Colombia Médica

CyberKnife Radiosurgery for refractory bilateral trigeminal neuralgia. Case report

2023-03-10T11:03:08-05:00

Case description:

A case of a 37-year-old female patient suffering from refractory bilateral trigeminal neuralgia is presented, she underwent various interventions such as acupuncture, block therapies and even microvascular decompression without effective pain relief.

Clinical findings:

Paresthesias and shooting-like twinges of pain intensity 10/10 in bilateral maxillary and mandibular branches of the trigeminal nerve, with nasal and intraoral triggers that made eating impossible, becoming increasingly severe since refractoriness to microvascular decompression and carbamazepine, triggering the twinges even during sleep, generating somnolence, depressive mood and social isolation.

Treatment and results:

The patient was evaluated by an interdisciplinary neuro-oncology team, where, in accordance with the analysis of the brain magnetic resonance imaging and the patient's history, it was indicated to perform Cyberknife® radiosurgery in mono-fraction on the left trigeminal and subsequently treat the contralateral trigeminal. When treated with Cyberknife® radiosurgery, the patient reported absolute improvement in her pain for 2 years.

Clinical relevance:

Radiosurgery by CyberKnife is not yet the first line of management in trigeminal neuralgia, however, it should be considered since several studies have managed to demonstrate an increase in the quality of life of patients and pain relief in refractory or severe cases. of said pathology.

Survival in stomach cancer: analysis of a national cancer information system and a population-based cancer registry in Colombia

2023-01-30T14:20:59-05:00

Background:
Stomach cancer is among the most frequent, is a leading cause of mortality in low- and middle-income countries. Assessing its survival is important to guide evidence-based health policies.

Aims:

To estimate stomach cancer survival in Colombia (2014-2019) with data from the national Cancer Information System (NCIS) and in Cali with data from the Cali Population Cancer Registry (RPCC) (1998-2017).

Methods:

NCIS estimated the overall 3-year net survival for 8,549 people, while RPCC estimated 5-year net survival for 6,776 people.

Results:

The 3-year net survival was 36.8% (95% CI: 35.5-38.1). Net survival was higher in people with special insurance (61.7%; 95% CI: 44.8-74.8) or third payer (40.5%; 95% CI: 38.7-42.3) than state insurance (30.7%; 95% CI: 28.7-32.8). It was also higher in women and people diagnosed at early stages. Multivariable analysis showed consistency with survival estimations with a higher risk of death in men, people with state insurance, and diagnosed at advanced stages. In Cali, the 5-year net survival remained stable in men during the last 20 years. In women the 5-year net survival in women increased 8.60 percentage points, equivalent to a 50% increase compared to the 1998-2002 period. For 2013-17, it was 19.1% (95%CI: 16.2-22.2) in men, and 24.8% (95% CI: 20.4-29.3) in women.

Conclusions:

Population survival estimates from the RPCC were lower than those observed in the NCIS. The differences in their methods and scope can explain variability. Nevertheless, our findings could be complementary to improve cancer control planning in the country.

Deliberative poll on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano carried out in Colombia

2023-02-27T09:16:23-05:00

Background:

There is a lack of published information on utilizing the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America.

Objective:

To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created to support the implementation of Resolution 825/2018 about regulating the euthanasia procedure for children and adolescents in Colombia.

Methods:

Participatory Action Research utilizes a Deliberative dialogue method that has been adapted based on feminist epistemological principles.

Results:

The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days before the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored.

Conclusions:

The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Melancholy as a healthy strategy in times of great human crises

2023-01-30T14:22:56-05:00

What happens in our thinking and feeling when we visit a certain historical moment of the past, find references, situations, and thoughts that make us think about the present?

Does the tango song ‘Cambalache’ compose by Enrique Santos Discépolo ensure the timelessness of the world’s misfortunes? However. specifying that it happens in “506 and in (the year) 2000 as well”, leaves a time frame of history outside of this sentence. Discépolo does not claim to be a historian but rather a philosopher. And a philosopher of skepticism like few others since he allows us to sing his philosophy since he made it known to the public.

But this is no more than a deliberate detour to point out that, in tango, skepticism operates as a radical expression of shared similarity due to the wide variety of things and characters that insist on repeating themselves throughout history. This essay aims not to reflect on continuity but on what is discontinuous and, incidentally, to question the notions of freedom and utopia. Allowing us to place freedom no longer in the field of the ideal but that of its origin while questioning the notion of freedom as an ideal will allow us to support the idea of freedom as a possible exercise.

What I propose is to reveal that the idea of the end of the world has always existed throughout history but that it has been questioned by exercises in the freedom that created conditions of resistance, which protected its practitioners from succumbing to needy resignation. In times where this idea is established in the field of culture as almost hegemonic, characters or events arise that demonstrate the possibilities of being placed in it, without being permeated with the prevailing pessimism, and establishing a consistent way of life; a certain degree of bitterness turned into a method, or according to some: a melancholic strategy to transcend life.

La Buena muerte

2023-02-22T13:55:22-05:00

Talking about good death is a significant commitment. From clinical practice, it is possible to have a distant view, highly focused on the biological domains of the process, but unquestionably the most accurate and complete vision is the one that unites the biological component with the human component; that is, as part of a process that will also be part of my existence.

Whenever we reflect on our death or that of a loved one, our innate desire emerges for this moment to be free of unnecessary suffering, recognizing this as a fundamental right for any human being. Moreover, this right will always be governed by the dignity of the human being; dignity is the basic framework that supports this desire.

The need for education about death in medical practice

2023-01-26T09:38:20-05:00

Colombia is one of the leading countries in the world regarding regulations and rights at the end of life. Currently, legislation on access to palliative care, limitation of therapeutic effort, euthanasia, euthanasia in children and adolescents, conscientious objection for doctors, and medically assisted suicide is decriminalized. Meanwhile, the remaining Latin American countries are just beginning the discussion about dignified death. Among many reasons for this delay, one of them is that it begins with the most controversial of issues, euthanasia, instead of focusing on humanizing the end of life.

Although, etymologically, euthanasia means "good death," a good death does not mean euthanasia. The definition of a good death is complicated because it corresponds to an individual notion affected by culture, religion, society, and medical science. Due to the lack of definition, the tools available to estimate the quality of death and end-of-life care are still unreliable. One of the most recognized criteria to define a good death is the preference of the place to die of the patient, but this depends on factors of the individual, their family environment, the disease, the logistical possibilities of the health system, and the health team that accompanies the process. Some of these determinants can be modified, but not others. Health team care is the one with the greatest potential and, possibly, requires the most investment in education and organization.

For physicians, death is transforming from being a natural part of the human experience into a crisis of patient health from which they must be rescued. In addition, technology-based clinical training ensures that they are well qualified to prolong life and poorly prepared to confront death or discuss it with their patients. The problem is bigger than it seems because the conviction about reliance on hospital-based, technologized medicine at the end of life is applicable to them. Research in Canada found that physicians died more in intensive care units and used more palliative care than the general population, but there was no difference in the possibility of dying at home.