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Resumen OBJETIVO: Determinar las concentraciones de 25(OH)D en ginecoobstetras y otros especialistas latinoamericanos y conocer la prevalencia de su deficiencia. MATERIALES Y MÉTODOS: Estudio transversal y observacional efectuado para determinar las concentraciones de 25(OH)D en médicos voluntarios, sobre todo ginecoobstetras, que acudieron a diferentes congresos en distintos países latinoamericanos. RESULTADOS: Se analizaron 643 determinaciones. El 19.4% tenían déficit (media 16.58 ng/mL), 72% insuficiencia (media 24.6 ng/mL) y 36.9% concentraciones normales (media 40.34 ng/mL). Los hombres tuvieron mayor déficit-insuficiencia (62.8%) que las mujeres (59.5%), pero sin diferencias significativas (p < 0.058). Las personas de piel clara tuvieron concentraciones deficitarias e insuficientes, menores que las de piel oscura (p < 0.001). Quienes tomaban suplementos de vitamina D tuvieron menor riesgo de déficit. CONCLUSIONES: El 60% de los ginecoobstetras, médicos internistas y generales de Latinoamérica tienen bajas concentraciones de 25(OH)D. La piel clara puede ser un factor de riesgo de mayor déficit-insuficiencia. En los grupos de médicos estudiados la suplementación con vitamina D parece incrementar las concentraciones de 25(OH)D.
OBJECTIVE: To determine 25(OH)D concentrations in obstetrician-gynecologists and other Latin American specialists and to know the prevalence of its deficiency. MATERIALS AND METHODS: Cross-sectional and observational study to determine 25(OH)D concentrations in volunteer physicians, mainly gynecologists, attending different congresses in different Latin American countries. RESULTS: A total of 643 determinations were analysed. 19.4% had deficiency (mean 16.58 ng/mL), 72% insufficiency (mean 24.6 ng/mL), and 36.9% normal concentrations (mean 40.34 ng/mL). Men had higher deficiency-insufficiency (62.8%) than women (59.5%), but no significant differences (p < 0.058). Light-skinned people had lower insufficiency levels than darker-skinned people (p < 0.001). Those taking vitamin D supplements had a lower risk of deficiency. CONCLUSIONS: Sixty percent of obstetrician-gynecologists, internists, and general practitioners in Latin America have low 25(OH)D concentrations. Caucasian skin may be a risk factor for increased deficiency. Vitamin D supplementation appears to improve 25(OH)D concentrations in the physician groups studied.
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Objetivo: determinar las características de los usuarios y servicios basados en el triaje. Método: estudio observacional descriptivo que incluyó pacientes que acudieron al servicio de urgencias y se les realizó triaje en dos instituciones de alto nivel de complejidad en Medellín en el año de 2018. Resultado: se incluyeron 4159 pacientes. La mediana de edad fue de 38 años, el 54,61 % eran de sexo masculino. El 85,54 % habitaban en el área metropolitana y el 67,78 % eran del régimen contributivo. En cuanto al mes con mayor afluencia de pacientes fue mayo con un 10,55 % seguido del mes de enero con 10,29 %; y el día de la semana fue el martes con 16,15 %, siendo el horario más frecuente entre las 9:00 y 12:00 del día con 18,32 %. Conclusión: una adecuada caracterización del paciente en urgencias por medio del triaje es útil para una atención oportuna y lograr la optimización de los servicios.
Objective: to determine the characteristics of users and services based on triage. Methods: descriptive observational study that included patients who attended the emergency department and underwent triage in two institutions of high level of complexity in Medellin in 2018. Results: 4159 patients were included. The median age was 38 years, 54.61 % were male. The 85.54 % lived in the metropolitan area and 67.78 % were in the contributory regime. The month with the highest number of patients was May with 10.55 %, followed by January with 10.29 %; and the day of the week was Tuesday with 16.15 %, the most frequent time being between 9:00 and 12:00 a.m. with 18.32 %. Conclusion: an adequate characterization of the patient in the emergency department by means of triage is useful for timely care and to achieve the optimization of services.
Objetivo: determinar as características dos usuários e dos serviços baseados na triagem. Método: estudo observacional descritivo que incluiu pacientes que compareceram ao departamento de emergência e foram submetidos à triagem em duas instituições de nível de alta complexidade em Medellín em 2018. Resultados: foram incluídos 4159 pacientes. A mediana de idade foi de 38 anos, 54,61% eram do sexo masculino. Os 85,54% residiam na região metropolitana e 67,78% estavam no regime contributivo. O mês com maior número de doentes foi maio com 10,55 %, seguido de janeiro com 10,29 %, e o dia da semana foi a terça-feira com 16,15 %, sendo a hora do dia mais frequente entre as 9:00 e as 12:00 com 18,32 %. Conclusão: a caraterização adequada dos doentes no SU através da triagem é útil para o atendimento atempado e otimização dos serviços.
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Humanos , Assistência AmbulatorialRESUMO
BACKGROUND: The Fitzpatrick Skin Phototype Classification (FSPC) is the most common tool used to assess skin phototype in White populations according to the amount of pigment the skin has and its reaction to sun exposure. Scientific evidence about the use of this scale for persons with darker skin is limited. OBJECTIVE: To assess the internal consistency, reliability, and construct validity of the FSPC for Ecuadorians. METHODS: This observational cross-sectional study recruited participants of both sexes between 40 and 90 years of age living in a rural area of Quito, Ecuador. Cronbach α values were used to assess the internal consistency of the scale. Construct validity was assessed with confirmatory factor analysis. RESULTS: The internal consistency coefficients indicated that the reliability of the responses to the scale was fair. Total α value was .515, whereas the α values of the two factors were .42 and .67. Most item-to-factor correlations had a low to moderate magnitude, ranging from r = 0.30 to 0.37. Confirmatory factor analysis supported a two-factor solution and achieved good overall fit as indicated by root mean square error of approximation = 0.08, and nonnormed fit index = 0.88 was mediocre. Goodness-of-fit χ = 177.10, P < .001. The factor loads were greater than 0.30, ranging from 0.30 to 0.99. CONCLUSIONS: The FSPC showed an acceptable construct validity and a fair internal consistency. The five-item scale could potentially be used as an effective instrument for assessing skin phototype in non-White people.
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Classificação/métodos , Pigmentação da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Equador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Quito, the capital of Ecuador due to its geographical location, has a high skin cancer incidence. Actinic keratoses, as premalignant lesions, are precursors of nonmelanoma skin cancer, and the prevalence of this medical condition in the country is unknown. METHODS: An observational, cross-sectional study was performed to assess the prevalence of actinic keratoses (AKs) in a rural area of Quito. Visual skin exams, dermoscopy and biopsy of suspicious lesions were performed. RESULTS: A total of 254 subjects older than 40 years old (71.3% female) were enrolled. The general AK prevalence was 22.4%; in women, the prevalence was 23.6%, while in men, it was 19.4%. The prevalence rates of basocellular and squamous cell carcinomas and Bowen disease were 1.6, 0.8 and 0.4%, respectively. No statistical associations were found between AKs and the studied variables. CONCLUSIONS: This study was the first reporting the prevalence of premalignant lesions in Ecuador. We could not demonstrate a relationship between the presence of AKs and any of the known risk factors for their development.
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Ceratose Actínica/epidemiologia , Adulto , Idoso , Doença de Bowen/epidemiologia , Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Neoplasias Cutâneas/epidemiologia , Protetores SolaresRESUMO
Introducción: El dermatofibrosarcoma protuberans(DFSP), es uno de los tumores cutáneos menos frecuentes, se clasifica dentro de los sarcomas fibrohistociticos y está caracterizado por un crecimiento lento y progresivo. Métodos: Se realizó una serie de casos retrospectiva de los pacientes con DFSP atendidos en el Centro de la Piel (CEPI) entre 2010 y 2019, se tomó en cuenta la información demográfica, características clínicas, tratamiento y su evolución. Resultados: Seis pacientes fueron diagnosticados y tratados por DFSP en el período evaluado, existió un predominio de mujeres (4 mujeres, 2 hombres) con una media de edad de 58.2 (DE =19,6), tres de ellos presentaron lesiones en forma de placa indurada y los restantes presentaron nódulo único, la localización de las lesiones fueron en hombro, cuello e hipogastrio. El tratamiento más utilizado fue la escisión amplia, ninguno de los pacientes presentó recidivas al primer y quinto año del seguimiento. Conclusión: Es necesario el reconocimiento de las características clínicas típicas de DFSP ya que podría pasar como una tumoración benigna de piel, por lo cual se debe apoyar con el estudio histopatológico frente a la sospecha de este tipo de lesión
Introduction: Dermatofibrosarcoma protuberans (DFSP) is one of the rare tumors found in the fibrohistocytic sarcomas and it is characterized by slow and progressive growth. Methods:A retrospective study of six cases treated at the Skin Center (CEPI) between 2010 and 2019 was carried out. We have take into account demographic information, characteristics, treatment and evolution of the lesions. Results:Six patients were diagnosed and treated by DFSP. There was a predominance of women (4 women, 2 men) with a mean age of 58.2 (SD = 19.6), three of them presented lesions in the form of indurated plaque and the rest presented a unique nodule. The locations of the lesions were the shoulder, neck and hypogastrium. The most commonly used treatment was wide excision, none of the patients presented recurrences at the first and fifth year of follow-up. Conclusion:Recognition of the typical clinical characteristics of DFSP is necessary since it could be mistaken as a benign tumor of the skin. The diagnosis must be always done by histopathological confirmation
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Pele , Cirurgia de Mohs , Dermatofibrossarcoma , Sarcoma HistiocíticoRESUMO
BACKGROUND: Few studies have been published related to the analysis of different skin aging parameters for whole-body skin using the SCINEXA scale for skin damage. The aim of this study was to evaluate the reproducibility of the SCINEXA scale (SCore for INtrinsic and EXtrinsic skin Aging) in South-Americans non-Caucasian population of a region of Ecuador. METHODS: Exploratory observational study. Thirty subjects of both genders, over 40 years old and living in a rural area with particular characteristics regarding sun exposure were included. The SCINEXA scale was applied at three different time points to assess its reproducibility. Repeated measures analysis of variance was used for comparison of mean SCINEXA scores. Intraclass correlation coefficient, 95% CI and "Cronbach's alpha" coefficient were performed to measure reproducibility. RESULTS: Among participants, 86.7% were female; mean age was over 67 years old, with mainly low educational level, and almost half had more than six hours of sun exposure per day. Test-retest reproducibility of this scale demonstrated almost perfect agreement. The SCINEXA score was greater than 2 points in half of the subjects, reflecting aging due to sun exposure. LIMITATIONS: Most participants were women from one town in a particular geographical area, and the sample size was small. Genetic determinants of skin phenotypes were not assessed. CONCLUSIONS: The SCINEXA score is reproducible in South American non-Caucasian subjects of a particular region of the country. Damage from sun exposure was evident in participants.
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Envelhecimento da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular , Carcinoma de Células Escamosas , Equador , Exposição Ambiental , Eritema , Dermatoses Faciais , Feminino , Humanos , Hiperpigmentação , Ceratose Actínica , Lentigo , Masculino , Melanoma , Melanose , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Neoplasias Cutâneas , Queimadura Solar , Luz Solar , TelangiectasiaAssuntos
Humanos , Papillomaviridae , Lesões Pré-Cancerosas , Ferimentos e Lesões , Mulheres , Lesões do Pescoço , Prevenção de DoençasRESUMO
OBJECTIVE: Bazedoxifene (BZA) is a selective estrogen receptor modulator that reduces fracture risk and bone turnover in postmenopausal women with osteoporosis. This analysis evaluated BZA's effects on bone mineral density (BMD) and bone turnover in Mexican women with osteoporosis from the global pivotal trial (Study Evaluating Bazedoxifene Acetate in Osteoporosis in Postmenopausal Women). METHODS: In this 3-year, phase 3, randomized, double-blind trial, healthy postmenopausal women with osteoporosis (Nâ=â7,492) received BZA 20 or 40âmg/d, raloxifene 60âmg/d, or placebo. The subanalyses of Mexican women assessed serum concentrations of osteocalcin and collagen type 1 C-telopeptide, BMD, and tolerability with BZA 20âmg/d versus placebo. RESULTS: In the Mexican subgroup (BZA, nâ=â39; placebo, nâ=â37) at month 12, BZA 20âmg/d produced significant (Pâ<â0.001) percentage decreases from baseline in osteocalcin (-40.5 vs -18.5) and C-telopeptide (-45.7 vs -29.4). For BZA versus placebo, percentage change in BMD from baseline to month 36 was 3.3 versus 0.64 for lumbar spine, -0.18 versus -1.8 for total hip, 0.21 versus -2.6 for femoral neck, and -0.55 versus -1.4 for femoral trochanter; differences were not statistically significant. Results were comparable to the overall study population in which differences were statistically significant. Common adverse events (≥20%) included arthralgia, back pain, gastritis, headache, influenza, and pain; none led to study withdrawal. CONCLUSIONS: In Mexican women with osteoporosis, BZA was well tolerated and seems to produce BMD changes comparable to the global phase 3 population, although differences versus placebo were not statistically significant in this smaller subgroup.
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Conservadores da Densidade Óssea/administração & dosagem , Indóis/administração & dosagem , Osteoporose Pós-Menopausa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Colágeno Tipo I/sangue , Método Duplo-Cego , Feminino , Humanos , México , Pessoa de Meia-Idade , Osteocalcina/sangue , Osteoporose Pós-Menopausa/sangue , Peptídeos/sangue , Cloridrato de Raloxifeno/administração & dosagem , Resultado do TratamentoRESUMO
The increase bone turnover is the most important fact at the physiopathology of postmenopausal osteoporosis. At the molecular level it is the increase of the RANK-L the principal mediator who allows the osteoclasts formation, survival and development of them. Multiple models have been in use in preclinical investigations for evaluating the effects of the inhibition of the RANKL, between which it is included on OPG's over-expression in mice and transgenic mouse and by means of other models that include the treatment with recombinant OPG. The results of these studies show that RANKL's inhibition improves the DMO as well as the geometry and resistance of the bone. Several references clinical trials have investigated the potential of denosumab as antiresorptive drug for the prevention and treatment of bone disease. It is a monoclonal antibody, the first fully human, which were recently published results of randomized clinical trials to eight years for increasing BMD in different locations and five years for the prevention of vertebral and hip fractures. We review the fundamentals of the mechanism of inhibition of RANK-L and the results of several clinical trials of Denosumab.
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Anticorpos Monoclonais Humanizados/uso terapêutico , Osteoporose Pós-Menopausa/prevenção & controle , Ligante RANK/fisiologia , Denosumab , Feminino , Humanos , Osteoporose Pós-Menopausa/etiologia , Osteoporose Pós-Menopausa/fisiopatologia , Ligante RANK/antagonistas & inibidores , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Fibromyalgia syndrome (FMS) is a disorder usually affecting middle aged women, who complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety and poor sleep. Neurotransmission disorders linked both to pain perception as well as mood, sleep and cognition modulation are involved in FMS etiopathogenesys. Treatments that may be effective to decrease pain and fatigue include tricyclic antidepressants, dual reuptake inhibitors of serotonin/noradrenalin and pregabalin. The climacteric syndrome is a set of symptoms caused by the decline of ovarian hormone levels, which alters brain neurotransmission and provokes musculoskeletal pains, mood disorders, poor sleep quality and hot flushes. The hormone therapy reverses those symptoms and its risks are marginal if women's own hormones are used through transdermal route. Some antidepressants may be useful for patients with climacteric symptoms. We have found it surprising the epidemiological, etiopathogenic, symptomatic and therapeutic similarity between FMS and climacteric that could lead us to hypothesize that FMS is a part of the climacteric syndrome. However, the existence of FMS non-climacteric patients points out that hormone deficit is not the only physiopathological mechanism involved in this syndrome's etiopathogenesys. Nevertheless, it is likely that hormone disorders are involved in the symptoms genesis of most middle aged women with FMS. Keeping this in mind, we see the point in considering the use of HT in climacteric patients with FMS. Studies assessing the FMS clinical response to HT in a prospective manner and with the current diagnose criteria are still required.