Progressive Multifocal Leukoencephalopathy associated with the use of Natalizumab in Patient with Multiple Sclerosis. First Case Report in Latin America Hospital de San Jose - Bogota, 2013

La Leucoencefalopatía Multifocal Progresiva (LMP) es una condición grave secundaria a la infección por virus John Cunningham (VJC) derivada de la deficiencia de inmunidad celular innata o adquirida. Se presenta el primer caso reportado en Latinoamérica de (LMP) asociada a Natalizumab (NZB) en un paciente con diagnóstico de esclerosis múltiple recaída-remisión, quien ingresa a urgencias con cuadro clínico de deterioro cognoscitivo, comportamental, motor y de lenguaje de curso progresivo. Se realizaron neuroimágenes con resonancia magnética cerebral sugestivas de LMP, estudios de reacción en cadena de polimerasa en líquido cefalorraquídeo para virus JC, que resultaron negativos en dos oportunidades; el diagnóstico se confirmó mediante la técnica de hibridación in situ en biopsia cerebral. Se realiza este reporte con el fin de resaltar la importancia de la vigilancia clínica y paraclínica en los pacientes con esclerosis múltiple que reciben NZB.Progressive Multifocal Leukoencephalopathy (PML) is a serious condition secondary to John Cunningham virus (JCV) infection derived from an innate or acquired cellular immunity deficiency. We present the first reported case in Latin America of PML associated with Natalizumab (NZB) in a patient with a diagnostic of relapsing – remitting multiple sclerosis, who entered the emergency room with progressive cognitive, behavioral, motor and language impairment. Neuroimaging performed with magnetic resonance imaging was suggestive of PML. Polymerase chain reactions in cerebrospinal fluid for JC virus were conducted twice with negative results. Finally the diagnosis was confirmed by in situ hybridization technique on brain biopsy. This report is made in order to highlight the importance of clinical and paraclinical monitoring in patients with multiple sclerosis receiving NZB

Ventriculitis and hydrocephalia secondary to meningeal cryptococcosis in a non-HIV patient: a case report in the Hospital de San Jose in 2014

La criptocococis meníngea es la infección fúngica más frecuente del sistema nervioso central; generalmente se presenta en pacientes VIH seropositivos, aunque existe una proporción considerable de paciente VIH seronegativos, siendo en estos casos su presentación más agresiva. Esta infección tiene manifestaciones neurológicas variables que son secundarias al aumento de la presión intracraneal. La ventriculitis con hidrocefalia secundaria es una de las complicaciones de mayor morbi-mortalidad especialmente en pacientes VIH seronegativos. Presentamos un reporte de caso de criptocococis meníngea género Neoformans subtipo Grubbi con ventriculitis e hidrocefalia secundaria en paciente VIH seronegativo confirmado por histopatologíaMeningeal criptocococis is the most common fungal infection of the central nervous system, occuring in HIV seropositive patients, although there is a significant proportion of HIV seronegative patients, in whom the presentation is more aggresive. This infection has variable clinical manifestations secondary to increased intracranial pressure. Ventriculitis with hydrocephalus is one of the complications with the poorest outcome and mortality especially in HIV seronegative patients. We present a case report of meningeal criptocococis Neoformans subtype Grubbi with ventriculitis and secondary hydrocephalus in HIV seronegative patient confirmed by histopatholog

Satisfacción del neurólogo y de los pacientes con diagnóstico de epilepsia en una consulta de seguimiento a través de telemedicina sincrónica vs consulta convencional en el hospital de Arjona-Bolívar –Hospital San José 2014-2015

24 p.Introducción: La gran demanda de consulta especializada de neurología y la poca oferta de profesionales entrenados y médicos especialistas principalmente en zonas aisladas por circunstancias geográficas o políticas, nos obligan a buscar nuevos recursos como la telemedicina para mejorar la falta de oportunidad. Objetivo: Explorar el grado de satisfacción del neurólogo y de los pacientes con epilepsia en una consulta por telemedicina en el Hospital San José de Arjona con conexión al Hospital de San José en Bogotá. Metodología: Estudio observacional prospectivo en pacientes mayores de 15 años con diagnóstico de epilepsia. Se diligenció el instrumento de evaluación de satisfacción del neurólogo y de los pacientes, que contiene una escala aplicada en Canadá, la cual consta de diecinueve preguntas, validadas en Colombia gracias a la prueba piloto realizada en el 2012 por nuestro Grupo de Neurología y Telemedicina, implementada para evaluar la satisfacción de los pacientes en la consulta de epilepsia por telemedicina. Además, este cuestionario está diseñado según una escala de Thurstone que consta de cinco alternativas de respuesta, las cuales en orden son: “muy en desacuerdo”, “en desacuerdo”, “neutral”, “de acuerdo”, “muy de acuerdo”. El reclutamiento de los pacientes se hizo mediante carteles alusivos al estudio, uno a dos meses antes de la realización de este. Resultados: Se valoraron 39 pacientes, de los cuales 51,3% eran mujeres, con una edad promedio 35 años DE ± 16. La satisfacción de los pacientes con la consulta de telemedicina se calificó “muy de acuerdo” en un 83,8%, el 91,9% ve la telemedicina como una vía aceptable para recibir atención en salud en y 94,6% considera que ahorra más dinero en comparación con la visita convencional. La satisfacción de dos neurólogos con la consulta de telemedicina se distribuye uniformemente entre “muy de acuerdo” y “de acuerdo”.Conclusiones: Según los resultados de este estudio, podemos concluir que tanto los pacientes como los neurólogos que realizaron la consulta guiada por telemedicina están satisfechos con el uso de esta herramienta, siendo este método una alternativa para la atención en salud

Biodiversidad 2018. Reporte de estado y tendencias de la biodiversidad continental de Colombia

Las cifras y temáticas contenidos en el presente Reporte, aunque no son el panorama completo del estado del conocimiento de la biodiversidad en Colombia, son un compendio seleccionado de los temas que, desde el Instituto Humboldt, consideramos son relevantes y merecen ser discutidos por el público general. En muchos de los casos, las cifras no son esperanzadoras u son un llamado urgente a la acción. En otro casos son la evidencia de que se requieren acciones a nivel nacional, y más allá de esto, son muchas las iniciativas que están germinando desde los territorios, cada vez desde una mayor variedad de actores.Bogotá, D. C., Colombi

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research