Guillermo Sánchez

Prácticas frente a la radiación ultravioleta y características epidemiológicas de un grupo de pacientes con carcinoma basocelular en un centro de referencia nacional en Colombia

Resumen Objetivo Describir y caracterizar a los pacientes con carcinoma basocelular diagnosticados en un centro nacional de dermatologia en Colombia y conocer sus practicas relacionadas con la radiacion ultravioleta. Metodos Estudio descriptivo en pacientes con diagnostico de carcinoma basocelular confirmado por estudio histopatologico. Se estudiaron aspectos sociodemograficos, historia de practicas relacionadas con exposicion a la radiacion ultravioleta, y una evaluacion de antecedentes y examen fisico. Resultados El promedio de edad fue 65 anos. Mas del 80% de ellos vivian en la region andina. En la etapa escolar se documento el mas alto porcentaje de exposicion a radiacion ultravioleta (el 76,4% de los sujetos), combinado con el mas bajo porcentaje de aplicacion de practicas protectoras (sombrero: 8%; mangas largas: 9%; protector solar: 0%). Las actividades del campo ocuparon el primer lugar en exposicion laboral a lo largo de la vida (menores de 15 anos: 89%; mayores de 30 anos: 48%). Se destaca un numero importante de casos fototipo III (22%), y la lesion concomitante mas asidua fue la queratosis actinica, presente en el 53% de casos. Conclusiones Los resultados apuntan a que algunos sectores de la poblacion deben ser priorizados en campanas de prevencion del carcinoma basocelular (ninos y trabajadores del campo) enfocando las estrategias educativas, principalmente, en la edad escolar. Es evidente la necesidad de explorar factores de riesgo, conocimientos y habitos frente a la radiacion ultravioleta propios de nuestra poblacion.

Clinical prediction rule for nonmelanoma skin cancer

Background: Skin cancer is the most frequent neoplasia in the world. Even though ultraviolet radiation is the main cause, established prevention campaigns have not proved to be effective for controlling the incidence of this disease. Objective: To develop clinical prediction rules based on medical consultation and a questionnaire to estimate the risk of developing nonmelanoma skin cancer. Methods: This study was developed in several steps. They were: Identifying risk factors that could be possible predictors of nonmelanoma skin cancer; their clinical validation; developing a prediction rule using logistic regression; and collecting information from 962 patients in a case and control design (481 cases and 481 controls). We developed independent prediction rules for basal cell and squamous cell carcinomas. Finally, we evaluated reliability for each of the variables. Results: The variables that made up the final prediction rule were: Family history of skin cancer, history of outdoor work, age, phototypes 1-3 and the presence of poikiloderma of civatte, actinic keratosis and conjunctivitis in band. Prediction rules specificity was 87% for basal cell carcinomas and 92% for squamous cell carcinomas. Inter- and intra-observer reliability was good except for the conjunctivitis in band variable. Conclusions: The prediction rules let us calculate the individual risk of developing basal cell carcinoma and squamous cell carcinoma. This is an economic easy-to-apply tool that could be useful in primary and secondary prevention of skin cancer.

Factores asociados con el tratamiento oportuno de mujeres con cáncer de mama apoyadas por una organización no gubernamental en Bogotá

INTRODUCTION The prognosis for a woman with breast cancer is related to the time that elapses before diagnosis and integral treatment. Colombian women face barriers that determine effective access to the health system. OBJECTIVE To establish the determinants of timely treatment for breast cancer in a group of women supported by a non-governmental organization in Bogotá. MATERIALS AND METHODS An observational analytical study was carried out on 136 women with breast cancer supported by the non-governmental organization. The cut-off point for timely treatment was defined as 90 days, calculated as the time between the appearance of symptoms and the initiation of treatment. Predictors of timely treatment were explored by means of multivariate analysis. RESULTS Although 96% of the women had health insurance only 26.4% received timely treatment, and 36 of them reported being denied medical services. Of these women, 23% took legal action to gain access to their healthcare rights. Significant associations were established by multivariate analysis for timely treatment among women belonging to socioeconomic strata IV and V (OR=3.39), as well as those with higher education (OR=2.72). CONCLUSIONS According to the international literature, the prognosis for women with breast cancer improves when they are able to access opportune treatment. In this group of women socioeconomic factors appeared to determine effective access to treatment, revealing the existence of inequalities that may be socially determined.

Reliability and agreement of two smear reading scales for classification and monitoring of multidrug therapy in leprosy patients

INTRODUCTION After the clinical diagnosis of leprosy, classification methods are necessary to define a treatment and prognosis of patients consistent with bacterial load. Bacteria are detected in skin smear, and bacterial load typically is established by the internationally used Ridleys logarithmic scale, However, in Colombia an alternative semiquantitative scale is used. OBJECTIVE The interobserver reproducibility was established for the Ridley and Colombia scales, and the level of correlation-matching was identified between the bacillary indices obtained in order to assess the degree of interchangeability. MATERIALS AND METHODS Standardization was attained by a reading of the smears by 2 readers with subsequent, blinded evaluation of inter-observer agreement. Each reader quantified the bacterial load of for each sample (n=325) using the Colombian and the Ridley scales. The degree of interobserver agreement was assessed with weighted kappa coefficient. The level of correlation and agreement between the measurements of the bacillary index was established with coefficient of Lin. RESULTS The interobserver weighted kappa coefficient was 0.83 for the Colombia scale and 0.85 for the Ridley scale. The Lin coefficient was 0.96 for the correlation-matching of bacillary indexes. CONCLUSIONS Interobserver agreement obtained for both scales was excellent as the correlation-matching bacillary indices determined with both methods. With the cut-off points yielded a good level of agreement, ensuring interchangeability between the scales defining the high or low bacterial load.