Boletín Coomtacto v.8.3 - Ingles

Newsletter

for health professionals of Coomeva Medicina Prepagada ISSN 2011-3579

Vol. 8

No. 3

September 2015

CONTENT 4

INTERVIEW ‘Safe Operating Rooms’: doctors are permanently alert tying to reduce surgical patient’s risks

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HEALTH UPDATE Bariatric surgery, a heavy weight choice

RESEARCH REPORT

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Pioneering research for the world Colombian specialists return sexual quality of life to women with a history of gynecologic cancer during the postmenopause

PROMOTION AND PREVENTION

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Sunlight can damage deep ocular tissues

EBM

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A new and simple method for the diagnosis of esophageal cancer

ACKNOWLEDGEMENTS 18  Honors for a Colombian cardiologist and internist  ACIC new representative in Colombia

FROM COOMEVA

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 Your smartphone is now a medical directory Coomeva Medicina Pregada is available on your mobile

MEDICAL WORLD BOOKS, REVIEWS AND EVENTS

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DENTISTRY IS KNOWLEDGE, AN ART, AND QUALITY SERVICE Currently the Colombian health care system is facing a complex situation. On the one hand, user requirements of care, attention, and prevention are increasingly strict, demanding, and globally tougher. While, on the other hand, market competition is very aggressive, and, unfortunately, it is not rare to even find informal, illegal, and low quality practices. But, Salud Oral Coomeva Medicina Prepagada is committed to high quality standards, so we demand, promulgate, and support ethical, responsible, legal, and professional behavior of all our partners, fulfilling our mission as promoters of health within the community.

Dentistry is one of the most affected areas by irregular practices. Professionals face major challenges, and even opportunities, situations that require righteousness, courage, and creativity. The dentist is a professional with high standards in their academic specialized training, requiring continuous programmatic innovations, as well as research in the field of dental sciences. Within the community, dentists certainly have an active role in creating oral public health policies. They are also involved in the decision making process, and the development of nationwide objectives for the oral health programs. They are in charge of the present and future of their noble profession.

Salud Oral Coomeva Medicina Prepagada is a specialized program, with high quality standards in consonance with the strict criteria with which we have designed all our services, also emphasizing in prevention, protection, and the assurance against new adverse events. Our oral health care program is intended to “provide high quality dental services at affordable prices, taking into account the needs for the professional development of our providers, while Coomeva Medicina Prepagada continues offering ample solutions with its broad portfolio of services”.

So we offer our users the opportunity to choose from a wide network of skilled professionals, whom fully meet the requirements of Sistema Obligatorio de Garantía de Calidad en la Atención de Salud in Clombia. Mean while, we do our job improving and facilitating the administrative workload, as well as the technical processes, and specially sponsoring, and promoting continuous education for the professional development of our affiliate providers in dental care.

Today it is very demanding for the dentist to compete with high quality, so that’s why we are so proud to say with certainty that we have been able to overcome these challenges.

For this reasons, in October, we will continue to provide our support, and show our appreciation to all the people who work with us in our oral health care services, a perfect amalgam between knowledge, art, and the desire to properly serve the community.

Soluciones de Salud Seguro de Desempleo

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Si eres empleado o independiente adquiere nuestra póliza de desempleo llamando a la línea nacional 018000960001 o escribiendo al correo: seguros@coomeva.com.co

Coberturas 6 rentas por desempleo involuntario.*

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*Aplica para trabajadores con contrato a término indefinido. **Aplica para trabajadores independientes. ***Hasta por 30 días.

La hospitalización debe ser por un tiempo superior a 24 horas. Seguro de accidentes personales con anexo de desempleo e incapacidad total temporal ACE seguros. “© 2015 ACE Group. Productos ofrecidos por una o más de las Compañías del Grupo ACE. Los productos ofrecidos no se encuentran disponibles en todas las jurisdicciones. Los derechos sobre las marcas comerciales “ACE”, su logotipo y “Asegurado con ACE”, son de propiedad de ACE Limited”.

INTERVIEW

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‘Safe Operating Rooms’:

OCTORS ARE PERMANENTLY ALERT TYING TO REDUCE SURGICAL PATIENT’S RISKS

With strict safety standards, continuing education, and technological resources, patients are monitored to reduce risks during their surgical procedures. Dr. Jose Ricardo Navarro, president of Sociedad Colombiana de Anestesiología y Rehabilitación, spoke to Coomtacto newsletter about the legal liabilities of medicine, and the educational campaigns designed to make surgeries safer.

Worldwide, two decades ago, deaths from anesthesia happened once in 10,000 procedures; and today they occur once in every 100,000 surgeries, reflecting the impact of training programs, and campaigns intended to improve safety for patients, aimed at professionals involved in these medical acts.

20 years ago anesthesiology in Colombia ranked 3rd among the five most sued specialties, today it ranks 17th.

Coomtacto Newsletter: What is a medical procedure, and who supervises it is done properly?

Doctor Jorge Ricardo Navarro: A medical procedure is everything that has to do with the relationship between a patient and a medical professional. And its goes even further, it also involves a multidisciplinary relationship, because health care professionals are part of a team, and they all share medical responsibility.

Law 23, of 1981, the Medical Ethics Law, states doctor’s behavior with all the responsibilities they acquire when facing a patient. The Law monitors the medical act through the Civil Code,

Photos: Gerardo Gómez

“These data indirectly shows the progress in the field of anesthesia, as well as the success of new monitoring systems and the surveillance techniques of the patient, aimed at providing safety”, said José Ricardo Navarro, anesthesiologist, and president of Sociedad Colombiana de Anestesiología y Reanimación (Scare), who talked to us about medical care in

general, and anesthesiology as a fundamental part of the health care system.

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the Constitution, protocols and guidelines, as well as health care authorities, issuing resolutions that allow health care services to function, and they partly refer to the actions of the health care professionals.

One of the most complex specialties, generating more risks to the patients, and more legal events, is anesthesiology. How can that improve?

We work with all that has to do with the safe handling of the patient. General anesthesia puts the person in an utter helplessness situation, and the anesthesiologist is part of the patient’s defense; so in order to take him to a situation of an essential unconsciousness, health care personnel must be very careful, and follow strict safety guidelines, and also strictly monitor the patient through technology. In Colombia, these standards have been set by Scare during the last 30 years. As a matter of fact, they were published a year before the American Society of Anesthesiologists (ASA) issued their guidelines. So we are pioneers.

There is no such thing as a trivial anesthesia. Even the most basic anesthesia requires a preanesthetic evaluation in order to establish a relationship with the patient, and assess the physical and physiological conditions, to know what the procedure will be, what the anesthetic technique will be, and if the patient signed the informed consent. Then, during the surgery, the anesthesiologist must monitor the patient, controlling blood pressure, heart and respiratory rates, as well as all the hemodynamic variables.

And after the surgery the anesthesiologist is responsible for the medical orders after evaluating

“For an adverse event four human errors are required; for instance, excessive work load, an inadequate work place, wrong application of medicines, and not verifying it”.

the patient and having established he satisfies the minimal requirements, in order for him to leave the recovery area.

Even though, Sigma 6 is an assessment protocol that measures all functions performed by human beings, the best monitoring system is carried out by the anesthesiologist, because he monitors and strictly controls the patient’s physiology until he regains consciousness. And there is also the bispectral index (BIS) and entropy, measurements of the state of consciousness.

Thus anesthesia must be at an adequate level: it should not be so shallow that the patient could feel pain and wake up; nor should it be too so deep as to hurt him or take a very long recovery.

Where is the boundary between doctor’s human error, and negligence?

Negligence is a bad practice. With regards to human error, some are latent, meaning that nobody notices them and they are not purposefully done, nor they neglect controlling the patient. Other errors are active faults.

For an adverse event, there must have occurred four human errors. For instance, if an anesthesiologist has worked several shifts, and has not rested, that is a mistake; if the surgery is performed in the dark, compromising the sense organs, the anesthesiologist must be fully aware of the patients situation, so this is another mistake; third, if an order is not understood and not corroborated,

INTERVIEW

for example, if the anesthesiologist tells the nurse to give the patient hyoscine, and she understands heparin; and finally, when the anesthesiologist is not sure of what medicine is being administered to the patient, if it is in fact what he requested, that’s the fourth error.

But all this demands an extensive expertise and permanent training...

Yes, indeed, it does. In complex situations, such as a surgical procedure, the risk increase, therefore, the entire team has to be well trained and permanently evaluated.

Today, in the world, we brief and debrief. Before any surgical procedure the surgical team meets, and all its members discuss several aspects of the procedure: the name of the patient, his age, what surgery is going to be performed, which medicines are being used, among other details of the case. Then, when they meet the patient, they ask again, what is the surgery, for example, if it is a knee, which side, this is all intended to reduce errors. And after the procedure, we debrief in a meeting to discuss how things went; and if something was out of the ordinary, we investigate what happened so that it won’t happen again.

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In theory all institutions should proceed this way, but are they doing it?

Everyone should do it, even in the most distant places. It must be so. In this regard, World Health Organization (WHO) has released an educational campaign called “Safe surgery, safe patient”, which is being implemented by Scare and many other scientific societies in order to reduce morbidity and mortality related to anesthesia, given that the quality of the health care system is a crucial aspect of any country’s development.

Are you involved in other projects?

Training is ongoing. We are implementing a course called “Back to Basics”, that is, to the basics of our specialty. But the most important thing is that we are working towards a safe operating room, and to repeat again and again what is going to be done, because that increases safety.

We have advanced in our safety workshops in several hospitals in Colombia, and in the meeting we always have a safety module, also the 21 departmental or sectional societies in the country have courses of continuing medical education, including reviews of adverse events, designed to evaluate what happened and define guidelines so it won’t happen ever again.

Soluciones de Protección Póliza RC Médica

MIENTRAS TÚ CUIDAS DE NOSOTROS Nosotros cuidamos de ti En Coomeva, la Cooperativa que nació para los profesionales de la salud, conocemos y entendemos los riesgos a los que estás expuesto, por eso te protegemos con nuestra póliza RC Médica.

Algunos beneficios: • Cubre los perjuicios patrimoniales y extra patrimoniales (lucro cesante, perjuicios morales, fisiológicos y de vida en relación, sin afectar el amparo básico) por errores u omisiones involuntarios.

• Línea de asesoría jurídica gratuita atendida por especialistas en riesgos legales de los profesionales de la salud. Puedes comunicarte desde cualquier lugar del país a la línea 018000 180252 o desde Cali al 893 3231

• Gastos de defensa del proceso civil, penal, tribunal de ética médica, administrativo o laboral.

• Cubre los eventos que se descubren durante la vigencia de la póliza o el periodo de retroactividad contratado.

• Asesoría y acompañamiento de abogados expertos en defensa de los médicos, desde la etapa pre procesal hasta el final del proceso.

• Respaldo de Liberty Seguros, una compañía de seguros AAA, vigilada por la Superintendencia Financiera.

• No aplica deducible para todas las coberturas.

Para más información visita nuestras oficinas.

Línea Nacional: 018000 950 123, desde Cali 333 0000, Bogotá 748 1515, Barranquilla 361 9800, Pereira 316 9300, Medellín 415 7700, Palmira 273 3302. Opción 4.

HEALTH UP TO DAY

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ARIATRIC SURGERY, A HEAVY WEIGHT CHOICE

Even though bariatric surgery improves the quality of life for patients with morbid obesity, it is not indicated for all the cases, and it also requires drastic changes in the eating and exercising habits, as well as psychological support.

CHANGING HABITS “Bariatric surgery is the most effective treatment available today for severe obesity; however, it is not foolproof. If the patient does not change habits, reducing sugar and liquor intakes, among others, obesity can return even after the bariatric surgery”, says Dr. José Pablo Vélez, a bariatric and gastric surgeon at Centro Médico Imbanaco at Cali.

According to the World Health Organization (WHO) more than 1,900 million adults are overweighed. Of them, about 600 million are obese.

And in Colombia, according to the National Survey on the Nutritional Status (Ensin 2010), 1 in 2 people are overweighed

Unfortunately some operated patients cheat. They can blend and liquefy all types of food, such as pizza, and they can take them as shakes.

The idea is to have an adequate, balanced and supervised diet, as well as physical activity in the daily routine.

Natan Zundel, president of the World Federation of Metabolic and Bariatric Surgery, an organization that represents 62 countries, including 17 Latin Americans, says: “eight years ago the leading cause of death in the world was smoking, but to two years ago obesity became the predominant cause”.

life, mobility, and self-esteem, explained Dr. José Pablo Vélez, a specialist in bariatric and gastric surgery at Centro Médico Imbanaco in Cali.

Today in Colombia more than 700 thousand people are candidates for this type of surgery, while in the United States there are 20 million people in need of it, and 200 thousand operations are performed annually.

For many people bariatric surgery is the only alternative to treat excess weight, and its morbidity. It helps with the severe health problems associated with obesity, loosing weight can help controlling hypertension and cardiovascular diseases, diabetes mellitus, and joint maladies, it can even reduce cancer risks, and improve the quality of

©2015 Shutterstock Photos

“To consider operating we start with a body mass index (BMI) of 30-35, as well as the risks and health implications for that particular patient, for instance in cases of diabetes associated with obesity. For people with a BMI over 35, a morbid obesity, experience has shown us that without the surgery chances are very slim of restoring a healthy weight, and a good quality of life. And there is one last group, patient with BMI over 60, for whom the surgery is an emergency”, adds Dr. Zundel.

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TYPES OF SURGERY “Bariatric surgery is a significant and permanent solution. It is not a cosmetic procedure, it is the definitive treatment for the disease”, says Dr. Vélez.

For those people who are not morbidly obese, there are endoscopic alternatives that allow us, for example, to put balls into the stomach that will give a feeling of satiety to the patient. And then they are removed within six months of installing them.

Another option is gastric banding. This technique involves placing an inflatable band on the upper stomach that can be tightened like a belt. It is useful for half of the people with morbid obesity.

Regarding large surgeries, currently the two most common alternatives are the gastric sleeve and the gastric bypass.

Gastric sleeve: “We remove between 80 and 85% of the stomach, resected it in a way similar to a shirt sleeve. A normal stomach has a two and a half liter capacity, and after the surgery the gastric capacity is reduced to 120-130 cubic centimeters.

Thus, food consumed decreases”, says Dr. Zundel.

Gastric Bypass: “the stomach is sectioned, reducing it from 120-130 cm to 30cm; then we climb the proximal intestine one and a half meters above the stomach, and finally reconnect them.

Thus food will not pass anymore through part of the stomach and the intestine. But this is the sight of the absorbtion for iron, vitamin D, B12 and others, so patients will require lifelong supplements. It is an aggressive surgery for a very aggressive problem.”

Although there are risks, as with any other surgery, the results are favorable as long as the patient is well selected and the protocols are met.

We are a multidisciplinary team, with specially trained anesthesiologists, cardiologists, nurses, nutritionists, obesity surgeons, plastic surgeons, psychologists, psychiatrists, and other specialists.

“If the patient has 100 kilos of overweight, with the gastric band, 40-45% of the excess weight can be lost; but if he opts for a sleeve, the loss will be around 80-85% of the overweight, on average a 75%; and if a bypass is performed, 90 to 95% of the target can be achieved”, said doctor Zundel.

According to a research published in the journal Psychology, Health & Medicine, with more than 2,250 operated patients, “there is an improvement after surgery in quality of life, related to psychological and physical aspects,” said doctor Alejandro Magallares, a researcher at Universidad Nacional de Educación a Distancia (UNED) in Spain, and also a co-author of that paper.

RECOMMENDED READINGS 1. http://www.revespcardiol.org/es/obesidad-corazon/ articulo/13191034/ 2. http://www.endocrino.org.co/files/Manejo_Quirurgico_de_la_Obesidad.pdf 3. http://www.who.int/mediacentre/factsheets/fs311/es/ 4. http://www.scielo.org.co/pdf/rcci/v28n1/v28n1a9.pdf

RESEARCH

REPORT

Pioneering research for the world

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OLOMBIAN SPECIALISTS RETURN SEXUAL QUALITY OF LIFE TO WOMEN WITH A HISTORY OF GYNECOLOGIC CANCER DURING THE POSTMENOPAUSE.

Dr. Juan Fernando Bojanini, gynecologist, leader of the research group.

Laser treatment for women with vaginal atrophy secondary to the decline in estrogen levels during the menopause has been an important advance, allowing the patients to regain the joy of sex. Figures suggest that between 4 and 6 in 10 women in this stage of life have less vaginal lubrication, pain during sexual intercourse, burning sensation while urinating, and other symptoms.

Currently, in women with a history of gynecologic cancer, the risk benefit ratio of treatments with hormones is being evaluated, and many patients have stopped these therapies. And that is why the gynecologist Juan Fernando Bojanini Betancur, along with his research team, started to measure outcomes with laser treatment in women with breast cancer histories.

“Excellent results were obtained after several months of laser treatments of vaginal relaxation with a technique called vaginal tensing, as well as in urinary incontinence and vaginal atrophy. We explored laser treatment for vaginal atrophy in postmenopausal patients whom could not receive hormone therapy because of their history of gynecological cancer, a clear contraindication for this type of treatment. So we designed a research protocol that would compare

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PROFILE

JUAN FERNANDO BOJANINI BETANCUR, MD (A professional that works with Coomeva Medicina Prepagada)

He graduated from Universidad Pontificia Bolivariana (UPB), and became a gynecologist at CES, as well as a Fellow in child and adolescent gynecology. He also completed his training in aesthetic vaginal laser surgery at the Laser Vaginal Rejuvenation Institute of America. He was a professor at the medical faculty at Universidad de Antioquia and Fundación Universitaria San Martín. He has been a clinical researcher for 13 years, and a national and international lecturer on laser and its uses in gynecology, especially on vaginal aesthetic issues.

Also he is a full member of Asociación Antioqueña de Ginecología y Obstetricia, and Federación Colombiana de Sociedades de Obstetricia y Ginecología. He is an expresident and former member of Asociación Latinoamericana de Obstetricia y Ginecología de la Infancia y la Adolescencia (Alogia), and president of Asociación Colombiana de Adolescencia (Asoadolescencia), as well as president of Asociación Colombiana de Obstetricia y Ginecología de la Infancia y la Adolescencia.

the outcomes in patients with a gynecological cancer history and women whom received no treatment at all for their postmenopausal symptoms”, said doctor Bojanini.

“We are also going to publish the results of a one year follow up, already processed, with data that shows that the positive effects of these procedures in most postmenopausal patients are stable a year later, and that the improvements obtained in the first trimester remains”, said the gynecologist.

THE FIRST OF ITS KIND This research on laser treatment of vaginal atrophy in postmenopausal women with history of gynecologic cancer is the first of its kind worldwide, and the paper is published in an international indexed journal. These are remarkable achievements of this group of Colombian researchers.

©2015 Shutterstock Photos

The research project lasted more than a year and a half, and showed positive results in the first three months of the treatment. With complete relief of vaginal dryness in 60% of the cases, and nearly complete relief in 40% of all the patients; also in all the cases, 100%, pain during intercourse was alleviated, and sexual satisfaction improved. These exciting results were published in the Journal of the Laser and Health Academy -2014; (1) -

Also, as Dr. Bojanini explains, this research gives patients the opportunity to regain their sexuality with a relatively painless treatment that does not require hormone therapy.

“In addition to the excellent results of our research, for me, the most important aspect of this treatment is the psychological improvements for the patients, achieving a better quality of life after months, and even after years of unpleasant sexuality.

But not anymore, women can now regain control of their own lives, as well as their own intimacy. This is definitely the biggest achievement of our research,” said the doctor.

Biomicroscopía Ultrasónica La biomicroscopía ultrasónica o UBM por sus siglas en inglés “ultrasound biomicroscopy” es una técnica diagnóstica realizada con el moderno Ecógrafo AVISO Quantel Medical para la observación de tejido vivo a una resolución microscópica, ahora disponible en la Clínica de Oftalmología de Cali.

Este dispositivo permite, en solo 20 minutos, la valoración profunda de estructuras del segmento anterior del ojo ante la presencia de medios opacos. Es útil en la descripción y diagnóstico de varios tipos de glaucoma, tumores y muchas más patologías del segmento anterior.

La UBM provee una imagen en 360°de los ángulos de la cámara anterior y al funcionar por medio de ultrasonido se convierte en una gran herramienta de ayuda diagnóstica para el manejo integral de sus pacientes.

Remisiones por medio de:

Gloria Valencia

Cel: 316 8303340 gloria.valencia@clinicaofta.com Carrera 47 Sur No 8C-94 www.clinicaofta.com Cali - Colombia

Nuevo Examen

S

UNLIGHT CAN DAMAGE DEEP OCULAR TISSUES

Recent studies suggest that much in the same way sunlight burns skin tissues because of the effect of high energy ultraviolet radiation (UV), they could also affect the eyes.

Therefore, it is very important to promote among patients, and the public in general, the idea of protecting them adequately. Also, if doubts arise, do not hesitate to go to the doctor.

New research suggests that there is a negative impact on the eyes when they are exposed to ultraviolet radiation. A recent publication in JAMA Ophthalmology (May 2015) says that “every hour of sunlight exposure during the summer increased by 4% the chance of developing structural changes in the lens”.

Another paper, funded partly by the National Eye Institute (NEI), in the United States, also found a link between the exposure to UV radiation, and the increase in the risk of developing cataracts.

And radiation can also cause “conjunctivitis, pterygium, and other diseases that can reduce, or impair vision, or even require complex surgery, and treatments, such as cataracts, macular degeneration, and retinal burns”, explains doctor José Manuel Gómez Ojeda, president of Federación Colombiana de Optómetras.

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According to Global Solar UV Index, “the eyes are embedded in the orbit, and shielded by the brow ridge, the eyebrows, and eyelashes.

Bright light stimulates the constriction, and pupillary reflexes, as well as partial closure of the eyelids in order to protect the eyes from the sun. However, under extreme conditions the effectiveness of these natural defense mechanisms is not enough. They can cause photokeratitis, and photoconjunctivitis, some of the acute effects of heavy exposure to UV radiation.”

The lens “is very sensitive to the bandwidths of the electromagnetic spectrum. And short ones are considered ‘catharactogenic’, probably because they increase free radical activity within the lens, breaking up molecules in the tissue”, says Dr. Alberto Chacón Aponte, scientific director at Instituto de Córnea.

©2015 Shutterstock Photos

PROMOTION AND PREVENTION

According to several studies, UV radiation affects cells in many ways. It can even generate tissue dehydration leading to the loss of transparency of the lens, and its eventual opacity, so that it will not allow the light to pass into the eye. “This is a cataract”, says DR. Gómez Ojeda.

SUNGLASSES ARE NOT ENOUGH The only reasonable alternative is to protect the eyes. It is not enough to simply wear sunglasses.

It is also important to choose them properly, ensuring their optical quality and safety, and also to wear a hat, or a visor, or any other protective gear of that sort. “It is important to clarify that sunglass protection does not depend on their darkness. The color of the lens is independent of its UV protection capability, which is related to its ability to control sun light radiation “, says Dr. Gómez Ojeda.

It is necessary to cover the lens of the sunglasses with a protective film against solar radiation.

“More and more new materials, lighter, and more resistant, in different sorts, colors, and shapes, have made eyewear a fashion accessory, as well as must for health care”, says Javier Oviedo, optometrist, and director of Ciudad Óptica.

But sunglasses are not enough to protect the visual area. To really protect the eyes against the impact of solar radiation additional protective barriers are required. Naturally, barriers that do not obstruct the view field while performing outdoor activities for long periods of time, for instance, during the holydays, while practicing sports, in field trips, even in a walk on the beach, or the river, as well as the family barbecue.

PREVENTIVE STRATEGIES The damage and effect of UV radiation accumulates, and it is permanent, particularly in the eyes. It can often affect almost all its tissues, the cornea, lens, iris, retina, and also the epithelium, and the conjunctiva. It is important to teach patients, and the general public, about visual protection. These are the recommendations experts gave us: • Avoid UV radiation exposure.

• Keep in mind, as doctor Ricardo Boatmen Pedraza tells us, a specialist in plastic, and aesthetic surgery, “eyes should not be exposed to the sun during its highest intensity hours, around 10 am to 3 pm. And if needed, use sunblock with a protective factor exceeding 30, also glasses, and a hat, especially at the beach, the sea, or the pool”.

• Besides eyewear, a good diet is also recommended, after all an adequate nutrition is essential for all the tissues of the body, and the eyes specially require vitamin C, and A. “Growing evidence suggests that vitamin C protects the cornea from the impact of UV radiation. It accumulates in the basal cells of the corneal epithelium, forming a screen with a very similar effect to that of sunscreens used for skin protection”, says Dr. Alberto Chacon Aponte, Instituto de Córnea.

• Also, he adds, “adequate eye lubrication protects the ocular surface from UV radiation, which is the main pterygium cause, an important precaution for heavily exposed people, such as athletes, and outdoor workers”.

• Choose eyewear according to the activity you will perform, considering the exposure time, and also keep in mind that it should be comfortable, and beautiful, but it is crucial that it ensures a least a 99% protection level of UV radiation. (See diagram).

Lens Optical Category

Lens optical category represents eyewear light transmission capability, it helps us to suggest its uses, and limitations. But it is the UV filter that protects the eyes against UV radiation, and it must be at least 99%.

EBM

A

new and simple method

FOR THE DIAGNOSIS OF ESOPHAGEAL CANCER

Cigarettes and alcohol increase the risk for esophageal cancer, but symptoms are often disregarded. But now a new test could change all this, making the detection of the tumor quick and efficient.

If all continues to go well, doctors could soon have a breath test that detects early esophageal cancer. A tumor that ranks sixth within global cancer mortality rates in Colombia, according to statistics from the World Cancer Report of the World Health Organization (WHO), Globocan.

To confirm these results, a new trail will be performed with approximately 400 patients in three hospitals in the UK. Researchers are convinced of the validity of the positive results, and the usefulness of the contribution of the breath test for the diagnosis of esophageal and gastric cancers in early stages.

Š2015 Shutterstock Photos

A report published by the London Imperial College says that a research done on 210

patients found a chemical in the breath of patients with esophageal and gastric cancers, and when detected it can have a diagnostic accuracy of up to a 90%.

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“Our breath test could diagnose patients with nonspecific early symptoms, and reduce the number of invasive endoscopies,” said Professor George Hanna, main author of the study conducted in the London Imperial College.

“With these results researchers hope to develop a device that could easily tell doctors whether a patient has a malignant tumor, or not”, said a Xinhua news agency publication in China.

ESOPHAGEAL CANCER IS UNCOMMON, BUT IT IS ALSO VERY SERIOUS Even though esophageal cancer has a relatively low incidence, it occurs throughout the world, and Colombia has one of the highest incidences in Latin America, particularly in the southwestern region, specially in Chocó, explained Dr. Wilson Caro Bedoya, a specialist in gastrointestinal surgery and endoscopy at Centro Médico Imbanaco in Cali.

Esophageal cancer is frequent after 50 years of age, and it is more common in men, with a ratio of 3:1.

“The prognosis is always determined by the stage of the tumor at the time of the diagnosis.

And, unfortunately, in our country, 90% of these cancers are diagnosed in late advanced stages, so it is common to find that the extent of the tumor and the involvement of neighboring tissues, such as the lymph nodes, together with metastasis to distant organs, are frequent”, said the Colombian expert .

The most important risk factors are smoking, gastroesophageal reflux, excessive intake of very hot beverages, and, in a small percentage, the genes. Also a connection with alcohol intake has

A simple breath test would detect substances that are secreted exclusively with the development of a tumor formation in the area of the esophagus.

been found. In a systematic review of the literature done by WHO, 14 relevant papers with dose related data were identified. Of them three were cohort studies and four were case-control studies.

These papers showed evidence that the risk of esophageal cancer increased 11.71 times in patients who took an equivalent of 100 g / day of pure alcohol, compared to those who never drank it”.

On the other hand, esophageal cancer has unspecific symptoms, similar to other diseases, and many times patients take them fore granted. They consider them trivial and temporary ailments that can be treated non medically, even with alternative medicines, delaying the diagnosis of this serious disease. Dysphagia, a difficulty swallowing solids that as the disease progresses it can also involve liquids, as well as pain behind the sternum, and epigastric burning, gastroesophageal reflux, vomiting, weight loss, and laryngeal symptoms, such as dysphonia, hoarseness, and a mass sensation in the throat, should all be taken very seriously”, says Dr. Caro Bedoya.

In other cases, when doctors recommend endoscopies, the best diagnostic mode for esophageal cancer, patients tend avoid them because they are considered annoying and dangerous. “But upper digestive endoscopy can detect early lesions, as

EBM

TIMELY AND ADECUATE TREATMENT

Images of endoscopy in cases of tumor tissue in the esophageal tube.

There are several esophageal cancer types. The epithelial squamous tumor is the most common, and it involves the esophageal lining. While the adenocarcinoma, a glandular tumor of stromal and muscular origin, appears near the junction of the stomach, and it is not as aggressive, so it has a better prognosis.

brachytherapy, radiofrequency, and their combinations”, explains Dr. Caro Bedoya Wilson.

The treatment for these tumors varies depending on the type and how advanced it is. Therapeutic alternatives rage from “spontaneous healing attempts, which are uncommon, maybe because of the late diagnosis, to radical surgery, chemotherapy, radiotherapy,

Finally, WHO and doctors insist on the need of education and prevention campaigns, to teach the general public about this disease, its signs and symptoms, and to encourage timely and frequent visits to doctor.

well as risk factors, such as gastroesophageal reflux and Barrett’s esophagus, a transformation associated with cancer at the junction of the esophagus and the stomach”, says the specialist from Imbanaco.

“So a breath test capable diagnosing esophageal cancer will undoubtedly help many. Eventhough endoscopy is still the best alternative available, and it will not disappear, neither will tomography, magnetic resonance, nor endoscopic ultrasound, we are trying to develop a cheap non invasive test that will establish the probability of a patient having esophageal cancer, as well as the degree and extent of tumor, defining the prognosis and the best treatment alternative”, he concludes.

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Also, in some cases, to improve symptoms and the quality of life, esophageal prosthesis are used, allowing patients to eat and minimize treatment complications.

RECOMMENDED READING 1. Chadwick G, Groene O, J Hoare, Hardwick RH, Riley S, Crosby TD, et al. A population-based, retrospective, cohort study of esophageal cancer missed at endoscopy. Endoscopy 2014; 46 (7): 553-60.

2. Boshier PR, Cushnir JR, OH Priest, Marczin N, Hanna GB. Variation in the levels of volatile trace gases hospital Within three environments: Implications for clinical breath testing. J Breath Res 2010; 4 (3): 031001.

3. http://www.wcrf.org/int/cancer-facts -figures/ data-specific-cancers/oesophageal-cancer-statistics 4. http://www.mayoclinic.org/diseases-conditions/ esophageal-cancer/basics/risk-factors/con-20034316 5. http://www.cancer.org/acs/groups/cid/documents/ webcontent/002292-pdf.pdf 6. http://www.cancer.gov/espanol/tipos/esofago/pro/ prevencion-esofago-pdq#section/_1 7. http://www.scielo.org.co/pdf/rcg/v23n1/v23n1a03

ACKNOWLEDGEMENTS

H

onors for a Colombian cardiologist and internist

With over 20 years of professional experience doctor Eduardo Ramírez Vallejo is one of the most prominent physicians in Latin America. He is the only specialist in internal medicine and cardiology to have received the Fellow of the American College of Physicians (FACP) in both specialties. FACP is the highest honor granted by that prestigious scientific institution to specialists in internal medicine, and cardiology. So they are very meritorious distinctions.

“With two ceremonies in the United States an oath is taken Eduardo Ramírez Vallejo, MD and a certificate is issued, it is the highest degree in internal medicine and cardiology in the world, and it is granted after studying the curriculum vitae together with the research projects, teaching position, exams, etc. Last year I received the internal medicine FACP, and this year the cardiology FACP”, emphasized doctor Ramírez, the only physician in the Latin America with these two qualifications.

He works with Coomeva Norte del Valle and Pereira. And he has also won several other awards. In 2003, together with doctor Carlos Alberto Isaza, also from Universidad Technológica de Pereira (UTP), they were distinguished with the National Medicine Award by Aventis Academia Nacional de Medicina for the best research paper in the category of Experimental ​​Basic Sciences. He also earned an Excellence Award in Internal Medicine, by Asociación Colombiana de Medicina Interna. And in addition, both Sociedad Colombiana de Cardiología y Cirugía Cardiovascular (SCC) and Asociación Colombiana de Medicina Interna (ACMI) honored him as an emeritus member.

Doctor Ramírez is currently a member of the board of directors of Liga de Lucha contra el Cáncer, he also works at UPT as a postgraduate teacher, and heads the adult medicine area at the medical faculty, as well as the exchange program IFMSA (International Federation of Medical Students Association), and the Fulbright Scholarship program.

Coomeva Medicina Prepagada is very proud to have this distinguishes physician among its selected health care providers, and sends with great pleasure its best regards to doctor Ramírez.

A

CIC new representative in Colombia

In March this year doctor Carlos Augusto Pérez Niño was appointed president of Asociación Colombiana de Centros de Investigación Clínica (ACIC) for the next two year period. He is a gynecologist and an obstetrician with a specialty in clinical densitometry, and he has been working in research projects for over 12 years, experience that is fundamental for this very important appointment.

Clinical research in Colombia has been underway for many decades now. In 2008 the group of standards at Invima issued a resolution Carlos Augusto Pérez Niño, MD that stipulated that all research institutions in the country should have the basic structure of an IPS, and as such they were to be monitored by Ministerio de Salud and Invima. “In order to group the vast majority of clinical research centers, ACIC was created 5 years ago to advise, support, promote, publicize, and defend the principles and activities of research in all the hospitals in the country”, said doctor Perez.

Today, in Colombia, there are 123 research centers approved by Invima for clinical research through a certification of good clinical practices (GCP). It also has 73 medical ethics in research committees directly responsible of the rights and safety of the patients admitted to research protocols.

Since 1994 doctor Pérez Niño works with Coomeva Medicina Prepagada. Currently he is a gynecologist and obstetrician at Universidad Militar Nueva Granada, and he is also a specialist in Clinical Densitometry (International Society for Clinical Densitometry, ISCD), as well as a specialist in health care management from Pontificia Universidad Javeriana. And he is a founding member of ACIC. Coomeva Medicina Prepagada is very enthusiastic about doctor Carlos Augusto Pérez’s new appointment, and expresses great satisfaction to have him within the family of health care professionals linked to our organization.

We encourage our health proffesionals to share with us their experiences research topics, academic activity or community programs.

In this way we can enrich this section providing its achievements and developments in their professional work. Write to prestadores_coomeva@coomeva.com.co

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FROM COOMEVA

C

Your smartphone is now a medical directory

OOMEVA MEDICINA PREGADA IS AVAILABLE ON YOUR MOBILE

Application development and mobile content are booming in Colombia.

Thanks to technological innovation and creativity we can offer a new way to access our services in a swift and comfortable manner.

The convergence of new platforms, widespread mobile services, better access to 3G and 4G networks, smartphones, and more digital content with better formats, makes everyday access to these technologies a very familiar experience.

Coomeva Medicina Prepagada is at the forefront of these, and other technological advances, continually improving our services. And it has created its own mobile application available for smartphones.

With this new app service the paper medical directory will soon be a thing of the past. Through the mobile application Coomeva Medicina Prepagada users will have available at their fingertips, at all times, through smartphones and tablets, the directory of professionals, specialists, and nationwide health care institutions. The searches can be made either by city or by specialty.

Likewise, through the app users can access information about the main services offered by Coomeva Medicina Prepagada.

This is part of the company’s commitment to modernize and invest in technology to improve, and make it easier for the user to access the services.

WHAT WILL USERS FIND IN THE NEW APPLICATION? The application can be downloaded on mobile devices from App Store and Google Play, and Medicina Prepagada Coomeva users can access the following information:

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• Medical Directory • Dental Directory • Emergency Network • Administrative Network • Special Partnerships • Favorites Users also have another doctor’s directory on the website: http://www.directoriocoomevamedicinaprepagada.com/

MEDICAL WORLD BOOKS

EVENTS  ‘XVI Colombian Congress of Pneumology and Thoracic Surgery’ Date and place: October 8th through 11th, Pereira Information: Asociación Colombiana de Neumología y Cirugía de Tórax Phones: (1) 623 1798 - 623 1868 Email: congresoasoneumocito@etb.net.co Website: www.asoneumocito.org.co

 ‘15th Regional Health Quality Forum’ Date and place: October 16, Cali Information: Clínica de Oftalmología de Cali S.A. Phone: (2) 552 0890 - 511 0200 Email: 15fororegionaldecalidad@ clinicaofta.com Website: www.clinicaofta.com/15foro

 ‘VIII International Congress of Arthroscopy and Sports Medicine’ Date and place: October 21st through 24th, Cartagena Information: Sociedad Colombiana de Cirugía Ortopédica y Traumatología Phone: (1) 625 7445 Email: secretaria@sccot.org.co Website: www.sccot.org.co

 ‘LIV Colombian Congress of Psychiatry’ Date and place: November 5th through 8th, Armenia Information: Asociación Colombiana de Psiquiatría Phone: (1) 256 1148 Email: acp@psiquiatria.org.co Website: www.psiquiatria.org.co

 ‘XIX International Meeting on Health Care Research’

Date and place: November 17th through 20th, Cuenca (Spain) Information: Instituto de Salud Carlos III Phone: (34) 91 822 2546/47/36 Email: investen@isciii.es Website: encuentros.isciii.es

 ‘Living with bipolar disorder’ Eduardo Vieta Pascual / Francesc Colom i Victoriano Bipolar disorder is now the sixth leading cause of disability, affecting more than 4% of the population. A lot of progress has been made in its treatment, as well as explaining its causes. This book is updated, accurate, critical, professional, and accessible. It contains very useful information on this very common condition. The reader will find concise answers on frequently asked questions about bipolar disorder, such as how does it occur, how to identify it, and how to treat it.

 ‘Anesthesia fundamentals, and clinical management ‘ Carlos Tornero With this book the health care professional can review in detail the basis of general anesthesiology, and can also focus his attention on the different surgical areas. The format of the book allows an updated and practical view of the subjects, including basic principles of the field, followed by chapters on pharmacology and applied physiology. Likewise, pre-anesthetic assessment, and other circumstances associated with anesthesiology are a considered carefully.

 “Humor me’ Megan Maxwell Tony Ferrasa is a successful composer. No woman can resist his charm, they cannot forget the way he looks. Ruth, a 20 year old woman who had to take care of her newborn sister, and her criminal brother, is finally getting her life back in order, but she becomes pregnant, and her partner leaves her. So she works as a waitress to take care of her family, and that is where she meets Tony. Slowly, carefully, they start having a relationship. And while they begin acknowledging that they really feel for each other much more than they were willing to admit, they try to avoid each other, but the more they try, the less they achieve, and the stronger the attraction becomes.

 ‘The Talent’ Mai Jia Rong Jinzhen is extraordinary: he is educated by a foreigner in China in the 20s, while living a lonely childhood immersed in his own world. So he soon develops a gift that makes him very unusual: Rong can see what nobody else can. He gets knowledge beyond what the average person can understand.

So he becomes a well known math genius throughout the country. But the young man is forced to leave his academic career when he is recruited by the Department of Cryptography of the Chinese secret service. Caught in the cracks of a terrifying system, he will become the country’s best code breaker, but he will face a huge challenge that no one had overcome so far, testing the limits of reason and sanity.

MEDICAL WORLD CINEMA

MUSIC  ‘Cerati infinitely’ Gustavo Cerati

As a tribute to the late front man of the legendary group Soda Stereo, this is the first Gustavo Cerati posthumous album of the famous Argentine singer. It compiles 19 solo songs, and two poems dedicated to him, written by Lilian Clark, together with his mother, and his colleague Luis Alberto Spinetta. This package, available in digital format, as well as in CD and DVD, includes songs like “Natural force”, “Goodbye”, “Lake in heaven”, “I take you to take me,” “Magic” and “Immoral stroll”.

 ‘IMMORTAL’ Director: Tarsem Singh Starring: Ryan Reynolds, Ben Kingsley, Natalie Martinez A powerful millionaire with cancer is given the possibility to undergo a radical medical procedure that will transfer his consciousness into the body of a younger man. At first, the operation goes well, the man enjoys his renewed youth, but the project goes soar when he discovers unexpected details about his new body.

 ‘THE CIPOL AGENT’

 ‘Dawn’

Bomba Estéreo This is the fourth studio album recorded by the band led by Li Saumet and Simon Mejia. It was produced by Ricky Reed in the United States with the Sony Music label. This work reflects the evolution of the band. It includes electronic rhythms, and vocals that will certainly fascinate its followers.

The album includes songs like, “We are two”, “Party”, “Something is changing”, “To my love,” “Only You”, and “Hips”.

General

manager

Coomeva Medicina Prepagada

Jorge Alberto Zapata Builes

Director: Guy Ritchie Starring: Henry Cavill and Alicia Vikander Forced to put aside their differences, two agents join forces in a mission that will stop a mysterious international criminal organization from destabilizing the existing fragile balance of power through nuclear weapons and technology. The only clue for the improbable duo is the disappearance of the daughter of a German scientist, a key element to infiltrate the criminal organization. Napoleon and Illya work against time to prevent global catastrophe.

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Editorial Meeting Pascual Estrada Garcés, MD

National Medical Director Coomeva Medicina Prepagada

Alexandra Arango Rojas

National Coordinator Relationship with providers (in charge)

Bertha L. Varela, MD

National Chief of Medical Audit

Mauricio Castillo

National Director of International Business

Publishing

production

mercadeorelacional@legis.com.co Avda. Calle 26 No. 82-70, Bogotá D.C. Phone: (571) 4255255, Exts.: 1314, 1552, 1142, 1486, 1516