Santa Fe De Research Articles

Experiencia de una clínica de anticoagulación

IntroductionThe anticoagulation clinic emerged as a strategy to reduce the complications associated with anticoagulation therapy. There, the indications, contraindications and drug interactions that could cause potential functional disabilities of individual patients receiving this treatment are evaluated. ObjectiveTo describe the demographic profile and pharmacologic indications and to determine the behavior of anticoagulant therapy of patients consulting at the Anticoagulation Clinic of the University Hospital Fundación Santa Fe de Bogotá. MethodsA descriptive retrospective study was carried out that included 257 patients of the anticoagulation clinic between April 2008 and December 2013, who received anticoagulation therapy with warfarin, enoxaparin, rivaroxaban, apixaban or dabigatran. Results62.6% were female; the average age was 65.3 years old; 71.20% received warfarin, 5.05% enoxaparin, rivaroxaban 14.78%, 8.17% dabigatran and 0.77% apixaban. The chief indications for anticoagulation were venous thrombosis (47.08%) and atrial fibrillation (36.96%.) Leading complications associated with total anticoagulant strategy were: major bleeding (1.16%), mild bleeding (8.17%) and re-thrombotic events (3.5%). The time spent in therapeutic range (INR 2-3) was 53.5% in the warfarin group. ConclusionThis study is consistent with international literature in suggesting that the selection and monitoring of anticoagulation therapy could reduce the frequency of adverse effects (bleeding and thrombosis). The anticoagulation clinic also allows to optimise the time in the therapeutic range of the patients treated with warfarin.

Workshop in Electrical Neuromodulation of astrocytes as therapeutic approach

Workshop in Electrical Neuromodulation of astrocytes as therapeutic approach

Canalización venosa yugular interna: ¿qué tanta seguridad podemos llegar a ofrecer?

IntroductionCentral venous catheterization, performed by the anatomical landmark technique, has a mechanical complication rate between 5% and 19%. This technique has been modified and new approaches have been implemented aiming to improve patient safety. With the introduction of ultrasonography in the clinical practice, and recently in central venous catheter insertion, the rate of complications has dropped over time. ObjectiveTo measure the clinical application of the algorithm “Successful ultrasound-guided internal jugular vein cannulation”. MethodsA descriptive, prospective, case series study. Patients over 18years of age were selected, and the informed consent documentation was filled out appropriately. Patients with masses, anatomical abnormalities, insertion site infections and coagulopathy (international normalized ratio ≥2.0, platelet count ≤50.000) were excluded. Central venous cannulation was performed under ultrasound guidance in accordance with safety recommendations from the Anaesthesia Department of the Fundación Santa Fe de Bogotá University Hospital (HUFSFB). Adjustment and validation of the algorithm was done according to an expert consensus in our department. A descriptive univariate analysis was conducted, and efficacy was determined on the basis of the number of attempts to achieve successful venous cannulation, and the incidence of complications. ResultsThis series included 38 patients with a mean age of 62years. In 97.4% of the cases, successful venous cannulation was achieved on the first attempt. Guidewire displacement was observed in one case, requiring a second attempt. The posterior jugular vein wall was punctured in two patients (5.2%), with no associated arterial vascular injury or pneumothorax. ConclusionsThis algorithm resulted in a high rate of successful first attempts and the prevention of potential complications, improving operational standards and healthcare quality for the patients.

Internal jugular vein cannulation: How much safety can we offer?

IntroductionCentral venous catheterization, performed by the anatomical landmark technique, has a mechanical complication rate between 5% and 19%. This technique has been modified and new approaches have been implemented aiming to improve patient safety. With the introduction of ultrasonography in the clinical practice, and recently in central venous catheter insertion, the rate of complications has dropped over time. ObjectiveTo measure the clinical application of the algorithm “Successful ultrasound-guided internal jugular vein cannulation”. MethodsA descriptive, prospective, case series study. Patients over 18 years of age were selected, and the informed consent documentation was filled out appropriately. Patients with masses, anatomical abnormalities, insertion site infections and coagulopathy (International Normalized Ratio [INR]≥2.0, platelet count ≤50.000) were excluded. Central venous cannulation was performed under ultrasound guidance in accordance with safety recommendations from the Anaesthesia Department of the Fundación Santa Fe de Bogotá University Hospital (HUFSFB). Adjustment and validation of the algorithm was done according to an expert consensus in our department. A descriptive univariate analysis was conducted, and efficacy was determined on the basis of the number of attempts to achieve successful venous cannulation, and the incidence of complications. ResultsThis series included 38 patients with a mean age of 62 years. In 97.4% of the cases, successful venous cannulation was achieved on the first attempt. Guidewire displacement was observed in one case, requiring a second attempt. The posterior jugular vein wall was punctured in two patients (5.2%), with no associated arterial vascular injury or pneumothorax. ConclusionsThis algorithm resulted in a high rate of successful first attempts and the prevention of potential complications, improving operational standards and healthcare quality for the patients.

Counterculture and Alternative Media in Utopian Contexts: A Slice of Life from the Rainbow Region

Counterculture and Alternative Media in Utopian Contexts: A Slice of Life from the Rainbow Region

Indicadores de calidad en la atención de pacientes con infarto agudo de miocardio

ObjectiveDescribe the quality of care in patients presenting with acute myocardial infarction in a fourth level hospital in Bogotá, Colombia. MethodsObservational, retrospective, descriptive study. From January 2011 to April 2013, all patients arriving to Hospital Fundación Santa Fe de Bogotá with acute myocardial infarction according to the Third Universal Definition of Myocardial Infarction were included. ResultsAspirin at arrival was given to 99% of patients. Aspirin at discharge was given to 98%. Evaluation of left ventricular ejection fraction was performed in 97% of patients. Ninety three percent received beta-blocker at discharge, 88% received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Ninety eight percent were enrolled in a cardiac rehabilitation program. All-cause mortality was 6%. ConclusionsQuality performance indicators are fulfilled and our results are comparable to those of international standards. Actually there is no record of this information in Colombia.

El «pueblo» bogotano en la revolución del 20 de julio de 1810

The Santa Fe de Bogota Revolution of the 20th of July of 1810, was planned, driven and carried out by a relatively small group of neogranadine patricians and some spaniards. Nonetheless, without the action of the agitators (called «chisperos») on the 20th of July and following weeks, possibly the beginning of the political transformation in the Nueva Granada would have failed. This article aims at a prosopographic aproximation of who the sparklers were, how they were organized, and who their main leaders were during the days between the 20th of July and the 13th of August of 1810. Twentyfive eyewitness written testimonials are the main source used to undertake this study.

The transition to a teaching hospital: Patient satisfaction before and after the introduction of medical students

Background: Several studies have explored the effect of the presence of medical students on patient satisfaction. However, nearly all of these studies took place in hospitals where medical students had been involved in patient care for many years. Less is known about patients’ perceptions of care in a hospital moving toward becoming a teaching facility with undergraduate students. No research has explored patient satisfaction before and after the introduction of medical students.Objective: To assess patient satisfaction as an indicator of quality of care (QoC) from the patients’ perspective, before and after the presence of medical students in a general hospital setting.Methods: This observational, cross-sectional study was conducted at Hospital Universitario–Fundación Santa Fe de Bogotá (HU–FSFB) in Bogotá, Colombia. The study had two phases. In 2006, prior to HU–FSBF becoming a teaching hospital, 385 subjects were asked to fill out a closed-question questionnaire addressing patients’ satisfaction and perception of QoC provided by attending physicians. During the second period in 2009, 372 patients answered the same questionnaire when medical students were involved in their care.Results: Patients’ perceptions of QoC provided by attending physicians improved in five aspects when medical students were present: friendliness (p = 0.003), competence providing medical care (p = 0.049), quality of information provided (p = 0.025), amount of time spent with the patient (p < 0.001) and availability to personally provide care (p < 0.001). Overall patient satisfaction also significantly increased (p < 0.001).Conclusions: The presence of medical students does not negatively affect patients’ perceptions of QoC, on the contrary, these results provide evidence of improved patient satisfaction in several aspects of care when medical students were involved. The relevance of this study lies in its unique way of comparing patient satisfaction before and after the introduction of medical students. This setting helps elucidate the real effect of the presence of medical students on patient satisfaction.

Seguimiento de pacientes llevados a pieloplastia abierta experiencia multiinstitucional durante 6 años

Introduction and ObjectivesUreteropelvic junction obstruction (UPJO) is the most common cause of pathological prenatal hydronephrosis. Ultrasound (US) has changed the diagnosis and management of this condition. The most common surgical approach is the Anderson-Hynes pyeloplasty technique. The purpose of the present study is to describe our experience with this technique over the last 6 years and to evaluate the advantages and disadvantages. Methods y MaterialsA record was made of every patient who was operated at the Hospital San Ignacio, Hospital Militar Central, and Fundación Santa Fe de Bogotá since january 2006. Data was collected until April 2012. Information was recorded at the time of the procedure and in every follow-up visit afterwards. Analyzed variables were: age at surgery, details about diagnosis, surgery, and postoperative care. ResultsDuring the study period, 57 patients underwent a pyeloplasty. The mean age at surgery was 59 months. Antenatal diagnosis of the hydronephrosis was made in 70% of the cases. All procedures were the Anderson-Hynes technique. No case was bilateral. The drain was removed, on average, on the fourth postoperative day and the double J stent at 6 weeks. All cases showed some improvement or resolution of the hydronephrosis. Of the total of patients, 44 had a double J catheter placed at surgery. In 14 (24%) patients a complication was detected, and almost all occurred during the first three months after surgery. The most common complication was postoperative urinary tract infection in 9 (15.7%) patients. On average, these patients had their double J stents for 7.3 weeks. ConclusionsAnderson-Hynes is very successful for resolving the obstruction of the urinary tract. The presence of postoperative UTI as the main complication questions the possibility of the timing of double J stent use and for how long.© 2013 Sociedad Colombiana de Urología. Published by Elsevier España, S.L. All rights reserved.

Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy

Our aim was to evaluate whether the use of barbed suture for vaginal cuff closure is associated with a decrease in postoperative vaginal bleeding compared with cuff closure with polyglactin 910 in patients who have undergone laparoscopic hysterectomy. We performed a cohort study of patients who underwent laparoscopic hysterectomy between January 2008 and July 2012 by the minimally invasive gynecologic surgery division of the Gynecology, Obstetrics and Human Reproduction Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. A total of 232 women were studied: 163 were in the polyglactin 910 group, and 69 were in the barbed suture group. The main outcome, postoperative vaginal bleeding, was documented in 53 cases (32.5%) in the polyglactin 910 group and in 13 cases (18.8%) in the barbed suture group (relative risk, 0.57; 95% confidence interval, 0.34-0.9; P = .03). No statistically significant differences were found in other postoperative outcomes, such as emergency department admission, vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. In this study an inverse association was observed between the use of barbed suture for vaginal cuff closure during laparoscopic hysterectomy and the presence of postoperative vaginal bleeding.

Effect of Celecoxib in addition to standard therapy in adults with Major Depressive Disorder: A&#160;double-blind, randomized clinical trial

Introduction: Major depressive disorder (MDD) is an important cause of disability and only about 50% of patients achieve remission with standard antidepressant treatment. There is evidence that inflammatory mechanisms mediate the development and progression of this disease. However, controversy remains about the use of anti-inflammatory drugs as a therapeutic option for MDD. Research Hypothesis: Patients with MDD who receive celecoxib plus standard therapy achieve a lower score in the Hamilton rating scale for depression (HRSD) when compared to placebo plus standard therapy. Methods: A total of 80 out-patients from the Mental Health Service of the Fundacion Santa Fe de Bogota, aged 20-40 years old, with a diagnosis of moderate or severe MDD without previous treatment in the last 6 months will be included. Patients will be randomized to Celecoxib or placebo with an allocation ratio of 1:1 using a web-based random number generator. The primary endpoint will be the difference between the pretest and posttest score of the HRSD, after 6 months of treatment. Feasibility: This trial is feasible and relevant to the theme, in spite of the difficulty to maintain adherence in a study with MDD. Anticipated Results: Decrease in HRSD is expected in both groups during follow-up, but it is expected to be larger in the celecoxib group. A more rapid decrease of HRSD scores is expected in the 1st weeks.

Diversidad de aves en el Centro Agropecuario Cotové, Santa Fe de Antioquia, Colombia

Fragmentation of natural habitats is a central concern of biodiversity conservation and is considered a significant factor contributing to species loss and populations decline. We studied this in Cotové Agricultural Center in the municipality of Santa Fe de Antioquia (Colombia),where the conversion of natural forests to different land use systems, has limited the amount of available habitat. With the aim to describe the effect of habitat loss on bird presence in five land uses (fruiting trees, silvopastoral systems, secondary forest, pasture low density of trees and grass cutting) in this area, we studied bird diversity using two methods: fixed point counts and mist nets to analyze the influence of land use in the composition, richness and abundance of birds present were studied. A total of 6633 individuals of 101 species were observed of which 11 species were migratory. The insectivorous and frugivorous foraging guilds were better represented. The Shannon index indicated the highest values of alpha diversity for the silvopastoral system, and the fruit with the lowest. The grazing and silvopastoral land systems shared more species with low tree density. The importance of the environmental heterogeneity found is highlighted as a positive factor for bird species richness, mostly of low and middle habitat specificity, and preferably from edge habitats and open areas. In order to preserve natural regeneration and connectivity between different land use types, and to promote stability of bird species populations, some management actions should be implemented in the area.

A local hemostatic agent for the management of postpartum hemorrhage due to placenta previa and placenta accreta: a cross-sectional study

To describe the use of a local hemostatic agent (LHA) for the management of postpartum hemorrhage (PPH) due to bleeding of the placental bed in patients taken to caesarean section at Fundación Santa Fe de Bogotá University Hospital. A total of 41 pregnant women who had a caesarean section and developed PPH. A cross-sectional study. Analysis of all cases of PPH during caesarean section presented from 2006 up to and including 2012 at Fundación Santa Fe de Bogotá University Hospital. Emergency hysterectomy due to PPH. The proportion of hysterectomies was 5 vs. 66 % for the group that received and did not receive management with a LHA respectively (PR 0.07, CI 95 % 0.01-0.51 p < 0.01). For the group managed without a LHA, 80 % of patients needed hemoderivatives transfusion vs. 20 % of patients in the group managed with a LHA (PR 0.24, CI 95 % 0.1-0.6 p < 0.01). A reduction in the mean days of hospitalization in addition to a descent in the proportion of patients admitted to the intensive care unit (ICU) was noticed when comparing the group that received a LHA versus the one that did not. An inverse association between the use of a LHA in patients with PPH due to bleeding of the placental bed and the need to perform an emergency obstetric hysterectomy was observed. Additionally there was a significant reduction in the mean duration of hospital stay, use of hemoderivatives and admission to the ICU.

Complications of Total Laparoscopic Hysterectomy: A 8 Year Experience at the Hospital Universitario Fundación Santa Fe De Bogota

To determine the number and type of surgical complications according to the Dindo classification, in patients who underwent total laparoscopic hysterectomy at the Fundación Santa Fe De Bogota University Hospital (HUFSFB).

Experiencia diagnóstica de diez años del tumor neuroendocrino de pulmón en la Fundación Santa Fe de Bogotá: 2001 - 2010

Introducción: los tumores neuroendocrinos de pulmón surgen a partir de las células de Kulchitsky dispersas en todo el árbol bronquial; éstos tienen un amplio espectro de diferenciación histológica y son capaces de producir aminas bioactivas.Objetivos: describir las características clinicopatológicas de la población con diagnóstico de tumores neuroendocrinos de pulmón en el Hospital Universitario Fundación Santa Fe de Bogotá (HUFSFB) de 2001 a 2010.Diseño: estudio descriptivo tipo corte transversal.Materiales y métodos: se incluyó toda la población con tumores neuroendocrinos de pulmón confirmados por patología en el HUFSFB durante el periodo 2001 a 2010. Se revisaron los reportes de patologías y los registros médicos para la obtención de datos.Resultados: se incluyeron 132 casos. El tipo de tumor más frecuente fue el carcinoma de célula pequeña. El carcinoide típico fue cinco veces más frecuente que el atípico. Los tumores bien diferenciados fueron más frecuentes en mujeres y los de alto grado en hombres, presentándose a mayor edad y asociados al antecedente de tabaquismo. La principal forma de llegar al diagnóstico fue la aparición de síntomas secundarios al tumor. De todos los sujetos, 50% tenía metástasis al momento del diagnóstico, la mayoría en las formas mal diferenciadas.Conclusiones: el pulmón presenta un espectro histológico, clínico y bioquímico muy heterogéneo de tumores neuroendocrinos. Aun no hay datos nacionales de incidencia y supervivencia de este tipo de tumor. Se busca motivar la investigación en este campo y alertar sobre el seguimiento necesario, incluso en los tumores bien diferenciados.

Salud mental en el hospital general: resultados del Cuestionario de Salud del Paciente (PHQ) en cuatro servicios de atención

IntroductionFew individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. ObjectiveDetection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). MethodCross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. Results1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. ConclusionsThe usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined.

El USO DE LOS CATECISMO EN LA ENSEÑANZA DE LA RElIGIÓN CATÓLICA EN EL PERÍODO NEOGRANADINO Y DE lOS ESTADOS UNIDOS DE COLOMBIA. 1831-1886

Este artículo es el resultado de una investigación sobre el proyecto “La enseñanza de la Religión Católica, en el siglo XIX en la Nueva Granada y de los Estados Unidos de Colombia”. Se ofrece una reseña, descripción y análisis sobre los principales catecismos, algunos fueron autorizados por el Presidente del Estado Soberano (Cundinamarca 1882), otros por el Arzobispo de Santa Fe de Bogotá (Monseñor Manuel José Mosquera 1843) y después de la Constitución Política de 1886, y del Concordato de 1887, el Arzobispo de Santa Fe de Bogotá Monseñor José Telesforo Paúl S.J. (1886) y Monseñor Bernardo Herrera (1896). El objetivo principal del estudio es señalar la participación directa de los sacerdotes de la Compañía de Jesús (los Jesuitas) en la construcción del proyecto educativo católico del siglo XIX, la dirección del seminario Colegio de San Bartolomé, de colegios, autoría de los principales catecismos, de la evangelización y en el ejercicio de ser los Arzobispos de Santafé de Bogotá.Palabras clave: Revista Historia de la Educación Latinoamericana, catecismos, textos religiosos, enseñanza religiosa, educación católica.

Potential of a Hand Transplantation Program in Colombia

The protocols and published results on hand transplantation show acceptable results of this technology. None of the registered groups, however has a sufficient number of patients to allow continuity of the process. In Colombia the main problems are violence, drug traffic, and guerrillas. Thanks to the profitability of drug traffic, guerrillas, who initially were created based on ideologic differences, have become terrorist groups whose main source of income is drug traffic. From that interest comes the use of landmines to protect illicit crops. Colombia is the most mined country in the world, followed by Cambodia and Afghanistan, and the only country in Latin America where there are still landmines. The mines, violence, and trauma produce a large number of people with disabilities and amputations. From 1990 to 2006, the number of victims rose from 21 to 1,041 per year. In Colombia, amputations are more frequently due to trauma than to disease. The fact that 88% of the victims are children and people of working age, affects the political and economic development. These alarming numbers generate a challenge for government, which has led to the creation of policies and laws aimed at comprehensive action against mines. This program under the Presidency has among its objectives assistance to victims, including integrated treatment, prostheses, and other procedures, financed entirely by the government. The number, type of victims, and their motivation to be transplanted, along with government programs directed to their attention, are key factors that we think will enable the continuity of our hand transplantation program at the Fundación Santa Fe de Bogotá, giving Colombia the unfortunate privilege of having the largest number of potential patients for transplantation.

Pollutant removal in a multi-stage municipal wastewater treatment system comprised of constructed wetlands and a maturation pond, in a temperate climate

A multi-stage municipal wastewater treatment system is proposed to comply with Mexican standards for discharge into receiving water bodies. The system is located in Santa Fe de la Laguna, Mexico, an area with a temperate climate. It was designed for 2,700 people equivalent (259.2 m3/d) and consists of a preliminary treatment, a septic tank as well as two modules operating in parallel, each consisting of a horizontal subsurface-flow wetland, a maturation pond and a vertical flow polishing wetland. After two years of operation, on-site research was performed. An efficient biochemical oxygen demand (BOD5) (94-98%), chemical oxygen demand (91-93%), total suspended solids (93-97%), total Kjeldahl nitrogen (56-88%) and fecal coliform (4-5 logs) removal was obtained. Significant phosphorus removal was not accomplished in this study (25-52%). Evapotranspiration was measured in different treatment units. This study demonstrates that during the dry season wastewater treatment by this multi-stage system cannot comply with the limits established by Mexican standards for receiving water bodies type 'C'. However, it has demonstrated the system's potential for less restrictive uses such as agricultural irrigation, recreation and provides the opportunity for wastewater treatment in rural areas without electric energy.

Incidence and risk factors for infections after liver transplant: single‐center experience at the University Hospital Fundación Santa Fe de Bogotá, Colombia

The incidence of infections in liver transplant patients is higher compared with recipients of other organs, and infections are one of the major complications after transplantation. The aim of our study was to evaluate the incidence, presentation and risk factors of infections in liver transplant recipients in a Latin-American population, and to compare the results with data worldwide. We performed a retrospective analysis of 94 consecutive patients undergoing liver transplantation between 2004 and 2008 at the University Hospital Fundación Santa Fe de Bogotá, Colombia. The patients contributed a total of 64.4 person years (PY). Fifty-two patients (55.3%) developed one or more infections, in total 83 events (128.9 infections/100 PY). Bacterial infections represented the most frequent event (71.1%), followed by viral (19.3%) and fungal infections (8.4%). In 1%, no causative organism was identified. More than one-third of infections (37%) occurred during the first 30 days, whereas 83% of all events were seen during the first 6 months. The most common site of pathogen localization was the bloodstream (25.3%), followed by the urinary tract (15.7%), liver with bile tract (14.5%), abdomen (10.8%), surgical site (7.2%), and lungs (9.6%). The overall mortality after 1 year was 14.9%, and 57.1% of the deaths were attributed to infections. We found that risk factors significantly associated with increased incidence rate ratio for infection were prolonged stay at the intensive care unit, the need for parenteral nutrition, and blood transfusion requirement. Our data provide additional information about etiology and epidemiology of infections after liver transplantation.