrado de abdomen, 3 fueron excluidos por cirugía inmediata (2 inestabilidad hemodinámica y 1 irritación peritoneal). De 67 pacientes que recibieron MNO, 58 tuvieron éxito y 9 presentaron falla (8 inestabilidad hemodinámica y 1 lesión de víscera hueca). Encontramos 3 factores asociados a la falla MNO: presión arterial (PAS) < 90 mmHg al ingreso (p=0,0126; RR =5,19), caída de la Hemoglobina (Hb) > 2 g/dl en las primeras 24 h (p=0,0009; RR= 15,3), y transfusión de 3 o más unidades de glóbulos rojos (UGR) (0,00001; RR= 17,1). Mecanismo del trauma, severidad e Índice de Trauma Pediátrico no se asociaron con fallo MNO. Conclusiones: Los niños con trauma cerrado hepático o esplénico responden al MNO. Los factores como PA menor de 90 al ingreso, caída de la Hb >2 g/dl en las primeras 24 h y la transfusión de 3 o más UGR pueden asociarse con la falla en el MNO.
Introduction: The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients.Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. Patients and Method: Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen. Results: 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) < 90 mmHg at admission (p = 0.0126; RR = 5.19), drop in hemoglobin (Hb) > 2 g/dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Conclusions: Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP < 90 mmHg at admission, an Hb fall > 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Bazo/lesiones , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/terapia , Tratamiento Conservador , Hígado/lesiones , Pronóstico , Heridas no Penetrantes/fisiopatología , Estudios Retrospectivos , Estudios de Seguimiento , Insuficiencia del TratamientoRESUMEN
The importance of cassava as the fourth largest source of calories in the world requires that contributions of biotechnology to improving this crop, advances and current challenges, be periodically reviewed. Plant biotechnology offers a wide range of opportunities that can help cassava become a better crop for a constantly changing world. We therefore review the state of knowledge on the current use of biotechnology applied to cassava cultivars and its implications for breeding the crop into the future. The history of the development of the first transgenic cassava plant serves as the basis to explore molecular aspects of somatic embryogenesis and friable embryogenic callus production. We analyze complex plant-pathogen interactions to profit from such knowledge to help cassava fight bacterial diseases and look at candidate genes possibly involved in resistance to viruses and whiteflies-the two most important traits of cassava. The review also covers the analyses of main achievements in transgenic-mediated nutritional improvement and mass production of healthy plants by tissue culture and synthetic seeds. Finally, the perspectives of using genome editing and the challenges associated to climate change for further improving the crop are discussed. During the last 30 yr, great advances have been made in cassava using biotechnology, but they need to scale out of the proof of concept to the fields of cassava growers.