Fundación Santa Fe de Bogotá
Recent publications
Objective To assess the rate of pathological response rate, and the oncological outcomes of preoperative brachytherapy (PBT) in early-stage cervical cancer. Methods A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISMA) statement. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from inception until April 2022. Only English and French articles were included. Studies containing data about pathology response or oncological outcomes among patients who received PBT as compared to those who underwent up-front surgery in early-stage cervical cancer were included. This study was registered in PROSPERO (CRD42022319036). Results Thirteen studies met the inclusion criteria, 3 randomized controlled trials (RCT), and 10 non-randomized studies (NRS). The 5-year survival was significantly higher in the PBT group compared with the up-front surgery group (OR 1.78, 95% CI 1.11–2.84, I² = 0%) in the NRS. Recurrence rate was significantly lower in the PBT group compared with in up-front surgery group in the analysis of the RCT but not in NRS, (OR 0.34, 95% CI 0.13–0.91, I² not applicable) and (OR 0.72, 95% CI 0.26–1.95, I² = 51%) respectively. PBT was associated with a statistically significant lower rate of positive margins (OR 0.28, 95% CI 0.09–0.89; I² = 42%) in the RCT and with a significantly higher rate of complete pathology response (CPR) in the RCT analysis (OR 2.55, 95% CI 1.11–5.85, I² = 0%) and in the NRS (OR 9.64, 95% CI 1.88–49.48, I² = 76%) compared with the up-front surgery group. Conclusion Preoperative brachytherapy in patients with early-stage cervical cancer could improve pathologic and oncologic outcomes, but it should be assessed in high-quality randomized controlled trials before its implementation in clinical practice.
Totally implanted central venous port systems are widely used to access central veins for patients needing long-term therapy. These devices have low rates of complications and are commonly used to administer medications like chemotherapeutic agents. Spontaneous rupture of a catheter segment is a rare mechanical complication, usually belatedly diagnosed and presenting with complications. We present a case of a spontaneously ruptured chemotherapy catheter diagnosed using a novel approach via oblique projections on chest X-rays and successfully removed using an endovascular approach.
This study aims to evaluate the effectiveness of an online course to enable orthopaedic surgeons to acquire the core competencies necessary to prevent and treat fracture-related infections (FRI). This study included orthopaedic surgeons and residents from Latin American countries who attended an online course focused on FRI. The online course included: didactic lectures, small-group clinical case discussions, and panel case discussions. The course was delivered using Zoom® platform and designed to address four core competencies: prevention, definition and diagnosis, antimicrobial therapy, and surgical treatment. An online questionnaire was created distributing 16 questions through six clinical scenarios. Participants were invited to answer the questionnaire before and after the course. Sixty of the 78 course participants answered the pre-course, and 42 the post-course assessment. Relative to before the course, the mean post-course assessment score rose significantly for prevention of FRI (4.1 before and 4.5 after; p = 0.014), definition and diagnosis (2.4 before and 3.4 after; p = 0.001), and surgical treatment (2.2 before and 2.8 after; p = 0.011). The final score encompassing all four core competencies also rose significantly (2.7 before and 3.3 after; p = 0.001). The online course on FRI was feasible and effective, significantly increasing course users’ knowledge of overall competency in managing FRI.
Background The COVID-19 pandemic tested the capacity of intensive care units (ICU) to respond to a crisis and demonstrated their fragility. Unsurprisingly, higher than usual mortality rates, lengths of stay (LOS), and ICU-acquired complications occurred during the pandemic. However, worse outcomes were not universal nor constant across ICUs and significant variation in outcomes was reported, demonstrating that some ICUs could adequately manage the surge of COVID-19. Methods In the present editorial, we discuss the concept of a resilient Intensive Care Unit, including which metrics can be used to address the capacity to respond, sustain results and incorporate new practices that lead to improvement. Results We believe that a resiliency analysis adds a component of preparedness to the usual ICU performance evaluation and outcomes metrics to be used during the crisis and in regular times. Conclusions The COVID-19 pandemic demonstrated the need for a resilient health system. Although this concept has been discussed for health systems, it was not tested in intensive care. Future studies should evaluate this concept to improve ICU organization for standard and pandemic times.
Introduction/objective: Major Depressive Disorder (MDD) is a multifactorial mental health disorder. Stressful events and childhood abuse have been included in different models to explain its etiology. However, little evidence is available on how attributional style and early maladaptive schemas are related to MDD. Method: A retrospective case-control study using a three-stage hierarchical logistic model was conducted to explore the relationship between MDD and psychosocial variables such as childhood adversity, stressful life events, attributional style, and cognitive schemas in a sample of 171 individuals with a current depressive episode and 171 healthy controls. Results: Depression could be predicted by childhood adversity, an attributional style characterized by interpreting stressful events as negative and uncontrollable and the cognitive schemas in impaired autonomy/performance domains and impaired limits. Conclusions: Our results highlight the relevance of identifying cognitive factors, beyond clinical symptoms that could be useful to better understand MDD. These findings may result in better preventive programs and create awareness of the role of cognitive domains in MDD.
Background Acute mesenteric ischemia is a lethal challenging pathology for surgeons in the emergency department due to its ambiguous clinical presentation and lack of early diagnostic markers. Serum lactate is considered a relevant biomarker in terms of bowel necrosis length and mortality prediction. Nevertheless, its association has been poorly studied. Hence, we evaluated the relation between serum lactate admission levels, bowel necrosis extension, and mortality in patients with acute mesenteric ischemia. Methods A Retrospective cross-sectional study with a prospective database was conducted, including patients over 18 years old with mesenteric ischemia that required surgical management between January 2012 and December 2018. We describe the association between serum lactate admission levels with bowel necrosis length and mortality in patients with acute mesenteric ischemia. Results 74 patients presented with acute mesenteric ischemia, 44 males and 30 females. Mean age was 73.5 ± 10.7 years old. Significant association between serum lactate admission levels and mortality was found (ROC cut-value of 3.8 mmol/l, 81.0% sensibility and 76% specificity, LR+3.41 (95%CI 1.57, 7.40), LR- 0.25 (95%CI 0.13–0.45))(P.001). Nonetheless no statistically significant association was found between serum lactate admission levels and bowel necrosis length (ρ = 0.195,95%CI -0.046, −0.436, P > .99). As post hoc analysis, a classification and regression tree on mortality was fitted. Conclusions Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate admission levels can be considered as a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.
Megacystic Magnetic resonance imaging Atypical inflammatory demyelinating disorders a b s t r a c t Multiple sclerosis is a frequent condition where the diagnosis relies on clinical presentation, neurologic examination, cerebro spinal fluid markers, and diagnostic imaging tests; however , atypical variants of the disease can lead to misdiagnosis in some scenarios. Herein, we describe a case of a 24-year-old patient with multiple sclerosis with megacystic plaques, in which appropriate interpretation of the imaging findings lead to a proper diagnosis and treatment.
Background Increases in the diameter of the optic nerve sheath (ONSD) on ultrasound are associated with high intracranial pressure (hICP). The normal value varies with altitude and the population studied. The objective of this study is to describe the normal values of the ONSD in a healthy adult population of the city of Bogotá, Colombia, at 2640 meters above sea level (masl). Patients and methods A prospective observational study was conducted on a total of 247 healthy individuals recruited from May 2021 to May 2022 who were subjected to the color, low power, optic disk, safety, elevated frequency, dual (CLOSED) protocol for measuring the bilateral ONSD adjusted to the eyeball transverse diameter (ETD). Results A total of 230 individuals were analyzed; the average ONSD of the right eye (RE) was 0.449 cm (range 0.288–0.7) and that of the left eye (LE) was 0.454 cm (range 0.285–0.698); the correlation between RE and LE was 0.93 ( p < 0.005), and the correlation of the ONSD/ETD ratios for the RE and LE was lower ( r ² = 0.79, p < 0.005). A total of 10.8% of the studied population had values greater than 0.55 cm. Conclusions The median ONSD and ONSD/ETD ratio in the city of Bogotá are similar to those described in other populations; however, approximately 10.8% of the healthy population may present higher values, which would limit the use of ONSD on its own for clinical decision-making, only repeated measurements with significant changes in the ONSD and ONSD/ETD or asymmetries between the measurements of both eyes linked to clinical findings would allow the diagnosis of hICP.
Virtual reality has been used in orthopedics for several years now, both as a training and assessment tool. The use of extended reality technologies in surgical training and simulation is the most developed and validated of all the current applications. However, formal and massive implementation in continuous orthopedic education has yet to happen. This report aimed to present our experience during the first AO trauma regional courses in Latin America that incorporated the use of immersive virtual reality (IVR) simulation as a hands-on activity as part of the program. IVR was used for the first time as part of a course activity during the advanced principles of fracture treatment course as part of the AO regional courses in Rio de Janeiro, Brazil, in 2022. The activity was implemented for 120 participants in a back-to-back fashion. Each participant used the IVR simulation for the trochanteric nail application and did a traditional hands-on exercise with a synthetic bone model. An appreciation survey was answered by participants. Seventy-four persons answered the survey. About 62% considered that the IVR simulation was like reality, and 76.38% thought that IVR was helpful in the learning process. The majority (91.6%) would like to use IVR for training, and 93% would be willing to use IVR again. This was the first time, IVR simulation was implemented as a massive and structured educational activity during the principles of fracture treatment course. Participant feedback was positive, and most people would use IVIR again. A systematic way of implementing IVR simulation sessions with educational goals needs to be developed for these activities.
Background Scalp complications in craniofacial surgeries can increase morbidity and mortality. Given the inelastic characteristics of the scalp, these surgeries can be challenging, and multiple complications can arise. The literature on craniofacial surgery is extensive. However, few articles address scalp complications, associated factors, and prevention. This study aims to identify and classify scalp complications in craniofacial surgery and describe associated risk factors, general preventive measures, and an initial therapeutic approach. Methods We conducted a literature search in PubMed, Scopus, Cochrane Library, and LILACS to review the scalp complications in craniofacial surgery. The studies selected included retrospective case series, narrative reviews, systematic reviews, and cadaveric anatomic studies. We completed the search with book chapters and specific topic reviews. Results We screened a total of 124 sources and selected 35 items for inclusion in this review. Based on the updated review, we categorized scalp complications into wound defects, soft tissue contour irregularities, neurovascular defects, and infection. We discuss the main characteristics, risk factors, preventive measures, and initial management of these complications. Conclusions For craniofacial surgery, understanding the surgical anatomy, identifying risk factors, adequate surgical planning, and interdisciplinary cooperation between neurosurgeons, plastic surgeons, and the interdisciplinary team are essential to prevent and treat scalp complications. Level of evidence: Not ratable
Introduction: The COVID-19 pandemic triggered transformations in the population's lifestyles, including electronic nicotine delivery system (ENDS) consumption. The aim of the study was to determine associations between ENDS consumption habits and lifestyles among higher education students in Bogotá, Colombia. Methods: This study employed a cross-sectional analytical design, based on a self-administered online survey, conducted in 2021, among students aged 18-59 years. The sample size was 3985 students. Statistical analysis was done through frequency studies, hypothesis testing and a multivariate-penalized logistic regression model (firthlogit), based on the Akaike information criterion (AIC). Results: A total of 3573 students completed the survey, 61.5% were female, 55.3% were young (aged 18-26 years), and 44.6% were adults (aged 27-59 years). The prevalence of ENDS use during the pandemic was 7.3%. Age was negatively associated with ENDS use, as young people had a higher likelihood of using these devices. The likelihood of ENDS use was negative among females (OR=0.38; 95% CI: 0.2-0.5). In contrast, it was positive in students with a history of psychoactive substance abuse and/or dependence (OR=3.59; 95% CI: 1.0-12.0), students who had tried conventional cigarettes (OR=5.12; 95% CI: 3.0-8.5), participants who smoked tobacco during the pandemic (OR=3.15; 95% CI: 2.3-4.2), those who studied virtually (OR=1.52; 95% CI: 1.0-2.3), participants who lived with other ENDS users (OR=3.86; 95% CI: 2.8-5.2) and students with negative perception of impacts on their mental health (OR=1.48; 95% CI: 1.1-1.9). Conclusions: Being male, aged <26 years, having a history of substance use, having tried conventional cigarettes, pandemic tobacco use, and having lived with other ENDS users, were the main factors associated with pandemic ENDS use. Studying the consumption habits of students in response to lifestyle changes, is fundamental for the formulation of strategies to reduce the development of addictive behaviors, especially in young students during the pandemic.
Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are the non-medical factors that influence health outcomes. Evidence indicates that health behaviours, comorbidities and disease-modifying therapies all contribute to multiple sclerosis (MS) outcomes; however, our knowledge of the effects of social determinants - that is, the 'risks of risks' - on health has not yet changed our approach to MS. Assessing and addressing social determinants of health could fundamentally improve health and health care in MS; this approach has already been successful in improving outcomes in other chronic diseases. In this narrative Review, we identify and discuss the body of evidence supporting an effect of many social determinants of health, including racial background, employment and social support, on MS outcomes. It must be noted that many of the published studies were subject to bias, and screening tools and/or practical interventions that address these social determinants are, for the most part, lacking. The existing work does not fully explore the potential bidirectional and complex relationships between social determinants of health and MS, and the interpretation of findings is complicated by the interactions and intersections among many of the identified determinants. On the basis of the reviewed literature, we consider that, if effective interventions targeting social determinants of health were available, they could have substantial effects on MS outcomes. Therefore, funding for and focused design of studies to evaluate and address social determinants of health are urgently needed.
Background: The COVID-19 pandemic has placed an unprecedented physical and mental burden on healthcare workers who are frequently at high risk of infection, particularly in low-income countries. This study aimed to assess the prevalence and associated factors of anxiety, depression, and stress, as well as changes in daily and occupational activities among healthcare professionals due to the COVID-19 pandemic in Colombia. Methods: An observational, cross-sectional study was conducted between February and June 2021. The survey incorporated validated mental health tools such as the Generalized Anxiety Disorder–7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10. Multivariable ordinal logistic regression analysis was performed to determine the factors associated with severe mental health outcomes. Results: Among 1345 healthcare workers the prevalence of anxiety, depression, and stress were 75.61, 59.18, and 53.09%, respectively. Anxiety (OR:1.44; 95%CI:1.16–1.8), depression (OR:1.74; 95%CI:1.27–2.37), and stress (OR:1.51; 95%CI:1.18–1.94) were more frequent in women, and individuals who expressed fear of a negative outcome (death, sequelae) (OR:2.25; 95%CI:1.60–3.25), (OR:1.49; 95%CI:1.03–2.16) and (OR:2.36; 95%CI:1.69–3.29) respectively. Age was negatively associated with anxiety (OR:0.98; 95%CI:0.98–0.99), stress (OR:0.98; 95%CI:0.97–0.99), and depression (OR:0.97; 95% CI:0.96–0.98). Reduction in consultations and surgeries (OR:1.01; 95%CI:1.0–1.01) was positively associated with anxiety. Due to the pandemic, most specialists expected to incorporate drastic long-term (>1 year) changes in their clinical setting and daily activities. Conclusions: The prevalence of anxiety, depression, and stress is higher among Colombian healthcare workers compared to previous reports. Further research regarding these psychological outcomes is needed to achieve early mental health intervention strategies
The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1–3 months (OR 5.5; 90 % confidence interval 1.1–26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.
Background: Programmed death ligand-1 (PD-L1) expression predicts immunotherapy utility in nononcogenic addictive lung adenocarcinoma (ADC). However, its reproducibility and reliability may be compromised outside clinical trials. This study aimed to evaluate factors associated with PD-L1 expression in lung ADC. Methods: This observational study assessed 547 tumor samples with advanced lung ADC from January 2016 to December 2020 in a single cancer institution. Tumor samples were stained by at least one approved PD-L1 clone, SP263 (Ventana) or 22C3 (Dako), and stratified in tumor proportion score (TPS) <1%, 1-49%, or ≥50%. Results: Of all the tumor samples, positive PD-L1 staining was higher in poorly differentiated tumors (67.3% vs. 32.7%, p < 0.001). Analytical factors associated with a PD-L1 high expression (TPS ≥ 50%) were the SP263 clone (19.6% vs. 8.2%, p < 0.001), time of archival tumor tissue <12 months (15.3% vs. 3.8%, p = 0.024), whenever the analysis was performed in the most recent years (2019-2020) (19.0% vs. 8.3%, p < 0.001), and whenever the analysis was performed by pathologists in the academic setting (Instituto Nacional de Cancerologia, INCan) (19.9% vs. 11.9%, p = 0.001). In the molecular analysis, EGFR wild-type tumors had an increased proportion of PD-L1 positive and PD-L1 high cases (60.2% vs. 47.9%, p = 0.006 and 17.4% vs.8.5%, p = 0.004). A moderate correlation (r = 0.69) in the PD-L1 TPS% was observed between the two different settings (INCan vs. external laboratories). Conclusion: Clinicopathological factors were associated with an increased PD-L1 positivity rate. These differences were significant in the PD-L1 high group and associated with the academic setting, the SPS263 clone, time of archival tumor tissue <12 months, and a more recent period in the PD-L1 analysis.
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192 members
Andres Jose Gomez Aldana
  • Internal Medicine
Manuel F. Granja
  • Department of Radiology
Juliana Quintero
  • Centro de Estudios e Investigación en Salud
Augusto Peñaranda
  • Otorrinolaringologia
Sonia Bermúdez
  • Diagnostic Imaging
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