Metástasis pulmonar y pleural en cáncer de pene, una patología infrecuente

Introduction: Carcinoma of the penis is a rare tumor in our environment, constituting less than 1% of deaths in men and it is defined as the proliferative disordered process of squamous epithelial cells of the penis. Objective: The objective of the following manuscript is to present the case of a patient who developed cancer of the penis with metastasis to the lung. Clinical case: An 85-year-old patient was admitted due to a 24-hour clinical picture consisting of hematuria associated with non-productive cough, low back pain, asthenia and adynamia. He had a history of squamous cell carcinoma of the penis, he was identified as a heavy smoker until two years ago and presented chronic exposure to wood smoke. On the physical examination, the patient evidenced a regular general state, respiratory sounds that suggested left hypoventilation, absence of penis due to his clinical history and outflow of hematuric urine through bladder catheter, ganglia in the inguinal region, edema in the lower limbs with formation of flictenas on the dorsal zone of the feet. Imaging studies confirmed the presence of mass in a pulmonary region together with pathological fractures at the thoracic level, thus, palliative care was provided, and the patient was discharged from the hospital. Conclusions: Penile cancer is a low prevalence worldwide pathology. Approximately 95% of these cancers are squamous cell carcinomas, which can easily spread locally through lymphatic or vascular channels; nonetheless, its metastatic disease development is rare and mainly affects organs such as the liver, bone, and brain. However, few cases of metastasis to the dorsal spine, heart, retroperitoneum, breast tissue, lung, and skin have been reported.  Introducción: El carcinoma de pene es un tumor infrecuente en nuestro medio con menos del 1% de muertes en el hombre. Se define como el proceso proliferativo y desordenado de las células epiteliales escamosas del pene. Objetivo: Presentar el caso de un paciente que presentó cáncer de pene con metástasis a pulmón. Caso clínico: Paciente de 85 años ingreso por cuadro clínico de 24 horas de evolución consistente en hematuria asociado a tos no productiva, lumbalgia, astenia y adinamia. Tenían antecedentes de carcinoma escamosos de pene, fumador pesado hasta hace dos años, exposición crónica a humo de leña. Al examen físico con regular estado general, ruidos respiratorios sugestivos de hipoventilación izquierda, ausencia de pene por antecedentes y sonda vesical salida de orina hematúrica, ganglios en región inguinal, edema en miembros inferiores con formación de flictenas en cara dorsal de los pies. Los estudios imagenológicos confirmaron la presencia de masa a región pulmonar junto con fracturas patológicas a nivel torácico, por lo que se dio manejo paliativo con egreso hospitalario. Conclusiones: El cáncer de pene es una patología de baja prevalencia a nivel mundial. Aproximadamente el 95% de estos canceres son carcinomas de células escamosas que fácilmente pueden diseminarse localmente a través de canales linfáticos o vasculares, a pesar de ello, la probabilidad de enfermedad metastásica es rara, y afecta principalmente a órganos como el hígado, los huesos y al cerebro, sin embargo, se han reportado pocos casos de metástasis a columna dorsal, corazón, retroperitoneo, tejido mamario masculino, pulmón y metástasis cutáneas. &nbsp

Metástasis pulmonar y pleural en cáncer de pene, una patología infrecuente

Introduction: Carcinoma of the penis is a rare tumor in our environment, constituting less than 1% of deaths in men and it is defined as the proliferative disordered process of squamous epithelial cells of the penis. Objective: The objective of the following manuscript is to present the case of a patient who developed cancer of the penis with metastasis to the lung. Clinical case: An 85-year-old patient was admitted due to a 24-hour clinical picture consisting of hematuria associated with non-productive cough, low back pain, asthenia and adynamia. He had a history of squamous cell carcinoma of the penis, he was identified as a heavy smoker until two years ago and presented chronic exposure to wood smoke. On the physical examination, the patient evidenced a regular general state, respiratory sounds that suggested left hypoventilation, absence of penis due to his clinical history and outflow of hematuric urine through bladder catheter, ganglia in the inguinal region, edema in the lower limbs with formation of flictenas on the dorsal zone of the feet. Imaging studies confirmed the presence of mass in a pulmonary region together with pathological fractures at the thoracic level, thus, palliative care was provided, and the patient was discharged from the hospital. Conclusions: Penile cancer is a low prevalence worldwide pathology. Approximately 95% of these cancers are squamous cell carcinomas, which can easily spread locally through lymphatic or vascular channels; nonetheless, its metastatic disease development is rare and mainly affects organs such as the liver, bone, and brain. However, few cases of metastasis to the dorsal spine, heart, retroperitoneum, breast tissue, lung, and skin have been reported.  Introducción: El carcinoma de pene es un tumor infrecuente en nuestro medio con menos del 1% de muertes en el hombre. Se define como el proceso proliferativo y desordenado de las células epiteliales escamosas del pene. Objetivo: Presentar el caso de un paciente que presentó cáncer de pene con metástasis a pulmón. Caso clínico: Paciente de 85 años ingreso por cuadro clínico de 24 horas de evolución consistente en hematuria asociado a tos no productiva, lumbalgia, astenia y adinamia. Tenían antecedentes de carcinoma escamosos de pene, fumador pesado hasta hace dos años, exposición crónica a humo de leña. Al examen físico con regular estado general, ruidos respiratorios sugestivos de hipoventilación izquierda, ausencia de pene por antecedentes y sonda vesical salida de orina hematúrica, ganglios en región inguinal, edema en miembros inferiores con formación de flictenas en cara dorsal de los pies. Los estudios imagenológicos confirmaron la presencia de masa a región pulmonar junto con fracturas patológicas a nivel torácico, por lo que se dio manejo paliativo con egreso hospitalario. Conclusiones: El cáncer de pene es una patología de baja prevalencia a nivel mundial. Aproximadamente el 95% de estos canceres son carcinomas de células escamosas que fácilmente pueden diseminarse localmente a través de canales linfáticos o vasculares, a pesar de ello, la probabilidad de enfermedad metastásica es rara, y afecta principalmente a órganos como el hígado, los huesos y al cerebro, sin embargo, se han reportado pocos casos de metástasis a columna dorsal, corazón, retroperitoneo, tejido mamario masculino, pulmón y metástasis cutáneas. &nbsp

Afecciones, manifestaciones y repercusiones neurológicas del COVID-19.

Introduction: Severe Acute Respiratory Syndrome (SARS-CoV-2) is the pathological entity responsible for the current pandemic that not only generates a distinctive respiratory pattern but has also been associated with multiple mechanisms of invasion of the central nervous system (CNS). Objective: To determine the affections, manifestations and neurological repercussions that SARS-CoV-2 infection can generate. Methods:  Review of the scientific literature of patients with SARS-CoV-2 infection, in whom the development of conditions, manifestations and neurological repercussions, selected outcome in the studies, presence of micro and macroscopic conditions of the CNS and peripheral (PNS) were evaluated. Results: 40 articles were included where the family and structure of SARS-CoV-2, pathophysiological mechanisms, neurological clinical manifestations, and possible repercussions at the central nervous system level were analyzed. Conclusions: SARS-CoV-2 is a pathological entity that is associated with different mechanisms of neurological intervention, through direct infection to the CNS, secondary to a parainfectious and postinfectious process, related to cytokine storm syndrome, endothelial damage, thrombotic disorders, in addition to secondary to hypoxia, hypoxemia and multiple organ failure.Introducción: El Síndrome Respiratorio Agudo Severo (SARS-CoV-2) es la entidad patológica responsable de la actual pandemia que no solo genera un cuadro respiratorio distintivo sino que también se ha asociado con múltiples mecanismos de invasión al sistema nervioso central (SNC). Objetivo: Determinar las afecciones, manifestaciones y repercusiones neurológicas que puede generar la infección por SARS-CoV-2. Métodos: Revisión de la literatura científica de pacientes con infección por SARS-CoV-2, en quienes se evaluó desarrollo de afecciones, manifestaciones y repercusiones neurológicas, desenlace seleccionado en los estudios, presencia de afecciones micro y macroscópicas del SNC y periférico (SNP). Resultados: Se estudiaron 40 artículos que analizaban la familia y estructura del SARS-CoV-2, mecanismos fisiopatológicos, manifestaciones clínicas neurológicas y las posibles repercusiones a nivel sistema nervioso central. Conclusiones: El SARS-CoV-2  es una entidad patológica que se asocia a distintos mecanismos de intervención neurológica, por medio de infección directa al SNC, secundario a un proceso parainfeccioso y postinfeccioso, relacionado con el síndrome de tormenta de citoquinas, daño endotelial, trastornos trombóticos, adicionalmente de secundario a hipoxia, hipoxemia y fallo multiorgánico

Afecciones, manifestaciones y repercusiones neurológicas del COVID-19.

Introduction: Severe Acute Respiratory Syndrome (SARS-CoV-2) is the pathological entity responsible for the current pandemic that not only generates a distinctive respiratory pattern but has also been associated with multiple mechanisms of invasion of the central nervous system (CNS). Objective: To determine the affections, manifestations and neurological repercussions that SARS-CoV-2 infection can generate. Methods:  Review of the scientific literature of patients with SARS-CoV-2 infection, in whom the development of conditions, manifestations and neurological repercussions, selected outcome in the studies, presence of micro and macroscopic conditions of the CNS and peripheral (PNS) were evaluated. Results: 40 articles were included where the family and structure of SARS-CoV-2, pathophysiological mechanisms, neurological clinical manifestations, and possible repercussions at the central nervous system level were analyzed. Conclusions: SARS-CoV-2 is a pathological entity that is associated with different mechanisms of neurological intervention, through direct infection to the CNS, secondary to a parainfectious and postinfectious process, related to cytokine storm syndrome, endothelial damage, thrombotic disorders, in addition to secondary to hypoxia, hypoxemia and multiple organ failure.Introducción: El Síndrome Respiratorio Agudo Severo (SARS-CoV-2) es la entidad patológica responsable de la actual pandemia que no solo genera un cuadro respiratorio distintivo sino que también se ha asociado con múltiples mecanismos de invasión al sistema nervioso central (SNC). Objetivo: Determinar las afecciones, manifestaciones y repercusiones neurológicas que puede generar la infección por SARS-CoV-2. Métodos: Revisión de la literatura científica de pacientes con infección por SARS-CoV-2, en quienes se evaluó desarrollo de afecciones, manifestaciones y repercusiones neurológicas, desenlace seleccionado en los estudios, presencia de afecciones micro y macroscópicas del SNC y periférico (SNP). Resultados: Se estudiaron 40 artículos que analizaban la familia y estructura del SARS-CoV-2, mecanismos fisiopatológicos, manifestaciones clínicas neurológicas y las posibles repercusiones a nivel sistema nervioso central. Conclusiones: El SARS-CoV-2  es una entidad patológica que se asocia a distintos mecanismos de intervención neurológica, por medio de infección directa al SNC, secundario a un proceso parainfeccioso y postinfeccioso, relacionado con el síndrome de tormenta de citoquinas, daño endotelial, trastornos trombóticos, adicionalmente de secundario a hipoxia, hipoxemia y fallo multiorgánico

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Caminando en la ruta sentipensante: configuración de experiencias pedagógicas nivel inicial

494 páginasEste texto es realizado en el contexto del Plan de Desarrollo 2016 – 2020, “Bogotá mejor para todos”, en el que se señala: Bogotá es entendida como una ciudad educadora, en la que todos los ciudadanos son agentes educadores y todos los espacios pueden ser escenarios pedagógicos para el aprendizaje. Una ciudad educadora tiene como centro el conocimiento e inspira aprendizaje, formas y lenguajes para reconocernos, para reencontrarnos; los espacios para el aprendizaje son entendidos como espacios para la vida, en los que se posibilita la investigación y la innovación para vivir mejor, para reinventarnos como ciudad, una ciudad mejor para todos. Los dieciocho textos aquí presentados, fruto del acompañamiento pedagógico realizado por el IDEP en 2019, son base y referente para seguir aportando en la configuración y consolidación de comunidades de saber y práctica pedagógica de la ciudad, así como en la conformación de colectivos y redes de maestros. Son la evidencia de un potente trabajo de acompañamiento a experiencias de nivel inicial, caracterizadas por contar con ideas o avances para problematizar, estructurar, fundamentar, elaborar estrategias y un plan de acción

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Las Metástasis pulmonar y pleural en cáncer de pene, una patología infrecuente.

Introduction: Carcinoma of the penis is a rare tumor in our environment, constituting less than 1% of deaths in men and it is defined as the proliferative disordered process of squamous epithelial cells of the penis. Objective: The objective of the following manuscript is to present the case of a patient who developed cancer of the penis with metastasis to the lung. Clinical case: An 85-year-old patient was admitted due to a 24-hour clinical picture consisting of hematuria associated with non-productive cough, low back pain, asthenia and adynamia. He had a history of squamous cell carcinoma of the penis, he was identified as a heavy smoker until two years ago and presented chronic exposure to wood smoke. On the physical examination, the patient evidenced a regular general state, respiratory sounds that suggested left hypoventilation, absence of penis due to his clinical history and outflow of hematuric urine through bladder catheter, ganglia in the inguinal region, edema in the lower limbs with formation of flictenas on the dorsal zone of the feet. Imaging studies confirmed the presence of mass in a pulmonary region together with pathological fractures at the thoracic level, thus, palliative care was provided, and the patient was discharged from the hospital. Conclusions: Penile cancer is a low prevalence worldwide pathology. Approximately 95% of these cancers are squamous cell carcinomas, which can easily spread locally through lymphatic or vascular channels; nonetheless, its metastatic disease development is rare and mainly affects organs such as the liver, bone, and brain. However, few cases of metastasis to the dorsal spine, heart, retroperitoneum, breast tissue, lung, and skin have been reported. &nbsp;Introducción: El carcinoma de pene es un tumor infrecuente en nuestro medio con menos del 1% de muertes en el hombre. Se define como el proceso proliferativo y desordenado de las células epiteliales escamosas del pene. Objetivo: Presentar el caso de un paciente que presentó cáncer de pene con metástasis a pulmón. Caso clínico: Paciente de 85 años ingreso por cuadro clínico de 24 horas de evolución consistente en hematuria asociado a tos no productiva, lumbalgia, astenia y adinamia. Tenían antecedentes de carcinoma escamosos de pene, fumador pesado hasta hace dos años, exposición crónica a humo de leña. Al examen físico con regular estado general, ruidos respiratorios sugestivos de hipoventilación izquierda, ausencia de pene por antecedentes y sonda vesical salida de orina hematúrica, ganglios en región inguinal, edema en miembros inferiores con formación de flictenas en cara dorsal de los pies. Los estudios imagenológicos confirmaron la presencia de masa a región pulmonar junto con fracturas patológicas a nivel torácico, por lo que se dio manejo paliativo con egreso hospitalario. Conclusiones: El cáncer de pene es una patología de baja prevalencia a nivel mundial. Aproximadamente el 95% de estos canceres son carcinomas de células escamosas que fácilmente pueden diseminarse localmente a través de canales linfáticos o vasculares, a pesar de ello, la probabilidad de enfermedad metastásica es rara, y afecta principalmente a órganos como el hígado, los huesos y al cerebro, sin embargo, se han reportado pocos casos de metástasis a columna dorsal, corazón, retroperitoneo, tejido mamario masculino, pulmón y metástasis cutáneas. &nbsp

Estrategias de redacción - HE59 201801

Descripción: Estrategias de Redacción es un curso de Humanidades, que brinda al participante un conjunto de herramientas lingüísticas para la redacción en el entorno laboral, tales como el uso apropiado de la normativa del español y la aplicación de estrategias de redacción como la enumerativa y la causal. Estas últimas se emplean en la elaboración de un tipo de documento: el informe de recomendación. Propósito: El curso desarrolla la competencia de comunicación escrita en el primer nivel de logro. La asignatura se orienta a la redacción de textos administrativos que ayuden a optimizar el desempeño profesional del participante, ya sea en el entorno universitario o en el ámbito laboral