Héctor Iván García

A prospective split‐face double‐blind randomized placebo‐controlled trial to assess the efficacy of methyl aminolevulinate + red‐light in patients with facial photodamage

Background  To date, there is no gold standard therapy for skin photoageing. In the last decade, laser technologies have offered great promise among skin‐rejuvenation therapies; however, both non‐ablative and ablative fractional resurfacing modalities have their own benefits and drawbacks. More recently, open‐label studies and few controlled trials have suggested that photodynamic therapy may have therapeutic potential in photodamage.

Homicides in Medellín, Colombia, from 1990 to 2002: victims, motives and circumstances

In Medellín, Colombia, homicide has been the first cause of morbidity and mortality for 20 years. Medellín has the highest homicide rates of all major cities in Latin America. This study describes the victims, motives, and circumstances in homicides in Medellín from 1990 to 2002. The period included 55,365 homicides, of which 1,394 were randomly studied. Of this sample, 93.6% (95%CI: 92.2%-94.8%) were males, 77.0% (95%CI: 75.0%-79.5%) less than 35 years of age, one-fourth had consumed alcohol, and nine out of ten were killed with firearms. The main motives were revenge and armed robbery. 37.0% (95%CI: 34.0%-41.0%) of the victims lived in the lowest socioeconomic stratum of the city. Characteristics of homicides in Medellín have remained unchanged since the 1980s, when the most violent period in the citys history began. The most heavily affected groups are young males who live and die in poor neighborhoods, and the murders are individual acts that leave no wounded behind.

An integrated malaria control program with community participation on the Pacific Coast of Colombia

The study focuses on integrated malaria control in 23 communities on the Pacific Coast of Colombia, with several elements of an ecosystem approach to human health, including malaria-related sociopolitical, ecological, and economic factors. The program fostered community participation. The program presented here had 2 components: implementation and research. The first was conducted in 23 communities, 21 of which lacked adequate health services in terms of education, community participation, prompt diagnosis and complete treatment, and vector control. Research focused on specific vector control measures and the current national health services decentralization process. The project: 1) created a malaria prevention culture in the community; 2) avoided deaths from malaria (no fatal cases in the 3-year period, compared to 5-8 deaths a year previously); 3) avoided cases of cerebral malaria (no cases, as compared to 90-110 per year previously); 4) reduced malaria incidence by 45.36%; 5) decreased length of sick leave from 7.52 to 3.7 days; 6) established a permanent network of microscope technicians and 2-way radio communications; 7) integrated work by local, regional, and outside institutions; 8) demonstrated efficacy of insecticide-impregnated bednets to reduce malaria transmission.

Validación del cuestionario KIDSCREEN-27 de calidad de vida relacionada con la salud en niños y adolescentes de Medellín, Colombia

Resumen Objetivo Validar el cuestionario de calidad de vida (CV) KIDSCREEN-27 en el area metropolitana de Medellin (Colombia). Materiales y metodos Estudio de validacion de una escala de CV para ninos y adolescentes entre 8 y 18 anos, sanos y con enfermedades agudas o cronicas. Se evaluo la validez de constructo y de contenido, la consistencia interna, la fiabilidad interobservador e intraobservador y la sensibilidad al cambio. Se encuestaron 161 ninos y adolescentes sanos de 3 instituciones educativas y 160 ninos y adolescentes enfermos, 81 con enfermedades de menos de 3 meses de evolucion y 79 de mas de 3 meses de evolucion, hospitalizados o ambulatorios, de 3 instituciones de salud, 2 privadas y 1 publica. Resultados La CV en todas las dimensiones fue menor en los ninos y adolescentes enfermos y aun peor en los hospitalizados y en los ninos que en las ninas; en los adolescentes fue similar en ambos generos. Para la validez de constructo las medias de cada uno de los grupos fueron diferentes en todas las dimensiones. En el analisis factorial exploratorio se encontraron 6 categorias, validadas en el analisis factorial confirmatorio. La consistencia interna fue mayor a 0,7 en todas las dimensiones. En todos los dominios el coeficiente de correlacion intraclase fue superior a 0,87 en la fiabilidad interobservador y mayor a 0,8 en la fiabilidad intraobservador. Conclusion El KIDSCREEN-27 se puede usar en poblacion de ninos y adolescentes del area metropolitana de Medellin ya que mostro adecuadas propiedades psicometricas de fiabilidad y validez.

Out-patient rehabilitation programme for spinal cord injured patients: Evaluation of the results on motor FIM score

Purpose. The aim of this study was to evaluate an out-patient attention programme based on a short in-patient phase followed by an out-patient interdisciplinary rehabilitation programme. Methods. A prospective quasi-experimental before-and-after study was carried out; a phase 2 trial. The study population consisted of 42 patients who met the inclusion criteria. The Functional Independence Measurement (FIM) was the main outcome, and the American Spinal Injury Association (ASIA) motor scores and morbidity the secondary ones. The intervention was a two-phase goal-based interdisciplinary programme which consisted of a hospital and an ambulatory phase. After an evaluation upon admission to hospital, follow-up was carried out 1, 3, 6, 12 and 18 months later. Results. Initially, 208 patients were evaluated and only 42 completed the study. The in-patient phase was short (average: 13.5 days) and the out-patient phase lasted 18 months. Motor FIM scores progressively increased from 25/91 up to 69/91 (p < 0.01). Some 25% of the patients had pressure sores at 1 month, and 11.9% still had them after 18 months. Pain was the most frequent complication, in 80% of patients by the third month. Urinary and fecal continence improved during follow-up (74% at 18 months and 81.1% at 12 months, respectively). Conclusions. Good functional evolution of SCI patients and low morbidity can be obtained with a low-cost out-patient rehabilitation programme. Such a programme must emphasize patient and family education concerning self-care and possible SCI complications.

Efficacy of early treatment with carbamazepine in prevention of neuropathic pain in patients with spinal cord injury.

Objective The aim of this study was to evaluate whether early treatment with carbamazepine decreases the incidence of neuropathic pain (NP) or its intensity in patients with spinal cord injury. Design This study was a randomized, double-blind, placebo-controlled clinical trial at a third-level university hospital involving patients older than 18 yrs with a diagnosis of spinal cord injury sustained within 2 wks before enrollment and without evidence of NP. The patients received either carbamazepine up to 600 mg/day or placebo for 1 mo. Pain intensity was measured with a 10-cm visual analog scale and the SF-36 bodily pain subscale; quality-of-life, with the Short Form 36 (SF-36) Scale; and depression, with the Zung Self-Rating Depression Scale. Measurements were carried out at the start of the randomized trial and at the 1-, 3-, and 6-month follow-up assessments. Results Twenty-one of 46 patients developed NP. At the 1-, 3-, and 6-month follow-up assessments, NP was present in 4, 11, and 10 patients of the carbamazepine group and in 8, 9, and 8 patients of the placebo group, respectively. At 1 mo, two patients in the carbamazepine group vs. eight patients in the placebo group reported moderate/intense pain (visual analog scale, ≥4.0; P = 0.024). At the 3- and 6-month follow-up appointments, moderate/intense pain was reported by eight vs. six (P = 0.498) and six vs. eight patients (P = 0.298), carbamazepine and placebo group, respectively. There was no difference in the depression ratings or in any of the SF-36 scales. Conclusions Early intervention with carbamazepine decreased NP incidence at the 1-month but not at the 3- and 6-month follow-ups in the group of patients with acquired spinal cord injury.

Treinta años de homicidios en Medellín, Colombia, 1979-2008

El homicidio en Medellin, Colombia, se convirtio en la primera causa de muerte desde 1986 y su participacion del total de muertes paso de 3,5% en 1976 a 42% en 1991 y 7% en 2006. Entre 1979 y 2008 hubo 81.166 homicidios (2.706 promedio/ano). La tasa de homicidios por 100.000 habitantes fue 44 en 1979 y 47 en 2008, con un maximo de 388 en 1991. Se describen caracteristicas de los homicidios en 30 anos, entre 1979 y 2008, por quinquenios, mediante una muestra aleatoria de 3.414 necropsias medico-legales. Los muertos fueron hombres 92.8% (IC95%: 91,8; 93,6), jovenes con promedios de edad entre 27 y 33 anos, residentes en estratos socio-economicos bajos, con predomino de los moviles ajustes de cuentas, rinas y atracos. Se evidenciaron tres periodos diferentes de la epidemia de homicidios: el primero de incremento acelerado 15 anos, el segundo de descenso sostenido hasta 1998 y el tercero ondulante y descenso abrupto en los 10 ultimos anos. Estos resultados de larga duracion de la violencia en la ciudad abren posibilidades analiticas para encontrar politicas mas consistentes de intervencion.

Validez y confiabilidad del 'Cuestionario de calidad de vida KIDSCREEN-27' versión padres, en Medellín, Colombia

OBJECTIVE Validate the KIDSCREEN-27 for parents in the metropolitan area of Medellín, Colombia, including the Social Acceptance (SA) subscale of KIDSCREEN-52, as it evaluates the effect of bullying in Life Quality of children. METHODS The study population was made up by parents of children between 8 and 18, from Medellín and its metropolitan area. A sample of 1,150 parents was estimated according to the different psychometric properties to be measured. Construct validation was made by comparing the mean scores between groups of high and low socioeconomic conditions. The content validity and the measurement of reliability were verified by internal consistency and test-retest stability. The parent-child agreement was also measured. RESULTS The internal consistency was adequate (Cronbach alpha 0,76-0,83). Parents of children with better socio-economic status had higher scores in all dimensions (p<0,05). Scores were higher among healthy children. Women had lower scores than men, while children registered higher scores than adolescents. The intraclass correlation coefficient for the reliability assessment was above 0.7 in all dimensions, except in School Environment-SE- (ICC 0,6-0,92). The parent-child agreement reached moderate and good levels (ICC 0,49-0,69). The exploratory factorial analysis, including social acceptance subscale, registered eight dimensions, four of which in agreement with the original questionnaire: Physical activity, SE, Social Support, and SA subscale. CONCLUSIONS KIDSCREEN-27 for parents is a valid and reliable instrument to be used in the Colombian context.Objective Validate the KIDSCREEN-27 for parents in the metropolitan area of Medellin, Colombia, including the Social Acceptance (SA) subscale of KIDSCREEN-52, as it evaluates the effect of bullying in Life Quality of children.

Mortalidad por homicidio en Medellín, 1980-2007

The Colombian city of Medellin has faced a severe problem of violence and homicide. The goal of this retrospective, descriptive-analytical study was to assess the magnitude, distribution, most salient characteristics and possible explanations for the problem between 1980 and 2007. Data were obtained from official databases, hospital records and the available literature, and a focus group was set up. There was a dramatic rise in homicides in the city in the time interval studied, with a total of 84,863 documented murders. Ninety-three percent of the victims were male. The 20 to 29 year-old age group was the most affected. Males in this age group, during the worst year of the period (1991), registered an astounding murder rate of 1,709 per 100,000. Even males in the 15 to 19 year age group and the older brackets saw high murder rates. The most common victims were from the lower and lower-middle socioeconomic strata, as has been observed elsewhere in the region. Serious problems were identified in information and in the provision of services. The impact of homicide on the delivery of healthcare services is discussed and a series of tasks for the healthcare sector in the control of this type of violence is proposed.

Comparación de la toma seriada de presión arterial y la monitorización ambulatoria para el diagnóstico de hipertensión esencial en una población colombiana

Objetivos comparar la toma seriada de la presion arterial en consultorio con la monitorizacion ambulatoria de la presion arterial durante 24 horas para el diagnostico de hipertension arterial con base en los criterios definidos en las guias de la European Society of Hypertension-European Society of Cardiology (ESH-ESC) y el Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-VII), en una poblacion adulta, en la ciudad de Medellin. Metodos se estudiaron 66 pacientes entre los 18 y 65 anos, sin diagnostico previo de hipertension arterial ni factores de riesgo para enfermedad cardiovascular, por medio de tres metodos de toma de la presion arterial (ocasional, toma seriada, monitorizacion ambulatoria), los cuales se compararon segun los diferentes metodos expuestos en las guias JNC-VII, ESH-ESC y de Atencion de la Hipertension Arterial, del Ministerio de la Proteccion Social de Colombia. Resultados se estudiaron inicialmente 3.589 pacientes con una toma ocasional de la presion arterial, de los cuales 680 tenia cifras de tension ≥ 138/88. De estos se citaron 346 para la toma seriada de la presion arterial; los restantes no cumplian con criterios de inclusion. Los 66 pacientes con promedio de presion arterial ≥140/90 clasificaron para una monitorizacion ambulatoria de la presion arterial. La sensibilidad de la toma seriada de la presion arterial interpretada por cualesquiera de las guias utilizadas, fue superior a 88% y la especificidad inferior a 22%; el coeficiente de probabilidad positivo fue cercano a 1 en todos los casos. Conclusion la toma seriada de la presion arterial comparada con la monitorizacion ambulatoria de la presion arterial, tiene alta sensibilidad (mayor de 88%) y baja especificidad (menor de 22%) con base en las tres guias clinicas utilizadas, y no es recomendable como prueba de referencia.