Enfermedad de Eales secundario a tuberculosis: a propósito de un caso

La enfermedad de Eales es una perivasculitis retiniana caracterizada por tres fases que incluyen a la inflamación, isquemia y neovascularización de la retina. Se reporta el caso de un paciente varón de 29 años con pérdida progresiva de la visión de un año de evolución sin respuesta a tratamiento médico ni quirúrgico, diagnosticado con enfermedad de Eales de causa tuberculosa. La etiología de la enfermedad de Eales es multifactorial, por ello el tratamiento continúa siendo controversial. Sin embargo, se postula un tipo de hipersensibilidad a la proteína tuberculosa, la cual estaría relacionada con la enfermedad. Después de iniciar el tratamiento con antituberculosos, mejoró la agudeza visual del paciente y desaparecieron las hemorragias; es decir, se obtuvo una respuesta favorable

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos de Pichincha, (Ecuador) y Cundinamarca, (Colombia).

El presente trabajo se realiza a partir del análisis subjetivo de diferentes casos expuestos que se encuentra inmersos en los escenarios de violencia en los diferentes contextos sociales de Colombia, donde cuya brecha social ha estado marcada a lo largo de la historia por un sin número de sucesos que han desencadenado consecuencias en los individuos a nivel social, familiar, económico político y cultural, cabe denotar que cuyos emergentes no sola mente se desenvuelven en hostigamientos si no que componen violación a los derechos humanos, desplazamiento forzado, abuso sexual, secuestro, muertes, inseguridad, pobreza, deterioro territorial entre otros más. Es por esto que el trabajo compone una mirada desde un punto psicológico a partir de la narrativa como herramienta de abordaje para indagar los sucesos psicosociales que componen el caso seleccionado en los diferentes escenarios de violencia, donde esta herramienta permite al grupo de profesionales en formación establecer estrategias psicosociales que ayuden a mitigar los daños causados a nivel psicológico, social y cultural de las personas que han sido víctimas de sucesos de violencia a manos de grupos armados al margen de la ley. Donde la narrativa como herramienta ayuda a la reconstrucción histórica promoviendo en gran medida el entramado simbólico, facilitando al individuo a tener un afrontamiento a la situación a partir de las diferentes acciones que son postuladas desde el abordaje psicosocial y en la identificación de los emergentes psicosociales.The present work is carried out from the subjective analysis of different exposed cases that are immersed in the scenarios of violence in the different social contexts of Colombia, where whose social gap has been marked throughout history by a number of events. that have unleashed consequences on individuals at a social, family, economic, political and cultural level, it should be noted that who’s emerging not only unfold in harassment but also constitute violation of human rights, forced displacement, sexual abuse, kidnapping, deaths, insecurity, poverty, territorial deterioration among others. That is why the work composes a look from a psychological point of view based on the narrative as an approach tool to investigate the psychosocial events that make up the selected case in the different scenarios of violence, where this tool allows the group of professionals in training to establish psychosocial strategies that help mitigate the damage caused at the psychological, social and cultural level of people who have been victims of violent events at the hands of illegal armed groups. Where the narrative as a tool helps historical reconstruction, greatly promoting the symbolic framework, facilitating the individual to have a coping with the situation from the different actions that are postulated from the psychosocial approach and in the identification of emerging psychosocial

Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men : a systematic review

Copyright © 2017 Elsevier Inc. All rights reserved.Peer reviewedPostprin

Innovative Technological Applications for Story-Telling in Reading and Conversation II, Group II at The Western Multidisciplinary Campus of The University of El Salvador During Semester I, 2020

To speak English with a proper level of pronunciation and confidence is crucial,especially for Reading and Conversation in English II, group 2 students at the Western Multidisciplinary Campus of the University of El Salvador, where students are not producing the language as expected. Students are not capable of producing the language in an effective way; this was observed by the research team that identified and described such a problematic situation. One of the variables that is influencing this problem is the old-fashioned teaching method to which students are being exposed to in the aforementioned subject

Rates and Predictors of Perioperative Complications in Cytoreductive Nephrectomy: Analysis of the Registry for Metastatic Renal Cell Carcinoma

Background: Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients. Objective: We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes. Design, setting, and participants: Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC). Outcome measurements and statistical analysis: Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates. Results and limitations: Intraoperative complications were observed in 69 patients (10.9%). Thrombectomy (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75, p = 0.009) and adjacent organ removal (OR 2.7, 95% CI 1.38-5.30) were significant predictors of intraoperative complications at multivariable analysis. Two hundred seventeen patients (29.5%) encountered AGCs, while 45 (6.1%) encountered an HGC, of whom 10 (1.4%) died. Twenty-four (3.3%) patients had multiple postoperative complications. Estimated blood loss (EBL; OR 1.49, 95% CI 1.08-2.05, p = 0.01) was a significant predictor of AGCs at multivariable analysis. CN case load (OR 0.13, 95% CI 0.03-0.59, p = 0.009) and EBL (OR 2.93, 95% CI 1.20-7.15, p = 0.02) were significant predictors solely for HGCs at multivariable analysis. Forty-one patients (11.5%) were readmitted within 30 d of surgery. No significant predictors were identified. Results were confirmed in a subanalysis focusing solely on patients treated in the contemporary targeted therapy era. Conclusions: Morbidity associated with CN is not negligible. Predictors of high-grade postoperative morbidity are predominantly indicators of complex surgery. EBL is a strong predictor of postoperative complications. CN case load correlates with lower high-grade morbidity and highlights the benefit of centralization of complex surgery. However, risks and benefits should be balanced when considering CN in mRCC patients. Patient summary: We studied patients with metastatic renal cancer to evaluate the outcomes associated with the surgical removal of the primary kidney tumor. We found that this procedure is often complex and adverse events are not uncommon. High intraoperative blood loss and a small number of cases performed at the treating center are associated with a higher rate of postoperative complications

A Systematic Review of the Efficacy and Toxicity of Brachytherapy Boost Combined with External Beam Radiotherapy for Nonmetastatic Prostate Cancer

CONTEXT: The optimum use of brachytherapy (BT) combined with external beam radiotherapy (EBRT) for localised/locally advanced prostate cancer (PCa) remains uncertain.OBJECTIVE: To perform a systematic review to determine the benefits and harms of EBRT-BT.EVIDENCE ACQUISITION: Ovid MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were systematically searched for studies published between January 1, 2000 and June 7, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies compared low- or high-dose-rate EBRT-BT against EBRT ± androgen deprivation therapy (ADT) and/or radical prostatectomy (RP) ± postoperative radiotherapy (RP ± EBRT). The main outcomes were biochemical progression-free survival (bPFS), severe late genitourinary (GU)/gastrointestinal toxicity, metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS), at/beyond 5 yr. Risk of bias was assessed and confounding assessment was performed. A meta-analysis was performed for randomised controlled trials (RCTs).EVIDENCE SYNTHESIS: Seventy-three studies were included (two RCTs, seven prospective studies, and 64 retrospective studies). Most studies included participants with intermediate-or high-risk PCa. Most studies, including both RCTs, used ADT with EBRT-BT. Generally, EBRT-BT was associated with improved bPFS compared with EBRT, but similar MFS, CSS, and OS. A meta-analysis of the two RCTs showed superior bPFS with EBRT-BT (estimated fixed-effect hazard ratio [HR] 0.54 [95% confidence interval {CI} 0.40-0.72], p &lt; 0.001), with absolute improvements in bPFS at 5-6 yr of 4.9-16%. However, no difference was seen for MFS (HR 0.84 [95% CI 0.53-1.28], p = 0.4) or OS (HR 0.87 [95% CI 0.63-1.19], p = 0.4). Fewer studies examined RP ± EBRT. There is an increased risk of severe late GU toxicity, especially with low-dose-rate EBRT-BT, with some evidence of increased prevalence of severe GU toxicity at 5-6 yr of 6.4-7% across the two RCTs.CONCLUSIONS: EBRT-BT can be considered for unfavourable intermediate/high-risk localised/locally advanced PCa in patients with good urinary function, although the strength of this recommendation based on the European Association of Urology guideline methodology is weak given that it is based on improvements in biochemical control.PATIENT SUMMARY: We found good evidence that radiotherapy combined with brachytherapy keeps prostate cancer controlled for longer, but it could lead to worse urinary side effects than radiotherapy without brachytherapy, and its impact on cancer spread and patient survival is less clear.</p

Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

En Colombia, actualmente no existen parámetros claros para el diagnóstico de pacientes con talla baja, ni sobre el tratamiento de esta población con hormona de crecimiento recombinante humana (somatropina), lo cual se ve favorecido por la diversidad de programas de formación de profesionales en endocrinología pediátrica. En respuesta a esta problemática se realizó el primer acuerdo colombiano de expertos en talla baja liderado por la Asociación Colegio Colombiana de Endocrinología Pediátrica (ACCEP); este trabajo contó con la participación y el aval de expertos clínicos de importantes instituciones de salud públicas y privadas del país, además de expertos metodológicos del instituto Keralty, quienes garantizaron la estandarización del uso de la somatropina. Después de realizar una minuciosa revisión de la literatura, se propone la unificación de definiciones, un algoritmo diagnóstico, los parámetros de referencia de las pruebas bioquímicas y dinámicas, una descripción de las consideraciones de uso de la somatropina para el tratamiento de las patologías con aprobación por la entidad regulatoria de medicamentos y alimentos en Colombia y, por último, un formato de consentimiento informado y de ficha técnica del medicamento.In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinanthuman growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation,the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order tostandardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium ofclinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada deServicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private healthinstitutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia ClínicaKeralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm,biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use amongthe indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consentand a medication fact sheet available for parents and patients.https://orcid.org/0000-0002-7856-7213https://orcid.org/0000-0003-2241-7854Revista Nacional - Indexad

Formulación de un plan de gestión integral de residuos hospitalarios y similares para la ips Clinical House s.a.s, Cúcuta, Norte de Santander

El propósito del proyecto es formular el plan de gestión integral para el manejo de los residuos hospitalarios y similares generados en la IPS Clinical House SAS, acorde con los requisitos de la normatividad vigente y a las necesidades de la entidad. Se utiliza un tipo de investigación aplicada, documental, descriptiva y de campo, para tomar datos de las personas y procesos de la clínica. Los resultados presentan la identificación de los lugares con mayor factor de riesgo biológico para motivar un cambio de cultura organizacional con respecto al manejo de los residuos hospitalarios. Igualmente, se cuantificaron los residuos peligrosos y similares que se generan en la IPS Clinical House S.A.S., mediante el pesaje directo en la segregación en la fuente. Se formula la caracterización cualitativa de los residuos generados y se realiza el mapa de procesos que permita identificar las actividades de mayor riesgo. Por último, se determina la matriz de riesgo biológico según la guía técnica GTC 45 y se diseña un folleto informativo con charlas para concientizar al personal sobre la responsabilidad ambiental.PregradoIngeniero(a) Biotecnológico(a

The Image of Latin America in Carlos Fuentes

El presente trabajo tiene como objetivo vislumbrar la imagen que Carlos Fuentes construye sobre Hispanoamérica; primero se ubicará en el contexto intelectual del continente americano, más adelante se estudiarán algunas obras ensayísticas del autor y por último se hará un análisis de sus dos obras maestras: Terra Nostra y El Espejo Enterrado. Carlos Fuentes se encargó de mostrar esa España producto de las tres culturas; judía, árabe y musulmana que construyeron no solo la cultura de España sino toda la multiculturalidad de Hispanoamérica que se vio influenciada por los caracteres del espíritu de las diversas civilizaciones europeas dejando una huella adversa a la dignidad del ser humano, ya que reflejó barbaries, violencia y miseria, pero también dejó elementos positivos como lo fue la lengua castellana, código a partir del cual el Nuevo Mundo tuvo reconocimiento por parte de las diferentes culturas del mundo y fundó la modernidad cultural dándole paso a la historia de las ideas, que deja como producto la Historiografía. Esta técnica es eje central en la obra de Fuentes puesto que, a través de él, se logra construir y propagar la realidad social de determinado contexto. Es el lector quien da significación a todos los símbolos de sus obras, es el lector quien se identifica y se define como parte de una raza, de una sociedad que se diferencia en su cultura y en sus costumbres; todo este juego de reflejos, de comprensión del mundo y de la vida deja finalmente una reflexión y es que los pueblos de Hispanoamérica se resisten a morir, todo el esplendor de su tradición lingüística, racial, étnica y social se expresa a nivel artístico, político y religioso.The present work aims to glimpse the image that Carlos Fuentes builds on Latin America; First it will be located in the intellectual context of the American continent, later on, some essay works will be studied of the author and finally there will be an analysis of his two masterpieces: Terra Nostra and El Espejo Enterrado. Carlos Fuentes was in charge of showing that Spain, a product of the three cultures; Jewish, Arab and Muslim who built not only the culture of Spain but all the multiculturalism of Latin America that was influenced by the characters of the spirit of the various European civilizations, leaving an adverse mark on the dignity of the human being, since it reflected barbarism, violence and misery, but it also left positive elements such as the 3 Spanish language, a code from which the New World was recognized by the different cultures of the world; I founded cultural modernity giving way to the history of ideas, which the Historiography leaves as a product. This technique is the central axis in Fuentes' work because it is thanks to this element that the social reality of a certain person is built and propagated. context. It is the reader who gives meaning to all the symbols in his works, it is the reader who identifies and defines himself as part of a race, of a society that differs in its culture and customs; all this game of reflections, understanding of the world and life, finally leaves a reflection and it is that Latin American people resist dying, all the splendor of their linguistic, racial, ethnic and social tradition is expressed at the artistic level, political and religious