RESUMEN

Background: The quality of the spirometry is estimated with criteria of acceptability and repeatability. The repeatability criteria accepted by consensus is < 0.150 L. Objective: To know the repeatability in quality A spirometry. Material and methods: Analytical cross-sectional design. The demographic variables and the 3 best spirometry curves with normal, suggestive of restriction and bronchial obstruction profiles were obtained from consecutive subjects of both genders from 18 to 80 years of age. The repeatability was analyzed with the mean difference (bias) and the intraclass correlation coefficient. Results: 630 curves from 210 subjects were accepted. Group age 60 ± 15 years. Female predominance 113 (53.8%), occupation: domestic services 61 (29%), and diagnosed with chronic obstructive pulmonary disease: 70 (33.4%). The differences in the curves were < 0.150 L. The mean difference (bias) and the intraclass correlation coefficient (95% confidence interval, 95% CI) of the forced expiratory volume in the first second were 1 vs. 2 maneuver: -0.01 (0.13, -0.14), 0.997 (95% CI 0.996, 0.998); 2 vs. 3 maneuver: 0.00 (0.13, -0.13), 0.997 (95% CI 0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.16, -0.17), 0.995 (95% CI 0.994, 0.996). Forced vital capacity: 1 vs. 2 maneuver: -0.01 (0.17, -0.18), 0.996 (95% CI 0.995, 0.997); 2 vs. 3 maneuver: 0.01 (0.17, -0.16), 0.997 (95% CI 0.0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.18, -0.19), 0.996 (95% CI 0.995, 0.997). Conclusion: The repeatability obtained in spirometry with quality A validates the use of the repeatability criterion of 0.150 L.

Introducción: la calidad de la espirometría se estima con criterios de aceptabilidad y repetitividad. La repetitividad aceptada por consenso es < 0.150 L. Objetivo: conocer la repetitividad en espirometrías de calidad A. Material y métodos: diseño transversal analítico. Se obtuvieron las variables demográficas y las 3 mejores curvas de espirometría con perfil normal, que sugiriera restricción y obstrucción bronquial de sujetos consecutivos de ambos géneros de 18 a 80 años. La repetitividad se analizó con la diferencia de medias (sesgo) y el coeficiente de correlación intraclase. Resultados: se aceptaron 630 curvas de 210 sujetos. Edad grupal 60 ± 15 años. Predominio femenino 113 (53.8%), ocupación: servicios domésticos 61 (29%) y con enfermedad pulmonar obstructiva crónica 70 (33.4%). Las diferencias en las curvas fueron < 0.150 L. Las diferencias medias (sesgo) y el coeficiente de correlación intraclase (intervalo de confianza al 95%, IC 95%) del volumen espiratorio forzado en el primer segundo fueron: maniobra 1 frente a 2: −0.01 (0.13, −0.14), 0.997 (IC 95% 0.996, 0.998); maniobra 2 frente a 3: 0.00 (0.13, −0.13), 0.997 (IC 95% 0.996, 0.998), y maniobra 1 frente a 3: −0.00 (0.16, −0.17), 0.995 (IC 95% 0.994, 0.996). La capacidad vital forzada: maniobra 1 frente a 2: −0.01 (0.17, −0.18), 0.996 (IC 95% 0.995, 0.997); maniobra 2 frente a 3: 0.01 (0.17, −0.16), 0.997 (IC 95% 0.0.996, 0.998), y maniobra 1 frente a 3: −0.00 (0.18, −0.19), 0.996 (IC 95% 0.995, 0.997). Conclusión: la repetitividad obtenida en espirometrías con calidad A valida el uso del criterio de repetitividad de 0.150 L.

Asunto(s)

RESUMEN

Objective: To examine the areas of the maxillary tuberosity (MT) (coronal, apical, width, and height) with respect to the presence or absence of the third molar to establish possible anatomical limitations for molar distalization. Methods: A total of 277 tuberosities were evaluated through sagittal computed tomography (CT) images, divided for measurement into coronal (free of bone), apical (area of influence of the maxillary sinus), and tuberosity (bony area) zones, and stratified by the presence or absence of the third molar, sex, and two age subgroups. Mann-Whitney U test was used to compare the groups considering the third molar. Results: The medians of the width and height of the tuberosity decreased significantly in the absence of the third molar (P < 0.001). The apical area also showed differences, with negative values in the absence of the third molar and positive values in the presence of the third molar (P < 0.001). However, no differences were observed for the coronal area (P > 0.05). Conclusions: In the absence of the third molar, the size of the MT, represented by its width and height, was smaller and negative values (decrease) were observed for the maxillary sinus. The sagittal CT provides useful information regarding the amount of bone tissue available for distalization and relationship of the second molar with respect to the maxillary sinus, which allows individualizing each case in relation to the amount and type of movement expected.

RESUMEN

In the context of pancreatic cancer, surgical intervention is typically recommended for localized tumours, whereas chemotherapy is the preferred approach in the advanced and/or metastatic setting. However, pancreatic cancer is closely linked to ageing, with an average diagnosis at 72 years. Paradoxically, despite its increased occurrence among older individuals, this population is often underrepresented in clinical studies, complicating the decision-making process. Age alone should not determine the therapeutic strategy but, given the high comorbidity and mortality of this disease, a comprehensive geriatric assessment (CGA) is necessary to define the best treatment, prevent toxicity, and optimize older patient care. In this review, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica, SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours (Grupo Español de Tratamiento de los Tumores Digestivos, TTD), and the Multidisciplinary Spanish Group of Digestive Cancer (Grupo Español Multidisciplinar en Cáncer Digestivo, GEMCAD) have assessed the available scientific evidence and propose a series of recommendations on the management and treatment of the older population with pancreatic cancer.

Asunto(s)

RESUMEN

Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica-SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón-GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres-ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations.

Asunto(s)

RESUMEN

Abstract Introduction: At present, few studies conducted in Latin America have addressed the demographic, clinical, and laboratory characteristics of patients with COVID-19 and intensive care unit (ICU) admission requirement. Objective: To compare the sociodemographic, clinical, imaging, and laboratory characteristics of patients diagnosed with COVID -19 and treated in the emergency department of a hospital in Cali, Colombia, based on ICU admission requirement. Materials and methods: Retrospective and descriptive single cohort study conducted in 49 adults with COVID-19 treated in the emergency department of a quaternary care hospital in Cali (Colombia) between March and April 2020. Patients were divided into two groups: ICU admission requirement (n=24) and non-ICU admission requirement (n=25). Bivariate analyses were performed to determine differences between groups (chi-square, Fisher's exact, Student's t, and Mann-Whitney U tests), with a significance level of p<0.05. Results: Participants' mean age was 53 years (SD=13) and 29 patients were men. Significant differences were found between groups in the following variables: mean age (ICU x̅ =58 vs. Non-ICU x̅ =49; p=0.020), presence of diabetes (8 vs. 1; p=0.010); presence of respiratory distress (20 vs. 11; p=0.007) ; unilateral or bilateral presence of areas of consolidation (12 vs. 3; p=0.005); median leukocyte (Med=7 570/mm3 vs. Med=5 130/mm3; p=0.0013), neutrophil (Med=5 980/mm3 vs. Med=3 450/mm3; p=0.0001) and lymphocyte (Med=865/mm3 vs. Med=1 400/mm3; p<0.0001) count; median C-reactive protein (Med=141,25mg/L vs. Med=27.95mg/L; p<0.001), ferritin (Med=1038ng/L vs. Med=542.5ng/L; p=0.0073) and lactate dehydrogenase (Med=391U/L vs. Med=248.5U/L, p=0.0014) levels. Finally, 15 patients required invasive mechanical ventilation, 2 presented with extubation failure, and 5 died. Conclusions. Significant differences were observed in the values of several inflammatory markers, cellular damage and complete blood count parameters between patients who required admission to the ICU and those who did not, so these variables could be used to develop tools that contribute to establishing the prognosis of this disease.

Resumen Introducción. Actualmente hay pocos estudios en Latinoamérica sobre las características demográficas, clínicas y de laboratorio de pacientes con COVID-19 y con requerimiento de ingreso a la unidad de cuidados intensivos (UCI). Objetivo. Comparar las características sociodemográficas, clínicas, imagenológicas y de laboratorio de pacientes diagnosticados con COVID-19 atendidos en el servicio de urgencias de una clínica en Cali, Colombia, según requerimiento de ingreso a UCI. Materiales y métodos. Estudio retrospectivo descriptivo de cohorte única realizado en 49 adultos con COVID-19 atendidos en el servicio de urgencias de un hospital de cuarto nivel de atención de Cali entre marzo y abril de 2020, los cuales se dividieron en dos grupos: requerimiento de ingreso a UCI (n=24) y no requerimiento de ingreso a UCI (n=25). Se realizaron análisis bivariados para determinar las diferencias entre ambos grupos (pruebas de chi-cuadrado, exacta de Fisher, t de Student y U de Mann-Whitney), con un nivel de significancia de p<0.05. Resultados. La edad promedio fue 53 años (DE=13) y 29 pacientes fueron hombres. Se encontraron diferencias significativas entre ambos grupos en las siguientes variables: edad promedio (UCI x̅ =58 vs. No UCI x̅=49; p=0.020); presencia de diabetes (8 vs. 1; p=0.010); presencia de dificultad respiratoria (20 vs. 11; p=0.007); presencia uni o bilateral de áreas de consolidación (12 vs. 3; p=0.005), y mediana del conteo de leucocitos (Med=7 570/mm3 vs. Med=5 130/mm3; p=0.0013), neutrófilos (Med=5 980/mm3 vs. Med=3 450/mm3; p=0.0001), linfocitos (Med=865/mm3 vs. Med=1 400/mm3; p<0.0001), proteína C reactiva (Med=141.25 mg/L vs. Med=27.95 mg/L; p<0.001), ferritina (Med=1038 ng/L vs. Med=542.5 ng/L; p=0.0073) y lactato-deshidroge-nasa (Med=391 U/L vs. Med=248.5 U/L; p=0.0014). Finalmente, 15 pacientes requirieron ventilación mecánica invasiva, 2 presentaron extubación fallida y 5 fallecieron. Conclusiones. Se observaron diferencias significativas en los valores de varios marcadores inflamatorios, daño celular y parámetros del hemograma entre los pacientes que requirieron admisión a la UCI y los que no, por lo que estas variables podrían emplearse para desarrollar herramientas que contribuyan a establecer el pronóstico de esta enfermedad.

RESUMEN

OBJECTIVE: To identify and summarize the processes implemented and the  activities performed by community and hospital-based pharmacists during the  COVID­19 pandemic. METHOD: A scoping review was carried out of the PubMed/Medline database  with the aim of identifying articles published until 30 June 2021. The PRISMA  recommendations for this type of review were followed. The articles included  were reviewed and classified according to their main characteristics and  outcomes, according to population, concept and context. The processes and  activities identified were grouped into three categories: those performed in  community and hospital pharmacies, those performed essentially in community  pharmacies, and those performed essentially in hospital  pharmacies. RESULTS: A total of 629 articles were identified, of which 454 were excluded  because they were unrelated to the object of the review and 81 due to meeting  the exclusion criteria. So, 94 articles were included in the analysis.  Most studies were conducted in Europe and the United States. During the  COVID­19 pandemic, the processes implemented and the activities carried out  in both community and hospital-based pharmacies included pharmaceutical  care, efficient and timely management of services, information and education,  psychological support, pharmacovigilance and telepharmacy. Processes  implemented and activities carried out essentially in community pharmacies  were those related to the detection recommendations, and drug indications.  Finally, processes and activities essentially occurring in hospital pharmacies  included those related to participation in drug treatment research, drug  evaluation and guidelines development, and to managing off-label drugs. CONCLUSIONS: During the COVID­19 crisis, pharmacists have led and implemented processes aimed at mitigating the impact of the pandemic on  the population´s health. Pharmaceutical care, efficient and  timely management of services, information and education, psychological  support, pharmacovigilance and telepharmacy, both in community and hospital pharmacies, are the main processes implemented by pharmacists  during the COVID­19 pandemic. These processes and activities, in addition to contributing to the control, prevention and effective and safe treatment of  COVID­19; have ensured the implementation of biosecurity measures, proper  dispensing of medication, the drug rational use, and the provision of evidence- based information and education.

OBJETIVO: Identificar y sintetizar los procesos y actividades realizados por el  farmacéutico en la farmacia comunitaria y hospitalaria durante la pandemia por  COVID-19.Método: Revisión sistemática exploratoria en PubMed/Medline de artículos publicados hasta el 30 de junio de 2021, siguiendo las  recomendaciones PRISMA para este tipo de revisiones. Los artículos incluidos  se clasificaron según sus principales características y resultados, acorde con la  estructura: población, concepto y contexto. Los procesos y las actividades  identificados se agruparon en tres categorías: realizados en farmacia  comunitaria y hospitalaria, llevados a cabo esencialmente en farmacia  comunitaria y realizados esencialmente en farmacia hospitalaria. RESULTADOS: Se identificaron 629 artículos, de los cuales se excluyeron 454  por no estar en relación con el objeto de la revisión y 81 por los criterios de  exclusión; por tanto, se incluyeron 94 en la revisión y análisis. La mayoría de  los estudios se desarrollaron en Europa y Estados Unidos. Entre los procesos y  actividades llevados a cabo por el farmacéutico durante la pandemia, tanto en  farmacia comunitaria como en hospitalaria, destacaron: atención farmacéutica,  gestión eficiente y oportuna de los servicios, información y  educación, apoyo psicológico, farmacovigilancia y telefarmacia. En farmacia  comunitaria destacaron también los relacionados con la detección de COVID-19  y derivación de pacientes, inmunización en farmacias, recomendaciones de  cuidados en el hogar e indicación farmacéutica. Entre los procesos  realizados esencialmente en farmacia hospitalaria destacaron los relacionados  con la participación en investigaciones de tratamientos farmacológicos,  desarrollo de guías de utilización de medicamentos basadas en evidencia y  manejo de medicamentos en indicaciones no aprobadas. CONCLUSIONES: Durante la pandemia por COVID-19, los farmacéuticos han  liderado e implantado procesos orientados a mitigar su impacto en la salud de  la población. Atención farmacéutica, gestión eficiente y oportuna de los  servicios, información y educación, apoyo psicológico, farmacovigilancia y  telefarmacia fueron los principales procesos y actividades realizados en  farmacia comunitaria y hospitalaria durante la pandemia por COVID-19. Dichos  procesos y actividades buscaron, además de contribuir al control,  prevención y tratamiento efectivo y seguro de la COVID-19, asegurar la  implantación de medidas de bioseguridad, la dispensación y uso adecuado de  los medicamentos y la información y educación basadas en la mejor evidencia  disponible.

Asunto(s)

RESUMEN

Introduction: Hospitalized patients with systemic autoimmune rheumatic diseases (SARDs) generate high impact in clinical terms. Objectives: To characterize the study population and estimate risk factors associated with the presence of adverse outcomes in hospitalized patients consulting rheumatology at Clínica Imbanaco between January 2013 and December 2019. Methods: We analyzed a historical cohort of hospitalized patients who were evaluated by rheumatology. The population was classified as follows: group 1, patients with new onset diagnosed SARDs; group 2, patients with known diagnosed SARDs; group 3, patients without diagnosed SARDs; and group 4, patients with unconfirmed suspicion of SARDs. A composite adverse outcome was defined if at least one of the following occurred: (1) hospital mortality, (2) admission to the intensive care unit, (3) hospital infection, or (4) readmission. Results: Information was collected from 327 hospitalization events (307 patients). The median age was 48 (34-63) years and 222 (72.3%) were women. The composite adverse outcome occurred in 136 (41.5%) hospitalization events. Group 2 had the highest number of adverse outcomes (61/128; 47.6%). The variables associated with the worst outcomes were cardiovascular diagnosis at admission (OR = 4.63; CI: 1.60-13.43; p = 0.005), longer hospital stay (OR = 1.04; CI: 1.01-1.07; p = 0.005), and a treating specialty other than internal medicine (OR = 2.79; CI: 1.26-6.17; p = 0.011). Male sex (OR = 0.29; CI: 0.12-0.66; p = 0.004), having special health coverage (OR = 0.39; CI: 0.15-.099; p = 0.047), and hemoglobin > 11.4 g/dL (OR = 0.82; CI: 0.69-0.99; p = 0.039) were the factors associated with lower odds of developing the composite outcome. Conclusions: In this historical cohort, the group of patients with known diagnosed SARDs presented a higher number in percentage terms of adverse outcomes. The most frequent adverse outcomes were admission to the ICU and hospital readmission.

Introducción: Los pacientes hospitalizados con enfermedades reumáticas o autoinmunes sistémicas (ERAS) generan gran impacto en términos clínicos. Objetivos: Caracterizar a la población y estimar factores de riesgo asociados con la presencia de desenlaces adversos en pacientes evaluados hospitalariamente por reumatología en la Clínica Imbanaco durante los arios 2013-2019. Metodología: Se analizó una cohorte histórica de pacientes hospitalizados que fueron evaluados por reumatología. La población se clasificó así: grupo 1, pacientes con ERAS diagnosticada de novo; grupo 2, pacientes con ERAS diagnosticada conocida; grupo 3, pacientes sin ERAS diagnosticada; y grupo 4, pacientes con sospecha no confirmada de ERAS. Se definió un desenlace adverso compuesto si se presentó al menos uno de los siguientes casos: 1) mortalidad hospitalaria; 2) ingreso a la unidad de cuidado intensivo; 3) infección intrahospitalaria; 4) reingreso. Resultados: En un total de 327 eventos de hospitalización (307 pacientes), la mediana de edad fue 48 (34-63) años y 222 (72,3%) fueron mujeres. El desenlace adverso compuesto se presentó en 136 (41,5%) eventos. El grupo 2 tuvo mayor número de desenlaces adversos (61/128; 47,6%). Las variables asociadas con peores resultados fueron: diagnóstico inicial cardiovascular (OR = 4,63; IC: 1,60-13,43; p = 0,005), mayor estancia hospitalaria (OR = 1,04; IC: 1,01-1,07; p = 0,005) y tener una especialidad tratante diferente a medicina interna (OR = 2,79; IC: 1,266,17; p = 0,011). El sexo masculino (OR = 0,29; IC: 0,12-0,66; p = 0,004), pertenecer a un régimen especial de salud (OR = 0,39; IC: 0,15-0,99; p = 0,047) y tener hemoglobina > 11,4 g/dL (OR = 0,82; IC: 0,69-0,99; p = 0,039) fueron factores asociados con menor oportunidad de desarrollar el desenlace compuesto. Conclusiones: En esta cohorte histórica se encontró que porcentualmente el grupo de pacientes con ERAS diagnosticadas conocidas presentó mayor número de desenlaces adversos, entre los que se destacan para el mismo grupo, el ingreso a UCI y el reingreso hospitalario.

Asunto(s)

RESUMEN

Background: The 6-minute walk test assesses the ability to perform exercise and it is widely used, of low cost, and of diverse variability. Objective: To define the usefulness of a second 6-minute walk test performed 30 minutes from the first. Material and methods. Material and methods: An observational, longitudinal and analytical study was carried out in subjects born and inhabitants from Mexico City, both genders, without cardiopulmonary disease. Their demographic variables were recorded. Differences were calculated with the t test for independent groups and variability with the Bland-Altman statistic; its magnitude, with the intraclass correlation coefficient and 95% confidence intervals (95% CI). A p < 0.05 was considered significant. Results: 200 tests from 100 subjects were studied. Average age was 36 ± 11 years. Body mass index average was 24.71 ± 3.24 kg/m2. 43 subjects were male (43%). The most frequent activity was arts and crafts in 38 (38%). Only 55 subjects (55%) increased by 24 the number of meters walked in the second test. Total of meters walked on walk 1 vs. 2 were: 437.65 ± 48.84 vs. 441.62 ± 11.49. Mean difference (bias) was of -4 (57.9, -65.9) and intraclass correlation coefficient of 0.800 (95% CI, 0.717-0.861). Conclusions: The 6-minute walk test is reproducible with wide variability. These results suggest to do only one 6-minute walk test.

Introducción: la prueba de caminata de seis minutos evalúa la capacidad para hacer ejercicio y es de amplio uso, bajo costo y variabilidad diversa. Objetivo: definir la utilidad de una segunda prueba de caminata de seis minutos realizada a 30 minutos de la primera. Material y métodos: se llevó a cabo un estudio observacional, longitudinal y analítico de sujetos nacidos y habitantes de la Ciudad de México, de ambos géneros, sin enfermedad cardiopulmonar. Se registraron sus variables demográficas. Las diferencias se calcularon con la prueba t para grupos independientes y la variabilidad con el estadístico de Bland-Altman; su magnitud, con el coeficiente de correlación intraclase e intervalos de confianza del 95% (IC 95%). Una p < 0.05 se consideró significativa. Resultados: se estudiaron 200 pruebas de 100 sujetos. La edad promedio fue de 36 ± 11 años. La media del índice de masa corporal fue 24.71 ± 3.24 kg/m2. Fueron 43 hombres (43%). La actividad más frecuente fueron las artes y los oficios en 38 (38%). Solo en 55 (55%) incrementaron en 24 los metros caminados en la segunda prueba. Los metros caminados totales de la caminata 1 frente a la 2 fueron 437.65 ± 48.84 frente a 441.62 ± 11.49. La diferencia media (sesgo) fue de −4 (57.9, −65.9) y el coeficiente de correlación intraclase de 0.800 (IC 95% 0.717-0.861). Conclusiones: la prueba de caminata de seis minutos es reproducible con variabilidad amplia. Estos resultados sugieren realizar solo una prueba de caminata de seis minutos.

Asunto(s)

RESUMEN

Introducción: la prueba de caminata de seis minutos evalúa la capacidad para hacer ejercicio y es de amplio uso, bajo costo y variabilidad diversa. Objetivo: definir la utilidad de una segunda prueba de caminata de seis minutos realizada a 30 minutos de la primera. Material y métodos: se llevó a cabo un estudio observacional, longitudinal y analítico de sujetos nacidos y habitantes de la Ciudad de México, de ambos géneros, sin enfermedad cardiopulmonar. Se registraron sus variables demográficas. Las diferencias se calcularon con la prueba t para grupos independientes y la variabilidad con el estadístico de BlandAltman; su magnitud, con el coeficiente de correlación intraclase e intervalos de confianza del 95% (IC 95%). Una p < 0.05 se consideró significativa. Resultados: se estudiaron 200 pruebas de 100 sujetos. La edad promedio fue de 36 ± 11 años. La media del índice de masa corporal fue 24.71 ± 3.24 kg/m2. Fueron 43 hombres (43%). La actividad más frecuente fueron las artes y los oficios en 38 (38%). Solo en 55 (55%) incrementaron en 24 los metros caminados en la segunda prueba. Los metros caminados totales de la caminata 1 frente a la 2 fueron 437.65 ± 48.84 frente a 441.62 ± 11.49. La diferencia media (sesgo) fue de −4 (57.9, −65.9) y el coeficiente de correlación intraclase de 0.800 (IC 95% 0.717-0.861). Conclusiones: la prueba de caminata de seis minutos es reproducible con variabilidad amplia. Estos resultados sugieren realizar solo una prueba de caminata de seis minutos

Background: The 6-minute walk test assesses the ability to perform exercise and it is widely used, of low cost, and of diverse variability. Objective: To define the usefulness of a second 6-minute walk test performed 30 minutes from the first. Material and methods: An observational, longitudinal and analytical study was carried out in subjects born and inhabitants from Mexico City, both genders, without cardiopulmonary disease. Their demographic variables were recorded. Differences were calculated with the t test for independent groups and variability with the Bland-Altman statistic; its magnitude, with the intraclass correlation coefficient and 95% confidence intervals (95% CI). A p < 0.05 was considered significant. Results: 200 tests from 100 subjects were studied. Average age was 36 ± 11 years. Body mass index average was 24.71 ± 3.24 kg/m2. 43 subjects were male (43%). The most frequent activity was arts and crafts in 38 (38%). Only 55 subjects (55%) increased by 24 the number of meters walked in the second test. Total of meters walked on walk 1 vs. 2 were: 437.65 ± 48.84 vs. 441.62 ± 11.49. Mean difference (bias) was of −4 (57.9, −65.9) and intraclass correlation coefficient of 0.800 (95% CI, 0.717-0.861). Conclusions: The 6-minute walk test is reproducible with wide variability. These results suggest to do only one 6-minute walk test

Asunto(s)

RESUMEN

Pharmacists play a vital role in public health during the COVID-19 pandemic. In this chapter, we present the most significant contributions that pharmacists could make to communitarian and hospital settings. It includes the provision of essential services, such as continuous access to medication and supplies, support to medical services, education and information to the population and the health team to reduce the misuse of medications, patient monitoring and follow-up, and the detection and referral of suspected cases of COVID-19. The chapter ends with a discussion over certain elements related to innovation needs, such as telepharmacy services.

Asunto(s)

RESUMEN

Colombia confirmed its first case of the COVID-19 on March 6th, 2020. On March 16th, 2020, 54 cases have been confirmed (36 imported and 18 associated), therefore, Colombia is at highest alert, and it is now trying to avoid or minimize the last stage of "community transmission". We present a route proposal that shows how the community pharmacist may develop his responsibility to contribute to the early detection and appropriate referral of possible cases of the COVID-19. In the route have been considered three possible entrances depending on the needs of the users: anti-flu drugs, symptoms related to COVID-19 infection or the request for items for hygiene and prevention of transmission such as alcohol and face masks. Later, self-care education should be given, and the possible cases should be reported to the telephone lines designated by the mayor or the governor, continuing the healthcare process. Community pharmacies and pharmacy staff play a crucial role in minimizing the stage of "community transmission" of COVID-19, through properly detection and management of possible cases and customer education.

Asunto(s)

RESUMEN

Resumen Objetivo: identificar y caracterizar las acciones/intervenciones realizadas desde los servicios farmacéuticos en el abordaje de pacientes con hepatitis C y proponer una vía clínica para la gestión de la enfermedad que incluya la participación del farmacéutico. Método: revisión sistemática en PubMed y EMBASE empleando los términos "Hepatitis C", "Pharmaceutical Services", "Community Pharmacy Services", y "Pharmacies"; artículos publicados hasta el 31 de marzo de 2019, cuyo tema central fueran las actividades realizadas por los servicios farmacéuticos en la atención a pacientes con hepatitis C. Se recopiló información sobre la actividad realizada, responsable, si la intervención era individual o colectiva y el entorno de aplicación. Las actividades se agruparon en promoción y prevención, gestión administrativa, atención farmacéutica, investigación y otros servicios de apoyo. De acuerdo con esto, se propuso una vía clínica para el manejo de la hepatitis C con participación del farmacéutico. Resultados: se incluyeron 60 artículos, principalmente de estudios descriptivos. La mayoría de las publicaciones reportó intervenciones realizadas en Estados Unidos y España. Se identificó la participación del personal farmacéutico en cada una de las etapas del proceso de atención, que incluye la provisión de servicios de reducción del daño, tamizaje del virus de la hepatitis C, vinculación de los pacientes al tratamiento, prescripción de medicamentos y órdenes de laboratorio. Conclusiones: se identifican y caracterizan las acciones/intervenciones realizadas desde el servicio farmacéutico para el manejo de la hepatitis C y se propone una vía clínica en la que se integran los servicios profesionales farmacéuticos a las demás actividades de la atención del paciente.

Abstract Objective: To identify and characterize the actions/interventions carried out by pharmaceutical services to approach patients with Hepatitis C and propose a clinical pathway for managing the disease that involves pharmacists. Methodology: A systematic review was conducted in PubMed and EMBASE using the terms "Hepatitis C," "Pharmaceutical Services," "Community Pharmacy Services," and "Pharmacies." Articles published until March 31, 2019, whose central topic was the activities carried out by the pharmaceutical services in the care of patients with Hepatitis C, were included. Information on the activity performed, the person in charge, whether the intervention was individual or collective, and the implementation environment was collected. The activities were grouped into promotion and prevention, administrative management, pharmaceutical care, research, and other support services. Based on the above, a clinical pathway for the management of Hepatitis C involving pharmacists was proposed. Results: Sixty articles were included, mainly descriptive studies. Most publications reported interventions in the United States and Spain. Pharmaceutical staff involvement was identified at each stage of the care process, including the provision of harm reduction services, Hepatitis C virus screening, enrolling patients to treatment, medication prescription, and laboratory orders. Conclusions: The actions/interventions carried out by the pharmaceutical service for Hepatitis C management were identified and characterized. A clinical pathway has been proposed to integrate professional pharmaceutical services with other patient care activities.

Asunto(s)

RESUMEN

Resumen Los resultados de las investigaciones sobre cannabis medicinal han traído a las mesas de gobierno discusiones sobre su potencial terapéutico y las medidas a tomar para controlar su producción, comercialización y utilización. En Colombia, desde el 2017, el mercado del cannabis medicinal se encuentra regulado; sin embargo, existen brechas entre la norma, disponibilidad y acceso de los pacientes a productos farmacéuticos con derivados del cannabis, aprobados por el ente regulatorio y que cumplan con los estándares de calidad. Desde esta perspectiva, se considera necesario que el gobierno nacional lidere, en coordinación con la academia y el sector productivo, el desarrollo de preparados farmacéuticos a base de cannabis; además de establecer e implementar medidas estratégicas y concertadas, orientadas a mejorar el acceso y la utilización adecuada de los productos farmacéuticos de cannabis medicinal, en especial para los casos en los que se pueda establecer una clara relación riesgo/beneficio. Con ello, se contribuye a mejorar las condiciones de salud de pacientes que se pueden beneficiar de estas opciones, al igual que al desarrollo y consolidación de un sector promisorio para el país. MÉD. UIS.2020;33(1):53-8.

Abstract The results of medical marijuana research have brought to the government tables discussions about their therapeutic potential and the measures to be taken to control their production, commercialization and use. In Colombia, since 2017, the medical cannabis market is regulated; however, there are gaps between the laws, availability and the access of patients to pharmaceutical products with cannabis derivatives approved by the regulatory entity and that comply with the standards of quality. From this perspective, it is necessary for the national government to lead, in coordination with the academy and the productive sector, the development of pharmaceutical preparations based on cannabis and to establish and implement strategic and concerted measures, aimed to improve access and proper use of medical marijuana pharmaceutical products, mainly for cases in which a clear risk/benefit relationship can be established. This would help to improve the health conditions of patients who can get benefits from these options, as well as the development and consolidation of a promising sector for the country. MÉD.UIS.2020;33(1):53-8.

Asunto(s)

RESUMEN

High-intensity ultrasound could be an alternative to pasteurization for cheeses made with fresh raw milk, the properties of which must be preserved as part of their intangible cultural heritage, such as Panela cheese in Mexico. This research aimed to study the effect of the amplitude (50% and 100%) and application time (0, 5, and 10 min) of ultrasound treatment of fresh raw milk, on the yield and microbiological and physicochemical qualities of Panela cheese after 24 h of storage at 4 °C. The yield was increased to 24.29% with 10 min of ultrasonication, although the amount of exudate was higher in the ultrasonic product than in the control (20.33%). As the ultrasonication time increased, the yellowness (b*) increased significantly, while the hue angle decreased (with values close to 90°), resulting in evident yellow tones in cheeses made with milk treated for 10 min. The pH significantly increased from 6.6 to 6.74 with 5 min of ultrasound, but decreased to 6.37 with 10 min of ultrasonication. Although no significant differences were found in fat content, the protein significantly increased with 5 min of sonication, but it decreased markedly when ultrasound was applied for 10 min. Ultrasound treatment with amplitudes of 50% effectively decreased the counts of coliform bacteria regardless of ultrasonication time. However, the mesophilic bacteria increased by a 0.9 log with an amplitude of 100% and 10 min treatment. The results showed that ultrasound improved the yield and microbial, nutritional, and physicochemical properties of Panela cheese.

RESUMEN

BACKGROUND: There is evidence in favor of using the ultrasound as the primary screening tool in looking for an occult cardiac injury. We report on a prospective single-center study to determine the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac wounds in a low-resource hospital from a middle-income country. METHODS: Data were collected prospectively. We included all consecutive patients 14 years and older who presented to the Emergency Trauma Unit with (1) penetrating injuries to the precordial area and (2) a systolic blood pressure ≥ 90 mmHg (hemodynamically stable). The main outcome measures were sensitivity, specificity, and positive and negative predictive values of ultrasound compared with those of the pericardial window, which was the standard test. RESULTS: A total of 141 patients met the inclusion criteria. Our results showed that for diagnosing an occult cardiac injury, the sensitivity of the chest ultrasonography was 79.31%, and the specificity was 92.86%. Of the 110 patients with a normal or negative ultrasound, six had a positive pericardial window. All of these patients had left hemothoraces. None of them required further cardiac surgical interventions. CONCLUSION: We found that ultrasound was 79% sensitive and 92% specific for the diagnosis of occult penetrating cardiac wounds. However, it should be used with caution in patients with injuries to the cardiac zone and simultaneous left hemothorax.

Asunto(s)

RESUMEN

Resumen Objetivo: Identificar estrategias orientadas a favorecer el acceso a medicamentos de interés en salud pública, de alto costo o protegidos por patentes, posiblemente aplicables al contexto colombiano. Metodología: revisión estructurada en PubMed/Medline, utilizando los términos MeSH: "health services accessibility", "pharmaceutical preparations", "policy", con filtros para artículos publicados en inglés y español, entre 2012 y 2017. Se incluyeron aquellos con información sobre estrategias o políticas que favorecieran el acceso a medicamentos de interés en salud pública de alto costo o protegidos por patentes. Las estrategias identificadas fueron agrupadas acorde con las cinco dimensiones del acceso a la atención en salud y medicamentos definidas por la Organización Mundial de la Salud: disponibilidad, asequibilidad, accesibilidad, aceptabilidad y calidad. Resultados: Se identificaron 62 artículos, de los cuales se incluyeron 18 y se consideraron 5 referencias adicionales. Se reconocieron 30 estrategias, distribuidas y clasificadas según las dimensiones del acceso: disponibilidad y asequibilidad, 15; accesibilidad, 6; aceptabilidad, 6; calidad, 2; estrategia transversal, 1. Conclusiones: Se identificaron estrategias claves para favorecer el acceso a medicamentos de interés en salud pública de alto costo o protegidos por patentes, dentro de las que se encuentran las negociaciones centralizadas de precios; el apoyo financiero público para la investigación, desarrollo y producción nacional de medicamentos genéricos; la aplicación de las flexibilidades del acuerdo sobre los "Aspectos de los derechos de propiedad intelectual relacionados con el comercio" y la implementación de programas de asistencia.

Abstract Objective: To identify strategies aimed to improve access to medicines of interest in public health with high cost or protected with patents, possibly applicable to the Colombian contextTo identify strategies aimed at promoting access to high-cost or patent-protected medicines of interest in public health, possibly applicable to the Colombian context.. Methodology: structured review in PubMed/Medline, using the MeSH terms: "health services accessibility", "pharmaceutical preparations", "policy", with filters for articles published in English and Spanish, between 2012 and 2017. Studies with information on strategies or policies that favored access to high-cost or patent-protected drugs of interest in public health were included. The strategies identified were grouped according to the five dimensions of access to health care and medicines defined by the World Health Organization: availability, affordability, accessibility, acceptability and quality. Results: 62 articles were identified, of which 18 were included, and 5 additional references were considered. 30 strategies were recognised, distributed and classified according to the dimensions of access: availability and affordability, 15; accessibility, 6; acceptability, 6; quality, 2; cross-cutting strategy, 1. Conclusions: Key strategies were identified to favor access to high-cost or patent-protected medicines of interest in public health, including centralized price negotiations; public financial support for national research, development and production of generic medicines; the application of the flexibilities of the agreement on "Aspects of intellectual property rights related to trade" and the implementation of care programs.

Resumo Objetivo: Identificar estratégias destinadas a favorecer o acesso a medicamentos de interesse em saúde pública, de alto custo ou protegidos por patentes, possivelmente aplicáveis ao contexto colombiano. Metodologia: Revisão estruturada no PubMed/Medline, usando os termos MeSH: "health services accessibility", "pharmaceutical preparations", "policy", com filtros para artigos publicados em inglês e espanhol, entre 2012 e 2017. Foram incluídos aqueles com informações sobre estratégias ou políticas que favoreciam o acesso a medicamentos de interesse em saúde pública de alto custo ou protegidos por patentes. As estratégias identificadas foram agrupadas de acordo com as cinco dimensões de acesso aos cuidados de saúde e medicamentos definidas pela Organização Mundial da Saúde: disponibilidade, alcançabilidade, acessibilidade, aceitabilidade e qualidade. Resultados: Foram identificados 62 artigos, dos quais 18 foram incluídos e 5 referências adicionais foram consideradas. 30 estratégias foram identificadas, distribuídas e classificadas de acordo com as dimensões do acesso: disponibilidade e alcançabilidade, 15; acessibilidade, 6; aceitabilidade, 6; qualidade 2; estratégia transversal, 1. Conclusões: Foram identificadas estratégias-chave para favorecer o acesso a medicamentos de interesse em saúde pública de alto custo ou protegidos por patentes, dentro das quais estão as negociações centralizadas de preços; o apoio financeiro público à pesquisa, desenvolvimento e produção nacional de medicamentos genéricos; a aplicação das flexibilidades do acordo sobre "Aspectos dos direitos de propriedade intelectual relacionados ao comércio" e a implementação de programas de assistência.

RESUMEN

Resumen Introducción: la hepatitis C (HepC) representa un problema de salud pública a nivel mundial. Se estima que en Colombia la prevalencia de virus de la hepatitis C (VHC) está entre el 0,5-1 %, y asciende al 2,1 % en pacientes mayores de 50 años. La Unidad de Hepatología del Hospital Pablo Tobón Uribe (HPTU) ha sido un referente en el manejo de la HepC en Medellín y Colombia durante años. Objetivo: describir las características sociodemográficas/clínicas y los resultados en salud de los pacientes con HepC crónica atendidos en el HPTU entre 2013 y 2018. Materiales y métodos: estudio observacional, descriptivo, retrospectivo de pacientes con HepC crónica atendidos entre el 1 de enero de 2013 y el 31 de marzo de 2018. Resultados: se analizaron 108 pacientes. La edad promedio fue de 55,8 años (desviación estándar [DE] 13,7), 51,9 % eran hombres, y 78,7 % pertenecían al régimen contributivo. El mecanismo de transmisión más frecuente fue la hemotransfusión; el genotipo 1 predominó en el grupo de pacientes analizados. La efectividad de los esquemas con interferón fue del 46,9 % y de los antivirales de acción directa (AAD) del 94,6 %. La presencia de reacciones adversas a medicamentos (RAM) fue del 68,2 % en pacientes con esquemas con interferón/ribavirina y del 25,9 % en pacientes con AAD. Conclusiones: se realiza la caracterización de los pacientes atendidos en el HPTU, en quienes los AAD han mostrado mayor efectividad y seguridad en comparación con esquemas con interferón/ribavirina.

Abstract Introduction: Throughout the world hepatitis C (HepC) is a public health problem. Estimates for its prevalence in Colombia range from 0.5% to 1% but 2.1 % for patients over 50 years of age. The Hepatology Unit at the Hospital Pablo Tobón Uribe (HPTU) has been a benchmark for management of HepC in Medellín and Colombia for years. Objective: To describe sociodemographic and clinical characteristics together with health outcomes of patients with chronic HepC who were treated at the HPTU between 2013 and 2018. Materials and methods: This is an observational, descriptive and retrospective study of patients with chronic HepC, treated between January 1, 2013 and March 31, 2018. Results: One hundred and eight patients were analyzed. The average age was 55.8 years (SD 13.7), 51.9% were men, and 78.7% belonged to the contributory health care scheme. Most frequently, the disease was transmitted by blood, and genotype 1 predominated in the group of patients analyzed. The effectiveness of interferon schemes was 46.9% while that of Direct-Acting Antivirals (DAA) was 94.6%. Adverse drug reactions were found in 68.2% of patients treated with interferon/ribavirin schemes but in only 25.9% of the patients treated with DAA. Conclusions: In this group of patients treated at HPTU, DAA were safer and more effective than interferon/ribavirin schemes.

Asunto(s)

Asunto(s)

RESUMEN

Resumen La hepatitis C (HC) es un problema de salud pública a nivel mundial, con alta prevalencia en pacientes mayores de 50 años. Esta población es más propensa a sufrir enfermedad renal crónica (ERC), tanto por la infección por el virus de la HC como por su edad y múltiples comorbilidades. Los pacientes con ERC en estadios 4 o 5 pueden ser una población de mayor complejidad farmacoterapéutica, por su variabilidad farmacológica y por la limitada información de seguridad y eficacia de los nuevos antivirales en ese grupo de pacientes. Objetivo: sistematizar información de dosificación de medicamentos para la HC crónica, a partir de estudios o reportes que incluyeran pacientes de edad avanzada con ERC. Materiales y métodos: revisión estructurada en PubMed/Medline con los términos: "Hepatitis C", "Aged" y "Renal Insufficiency"; artículos publicados entre 1 de agosto de 2012 y 1 de agosto de 2017, en inglés o español, estudios realizados en humanos, con acceso a texto completo. Resultados: se identificaron 83 artículos, de los cuales se seleccionaron 14; además, se incluyeron 4 manuscritos referenciados en las publicaciones revisadas. Se estructuró un cuadro con información de dosificación de antivirales para el tratamiento de la HC en pacientes de edad avanzada con ERC. Discusión: Se presenta información sobre el ajuste de dosis de los medicamentos antivirales utilizados para la HC crónica, en pacientes de edad avanzada y ERC, que podría favorecer los procesos de prescripción y seguimiento para contribuir con la efectividad y seguridad de dichos fármacos en esta población.

Abstract Hepatitis C (HC) is a public health problem worldwide and has especially high prevalence in patients over 50 years of age. This population is more prone to suffer from chronic kidney disease (CKD) due to HC infections as well as to age and multiple comorbidities. Those with CKD stages 4 or 5 constitute a population of greater pharmacotherapeutic complexity due to pharmacological variability and limited information on the safety and efficacy of the new antivirals for this group of patients. Objective: This article systematizes information about medications and proper dosages for treating chronic HC and is based on studies and reports that include elderly patients with CKD. Materials and method: This is a structured review of studies carried out in humans with access to full text published between 01/08/2012 and 01/08/2017 in English or Spanish found in PubMed/Medline using the terms: "Hepatitis C", "Aged", and "Renal Insufficiency". Results: Eighty-three articles were identified, fourteen of which were selected. In addition, four manuscripts referenced in those publications were included. A table with antiviral dosing information for treatment of HC in elderly patients with CKD was structured. Discussion: We present information on adjustment of dosages of antiviral drugs used for chronic HC in elderly patients and CKD. This could favor prescription and monitoring thereby contributing to the effectiveness and safety of these drugs in this population.

Asunto(s)

RESUMEN

Abstract Aim: Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. Methods: A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion: We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

Resumen Objetivo: Describir las variaciones en los soldados heridos en combate admitidos al departamento de emergencias durante el periodo de negociación del proceso de paz colombiano entre el 2011 y el 2016. Métodos: Estudio retrospectivo de todos los soldados heridos en combate que fueron manejados en un centro de trauma desde Enero del 2011 a Diciembre del 2016. Los pacientes se dividieron en dos grupos: aquellos que ingresaron al departamento de emergencias antes de la tregua del proceso de paz (Noviembre 2012) y aquellos que ingresaron durante la negociación. Los grupos se compararon con respecto a los periodos de tiempo. Resultados: Un total de 448 soldados heridos en combate fueron incluidos. Hubo una disminución gradual en el número de admisiones durante el periodo de negociación. Además, el número de soldados que sufrieron heridas por explosiones y fusiles disminuyó durante este periodo. En el 2012 se registraron 150 soldados heridos en combate. Este número disminuyó a 84, 63, 32 y 6 en los años 2013, 2014, 2015 y 2016 respectivamente. La proporción de pacientes con un ISS ≥9 y la proporción de admitidos a la unidad de cuidado intensivo fueron significativamente mayores en el periodo antes de la negociación. Desde Agosto a Diciembre/2016 no se registraron admisiones. Conclusión: Este estudio describe una disminución gradual en el número de soldados heridos en combate admitidos al departamento de emergencia en un periodo de 6 años. Este fenómeno pudo deberse al periodo de negociación del proceso de paz.

Asunto(s)