Introducción. Conocer los tipos de terminación de las psicoterapias y los factores asociados, permite comprender esta dimensión del tratamiento y pensar estrategias para el mejoramiento del proceso. Objetivo. El presente estudio busca identificar los tipos de terminación de la psicoterapia en niños y adolescentes y los factores que influyen en ellos en dos centros de atención psicológica. Metodología. Se utilizó un diseño cuantitativo, exploratorio, transversal, con un alcance descriptivo y de asociación, fueron encuestados 100 pacientes (48 niños y 52 adolescentes). Resultados. Se encontraron cuatro tipos de terminación: por factores institucionales o del terapeuta, atribuida a factores externos del tratamiento, por insatisfacción de los usuarios y por cumplimiento de objetivos. Se identifican algunas asociaciones entre estos y las características clínicas y sociodemográficas del tratamiento. Discusión. Los aspectos institucionales y las condiciones externas al paciente deben ser considerados en la construcción de las estrategias de intervención con esta población. Además, se requiere un proceso de educación a padres sobre la intervención psicológica y su alcance institucional para modular las expectativas asociadas al proceso.

Corticosteroids play a vital role in enabling the body to tolerate stressful situations and regulate the inflammatory process. Excessive or persistent inflammation can lead to tissue damage and the development of diseases. Glucocorticoids are crucial in modulating the impact of inflammatory disorders, such as allergies, autoimmune diseases, and sepsis. These disorders can be life-threatening and benefit from glucocorticoid administration. Natural and synthetic glucocorticoids are utilized for the diagnosis and treatment of adrenal function disorders and various inflammatory, immune, and neoplastic conditions. The discovery of glucocorticoids is a testament to the ingenuity and collaboration of researchers. For over 70 years, glucocorticoids have revolutionized medicine and are widely employed in various medical conditions. This article provides a comprehensive review of the critical considerations for the clinical application of glucocorticoids, aiming to strike a balance between their benefits and potential risks. Understanding its history, chemical structure, pharmacology, and mechanisms of action provides the foundation for achieving proper use of this type of medication.

Introducción: el síndrome de intestino irritable (SII) es el principal trastorno funcional gastrointestinal caracterizado por múltiples síntomas sin una causa orgánica clara, constituye un problema de salud por sus altos costos e impacto en la calidad de vida.Objetivo: determinar la prevalencia del síndrome de intestino irritable en los estudiantes de Medicina de la Fundación Universitaria San Martín Sabaneta a noviembre de 2016.Materiales y métodos: estudio de corte transversal, incluyó los estudiantes de Medicina de la FUSM matriculados en el programa para el periodo 2016-2. Se determinó la prevalencia del síndrome por medio de los criterios de Roma III mediante una encuesta autodiligenciada. Se realizó un análisis univariado y bivariado en búsqueda de asociaciones.Resultados: se encontró una prevalencia de SII en 17,92% de 173 encuestados, el patrón mixto fue el más frecuente (77,41%). Hubo una posible asociación entre el SII y trastorno de ansiedad generalizada, presencia de al menos un síntoma gastrointestinal, y consumo de alcohol al menos una vez al mes.Conclusiones: la prevalencia del SII es del 17,92%, la ansiedad podría asociarse al SII. La depresión mayor no se relaciona con tener SII en este estudio. Se necesitan estudios que permitan ampliar la relación de los hábitos y estilos de vida incluidos el consumo de licor y cigarrillo.

El síndrome de cascanueces se produce por la compresión de la vena renal izquierda entre la aorta y la arteria mesentérica superior, este síndrome se asocia a síntomas variables e inespecíficos de congestión venosa secundarios. La forma más común del síndrome es la clásica o anterior, pero existen otras variantes atípicas, entre ellas se encuentra el síndrome de cascanueces posterior, el cual ocurre por la compresión de la vena renal izquierda entre la aorta y la columna lumbar. Se describe el caso de una paciente de 5 años con hematuria macroscópica y proteinuria leve persistentes, en la cual se descartó compromiso glomerular y, por lo atípico del cuadro clínico, se realizó angioresonancia magnética abdominal que confirmó el diagnóstico del síndrome de cascanueces posterior.

Background: Hodgkin lymphoma (HL) is a lymphoid neoplasm with high cure rates. Around 90% of patients (pts) will achieve response to first-line treatment. Real-world studies in Latin America (LATAM) are lacking. Moreover, inequity in the access to imaging technology and drugs represent a real challenge for Latin American countries with palpable influences in patient outcomes. Herein, we describe the clinical features, treatment patterns, and outcomes of HL pts managed in LATAM. Method: We conducted a retrospective cohort study of adults aged ≥17 years with newly diagnosed HL across academic centers in 7 LATAM countries from 2003 to 2022, with follow-up through July 2023. Medical records were manually reviewed, and data were abstracted in a standardized form. Cancer staging was performed by Ann Arbor and German HL Study Group criteria. Survival probabilities were estimated with the Kaplan-Meier method and compared with the Log-rank test. Multivariable Cox regression models were fitted by cancer stage stratification. A landmark analysis was performed to assess the lack of PET scan availability at the end of treatment (EOT) in LATAM. Results: Of 965 pts identified, 864 had sufficient data for analysis. Pts were young (56% <40 years; median 36 [17-88]) with slight male predominance (53%). 9 (3%) pts were HIV positive. Nodular sclerosing (62%) and mixed cellularity (22%) were the most common HL subtypes (p<0.01). Clinically, most pts had good performance status (ECOG≤1, 96%), no B symptoms (62%) and normal serum LDH (60%). Mediastinal presentation was seen in 14%, bulky mass (>10 cm) 23%, nodal involvement >3 sites 34% and extranodal involvement 25%. Advanced stage was common (57%); 22% and 21% had favorable and unfavorable limited stage HL, respectively. ABVD was the most common first-line regimen (96%); 8 pts received BEACOPP, and 1 BV-AVD. Radiation was utilized in 40% of limited and 21% of advanced stage HL. Only 63% and 48% had interim (iPET) and EOT PET scan, respectively. Most pts were managed at private than public institutions (59%, p<0.01). With a median follow up of 65 [59-71] months the 5-yr overall survival (OS) and progression-free survival (PFS) rates in all HL pts were 85% (82-88, 95% CI not reached, NR) and 64% (60-69, 95% CI NR), respectively. Better OS and PFS were seen in pts younger than 60 (p<0.01), ECOG≤1 (p<0.01) and limited stage HL (p<0.01). Overall response rate at the EOT assessed by either PET or CT scan was 89% (76% complete and 13% partial). In those assessed by iPET, results yielded 86% keeping same plan, 7% de-escalation and 3% escalation. In our cohort, 11% had refractory HL and 18% relapsed after achieving response. Given the inferior PFS to first-line seen in our LATAM HL pts compared to historical cohorts, we looked at possible factors associated to early relapse. Those assessed by PET at the EOT had significantly superior 5-yr PFS than those assessed by CT scan (PET vs CT: favorable HL 91 vs 71%; unfavorable 83 vs 35%; advanced 79 vs 51%) ( Figure). OS was inferior only in pts with unfavorable HL not assessed by PET (94 vs 76%, p=0.03). In the multivariable analysis, the lack of PET assessment at the EOT was associated with short PFS in unfavorable (aHR 7.81 [1.46-41.88], p=0.02) and advanced (aHR 17.35 [4.66-64.61], p<0.01), and a non-statistically significant worse PFSvin favorable HL (aHR 5.05 [0.56-45.72], p=0.15). Other factors associated to short PFS were extranodal disease (aHR 35.29 [5.62-209.07], p<0.01) in unfavorable, and high serum LDH (aHR 2.31 [1.2-4.46], p=0.01) in advanced HL. Interestingly, pts with advanced HL managed in public institution had less risk for relapse than those in private institutions (aHR 0.13 [0.03-0.51], p<0.01). Conclusion: To our knowledge, this is the largest cohort of newly diagnosed HL pts in LATAM in the real-world setting. We observed similar clinical features in LATAM HL pts than those previously reported. ABVD was widely utilized in LATAM, and the 5-yr OS of 85% in all pts aligns with international estimates. However, our findings underscore the impact of limited access to PET scan at the EOT in LATAM, leading to lower PFS outcomes compared to those reported in developed countries. Despite this challenge, salvage therapy seems to rescue our LATAM HL pts, thus, OS remains optimal. To improve outcomes and minimize late effects following treatment completion, increasing the use of PET-adapted therapy for managing adult pts with HL in LATAM should be prioritized.

IntroductionObesity is a disease that has become a major public health concern. The objective of this research was to analyze the changes in the quality of life and in clinical, physiological, and anthropometric parameters in patients with obesity, belonging to a multidisciplinary program for weight loss. Materials and methodsObservational retrospective cohort study that included obese patients in a multidisciplinary program. The comparison of quantitative variables at admission and discharge from the program was performed with the Wilcoxon signed rank test, while the qualitative variables were compared with the McNemar test. Statistical analysis was performed in the STATA V.15 program. Results323 patients were analyzed; it was shown that the median weight decreased 4.4 kg (p < 0.001). Adherence to physical activity increased from 30% (n = 97) to 90% (n = 289) (p < 0.001). Similarly, the median VO2 max increased from 23.6 (IQR 19.7-30.4) on admission to 32.9 (IQR 27.8-38) on discharge. Regarding quality of life, self-care was one of the dimensions with the greatest impact during the program, with a decrease in the report of extreme difficulties from 17.7% to 0.3%. Likewise, the visual analogue scale (VAS) increased the median from 50 (RIC 50-70) to 80 (RIC 70-90) (p < 0.001). ConclusionThe multidisciplinary approach to obesity offers a comprehensive approach to the patient, impacting not only physical, but also psychological and emotional aspects of the problem, improving her quality of life.

Magnolia unicarmensis is described as a new species of mountain Colombian Magnoliaceae. M. unicarmensis can be distinguished from the other members of subsection Dugandiodendron by a combination of characters, including smaller leaf size (3.20–6.73 × 1.91–3.93 cm); leaf shape obovate, base cuneate, woolly abaxial pubescent only in the midvein extending to a small prolongation in the emarginated apex; prefoliation marks on the lamina absent; golden woolly stipules; flowers 5.13–6.37 cm in diameter, 92–100 staments with six to eight petals and fruit ellipsoid 3.04–3.62 × 2.02–2.35 cm with six to seven glabrous carpels. This species is endemic from Antioquia, it is currently known only from Carmen de Viboral and La Unión Municipalities and it is proposed as Critically Endangered under criteria B1 ab(i,ii,iii,v) of IUCN.

IntroductionThe evidence supporting pharmacological heart failure treatment relies on randomized clinical trials with stringent inclusion and exclusion criteria. Objectives: Assess the eligibility of outpatients with chronic heart failure for the trials DAPA-HF, EMPEROR-reduced, and PARADIGM-HF, while exploring potential differences among study populations. MethodsBy reviewing medical records, we determined the eligibility rate for each study and evaluated the incidence of heart failure hospitalizations and all-cause mortality during this period. ResultsA total of 446 patients were included in the cohort. Approximately 75% would be ineligible for the trials, mainly because of their comorbidities. Ineligible patients had a higher all-cause mortality, but a similar incidence of hospitalization. ConclusionApproximately 1 in 4 patients from a heart failure clinic in Medellin, Colombia would meet the eligibility criteria for the DAPA-HF, EMPEROR-reduced, and PARADIGM-HF trials. These findings highlight the need to complement randomized clinical trials with real-world data.