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El termino cáncer comprende un grupo de enfermedades que comparten la característica de crecimiento no controlado de células anormales en un órgano o tejido determinado, que lleva a invasión de los tejidos adyacentes o diseminación a distancia a otros órganos o tejidos. Es la segunda causa de muerte a nivel mundial, con un estimado de 9,6 millones en el año 2018 (1). Según datos de la Organización Mundial de la Salud (OMS), en el año 2018, el cáncer de pulmón representó el 11,6% de la totalidad de la enfermedad por cáncer en el mundo, con una mortalidad del 18,4%. En Suramérica se reportaron 68 504 casos, de los cuales, 29 249 correspondían a nuevos casos; la mortalidad reportada fue de 62 922 casos (2). Esto nos lleva a plantearnos la necesidad de realizar un diagnóstico y tratamiento oportuno del cáncer pulmonar. En diciembre de 2019 se describieron los primeros casos de neumonía generada por un nuevo coronavirus de origen animal: el coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), que genera la enfermedad denominada COVID-19 (3). La OMS catalogó a la enfermedad por COVID-19 como una emergencia de salud pública de importancia internacional. En Colombia se confirmó el primer caso el 6 de marzo de 2020. Es una prioridad comunicarse con los pacientes, explicarles la situación actual a nivel mundial y local, y dar el soporte requerido para mantener un buen estado físico, mental y emocional durante la crisis, en busca del mejor plan terapéutico para cada caso (4).

Los cuerpos extraños en la vía aérea son poco frecuentes y, por lo general, son de origen mucoso; sin embargo, en la literatura, no hay reportes de objetos metálicos, como en nuestro caso. Su principal complicación es la neumonía postobstructiva. La vía ideal para el manejo es la endoscópica, pero en casos especiales como el reportado, la vía quirúrgica por toracoscopia o toracotomía es la pertinente. La bronquioplastia permite la extracción del cuerpo extraño y evita la necesidad de realizar una resección pulmonar.

Here we report a case of a young, never-smoker Hispanic woman with a hereditary familial overlap syndrome (Li-Fraumeni plus CDH1). The patient developed multiple synchronous primary lung adenocarcinomas related to Intra-Alveolar Tumor Spread (STAS) several years after the diagnosis of a locally advanced lower limb osteosarcoma. Comprehensive genomic profiling by next generation sequencing (NGS) was performed on 90 cancer-related genes over each lung lesion (including two nodules of acinar adenocarcinoma, one lepidic spread tumor and in the STAS area). Likewise, the broad genomic analysis was performed on archival tissue from the previous bone tumor. Lung tumors were found to harbor PIK3CA (invasive lesions) and a rare in-frame insertion of nucleotides in exon 19 of EGFR (lepidic tumor). STAS area showed KRAS and BRAF mutations in two different segments, and osteosarcoma tested positive for well known PIK3CA, KRAS and CDH1 alterations. This unique case raises practical questions as to the challenges of molecular testing and highlights the potential association of germline TP53 and CDH1 mutations with concurrent somatic alterations that elucidate the basis of tumor heterogeneity.

el tórax inestable. Desde entonces existe gran controversia sobre el manejo conservador comparado con el manejo quirúrgico. Objetivo: Dar a conocer los beneficios, las indicaciones y las contraindicaciones de la fijación temprana de fracturas costales en el tórax inestable. Conclusión: La reducción abierta y la fijación temprana de fracturas costales en pacientes con tórax inestable ha demostrado ser un método útil, efectivo y seguro. Antecedentes: En 1926, Jones y Richardson describen por primera vez el tórax inestable. Desde entonces existe gran controversia sobre el manejo conservador comparado con el manejo quirúrgico. Objetivo: Dar a conocer los beneficios, las indicaciones y las contraindicaciones de la fijación temprana de fracturas costales en el tórax inestable. Conclusión: La reducción abierta y la fijación temprana de fracturas costales en pacientes con tórax inestable ha demostrado ser un método útil, efectivo y seguro. Background: In 1926, Jones and Richardson described flail chest for the first time. Since then, exist great controversy about conservative vs surgical approach. Objective: Define the benefits, indications and contraindications of the early fixation of rib fractures in flail chest. Conclusion: The open reduction and early fixation of rib fractures for patients with flail chest has proven to be a useful, effective and safe method

En 1926, Jones y Richardson describen por primera vez el tórax inestable. Desde entonces existe gran controversia sobre el manejo conservador comparado con el manejo quirúrgico.Dar a conocer los beneficios, las indicaciones y las contraindicaciones de la fijación temprana de fracturas costales en el tórax inestable.La reducción abierta y la fijación temprana de fracturas costales en pacientes con tórax inestable ha demostrado ser un método útil, efectivo y seguro.In 1926, Jones and Richardson described flail chest for the first time. Since then, exist great controversy about conservative vs surgical approach.Define the benefits, indications and contraindications of the early fixation of rib fractures in flail chest.The open reduction and early fixation of rib fractures for patients with flail chest has proven to be a useful, effective and safe method.

The health benefits of extra virgin olive oil (EVOO) are related with its chemical composition and the presence of bioactive compounds with antioxidant properties. The aim of this study was evaluate antioxidant compounds (pigments, CoQ10 and phenolic compounds) and antioxidant properties of EVOO from the same region comparing different cultivars (Hojiblanca and Arbequina), harvest year and crop stage. Antioxidant properties of oils were studied before and after a gastrointestinal digestion process, by in vitro assays (DPPH, ABTS and FRAP) and antioxidant markers in Caco-2 cells (reactive oxygen species production). The content of bioactive compounds measured was significantly affected by cultivar and harvest year (except for carotenoids) and by the crop stage (except for coenzyme Q10). Higher amount of coenzyme Q10 was observed in Hojiblanca than in Arbequina EVOO. Total phenol content and antioxidant properties were also different depending on cultivar and harvest year and the in vitro digestion process strongly improved antioxidant marker values. Antioxidant potential in bioaccessible fractions was mainly related with content of coenzyme Q10 and phenolic compounds in EVOO. Chemometric analysis showed that the oils were clearly classified by cultivars, harvest and crop stage, according with chemical composition and antioxidant activity analyzed in the present study

La trombosis séptica de la porta es una complicación poco frecuente y altamente mortal que se presenta en los pacientes como complicación de patología quirúrgica abdominal principalmente en casos de apendicitis aguda y enfermedad diverticular complicada. Las manifestaciones clínicas de la condición son bizarras lo que hace el diagnostico difícil y por ende la intervención tardía, favoreciendo así las tasas de complicaciones y desenlaces adversos. La aproximación diagnostica se enfoca en la clínica y técnicas de imagen. Se presenta un caso en relación a trombosis séptica de la porta secundario a patología dependiente del apéndice cecal manifiesto como choque séptico.

Early separation of mild cognitive impairment (MCI) from normal aging and mild cases of dementia remains a challenge, especially in the general population. We aimed to analyze the diagnostic accuracy of a brief neuropsychological battery (BNB) in dementia and MCI cases from the Neurological Disorders in Central Spain (NEDICES) population-based cohort study. We screened 3,891 participants into dementia and non-dementia groups using a two-phase procedure: screening (MMSE-37 and Pfeffer-11) and clinical diagnosis by specialists (DSM-IV criteria). We selected subsequently a subsample of dementia (nA¢Â€ÂŠ=A¢Â€ÂŠ98), MCI (nA¢Â€ÂŠ=A¢Â€ÂŠ71), and cognitively healthy (nA¢Â€ÂŠ=A¢Â€ÂŠ123) participants matched in socio-demographic characteristics. The clinical validity of each test of the BNB was determined by the area under the ROC curve. We determined the best combination of tests to classify individuals into the diagnostic groups by logistic regression analyses. The results indicated that dementia and MCI groups could be best discriminated from the healthy control group on the basis of their scores on the semantic verbal fluency and delayed recall subtests of the BNB. As for discriminating the MCI group from the dementia group, immediate recall tasks (stories and pictures) yielded the highest level of accuracy. Probably the most interesting finding is that the verbal fluency task consistently allowed discrimination among the diagnostic groups. Overall, subtests of the BNB are more accurate in differentiating dementia patients than MCI patients from healthy controls. In this population-based sample, a more fine-grained discrimination that includes MCI patients should follow a systematic subtest-wise analysis and decision.

Este artículo tiene como objetivo realizar una revisión bibliográfica acerca del autismo infantil. Se hace énfasis en las diversas teorías e hipótesis psicológicas que subyacen a este singular trastorno y se complementa la información acerca de las diversas técnicas de intervención que a nivel interdisciplinario se vienen manejando, con el fin de mejorar la calidad de vida de los afectados. El autismo infantil presenta una gran heterogeneidad en sus manifestaciones sintomáticas, por lo que es posible confundirlo a nivel de diagnóstico diferencial. Se han encontrado contradicciones en los resultados de algunas investigaciones en relación con las diversas técnicas de intervención con las que se viene tratando actualmente el trastorno.

Introducción. El diagnóstico de apendicitis es difícil y existen algunas escalas que pretenden mejorar la exactitud diagnóstica. Objetivo. Determinar las características operativas de las escalas de Alvarado y Fenyö, comparándolas con la impresión diagnóstica del cirujano y la patología en el dolor abdominal sugestivo de apendicitis. Materiales y métodos. Se trata de un estudio prospectivo de evaluación de pruebas diagnósticas. Se registraron los signos, síntomas y resultados de exámenes de laboratorio incluidos en las escalas. Se registró de manera ciega el diagnóstico del cirujano y su conducta. Se determinó la sensibilidad, especificidad, valores diagnósticos positivos y negativos, y likelihood ratio (índice de verosimilitud) de cada escala y del cirujano, discriminado por sexo. Resultados. Se analizaron 374 sujetos, sin diferencias estadísticamente significativas de variables entre sexos. Se operaron 269 pacientes. El 16,9% de los hombres y el 31,4% de las mujeres no tuvieron apendicitis. Para los hombres, la sensibilidad del diagnóstico por el cirujano fue mayor que las escalas (86,2% Vs. 73% en Alvarado Vs. 67,2% en Fenyö) con una especificidad similar. Para las mujeres la sensibilidad del cirujano y la escala de Alvarado fueron similares y superiores a la de Fenyö (77,1% Vs. 79,5% en Alvarado y 47% en Fenyö) pero la especificidad fue superior para Fenyö (92,9% Vs. 71,4% en Alvarado y 75,9% en cirujano). La frecuencia de apendicitis crece de manera proporcional al puntaje de Alvarado. Conclusión. Para hombres con dolor en la fosa iliaca derecha, el diagnóstico hecho por el cirujano es mejor que las escalas diagnósticas. Para el caso de las mujeres, la escala de Fenyö ofrece una mejor sensibilidad. La escala de Alvarado puede facilitar la conducta en pacientes con dolor en fosa iliaca derecha.

Introduction: The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. Objective: To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. Materials and methods: The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p 0.90) for all measurements in both environments, and there was consistency across all cohorts. Conclusions: The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

Laparoscopic surgery has been recommended as an effective strategy because of its advantages in decreasing abdominal surgical site infections (SSIs). The aim of this study was to assess the effect of laparoscopy on superficial and organ/space SSIs compared with open surgery in hollow-viscus procedures over time.Data on SSIs from randomized-controlled trials (RCTs) evaluating open versus laparoscopic abdominal surgeries were extracted from the Cochrane Database Reviews. Re-analysis of these data was performed to assess infections. Heterogeneity was also explored. A subgroup analysis was performed according to elective/emergency surgery status.Data from 72 RCTs including 8218 patients were collected (4116 patients in the laparoscopic group and 4102 patients in the open group). For superficial SSI, the pooled RD was -4.4% (95% CI: -5.4% to -3.3%), which indicated a lower risk in the laparoscopic group. For organ/space SSI, the pooled RD was 0.5% (95% CI: -0.1% to 1%), which indicated similar rates between the groups. Changes in SSI frequency had occurred over time.Laparoscopic surgery significantly decreases the risk of superficial SSI but does not affect the risk of organ/space SSI. Experience with technique improves outcomes.

The first video-assisted thoracic lobectomy in non-intubated patient in America was performed on 27th of September 2014 in Bogotá Colombia, The National Cancer Institute in Bogotá received Dr. Diego González-Rivas to make possible this kind of procedure in a 53-year-old man, with a history of papillary thyroid cancer treated with surgery and Iodine therapy, in whom two pulmonary nodules were found in the monitoring tomography. We resected the nodule located at the right upper lobe previously marked by scintigraphy, the other one required a lobectomy because it was a deep nodule with malignant radiologic appearance inside of the middle lobe. The procedure discoursed in a non-intubated patient without technical difficulties or complications, very short recovery time, minimum pain and a quiet and usual postoperative evolution. This procedure, the first reported in America was replicated after others with similar results in several countries thanks to the collaboration between surgeons, anesthesiologists, radiologists, nurses and therapists, because especially in such interventions teamwork is essential. We believe that given the benefits in terms of recovery for the patient and anesthetic time, we could go on replicating the experience in selected patients.

Este artículo tiene como objetivo realizar una revisión bibliográfica acerca del autismo infantil. Se hace énfasis en las diversas teorías e hipótesis psicológicas que subyacen a este singular trastorno y se complementa la información acerca de las diversas técnicas de intervención que a nivel interdisciplinario se vienen manejando, con el fin de mejorar la calidad de vida de los afectados. El autismo infantil presenta una gran heterogeneidad en sus manifestaciones sintomáticas, por lo que es posible confundirlo a nivel de diagnóstico diferencial. Se han encontrado contradicciones en los resultados de algunas investigaciones en relación con las diversas técnicas de intervención con las que se viene tratando actualmente el trastorno.Palabras clave: Autismo infantil, diagnóstico, intervención-autismo.The goal of this article is to clarify the state of art related to Autism emphasizing the diverse theories and psychological hypotheses implied in this singular disorder. Also, we will relate this to the interdisciplinary and diverse present techniques of intervention. The idea is to clarify how to improve the quality of life of the affected ones with this disorder. Clarifying all of this is very important in order to do a differential diagnosis properly because this disorder presents a great heterogeneity in its symptomatic manifestations, and it is often confused with other disorders. It has been found several contradictions in the results of some investigations in relation to the diverse techniques of intervention with which this disorder is treated.Key words: Child autism, diagnosis, intervention-autism.

The study aimed to verify whether the format of an individual or group intervention, applied in a multimodal cognitive stimulation program (MCSP), had an impact on progression and beha vioral disturbances associated with Alzheimer's disease patients (AD). Forty-fi ve participants diagnosed with probable AD were randomly divided into 3 groups. The performance of both experimental groups, receiving the MCSP either in individual or in group format, were compared with a control group with the use of a pre-post design on standard neuropsychological, functional and behavioral measures. Both MCSP groups achieved to signifi cantly slow the progression of cognitive impairment and reduce behavioral symptoms associated with AD patients. However, the individual intervention format in- creases the benefi ts of the MCSP for AD patients in comparison with the group format.

Diagnosis of apendicitis is difficult; however several clinical scales have been developed that attempt to improve diagnostic accuracy.The operational characteristics of Alvarado and Fenyö scales were defined in patients with abdominal pain suggestive of appendicitis and were compare with clinical and pathological diagnoses.A prospective trial assessed the diagnostic tests. Sign, symptoms, and laboratory tests were included in scales selected. Surgeon decision was maintained independent from the results of the scales. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio for each scale was compared with the surgeon evaluation.The sample included 374 patients with approximately equal sexes. Of these 269 patients underwent surgery. Howeve, 16.9% of the male and 31.4% of female patients did not have appendicitis. For men, a diagnosis made by the surgeon had better sensitivity than scales (86.2% vs. 73% for Alvarado and 67.2% for Fenyö) without significant differences in specificity. For women, surgeon and Alvarado scale diagnoses were similar, and better than Fenyö scale (77.1% vs. 79.5% for Alvarado and 47% for Fenyö), but specificity was higher for Fenyö scale (92.9% vs. 71.4% for Alvarado and 75.9% for surgeon). Accuracy in diagnosis of appendicitis increases with a higher Alvarado score.For men with abdominal pain on right lower quadrant, surgeon diagnosis is more accurate than scales. For women, Fenyö scale offers a better sensitivity. Alvarado score can facilitate decision-making in patients with these abdominal symptoms.