Ricardo Sánchez Pedraza

Use of lithium during pregnancy: a case report using clinical decision analysis

Revista Brasileira de Psiquiatria • vol 32 • no 1 • mar2010 • 95 References 1. Teixeira-Jr AL, Caramelli P. Apathy in Alzheimer’s disease. Rev Bras Psiquiatr. 2006;28(3):238-41. 2. Robert P, Onyike CU, Leentjens AF, Dujardin K, Aalten P, Starkstein S, Verhey FR, Yessavage J, Clement JP, Drapier D, Bayle F, Benoit M, Boyer P, Lorca PM, Thibaut F, Gauthier S, Grossberg G, Vellas B, Byrne J. Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur Psychiatry. 2009;24(2):98-104. 3. Rodda J, Morgan S, Walker Z. Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer’s disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. Int Psychogeriatr. 2009;21(5):813-24. 4. Figiel G, Sadowsky C. A systematic review of the effectiveness of rivastigmine for the treatment of behavioral disturbances in dementia and other neurological disorders. Curr Med Res Opin. 2008;24(1):157-66. 5. Winblad B, Cummings J, Andreasen N, Grossberg G, Onofrj M, Sadowsky C, Zechner S, Nagel J, Lane R. A six-month double-blind, randomized, placebo-controlled study of a transdermal patch in Alzheimer’s disease--rivastigmine patch versus capsule. Int J Geriatr Psychiatry. 2007;22(5):456-67.

Algorithm for the evaluation of therapeutic failure reports—proposal and pilot analysis

To propose and validate an algorithm to analyze the reports of suspected therapeutic failure (TF) received in pharmacovigilance programs.

Muertes por causas violentas y ciclo económico en Bogotá, Colombia: un estudio de series de tiempo, 1997-2006

OBJETIVOS: Caracterizar las tendencias temporales del numero de muertes por causas violentas en la ciudad de Bogota entre 1997 y 2006 y analizar su posible asociacion con los ciclos economicos de la ciudad. METODOS: Estudio ecologico a partir de las cifras absolutas de muertes violentas registradas entre enero de 1997 y septiembre de 2006 en Santa Fe de Bogota, Colombia. Se utilizaron modelos ARIMA de series de tiempo trimestrales para caracterizar el comportamiento de las muertes violentas. Como variables explicativas del ciclo economico de la ciudad se utilizaron las series trimestrales del indice de precios al consumidor, la tasa de desempleo y el numero total de personas ocupadas; se evaluo su asociacion con las series de muertes mediante modelos de funcion de transferencia. RESULTADOS: Del total de 36575 muertes por causas violentas en Bogota, 57,7% fueron por homicidios y 23,7% por accidentes de transito. Las series de homicidios, suicidios y muertes por accidentes de transito mostraron tendencias decrecientes, con un marcado comportamiento estacional en las series de muertes por accidentes de transito y suicidios, con picos en los dos ultimos trimestres de cada ano. Se hallaron asociaciones significativas entre todas las series de muertes por las diferentes causas con al menos una serie economica y en cada caso se identifico el modelo de funcion de transferencia respectivo. CONCLUSIONES: Los homicidios constituyen la mayor parte de las muertes por causas violentas y revelan la existencia de patrones temporales en este tipo de muertes. Se encontraron asociaciones significativas entre las muertes por causas violentas y algunas variables economicas que describen el ciclo de la actividad en la ciudad. Se confirmo que diferentes circunstancias socioeconomicas que afectan a una sociedad pueden influir en el nivel de violencia.

Edad de inicio como marcador de subtipos de enfermedad maniacodepresiva

Introduction: Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. Objective: To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. Methods: Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. Results: According to age at onset, three distributions haveINTRODUCTION Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. OBJECTIVE To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. METHODS Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. RESULTS According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. CONCLUSIONS In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics.

Adaptación transcultural de la escala Caregivers Quality Of Life Index-Cancer para cuidadores en Colombia

espanolIntroduccion: La mayoria de las escalas que evaluan la calidad de vida en cuidadores de pacientes oncologicos han sido elaboradas y validadas en idiomas diferentes al espanol, lo cual disuade su uso en poblacion hispano-hablante. La escala Caregiver Quality Of Life Index-Cancer (CQOLC), que evalua este constructo en este grupo poblacional, es el instrumento mas empleado para tal fin; sin embargo, no se encuentra validada en Colombia. Considerando la relevancia de la evaluacion de este constructo en el tratamiento integral de la poblacion con cancer, se presenta la traduccion y adaptacion transcultural al espanol colombiano de la escala CQOLC, para su posterior validacion. Materiales y Metodos: Tras obtener el permiso del autor de la escala, esta se tradujo directa e inversamente. Luego, se ejecuto la prueba piloto con una version provisional en espanol, que identifico dificultades en la comprension de los items o posibles molestias provocadas por los mismos. Resultados: La prueba piloto se ejecuto en 21 cuidadores de pacientes con cancer que asistieron al Instituto Nacional de Cancerologia en mayo del 2016. Durante la prueba piloto, se presentaron dificultades en la comprension del item 5, por lo cual se decidio cambiar la redaccion del mismo. El resto de los items se comprendieron facilmente y se produjo una version final del instrumento. Conclusion: Se encuentra disponible la escala CQOLC en espanol colombiano. Esta escala podra emplearse en el proceso subsiguiente de validacion, para asi estimar la calidad de vida de los cuidadores de pacientes con cancer en el pais. EnglishIntroduction: Most of the scales that evaluate quality of life in cancer caregivers have been designed and validated in different languages from Spanish which limits their utilization in Spanish-speaking population. The Caregiver Quality of Life Index-Cancer (CQOLC), which evaluated this construct in this specific group, is the most commonly used instrument in assessing quality of life among cancer caregivers. However, it is neither validated in Colombia nor in Spanish. Considering the relevance of this construct as part of the comprehensive treatment of cancer patients, we present the translation and cross-cultural adaptation of the scale into Colombian Spanish. Methods: We obtained the author’s permission. Then, the instrument was translated and back-translated. After that, we executed a pilot test with a provisional Spanish version, in order to identify difficulties at understanding items. Results: Pilot test was executed in 21 cancer caregivers that visited the Instituto Nacional de Cancerologia in May of 2016. During the pilot test, there was difficulty at understanding the 5th item of the scale. Therefore, we paraphrased it. There were not additional problems at understanding the other items, and the final Spanish version of the scale was released. Conclusion: The CQOLC in Colombian Spanish is available. Now, it is possible to use it in the ulterior validation process, in order to estimate quality of life in Colombian cancer caregivers.

Morbimortalidad asociada a derivación percutánea de la vía urinaria en pacientes con obstrucción ureteral maligna secundaria a cáncer de cuello uterino

Cervical cancer is a public health problem in Colombia and the world; despite screening campaigns diagnosis is delayed and up to 60% are at risk of malignant ureteral obstruction. Previous studies suggest increased morbidity and mortality from the use of nephrostomies. Objectives: To evaluate the morbidity and mortality associated with nephrostomies in patients with malignant ureteral obstruction secondary to cervical cancer. Methods: This is a partial analysis of a study of bidirectional cohort conducted at the Instituto Nacional de Cancerología between May 2014 and May 2016, a sample size of 109 patients was calculated. The medical records of the time of insertion of nephrostomy were reviewed and subsequent hospital admissions to define the reason for hospitalization, frequency of complications and reoperations, the frequency of urinary tract infections, microbiological profile, the frequency of mortality and causes of it. Results: We collected only a fraction of the sample with 77 patients. The time between diagnosis of cervical cancer and obstructive uropathy had a median of 262 days; the time between the diagnosis of obstructive uropathy and insertion of the nephrostomy had a median of 19 days. In 19 patients the diagnosis of obstructive uropathy and cervical cancer were performed simultaneously with insertion of the nephrostomy during the same hospitalization. The first episode of urinary tract infection was monomicrobian, predominantly germs with AmpC production; in recurrences they were more frequent polymicrobial infections with appearance of carbapenemases producing strains. The reasons for hospital readmission were related to the device of the urinary tract in 22% of

OriginalFactores asociados con la participación de pacientes en ensayos clínicos en cáncerSome reasons why patients take part in cancer clinical trials

Background Cancer clinical trials require the voluntary participation of patients for their adequate development. Not all patients wish to do this, thus affecting their development. In other studies, the most important identified reasons in that influence the decision have been lack of information about study design, randomisation methods, and kind of treatment, use of placebos, toxicity, and side effects of the investigational medicinal product.

Health-related quality of life in stroke patients questionnaire, short version (HRQOLISP-40): validation for its use in Colombia.

BackgroundThe health-related quality of life in stroke patients (HRQOLISP-40, short version) survey was developed in Nigeria and constitutes a 40-item, multidimensional, self-administrated questionnaire. We assessed the validity and reliability of the HRQOLISP-40 Spanish version for stroke patients in Colombia.MethodsThe analysis included factor analysis, confirmatory factor analysis, Rasch analysis, convergent validity, internal consistency (261 stroke patients), test-retest reliability (73 patients assessed at two different times) and sensitivity to change (46 patients assessed before and after a rehabilitation intervention).ResultsWe found an 8-domain structure. None of the items had a significant impact on the global alpha value in order to be removed. Lin’s concordance correlation coefficient indicated test-retest reliability (Rho IC: 0.76 to 0.95), suggesting an adequate stability of the instrument. Regarding sensitivity to change differences, they were only significant in the psychological and eco-social domains (p <0.05). When comparing SF-36 with HRQOLISP-40, all the correlation coefficients values were significantly different from zero, except those related to vitality. The highest scores were found in the physical and physical functioning domains, with a value of 0.722.ConclusionsThe HRQOLISP-40 scale is valid and reliable for assessing patients’ quality of life after a stroke. Validating quality of life assessment instruments is necessary in order to improve the effectiveness of rehabilitation programs for Colombian stroke patients.

Espiritualidade, religiosidade e doença: uma olhada desde mulheres com cancro de mama

The present investigation aims to explore the role of spirituality and religiosity in the way that women with breast cancer assume, signifiy and face their illness. For this, a qualitative analysis of a series of in-depth interviews with a group of four women participating in a “spirituality based intervention” of the Instituto Nacional de Cancerologia, is made. After an exercise of review and theoretical confrontation, an approximation towards the modes of agency and interpretation of the illness was achieved, modes which are crossed concepts and practices related to the “spiritual” and “religious” area as well as the medical knowledge. The ideas of the

Spirituality, Religiosity and Illness: a view from Women with Breast Cancer

The present investigation aims to explore the role of spirituality and religiosity in the way that women with breast cancer assume, signifiy and face their illness. For this, a qualitative analysis of a series of in-depth interviews with a group of four women participating in a “spirituality based intervention” of the Instituto Nacional de Cancerologia, is made. After an exercise of review and theoretical confrontation, an approximation towards the modes of agency and interpretation of the illness was achieved, modes which are crossed concepts and practices related to the “spiritual” and “religious” area as well as the medical knowledge. The ideas of the