Center In Colombia Research Articles

TUMORES GERMINALES GONADALES EN NIÑOS: EXPERIENCIA DE 20 AÑOS EN UN CENTRO DE REFERENCIA PEDIATRICO

<p class="Predeterminado"><strong><em>INTRODUCCIÓN:</em></strong> Los tumores de células germinales son un grupo heterogéneo de neoplasias que corresponden al 1-3% de los tumores en pediatría. Por lo general, se manifiestan clínicamente con masa testicular o dolor abdominal.</p><p class="Predeterminado"><strong><em>OBJETIVO:</em></strong> Describir las características de los pacientes con tumores germinales gonadales en un centro de referencia de cáncer pediátrico en Bogotá.</p><p class="Predeterminado"><strong><em>MATERIALES Y METODOS:</em></strong> Este artículo hace una revisión retrospectiva recopilando 20 años de experiencia en el diagnóstico y manejo de estos tumores en La Fundación Hospital de la Misericordia.</p><p class="Predeterminado"><strong><em>RESULTADOS:</em></strong> Se encontraron 79 pacientes, 35 hombres y 44 mujeres, con un promedio de edad al diagnóstico de 6 años. El teratoma fue la neoplasia más frecuente en el género femenino y el tumor del seno endodérmico en el masculino. El 70.9% de los pacientes se diagnosticaron en estadio I, se tienen datos de marcadores tumorales en 84.8%. El 98.7% se manejaron con cirugía y 58.2% recibieron además quimioterapia, especialmente protocolo BEP. 96% alcanzaron remisión de la enfermedad, 3 pacientes fallecieron.</p><p class="Predeterminado"><strong><em>CONCLUSIONES:</em></strong> El estudio demuestra buenos resultados en el manejo de los tumores germinales gonadales con el protocolo establecido de manejo quirúrgico y quimioterapia, se encontró una baja tasa de recurrencia en el periodo evaluado y alto porcentaje de niños libres de enfermedad. </p>

How Can We Tell the Story of the Colombian War?: Bastardized Narratives and Citizen Celebrities

This article explores how popular culture theory can be used in postconflict situations to raise awareness about human rights violations. This case study investigates a media narrative produced by the Memory Center in Colombia, about a political assassination of a community leader. On February 12, 2009, Luis Arango was murdered in the Colombian region known as Magdalena Medio. Arango was a fisherman and a leader of local and regional fishing communities struggling to defend wetlands and natural environments from encroaching cattle and agribusiness economies. Arango was murdered to stop his leadership and environmental agendas. Arango’s assassination was selected as an emblematic case that illustrates well how Colombia’s armed conflict impacts community leaders trying to advance social justice agendas. This article explores how a new understanding of “the popular” was used to frame a media narrative about Arango’s case.

Papel de la cistouretrografía miccional en el protocolo de trasplante renal: ¿reemplaza al urólogo?

Introduction and objectivesThere is no consensus on the different clinical tests used for kidney pre-transplant urological evaluation. The protocols vary according to the experience of each transplant group, with no clear guidelines for these protocols. The experience is presented from a high volume kidney transplant center in Colombia, where voiding cystourethrography (VCU) is used as part of the protocol prior to renal transplantation. Materials and methodsA total of 331 kidney transplants were performed from January 2009 to December 2012 in Hospital Pablo Tobon Uribe. The study included the evaluation of 233 clinical records and 223 voiding cystourethrographs (VCU). Results and discussionThere were 39 abnormal VCU (17.4%), 19 (4 bilateral and 15 unilateral) vesicoureteral reflux, 5 with reduced bladder capacity, one with benign prostate hyperplasia, and one due to increased bladder capacity. ConclusionAlthough a large proportion kidney pre-transplant patients have an abnormal VCU, this does not change clinical or surgical approached before transplantation. Instead of using urinary tract protocol tests, a complete urological evaluation should be considered.

An experience of liver transplantation in Latin America: a medical center in Colombia

Liver transplantation is the treatment of choice for acute and chronic liver failure, for selected cases of tumors, and for conditions resulting from errors in metabolism. This paper reports the experience of a medical center in Latin America. Were conducted 305 orthotopic liver transplantations on 284 patients between 2004 and 2010. Of these patients, 241 were adults undergoing their first transplantation. The average age of patients was 52 years old, and 62% of the individuals were male. The most common indication was alcoholic cirrhosis. The rate of patient survival after 1 and 5 years was 82 and 72% respectively. The rate of liver graft survival after 1 and 5 years was 78 and 68% respectively. The main cause of death was sepsis. Complications in the hepatic artery were documented for 5% of the patients. Additionally, 14.5% of the patients had complications in the biliary tract. Infections were found in 41% of the individuals. Acute rejection was observed in 30% of the subjects, and chronic rejection in 3%. In conclusion, liver transplantation at our medical center in Colombia offers good mid-term results, with a complication rate similar to that reported by other centers around the world.

Experience in therapeutic plasma exchange by membrane filtration at an academic center in Colombia: Registry of the first 500 sessions.

Therapeutic plasma exchange (TPE) is an extracorporeal blood purification therapy that is part of the treatment of various diseases. Plasma and blood cells can be separated by centrifugation or using membrane separators. A descriptive analysis, in which the first 500 TPE sessions using membrane filtration without anticoagulation of the extracorporeal circuit are described. Five hundred (500) TPE sessions were performed on 68 patients over a period of 5 years. Therapeutic indications were 17 different diseases. 5% albumin was the most frequent replacement solution used in 62% of sessions. The mean number of plasma volume replacements was 1.33. Complications occurred in 7.6% of the sessions. Arterial hypotension was the most common event and clotting of the extracorporeal circuit was documented in just one TPE session. Electrolyte tests performed in patients during the procedure showed: 11% hypocalcemia, with a similar distribution of hypokalemia. Twenty-two percent (22%) and 37% of phosphorus and magnesium records, respectively, were higher than normal. No symptoms associated with electrolyte abnormalities were documented. TPE by membrane filtration is one of the techniques by which it is possible to perform such therapy. In this registry, a low rate of complications was documented. While the need for anticoagulation may be related not only to clotting of the circuit but also to the efficiency of the therapy, clinical response in this series of patients was as expected for each disease. Continuous monitoring and an individualized analysis of electrolytes should be performed in TPE patients.

Outcomes of a Peritoneal Dialysis Program in Remote Communities within Colombia

Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. The present study was a multi-center cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 - US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia.

Effect of the addition of pentoxifylline on the therapeutic and inflammatory response in patients with cutaneous leishmaniasis: A Randomized Placebo Controlled Trial

Effect of the addition of pentoxifylline on the therapeutic and inflammatory response in patients with cutaneous leishmaniasis: A Randomized Placebo Controlled Trial

Health-related quality of life and depression in a sample of Latin American adults with rheumatoid arthritis.

To compare the health related quality of life (HRQoL) and depression of individuals with rheumatoid arthritis (RA) to healthy controls in Colombia, as well as to examine the connections between these two variables in individuals with RA. One hundred and three individuals with RA were recruited from ambulatory centers in Colombia. Seventy-three control participants were recruited from the local community. Both groups differed with respect to age, gender and marital status (P<0.001), while education and socio-economic levels were similar. HRQoL was assessed using the Short Form-36 (SF-36) and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). A multivariate analysis of covariance found that RA patients reported substantially higher depressive symptoms and lower HRQoL than healthy controls (P<0.01 and P<0.05, respectively). The effect sizes of the differences between patients and controls in HRQoL and depressive symptoms were all large. All SF-36 HRQoL variables were significantly correlated with depressive symptoms in patients and controls (P<0.05). Social functioning and vitality were uniquely associated with depressive symptoms in the RA group (P<0.01 and P<0.05, respectively), whereas education and social functioning were uniquely associated with depressive symptoms in controls (P<0.05 and P<0.005, respectively). Research indicates that individuals with RA have deteriorated HRQoL, and this study extends these findings to a Colombian sample and highlights the importance of the independent relationship between depressive symptoms and vitality in this group of Colombians with RA.

AB1031 Misdiagnosis of Rheumatoid Arthritis in A Colombian Specialized Center and Socio-Demographic Characterization

BackgroundThere is a lack of expertise in the rheumatoid arthritis (RA) diagnosis in primary level medical centers in Colombia, leading to misdiagnosis, which derives in wrong treatment for patients and...

AB0407 Dermatologic Adverse Events in A Cohort of Patients with Rheumatoid Arthritis Using Anti-TNFs in A Real-Life Setting

BackgroundBiological therapy is a major therapeutic tool to prevent clinical and radiological progression of rheumatoid arthritis (RA). On the other hand, adverse effects of these medications are a problem in...

AB1138-HPR Systemic Adverse Events in A Cohort of Patients with Rheumatoid Arthritis Using BIOLOGICS in A Real-Life Setting

BackgroundBiological therapy is a major therapeutic tool to prevent clinical and radiological progression of rheumatoid arthritis (RA). On the other hand, adverse effects of these medications are a problem in...

FRI0031 Better Outcomes of Disease Activity in A Large Cohort of Rheumatoid Arthritis Patients Treated under Treat to Target Recommendations

BackgroundThe importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets...

AB0303 Osteoarthritis is the Most Frequent Cause of Rheumathoid Arthritis Misdiagnosis in A Colombian Specialized Center

BackgroundThere is a lack of expertise in the rheumatoid arthritis (RA) diagnosis in primary level medical centers in Colombia. Frequently, patients with osteoarthritis (OA) are misdiagnosed as rheumatoid arthritis (RA)...

AB0782 Misdiagnosing Osteoarthritis as Rheumatoid Arthritis and IT High Cost for Colombian Health System

BackgroundThere is a lack of expertise in the rheumatoid arthritis (RA) diagnosis in primary level medical centers in Colombia. Frequently, patients with osteoarthritis (OA) are misdiagnosed as rheumatoid arthritis (RA)...

Estándares de Acreditación “derechos de pacientes”: revisión y estado actual en Centros de Tratamiento en Drogadicción en Colombia

Characterizing and contrasting the current state of affairs concerning patients' rights-associated accreditation standards in a sample of drug-addiction treatment centers in Colombia.This was mixed methodology research (i.e. descriptive and hermeneutic); a pilot sample of 21 drug-addiction treatment centers in Colombia was used for determining the current state of patients' rights accreditation standards. The possible relationship or independence between categorical variables was evaluated by using Fisher's exact test (0.05 significance level). A contrasting documentary review was made at the same time.Drug-addiction treatment centers provided more information for families (95 %) than patients (90 %) or minors (81 %). Possible barriers to gaining access for treatment were being HIV positive (29 %), being part of the LGTB population (14 %) and being female (10 %); religion and ethnicity were not seen as grounds for discrimination or treatment barriers. The patients' rights standards group coincided with Colombia's accreditation system and Joint Commission standards; however, the latter accreditation entity has made significant progress regarding a specific manual for drug-addiction treatment centers.The centers assessed in Colombia had made advances regarding accrediting patients' rights, but such standards require revision for being adapted to international developments and specific matters involved in treating addicts and the specific conditions for institutions dealing with such treatment.

Video-Assisted Thyroidectomy for Selected Cases of Differentiated Thyroid Carcinoma. Initial Experience in Colombia

Background: Minimally invasive video-assisted thyroidectomy (MIVAT) has been proposed as an alternative procedure to get the same completeness as a conventional thyroidectomy in selected cases of differentiated thyroid cancer. It’s considered as safe as the conventional procedure. Objective: The purpose of the study was to do a retrospective evaluation in a series of patients who underwent MIVAT for thyroid nodule or thyroid cancer over a two and a half year period, in two academic centers in Colombia in terms of the completeness of the surgical resection, morbidity and short-term recurrence. Results: 45 patients underwent a MIVAT, and 20 had also a central neck dissection (CND); frozen section study was realized in 9 cases. The final pathology showed 27 patients with papillary carcinomas, and 1 patient with incidental medullary carcinoma. Post-operative complications included temporary recurrent nerve paralysis (1.1%), permanent recurrent nerve paralysis (1.1%), temporary hypocalcaemia (4.4%) and postoperative seroma (8.8%) No definitive hypoparathyroidism was found. The short term follow-up didn’t show recurrences. Conclusion: With this initial experience, we consider that this technique could be proposed as an alternative procedure to conventional surgery, including the resection of selected small thyroid carcinomas as other authors have proposed.

Corneal Transplantation at an Ophthalmological Referral Center in Colombia: Indications and Techniques (2004-2011)

Purpose: To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period.Methods: A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011.Results: During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK).Conclusions: Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantation in this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers.

AB0283 Dermatologic adverse events in a cohort of patients with rheumatoid arthritis using anti-tnf therapy in a real-life setting

BackgroundBiological therapy is a major therapeutic tool to prevent clinical and radiological progression of rheumatoid arthritis (RA). On the other hand, adverse effects of these medications are a problem in...

AB0285 First real life experience with certolizumab pegol in rheumathoid arthritis (ra) in latinamerica

BackgroundCertolizumab pegol (CZP) is a novel TNF inhibitor, consisting of a humanized Fab’ fragment fused to a 40-kd polyethylene glycol moiety with proved efficacy and safety in multiple RA clinical...

AB1000 Rheumathoid arthritis misdiagnosis and osteoarthritis as the most frequent cause for diagnosis mistake

BackgroundThere is a lack of expertise in the diagnosis of rheumatoid arthritis (RA) in primary care centers maybe worldwide and commonly, many patients with osteoarthritis (OA) are misdiagnosed with RA,...