ISSN 2011-357 9
A MAGAZINE FOR COOMEVA MEDICINA PREPAGADA HEALTH CARE PROFESSIONAL VOL. 9 # 2 โ ข JUNE 2016
HEALTH UPDATE The rare disease universe | PAG. 8
P P
Eating desorders increase with life style | PAG. 18
EBM
Transfusional medicine requires more usual donors | PAG. 22
Alexandra Mora Hernรกndez
A HEALTH AND BEAUTY AMBASSADOR | PAG. 14
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A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
Content
18 Jorge Zapata Builes General Manager Coomeva Medicina Prepagada
Editorial council Pascual Estrada Garcés, MD National Health Director Martha Liliana Cifuentes National Coordinator of Relationships with Providers
5 EDITORIAL 6 MEDICAL ADVANCES
Brief notes on recent and innovative medicine.
8 HEALTH UPDATE The rare disease universe More than 2,000 diseases of this type have been described in the colombian medical literatuere, they are challenges for medicine, patients, as well as their families.
14 COVER Alexandra Mora Hernández A Health And Beauty Ambassador This otolaryngologist and facial plastic surgeon is convinced that pssion for a job well done governs medical practice, promoting satisfaction, happiness and quality of life for the patient.
18 PROMOTION AND PREVENTION Eating desorderrs are more frequent with modern lifstyle Stress and peer pressure are associated with eating disorders. But, today, there are promising therapeutic approaches.
June • 2016
22 EBM Transfusional medicine requires more usual donors The lack of adequate blood for transfusions contrasts medical and technological pogresses, and doctors using update guidelins to make the best decisions.
26 MERITS A life dedicated to children His dedication to promoting children’s rigth through community work with parents and caregivers, had made him an apostle of Colombian pediatrics. 28 RESEARCH REPORT The challenging prevention of kideny disease Eventhough there are treatments, and dialysis, prevention is still fundamental in this field, ant it should start with children and schools.
Bertha Lucía Varela, MD National Head of Medical Audits Julián Adolfo Villegas National Head of Health Risk Management Ana María Correa National Quality Auditor Marco Emilio Ocampo National Medical Auditor
Editorial production and printing Legis S.A.
32 MEDICINA PREPAGADA
PROMOTES To sleep safely, babies should sleep face up
www.comunicaciongraficalegis.com
34 OUR PLUS
mercadeorelacional@legis.com.co Tels.: (1) 4255255, Exts.: 1314, 1393, 1552, 1516
New! Online medical order authorization services The best coverings because you are a Coomeva Cooperativa associate
Sales: María Cristina Arévalo Durán Cel.: 3112862724 maria.cristina.arevalo@gmail.com
36 MEDICAL WORLD Specialty congresses, academic and professional meetings, books and movies.
32 Front page: Personal file
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The level of SATISFACTION and COMMITMENT
grows within the professionals linked COOMEVA
Jorge Alberto Zapata Builes General manager Coomeva Medicina Prepagada
T
o provide the best possible services, with quality, humanity and dedication, is the goal we have set, and the first step to achieve it was to choose the best possible health care professionals, people fully committed to their work, and team who devote their working to attain common end: to benefits our affiliates. S o , u p o n re c e i v i n g t h e re s u l t s of the IV study “Satisfaction level of Coomeva Medicina Prepagada Providers - 2015-2016”, it made us very proud to find that the professionals involved are very satisfied. As a matter of fact, in cities like Palmyra and Valledupar, satisfaction reaches a hundred percent; while in Bogota, Cali, Manizales, Medellin and Pereira, it has increased dramatically when comparing it with previous studies, from levels of 94, 95, 94, 91 to 99% satisfaction. We are aware of these achievements, that also allow us to say that we have
been able to correctly identify the factors that can be improved, while we are still working on a daily basis to keep up the good work; and also we undertook a detailed analysis of declining variables of these surveys, issues we consider challenges, in order to find the causes and implement protocols and programs that will allow us to overcome these problems, while still growing throughout the country. In general, to know that our professional members are satisfied with Coomeva Medicina Prepagada, that they consider the way we paying their bills meets agreed terms and that they would not hesitate to recommend the organization to their patients, gives us joy, but it is also an incentive to carry on the good work with honesty and humility, in order to become better every day at what we do best. In all, 522 interviews were conducted in all the regionals (Caribbean, North Western, Coffee Region, South Western, Central Eastern and Northeast), so it was a quantitative survey with a 95% confidence interval. And we want to thank all our linked professionals and our affiliates for the trust they have always placed in us. We want to assure them that we are fully committed to our work with you, because the goal is to provide the best services possible, measuring them with quality variables and offering health care programs, as well as promotion and prevention programs that will allow us to keep steady our healthy, active and happy population. A commitment we renewed every day. And through these pages we want to inform about the good news within Coomeva family. So that’s why in this particularly interesting issue we included articles like “Eating disorder are more frequent with the modern lifestyle”, “The rare disease universe” and “Research Report on doctor Gustavo Martínez Aroca’s work on kidney disease”. 5
A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
June • 2016
Editorial
DEVELOPMENTS
THE BENEFITS OF PHYSICAL THERAPY COMPARED TO SURGERY FOR THE CARPAL TUNNEL SYNDROME TREATMENT When the carpal tunnel syndrome becomes a nuisance for the patient surgery is one of the treatment alternatives; nevertheless, researchers at Universidad Rey Juan Carlos in Spain suggest physical therapy programs are effective in the short, medium and long terms, compared with operations. A research conducted in 120 patients whom were grouped into two study groups, where one was treated with physical therapy and the other with surgery; the first one received three sessions with techniques aimed at relaxing anatomical structures related to the median nerve and exercises for the tendons of the upper limb; while the second group underwent decompression surgery of the transverse ligament of the carpal tunnel, according to international guidelines. Better results were obtained, alleviating pain and improving function, in the short term group (1 and 3 months) receiving physiotherapy compared to those who underwent surgery. At 6 and 12 months, no significant differences were identified. They also arrived at the conclusion that three physiotherapy sessions directed to pain neuromodulation are equally as effective in the long term than surgery.
Photos: ®2016 SHUTTERSTOCK PHOTOS
MEDICAL
June • 2016
SOURCE: ARTICLE “MANUAL PHYSICAL THERAPY VERSUS SURGERY FOR CARPAL TUNNEL SYNDROME: A RANDOMIZED PARALLEL-GROUP TRIAL”, PUBLISHED IN THE SCIENTIFIC JOURNAL, THE JOURNAL OF PAIN. UNITED STATES. APRIL 2016.
TOBACCO SMOKE IS RELATED TO FRAGILITY IN THE ELDERLY
THE CREATION OF AN ATLAS OF HEREDITARY DISEASES
Elders are susceptible to diseases related to the exposure to pollutants like tobacco smoke. According to Spanish and American researchers this condition is a fragility syndrome, a decrease in body reserves and resistance. This study used data from the National Health and Nutrition Examination Survey. Researchers selected 2,059 nonsmokers over 60 years old. Serum nicotine concentrations were measured with a specific biomarker. And they found that the higher the exposure to tobacco smoke, passive or active, the greater the fragility syndrome frequency. Also they considered other variables, like diseases, sex, age and cohabitation with smokers. These results are expected to encourage protection of the elderly against cigarette smoke.
An international group of geneticists, together with other medical specialists, are working on an atlas of malformations in different human populations, seeking to support and expedite the diagnostic process for these congenital diseases. Experts from the United States, South America, China, India and Mali, as well as countries in the Middle East, Malaysia, Nigeria, Rwanda, South Africa, Thailand and Uganda, are working together to put this information online, as a free tool that includes a pathology index, that classifies these conditions according to their characteristics and geographical distribution. It also includes descriptions and images. It is a project that allows professionals in different communities to diagnose these diseases easily and precisely. Also, whenever possible, this atlas will improve the chances of an effective and opportune treatment for the patients.
SOU RCE : ARTICLE “EXPOSURE TO SECONDHAND TOBACCO SMOKE AND THE FRAILTY SYNDROME IN US OLDER ADULTS”, PUBLISHED IN THE SCIENTIFIC JOURNAL AGE. UNITED STATES. APRIL 2016.
SOURCE: ARTICLE “ATLAS OF HUMAN MALFORMATION SYNDROMES IN DIVERSE POPULATIONS”, PUBLISHED IN THE WEB PAGE OF THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE. UNITED STATES. APRIL 2016.
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IRREGULAR MENSTRUAL PERIODS ARE RELATED TO OVARIAN TUMORS
LIQUOR, SAUSAGES AND OBESITY ARE LINKED TO GASTRIC CANCERS Gastric cancers are increasingly frequent, perhaps due to risk factors, such as overweight, eating processed meats and drinking alcohol, according to the American Institute for Cancer Research and the Global Fund for Cancer Research. They selected 89 papers, involving 17.5 million adults, of whom 77,000 had this type of cancer. This review suggests that for every 1.8 ounces of daily processed meat, the risk of developing this cancer increases by an 18%. It implies that alcohol works like a solvent, helping carcinogens enter the cells. Be sides, the risk increases up to 23% for every five unit increase in the body mass index. Further studies are being carried out right now, trying to understand these disturbing patterns.
A recent study by researchers at the Public Health Institute, Child Health and Developmental Studies in Oakland (United States) suggests that young women with irregular menstrual might have an increased risk of an ovarian cancer. Of the 15,000 women enrolled in a research on pregnancy in 1959, which were followed up throughout their lives, 13% had irregular periods. And during the following 50 years, 116 developed the disease, while 84 died. These results suggest irregular menstrual periods are linked with ovarian cancer and death twice as frequently during the next 70 years, when compared with regular menstrual periods. SOURCE: ARTICLE “IRREGULAR PERIODS COULD BOOST OVARIAN CANCER RISK”, PUBLISHED IN THE WEB PAGE OF THE SCINTIFIC JOURNAL SCIENCE. UNITED STATES. APRIL 2016.
ASPIRIN MAY BE AN ALLY IN THE FIGHT AGAINST CANCER
SOURCE: ARTICLE “ALCOHOL, PROCESSED MEATS AND OBESITY UPS STOMACH CANCER RISK”, PUBLISHED IN THE WEB PAGE OF THE AMERICAN INSTITUTE POR CANCER RESEARCH. UNITED SRATES. APRIL 2016.
SOURCE: ARTICLE “ASPIRIN IN THE TREATMENT OF CANCER: REDUCTIONS IN METASTATIC SPREAD AND IN MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSES OF PUBLISHED STUDIES”, PUBLISHED IN THE SCIENTIFIC JOURNAL PLOS ONE. UNITED STATES. APRIL 2016.
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In addition to usual cancer treatments, researchers at Cardiff University in the UK, suggest that these patients could benefit, increasing the survival rate by up to 20% and reducing the spread of the disease, with low dose aspirin. They reviewed 42 trials with follow ups of at least five years. And they found there was a significant reduction in the mortality and the progression of the disease related to Aspirin. These results suggest that used in low doses, patients with colon, breast and prostate cancers, could reduce their death rates between 15 and 20%.
June • 2016
HEALTH UPDATE
The RARE DISEASE universe 8 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
MORE THAN 2,000 DISEASES OF THIS TYPE HAVE BEEN DESCRIBED IN THE COLOMBIAN MEDICAL LITERATURE, THEY ARE CHALLENGES FOR MEDICINE, THE PATIENTS, AS WELL AS THEIR FAMILIES
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here is a group of illnesses that challenges health care systems, families and the patients, they are c a l l e d r a re o r o r p h a n diseases. They are defined by Ministerio de Salud y Protección Social as “chronically debilitating, serious, life-threatening diseases, with a prevalence bellow 1 per 5,000 people, rare diseases, also known as orphan and forgotten diseases (Law 1392 of 2010 / Law 1438 of 2011)”. Primarily, they have unknown causes, even though sometimes they are genetically linked (Up to 80%), and occasionally to mutations. Others are immune diseases, malformations or congenital conditions, while some are attributed to toxic and infectious diseases. Also factors like the diet,
smoking and exposure to chemicals have also been involved. There are as many as 6,000 and 7,000 rare diseases. And they are found heterogeneously over the whole country, making them even harder to deal with. The list includes Huntington’s disease, multiple sclerosis, myasthenia gravis, Cushing’s disease, acromegaly, Noonan syndrome, acondroplasia, muscular dystrophies, some types of dementia and rare cancers. Up until recently it was a forgotten problem. And today preliminary reports from several EPS, IPS and other emergency entities, as well as department, district and municipal health organizations, together with patient groups, suggest there can be as many as 13,238 patients in Colombia.
A DIFFICULT LIST t is hard to define the most common rare diseases in Colombia, for now, because accurate epidemiology is unavailable. In spite of that, some incidences are beginning to be known, for instance for hemophilia, myasthenia gravis and cystic fibrosis. Statistics from Secretaría Distrital de Salud track congenital anomalies, as well as some patient organizations, track lysosomal storage diseases (a group of some 50 anomalies) and other inborn errors in the metabolism (some 500); also rare bone diseases, such as osteogenesis imperfect or progressive ossificant fibrodysplasia, bone marrow alterations; paroxysmal nocturnal hemoglobinuria and myelofibrosis. And also, in the skin, diseases like epidermolysis bullosa and ichthyosis; while in the nervous system leukodystrophies, Tourette’s syndrome, Rett; neuromuscular disorder, ataxias, amyotrophic lateral sclerosis and Pompe disease; and also connective tissue disorders, like Marfan and Ehlers-Danlos syndromes. A booklet published by Defensoría del Pueblo teaches about these pathologies, with special interes in cystic fibrosis (424 cases), diffuse cutaneous systemic sclerosis (408 cases); Guillain-Barre syndrome (392 cases), idiopathic pulmonary arterial hypertension (377 cases) and von Willebrand Disease (281 cases). 9 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
June • 2016
Photos: ®2016 SHUTTERSTOCK PHOTOS
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HEALTH UPDATE “Initial results, by Instituto Nacional de Salud, estimate there are 2,149 identified rare diseases in Colombia, included in Resolution 2048 issued in 2015. And these figures will also allow us to find the majority of those 1,100,000 patients”, says doctor Angela Patricia Chaves Restrepo, p re s i d e n t of Federación Colombiana de Enfermedades Raras (Fecoer). This organization, together with the patients and 35 other groups, have already seen progresses, such as “the recognition that they are vulnerable subjects by Law (1751, 2015), especially in the 11th article. Undoubtedly a step forward towards the protection of the essential right to global health”, explains the expert.
June • 2016
WHO TREATS THESE PATIENTS? This year, on Rare Diseases World Day, Ministerio de Salud y Protección Social together with Defensoría del Pueblo, Secretaría Distrital de Salud and Instituto Nacional de Salud launched “Plan de Acción 2016”, in order to “define comprehensive strategies to take care of rare diseases within our health care model, promoting international cooperation specially on technical issues, and also creating a rare disease observatory within the Ministry”. For Chaves, training general practitioners is crucial. “Patients go first to the primary care physician, whom isn´t supposed to know it all about the 6 to 7,000 rare diseases, but should be able suspect them”. Rare diseases also require an “interdisciplinary and often an interinstutional treatment, centered on the particular case, as well as the support of social workers and psychologists,
UNITED IN THE DIGITAL AGE
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echnologies for information and communications are important factors to get to know and to make these patients visible. “Social networks are useful tools for them and their families. As a matter of fact, it has been a beautiful process”, says Angela Chaves. They discovered that they are not alone, alleviating their isolation feelings, communicating, meeting people with similar problems. Quality of life can improve if these patients are diagnosed early on the course for disease, while sharing information on the rare disease and protecting their health rights. Also there is the possibility of a global reference network. In Colombia, with the help of Fecoer, an organization founded in 2011 out of six smaller patient organizations that decided to become visible, and right now it is the only legally constituted association, and the biggest representing these patients in the
country. Internationally, European Organization Of Rare Disease (Eurordis), “a non-governmental alliance of patient organizations, that is directed by patients, represents 710 organizations, speaking for 30 million patients in 63 countries affected by rear diseases”, according to its web page. So networking goes way beyond searching for people whom understand what is going on. “It is how they find out about new treatments and research. This is one of the reasons why associations like Eurordis is international”. Options like Orphanet (1997), consisting initially of a list of rare disease experts, in 2000 turned it into a web page that includes information on these pathologuies and a list of orphan medicines. And it is now “coordinating the WHO Thematic Reference Rare Diseases Group, in charge of reviewing the international classification”.
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HEALTH UPDATE in order to help the family cope with the challenges imposed on them by these progressive and chronic illnesses, that usually need palliative care. Therefore, clinical guidelines are available useful”. Currently, POS covers certain medications and procedures, but not emerging new treatments. “The major vulnerability is the fragmentation of the health care system, from the point of view of patient care and the administrative issues. One aspect is handled in one place, while another somewhere else; and, if the patient is subsidized, things are different than if he is a contributing patient; also sometimes people can access health care networks with more or less technology, and all this is complicated even more with nonexistent or fragmented knowledge about these diseases. That’s why many patients, up to 90%, have to sue, an additional problem to the already existing ones“.
Aunque el POS cubre algunos procedimientos y medicamentos, los tratamientos innovadores para las enfermedades raras todavía no están incluidos.
In the not so far away future, advances in gene therapy may help curing rare diseases, especially those of genetic and metabolic origins. But these
GLASS SKIN
E
June • 2016
pidermolysis bullosa, also known as skin glass or butterfly skin, affects 1 person per 17,000 in the UK. “ They are heroes who fight for strength and a day without pain. This people really value the important things in life, they are very intelligent, and can teach us a great deal about living”, says doctor Liliana Consuegra Bazzani, with a masters degree in child nutrition and the head of scientific activities at Debra Foundation Colombia, an organization with 52 registered patients. “It is a genetic disease. Patients are born with it, and it manifests itself a few hours after birth with blisters and wound healing difficulty. It is one of many bullous diseases, so it requires a differential diagnosis with a skin biopsy. Also it is not a contagious disease”, she adds.
treatments are not available for now. Treatment is directed towards stopping the disease, improving the quality of life and providing palliative care. REFERENCES AND FURTHER READINGS
Palliative treatment is the choice, in order to prevent blistering and injuries that will induce the healing process. Also these patients require nutritional interventions and pain handling. In the future, gene therapies and molecular biology technologies will allow us to correct these defects in the collagen synthesis of the skin and mucosa. Debra is an organization created in the UK in 1978, by Hilton Phillips, Debra’s mother, a little girl who suffered from this condition. In Colombia it was founded in 2009. It provides specialized care and interdisciplinary dermatology, pediatrics, nutrition, alternative medicine, rehabilitation, dentistry, psychology and school inclusion programs (Debraprende). And it also delivers periodically special healing material and nutritional supplements to the patients.
1. HTTP://WWW.ORPHA.NET/ORPHACOM/CAHIERS/ DOCS/ES/PREVALENCIA _ DE_ LAS _ ENFERMEDADES _ R AR AS _ POR _ PREVALENCIA _ DECRECIENTE_O_CASOS.PDF 2. H T T P : // I N F OVAT I C A N A . C O M / 2 0 1 6 /0 5 /0 2 / PA PA - F R A N C I S C O - N O - L A - I N D I F E R E N C I A - A N TE-LAS-ENFERMEDADES-RARAS/ 3. FEDERACIÓN ESPAÑOLA DE ENFERMEDADES RARAS-HTTP://WWW.ENFERMEDADES-RARAS.ORG/ 4. HTTP://WWW.EURORDIS.ORG/ES/ACERCA-DE-EURORDIS 5. H T T P : // W W W . W H O . I N T/ B U L L E T I N / V O L U MES/90/6/12-020612/ES/ 6. H T T P : // W W W. PA H O.O R G/ H Q / I N D E X . P H P ? O P T I O N = - C O M _ C O N T E N T&V I E W = C AT E G O R Y& I D=903&LAYOUT=BLOG&ITEMID=1048&LANG=ES 7. HTTPS://WWW.MINSALUD.GOV.CO/NORMATIVIDAD_ NUEVO/LEY%201751%20DE%202015.PDF 8. H T T P : // W W W. F E C O E R . O R G /C O M I S I O N - I N TER AMERICANA- DE- DER ECHOS - H UMAN O S - P R OT E G E - A - PAC I E N T E - C O LO M B I A -NA-CON-%E2%80%AA%E2%80%8EEPIDERMOLISIS-BULLOSA%E2%80%AC/ 9. HTTP://WWW.ORPHA.NET/CONSOR/CGI-BIN/INDEX. PHP?LNG=ES 10. HTTP://DEBRACOLOMBIA.ORG/ 11. HT TP:// W W W. DEFENSORIA .GOV.CO/ES/N U BE / N O T I C I A S /4 8 6 9 / D E F E N S O R % C 3 % A D A - P R E SENT%-C3%B3-CARTILLA-SOBRE-DEREC H OS - D E- LOS - PAC I EN T ES - CO N - EN FER M EDADES-HU%C3%A9RFANAS-ENFERMEDADES-HU%C3%A9RFANAS-DEFENSOR%C3%ADA-DEL-PUEBLOSALUD.HTM 12. HTTP://WWW.SLIDESHARE.NET/FECOER/ESTRATEGIA-NACIONAL-RARAS-TECNICO0112
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FRONTPAGE
ALEXANDRA MORA HERNÁNDEZ
A HEALTH AND BEAUTY AMBASSADOR THIS OTOLARYNLOGIST AND FACIAL PLASTIC SURGEON IS CONVINCED THAT PASSION FOR A JOB WELL DONE GOVERNS MEDICAL PRACTICE, PROMOTING SATISFACTION, HAPPINESS AND QUALITY OF LIFE FOR THE PATIENT.
June • 2016
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he would like days to be longer in order to enjoy more of the family and friends, to take care of the patients and to further explore, traveling, writing, reading, taking photographs, collecting memories and writing medical articles (both formal and informal), mainly focused on preserving health and wellbeing. But, since she doesn’t have that much time, Alexandra Mora Hernández, otolaryngologist, facial plastic surgeon, a specialist in aesthetic medicine and head of the health and beauty center, Cosmedicals, makes the most of every second she’s got in her life. And she has managed to consolidate a successful career, full of
achievements and results, reflected mainly in the patient’s wellbeing. How do you define success? “Success is increasingly to need less in order to be happy and to be able to sleep peacefully; it is being able to enjoy everything I do; being grateful to life for the experiences it has given me, as well as my children, family, friends, colleagues and employees, also for being healthy; it is to be able to make fun of myself, and being able to turn the sad and negative things into victories”, she muses. Surely, she is a fighter who works for the patient’s quality of life. And she spoke to Coomtacto about her 20 years of professional experience.
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PERFIL
A RESEARCHER AND A WRITER lexandra Mora Hernández is an otolaryngologist, a specialist in facial plastic surgery and aesthetic medicine; a consultant member and a surgeon at Clínica del Country, and a national and international speaker on these topics. She has also received several national and international awards for her achievements. And in 2015 she was named ambassador to Colombia for the University of California health system. She was born in Bogota, graduated from Universidad del Rosario, Universidad CES and the American Academy of Facial Plastic Surgery; and she is also the mother of two children, a nature lover, and enjoys horseback riding as well as skiing, activities she shares with her kids. But she’s also a writer, and has already displayed her talent in her two novels. “In the novel Nubes de Abril, you can find a space for all sorts of emotions, those producing happiness as well as unfortunate situations. I imagined and remembered moments, then froze them like photographs, and combined them with the tools of the at sign (@) generation. I conceived it like a movie. And, on the other hand, Conneccion Purg@torio is the shocking life story of a character (Twitter: @MikoLecter) narrated from the tunnel beyond the grave after a terrible accident, it is about events that force him to unexpectedly turn his destiny around, after questioning his life and his family’s, as well as his work and emotional wellbeing.” But her resume, as a writer, is still growing. She has two new unpublished works, which we will soon be able to read: “I just finished writing Perdí la cabeza, it is about a recently widowed woman who decided to study photography in Iceland, where she discovers herself. And I also finished recently a luxury book on health, beauty and wellbeing, both in English and in Spanish, and it is illustrated with photographs I took myself.”
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Photos: PARTICULAR FILE
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FRONTPAGE Why did you choose medicine as your career, and then specialized in facial plastic surgery? Was that a personal or an inherited decision? I think it had something to do with my genetically inherited traits. Artistic sensitivity and appreciation have much in common with my specialty, and they are related with my childhood experiences: my father is an architect and one of his hobbies is wood carving, while my mother is a
sculptor and a painter. Facial plastic surgery is one of the most important areas of otolaryngology, because it encompasses the face and neck anatomical structures, while it also demands up-to-date knowledge, research and creativity to be able to work aesthetically, while preserving functionality. My specialty has allowed me to combine my fascination with surgery and my artistic sensibility; and I constantly have to be in training in
order to be able to offer the latest and the best technology available, patients deserve it, and that allows me to inform them realistically in order to show alternatives, avoiding unrealistic expectations. After 20 years of a professional career, what is your final impression? During these years my clinical practice has been focused on a constant search to highlight and maintain natural features in the final result. And this requires constant technical renewal, an eye for details, delicate movements and very careful hands. I promote natural beauty, adapting to the patient’s personal needs and also his limitations, striving not only to strengthen appearances, also I want to enhance the person’s self-esteem. Patient’s wellbeing dominates over any other aspect.
June • 2016
What led you to pursue topics like rejuvenation, and to your own medical skin care line? For me, the skin is the most important part the human body. It’s not only its resilience, it is so grateful when properly cared for. It reflects physical and emotional health. For all the above, and following the search of an ideal complement to optimize harmonically surgical and non-surgical procedures, I perceived the need to create a skin care line. So I studied cosmeceuticals, allowing experts to guide me in the product line.
“SUCCESS IS INCREASINGLY TO NEED LESS IN ORDER TO BE HAPPY AND TO BE ABLE TO SLEEP PEACEFULLY; IT IS BEING ABLE TO ENJOY EVERYTHING I DO; BEING GRATEFUL TO LIFE FOR THE EXPERIENCES …”. 16 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
TO PROVIDE TRUST AND SECURITY
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Many people are concerned with aging, are there any recent innovations in this field? There are advanced surgical techniques and simplified procedures for blepharoplasty, rhinoplasty, ritidoplastia, facial lift, submental liposuction, chin surgery, cervicoplasty, otoplasty, lobuloplasty (in order to repair the torn ear lobe), face lift or neck bichectomy, which in expert hands achieve harmonious, durable and, especially, natural results, with minimal disability on an outpatient basis. These procedures are minimally invasive, but there are also nonsurgical alternatives that are already widely known, and that year after year they are being perfected. Currently, people are fearful for different aspects of the procedure’s results, on what are they dependent? Most patients are scared of the anesthetic consequences, especially women with young children. But now a day, anesthesia is safe, with the care and supervision of specialized professionals, also with the
“THE MOST IMPORTANT THING IS TO CREATE A GOOD DOCTOR-PATIENT RELATIONSHIP, OPEN TO DIALOGUE, CLARIFYING ALL QUESTIONS, WHILE ALSO BUILDING REALISTIC EXPECTATIONS “.
latest technology. In addition, risks are assessed and avoided through an appropriate prior evaluation by the anesthesiologist. Another group of patients doubt because of the lack of accurate information about the surgical and nonsurgical procedures. They are afraid of cosmetic deformities and disabilities, as well as the pain caused by the products applied on them, not to mention their origin. The most important thing is to create a good doctor-patient relationship, open to dialogue, clarifying all questions, while also building realistic expectations. 17
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’m focused on conservative, effective and safe techniques that give confidence and have a short duration, while generating minimal inflammation and bruises, with fast recovery and no scarring risk. I strive for natural looks, not so much for different looks”, says doctor Alexandra Mora Hernández. Her aim is to provide greater confidence and security in the quality of her work, issues that often cause distrust and fear.
PROMOTION
PREVENTION
EATING DESORDERS increase with life style STRESS AND PEER GROUP PRESSURE ARE ASSOCIATED WITH EATING DISORDERS. BUT, TODAY, THERE ARE PROMISING THERAPEUTIC APPROACHES.
June • 2016
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enetic and epigenetic factors, as well as neurobiological, social and cultural factors are related with eating disorders, and in general to eating behaviors, a growing worldwide problem. In Colombia, Encuesta Nacional de Salud Mental 2015 suggests “being a young woman who participates in certain activities related to the appearance and body shape, with a history of sexual or physical abuse, have an increased risk of developing an eating disorder”. But eating disorders have signs and symptoms “such as a dominant concern about the food content o nutrients, body weight, the possibility of being obese or feeling fat despite being normal or below normal weight”, says doctor Maritza Rodríguez, a clinical epidemiologist and a psychiatrist at Pontificia Universidad Javeriana. They “restrict voluntarily and progressively their food intake, skipping whole meals, or using compensatory behaviors, such as inducing vomit, taking laxatives or appetite suppressant pills, and also exercising compulsively”, explains doctor Rodriguez, scientific director at Equilibrio, a specialized program in eating disorder diagnosis and integral treatment. A body image distortion is central: that is a very different perception of 18 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
the body from the one of the brain, others have or the mirror shows.
DIFFERENT AND LINKED These complex disorders are “anorexia nervosa, bulimia nervosa, binge eating disorder and Unspecified eating disorders, as defined by Encuesta Nacional de Salud Mental”. Anorexia is, according to the Panamerican Health Organization, “a lack of appetite, which becomes a selective or total rejection of food”. So, the evaluation requires an analysis of the patient’s environment, involving the premorbid personality and related history”.
While in bulimia nervosa patients eat and remorsefully induce vomit and then eat again, the body weight can be normal or high. In binge eating disorder, on the other hand, there are periods of large food intake, so overweight and obesity is frequent. In general, says doctor Andrés Ospina, head of the Bariatric Surgery Group at Clínica Reina Sofia, “obesity is closely linked to eating disorders that may have existed in the past, as warning signs”. “There are patients who eat compulsively and end up obese with a history of bulimia or binge eating disorder, people eating large amounts of food, without recalling it, and they should be evaluated and treated by mental health professionals. The treatment for these cases of obesity might not be surgical until the mental problem is treated, because it can be very dangerous,” said the expert during a workshop on obesity organized by Johnson & Johnson in Bogota, Colombia.
THE CHARACTER IS IMPORTANT Endophenotypes have been identified, they refer to those characteristics that favor eating disorders. “The basic profile of a person with anorexia is often perfectionism and high
persistence, they insist on the task,” says doctor Rodriguez. These features can also be found in bulimia patients, accompanied by impulsiveness. Anxiety is also often present, and changes are perceived as threats, not as opportunities. The onset age for eating disorders is usually during adolescence, a vulnerable period, with major physical and mental changes. But cases are now emerging of women between 30 and 45, in whom “the symptoms are triggered by fears of aging and loss of attractiveness”. Studies suggest there
A KNOWN RELATIONSHIP ttempted suicide and non-suicidal self-injurious behaviors have been described in patients with eating disorders, and have been related to increasing morbidity and poor prognosis, suggest doctors Maritza Rodríguez, Nelcy Rodriguez, Juanita Gempeler and Daniel Felipe Garzón, in a paper published in the Journal of Psychiatry (2013). They studied 908 patients, men and women, whom attended an outpatient eating disorder clinic in the Equilibrio program. And found a statistical relationship between these two issues after multivariate analysis. Of the patients, 13% reported to be suicidal at some point in their lives, and 26% had non-suicidal self-injurious behaviors. The variables were also linked to bipolar disorder (OR: 3.86; 95% CI 2.4 to 6.1), borderline personality disorder, purgative subtype eating disorder and self-inflicted harm. And in relation to non-suicidal self-injurious behaviors, associations were found with sexual abuse (OR: 3.48; 95% CI 2.2 to 5.4), bipolar disorder, trichotillomania and suicide attempts.
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Photos: ®2016 SHUTTERSTOCK PHOTOS
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PROMOTION
PREVENTION
is one man affected by eating disorder for every 6 women (while up until 10 years ago the proportion was 1 man in 10 women). For them, fear is not of being fat, but of sagging muscles.
INTEGRAL TREATMENT Eating disorders treatments are multimodal and multidisciplinary, using several “therapeutic tools, in some cases pharmacological, but above all, psychotherapies and family interventions, when very large dysfunction are present”, explains Rodriguez. “For anorexia the rate of recovery is between 60-70%, while 30% of the cases become chronic and worsens. This is the mental disorder with the highest mortality rate, and the causes are related to starvation or suicide”. Rodriguez explains.
RISKY BEHAVIOURS
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June • 2016
ncuesta Nacional de Salud Mental 2015 shows around 9% of the population has one or two risky food behaviors. Also, 12% of the young adults, between 18 and 25 years, diet in order to lose weight despite having normal or low body mass index. Something is happening,” says doctor Maritza Rodríguez, a psychiatrist who participated in the analysis of these results related to eating disorders. Five items of the Abbreviated Scale of Food Attitudes (EAT-26), were used to assess anomalous eating attitudes, not disorders in themselves, but conducts that are the gateway to them. And in some cases they are related to deregulations of the serotonergic system and hypothalamic-pituitary-adrenal axis response in order to cope with stress.
And on the other hand, the recovery rate for bulimia nervosa is well over 80%. Where those who do not improve, usually have other
associated disorders, like personality disorders, substance dependence, bipolarity and trauma history.
WARNING SIGNS
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eers are often the first to know about anorexia. Communities, like schools, begin to detect it because of the resistance to go to the dining room and frequent visits to medical services. With bulimia and binge eating disorder, the behavior is secretive, and many times, the person vomits or binges for a long time before anyone notices. “In addition, there are web pages that teach the patients all sorts of tricks in order to vomit without making a sound”, says doctor Rodriguez. It is important for family, caregivers and teachers to be watchful and seek specialized help. In the words of doctor Alicia Cleves Huergo, a dietitian at Centro Integral de Nutrición y Medicina (Cinumed), the first sign can be “an increase in the exercise routine, reading labels regarding the nutritious facts of food, fear of eating carbohydrates, complaints about the physical appearance or avoiding people because they feel fat, preferring isolation or going to the bath room after eating and remaining there”. Other aspects to be considered, adds doctor Rodriguez, “are stereotyped food behaviors and
rituals, like eating light products, cutting food into small pieces, and spreading them on the plate, refusing to sit at the table, offering excuses”. Other signs and symptoms appear later on with the onset of malnutrition, they are hair loss, dry skin and hypothermia.
REFERENCES AND FURTHER READINGS 1. ENCUESTA NACIONAL DE SALUD MENTAL (ENSM) 2015. DISPONIBLE EN: HTTP://WWW.ODC.GOV.CO/PORTALS/1/ PUBLICACIONES/PDF/CONSUMO/ESTUDIOS/NACIONALES/CO031102015-SALUD_MENTAL_TOMOI.PDF 2. GEMPELER J. TRASTORNOS DE LA ALIMENTACIÓN: CONCEPTUALIZACIÓN Y MANEJO. CONGRESO DE LA SOCIEDAD DE OBESIDAD Y METABOLISMO, FUNCOBES, OCTUBRE 2012. 3. RODRÍGUEZ M, GEMPELER J. SELF-PERCEPTION OF BODY IMAGE AND RISK EATING BEHAVIORS IN COLOMBIAN INDIGENOUS PEOPLE AND AFRO-DESCENDANT POPULATION. PÓSTER PRESENTADO EN EL CONGRESO DE LA EATING DISORDERS RESEARCH SOCIETY, PORTO (PORTUGAL), SEPTIEMBRE 2012. 4. GEMPELER J, RODRÍGUEZ M, SARMIENTO OL, CLEVES D. MULTIVARIATE ANALYSIS OF FACTORS ASSOCIATED WITH BODY IMAGE DISCORDANCE IN COLOMBIAN POPULATION. PÓSTER PRESENTADO EN LA CONFERENCIA ANUAL DE LA EATING DISORDER RESEARCH SOCIETY, EDIMBURGO (UK), 2011. 5. RODRÍGUEZ M. USO DE SUSTANCIAS, IMPULSIVIDAD Y TRAUMA EN PACIENTES CON TRASTORNOS DEL COMPORTAMIENTO ALIMENTARIO: UNA TRÍADA DE RIESGO PARA COMORBILIDADES COMPLEJAS QUE AFECTAN EL PRONÓSTICO. REVISTA COLOMBIANA DE PSIQUIATRÍA 2009;45(3):420-32. 6. HTTP://WWW.SLD.CU/GALERIAS/PDF/SITIOS/GERICUBA/GUIA04.PDF
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EBM
TRANSFUSIONAL MEDICINE
June • 2016
REQUIRES MORE USUAL DONORS
22 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
THE LACK OF ADEQUATE BLOOD FOR TRASFUSIONS CONTRASTS WITH MEDICAL AND TECHNOLOGICAL PROGRESSES, AND DOCTORS USING UPDATED GUIDELINES TO MAKE THE BEST DECISIONS
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strategies to compare them with the Colombian situation. Doctor Bernardo Camacho Rodriguez, scientific director at Banco Distrital de Sangre, Tejidos y Células Hemocentro Distrital, in Bogotá, insists that their “model, and what they do, should be taken into account, after all their system is designed to ensure people enough blood components, with quality, safety and strict transfusion chain control”. This does not mean that in Colombia guidelines and publicat i o n s a re l a c k i n g . M i n i s t e r i o d e Salud y Protección Social and local health organizations are making h u g e e f fo r t s . “I n c i t i e s l i ke B o gotá, hospitals have developed blood transfusion and components guidelines: there are criteria for their indications, how to do it and the risks involved. Also Instituto Nacional de Salud published Quick Decisions Based on Guidelines on Transfusion
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June • 2016
Photos: ®2016 SHUTTERSTOCK PHOTOS
Photo: YURI2010 / SHUTTERSTOCK.COM
olombia has a blood donation index of 15 per 1,000 inhabitants year, compared to the United States and Europe where it is around 40-45, and the average in Latin America is near 20. This means we are facing a challenge: in order to be able to increase donations and benefit from the advances in transfusional medicine. Only Bogotá is above the national and regional averages, with 30 donations per 1,000 inhabitants year. The system implemented in the United Kingdom is a model of efficiency with high technical and scientific standards, in relation to the collection, the distribution and hemosurveillance. As a matter of fact, the National Institute for Health and Care Excellence (NICE) in the UK updated its guidelines for blood transfusions and the use of other blood products, so it is worth while reviewing their
EBM Medicine, pretty much the same as the British publication, only that it is more accurate and concrete”. Latin-American specialists, regionally, including Colombians like doctor Camacho, published a book titled Applications and Practices in Transfusion Medicine, a book with more than 70 chapters, edited on behalf of Grupo Cooperativo Ibero-Americano de Medicina Trasfusional. In part, the problem is that we have the guidelines but they are difficult to implement. We haven’t been able to raise public awareness on blood donation. In England, for instance, 80 to 85% of the donors return on a regular basis, while they have only 5 to 10% new donors. Ideally, each person should donate blood twice a year, and in doing so, voluntarily, they improve the security of the system, in spite of the tests blood banks must make, as indicated by Ministerio de Salud y Seguridad
ALTERNATIVES TO TRANSFUSIONS
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ne of the strategies promoted by the National Institute for Health and Care Excellence (NICE) in the United Kingdom, through its Guidelines for transfusion practices of blood and blood products, is the use of alternatives in specific cases, within an interdisciplinary teams of specialists, including surgeons and anesthesiologists.
June • 2016
These are their suggestions: • Use tranexamic acid in adults undergoing elective surgeries when a possible moderate bleeding (> 500 ml) may ensue. Do not use cellular preparations without acid tranexamic. • Consider single unit transfusions of red blood cell concentrate if the patient is not bleeding actively, then reassessed after each transfusion. • Erythropoietin could be considered in anemic patients whom meet the criteria for a blood transfusion in the cases when it is impossible for various reasons, particularly because of religious beliefs. • Intravenous and oral iron administration before and after surgery in patients with iron deficiency
•
•
•
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anemia, the most common type, could be useful, unless the patient is intolerant to oral iron. For patients who need a blood transfusion because of chronic anemia, without major bleeding nor an acute coronary syndrome, packed erythrocytes can be used. They are also indicated for patients with active bleeding, the recommendation is a single packed cells transfusion or the equivalent volume by body weight if it is a child or an underweight elderly. Platelet transfusions are indicated in major bleeding (prolonged epistaxis, extensive skin bleeding, hematemesis), patients with platelet counts below 30 x liter. It is not recommended to systematically carry out prophylactic platelet transfusions in patients with chronic bone marrow failure, autoimmune thrombocytopenia, heparin induced thrombocytopenia or purpura. Fresh frozen plasma is indicated in patients with clinically significant bleeding, without serious complications, only in the presence of altered coagulation tests.
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SOME BLOOD SUPPLY CLUES
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n Quick Decisions Based on Guidelines on Transfusion Medicine published Instituto Nacional de Salud, the National Network of Blood Banks and Transfusion Services of Colombia, there are also some fundamental recommendations: Acute blood loss • Classify bleeding according to the blood volume lost and the signs and symptoms of the patient. • Assess the risk of the ischemic patient (history of AMI, CPOD, CVD). • H e m o g l o b i n ( H b ) i s n o t t h e o n l y p a r a m e t e r t o i n d i cate a transfusion (take into account vital signs, diuresis, SvO2, lactate, BE). • Patients have varying degrees of adaptation to anemia, individual cases should always be considered. • In hemorrhagic shock, prioritize damage control surgery, and minimize the administration of crystalloids. • In case of massive transfusion, erythrocyte-plasma-platelet ratio should be close to 1: 1: 1, while avoiding hypothermia and acidemia.
COLOMBIA IS MOVING ON THE RIGHT TRACK “I think what is being done in cities like Bogotá is promising. There has been progress, especially during the past 10 years. Donors used to go and donate at the institutions; now blood banks have mobile donation units that go to where people are. For example, they go to organizations, sports clubs, universities, religious groups, because this units allows us to locate adequate donors, while we can easily
find altered results, and at the same, we can promote fidelity and commitment within the public”, explains doctor Camacho. But the donation average in our country remains low, in contrast to the astonishing advances in transfusion medicine. “All models are based on availability. A national blood system must not only ensure supply, it must also guarantee it is well used, together with the availability of all that is needed. Unfortunately in Colombia there are critical departments with inadequate blood component supply, such as Chocó and La Guajira, while in other regions the system is simply not working in the proper manner”. “A huge job is still to be done with the civic culture within the population, in order to inform people to respond
to campaigns, avoiding shortages, as it tends to happen during holiday seasons. When blood or its components are not available, morbidity and mortality increases”, sentenced doctor Camacho. REFERENCES AND RECOMMENDED READINGS 1. HT TP : // W W W.WH O. I NT/M ED IAC ENTR E /FAC TSHEETS/FS279/ES/ 2. HTTP://WWW.INTRAMED.NET/CONTENIDOVER.ASP?CONTENIDOID=88219 3. C O RT É S A , L EÓ N G , M U Ñ OZ M , JA R A M I L LO S , E T A L . A P L I C AC I O N E S Y P R ÁC TI C A D E L A M EDICINA TRANSFUSIONAL.GRUPO COOPERATIVO IBEROAMERICANODE MEDICINA TRANSFUSIONAL (GCIAMT). 4. GUÍA PRÁCTICA PARA LA TRANSFUSIÓN DE SANGRE (PRACTICE GUIDELINES FOR BLOOD TRANSFER). UNA COMPILACIÓN DE LA LITERATURA RECIENTE REVISADA POR ACADÉMICOS, DE LA CRUZ ROJA AMERICANA. 5. HTTP:// W W W.WHO.INT/FEATURES/FACTFILES/ BLOOD_TRANSFUSION/ES/ 6 PEÑUELA O, BELTRÁN M. GUÍA RÁPIDA PARA TOMAR DECISIONES EN MEDICINA TRANSFUSIONAL. INSTITUTO NACIONAL DE SALUD, RED NACIONAL DE BANCOS DE SANGRE Y SERVICIOS DE TRANSFUSIÓN. COLOMBIA; 2010
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Social, in accordance with international standards. For the World Health Organization (WHO) “a stable base of regular volunteers and unpaid donors guarantees a reliable and adequate supply of uncontaminated blood. They are considered the safest donor group, because they have the lowest prevalence of blood transmissible infectious diseases”.
Chronic Anemia • Transfusion threshold is significantly lower than in acute anemia. • Identify the type of patient anemia (Hb, MCV, MCH, reticulocytes). • Treat specific deficiency with pharmacological agents (EPO, iron, folic acid, vitamin B12). • In the absence of acute bleeding, transfuse 1 unit (level 2). • Transfuse if Hb <5 g /dl in adults or <7 h / dl in children.
MERITS
A LIFE DEDICATED TO CHILDREN HIS DEDICATION TO PROMOTING CHILDREN’S RIGHTS THROUGH COMMUNITY WORK WITH PARENTS AND CAREGIVERS, HAS MADE HIM AN APOSTLE OF COLOMBIAN PEDIATRICS.
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here are plenty of reasons. He has always enjoyed children because of their attunement with life and their capacity of amazement. For him, “they are human beings in a pure state.” And in the current context, pediatrics promotes good health for children, adults and even the elderly. “Children’s doctors promote health while the adult’s doctor repair lost health”. When asked about the requirements to be a good pediatrician, doctor. Gomez points out empathy, the capability of being humane and understanding in order to establish a rich contact with the suffering child and his troubled parents, but also the person must have the academic interest along with the social commitment. An attitude that can be summarized with the wise aphorism: “the adequate doctor treats diseases, while the good doctor treats the patient and the best doctor treats the community”, he says. Juan Fernando Gómez Ramírez is a pediatrician, a pediatrics profe s s o r at U n i v e r s i d a d d e A n t i o q u i a, i n Me d e l l i n ; H e i s a l s o a n advisor to Sociedad Colombiana de Pediatría, the head of the Puericulture Group at Universidad de Antioquia and a coauthor of books like: Puericultura, el arte de la crianza; El niño sano, Fundamentos de pediatría, Semiología pediátrica, Pautas de Tratamiento en Pediatría, Pediatría Ambulatoria y Manual de Urgencias
en Pediatría. He also heads ‘Crianza & Salud’, a program developed by Sociedad Colombiana de Pediatría (SCP), as well as its journal Crianza & Salud; and he is the editor of the newsletter Crianza humanizada and he directs the website ‘Crianza & Salud’, also belonging to Sociedad Colombiana de Pediatría. And, at what time does he do it all? Well, among his achievements, he has been able to practice pediatrics from several angles. “First of all, he works with the sick child and his family in the context of a friendly, warm and respectful relationship, strengthening the therapeutic alliance, so it promotes and facilitates the recovery of the patient, and his health, preventing disease and rehabilitating him. On the second hand, I have had the opportunity for several decades now to be linked to the university, teaching, so I have exchanged and renewed knowledge in the educational process. Finally, I have also had the wonderful opportunity to work with the community, thousands of parents all over the country, exchanging ideas about child-rearing, developing a common language. Together we have called this activity ‘Crianza Humanizada’, responding to the complexities of the exciting realities of the XXI century,” says the pediatrician. As far as the program ‘Crianza y Salud’ is concerned, he emphasizes the opportunity to communicate
with people ensures “better informed parents about their children’s growth and developmental milestones, become more confident about their presence in the infant’s life. So pediatricians, as well as all other health care personnel, have the obligation to educate.” Hence one of his concerns is children’s situation in our country, to the extent that many infants have to live with unsatisfied primary and fundamental needs, they are growing in unhealthy environments, not only physically but also mentally. Neglect, abuse, violence, domestic and armed conflicts, have devastating effects on their wellbeing, therefore, despite the importance of state actions in favor of childhood, it is mandatory to consider children the present and future of our society. We must look out for children’s best interests.
WE INVITE OUR HEALTH PROFESSIONALS to share with us their experiences on research, academic activity, community programs or art activities. In this way we can enrich this section providing its achievements and developments in their professional work. Contact Us: prestadores_coomeva@coomeva.com.co
A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
RESEARCH
REPORT
THE CHALLENGING
PREVENTION OF KIDNEY DISEASE EVENTHOUGH THERE ARE TREATMENTS, AND DIALYSIS, PREVENTION IS STILL FUNDAMENTAL IN THIS FIELD, AND IT SHOULD START WITH CHILDREN AND SCHOOLS.
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June • 2016
s of 2016, estimates in Colombia suggest that there are 1,070,000 patients with chronic renal failure, and 3.2% of them require renal replacement therapy, like dialysis (that is almost 32 thousand people need it, and the number is expected to double during the coming years). While, of them, 20% are on the transplant waiting list. And there is an even greater problem, “1 in 10 Colombians may have some form of kidney disease and, because they tend to be silent, they only manifest themselves when they are already too advanced. There is not enough prevention nor education within the community, and also referrals to the nephrologist are too late,” says the concerned nephrologist and researcher Gustavo Aroca Martinez, for whom prevention of kidney disease is a major concern, and he works on it every day. Since the beginning of his medical career, he was struck seeing young patients with renal failure, requiring dialysis, so he decided to specialize in internal medicine and nephrology in order “to help improve that situation,
because many patients died early, and at that time there were too few nephrologists in Colombia”. Today, he has become a leader in this field. A well-known and highly regarded researcher, dedicated to looking for the best alternatives to prevent kidney disease, while helping the suffering to increasing their quality of life. Renal diseases are chronic, and growingly prevalent. They require permanent treatments that demand high technology, with large quantities of high cost resources, so they also impact the national economy.
A MULTIDISCIPLINARY AND SUCCESSFUL GROUP Doctor Gustavo Aroca heads the nephrology research group supported by Universidad Simon Bolivar and Clínica de la Costa, which last April was rated A category by Colciencias. It is a multidisciplinary team made up by renowned national and international researchers: nephrologists, rheumatologists, immunologists, public health specialists, pediatric nephrologists, epidemiologists, statisticians, biologists, nurses, physiotherapists and psychologists.
WE INVITE OUR HEALTH PROFESSIONALS to share with us their experiences on research, academic activity, community programs or art activities. In this way we can enrich this section providing its achievements and developments in their professional work. Contact Us: prestadores_coomeva@coomeva.com.co 28 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
PROFILE
A FULL TIME RESEARCHER vallenato lover and part of a traditional and proud medical family, doctor Gustavo Aroca Martinez studied medicine at Universidad del Norte in Barranquilla, and then specialized in Internal Medicine and Nephrology at Hospital Militar, Bogota. And currently he is working on his doctoral thesis, titled “Clinical problems and health impact of lupic nephritis in the Colombian Caribbean region”. He is also the editor of Revista Colombiana de Nefrología, since 2014 he is vicepresident of Asociación Colombiana de Nefología and is the current president elect for the period 2018-2020. He received the award ‘Acknowledgement Illustrious Labor’ for his clinical work with patients at department of Cesar; also the ‘Best Paper on Prevention and Promotion of Renal Disease 2007’; first place for his work on health promotion and renal prevention, in the XVI Colombian Congress of Nephrology and Hypertension, 2009; National Award for Research in Nephrology for ‘Models for kidney health applied to the district of Barranquilla, Universidad Simon Bolivar 2008’; ‘Best Work on Prevention and Health Promotion Renal Health’ by Asociación Colombiana de Nephrología e Hipertensin Arterial in 2014, among others. He was also commended as ‘Exemplary Citizen’ of Barranquilla and obtained an ‘Excellent Researcher Award’. “Exemplary Citizen means to work on prevention with communities; specially the most vulnerable, with activities like education and promotion”. The later one is a recognition for his work as a researcher and his publications since 1980 in more than 100 prestigious magazines. Some of his guidelines are “Therapeutic intervention guidelines for patients with chronic renal failure in the renal unit at Clínica del Caribe”; “Acute renal failure in the intensive care patient”; “Infections in the blood stream related to the central catheter for hemodialysis patients in the Atlantic Coast” and “Implementation of a model of renal health at the Barranquilla district”.
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Photos: ®2016 SHUTTERSTOCK PHOTOS
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RESEARCH
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One of their many achievements is the award to the ‘Best Paper on Prevention and Promotion on Renal Health Promotion’ granted by Asociación Colombiana de Nefrología, and doctor Aroca says: “our work plan was to set to intervene on risk factors for kidney diseases in the Caribbean region, through a systematic and sustainable renal health model for the social security system in the Barranquilla district, starting with the diagnosis of risks, our work integrates it with health promotion, protection and prevention, also with early detection of renal disease, research and teaching, considered the basis for kidney health”. “In order to work on chronic renal disease, multidisciplinary work is needed between the university, state organizations and scientific societies. So planning was carried out carefully and systematically, with a strategic analysis on chronic renal disease risk factors that affect most our population, also diagnosis and intervention were conducted on each aspect,” he complements.
This and other papers are important to medicine, research is a key instrument to improve renal health, allowing us to “implement models that improve the care of chronic renal disease”. Obviously, we have still a long way to go, for instance “integrating health promotion and early nephropathy
detection based upon research on basic concepts that will achieve and maintain renal health.” As for the future, the vision is “the research group should develop into an agent of change for chronic renal disease risk factors in our region, and in the country in general”, says the doctor.
KEYS TO THE PREVENTION OF KIDNEY DISEASE
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June • 2016
iabetes is the major cause of chronic renal failure, followed by hypertension, glomerulonephritis and hereditary diseases, like polycystic kidneys, as well as rapidly growing autoimmune diseases, like lupus, and also toxicities related to water pollution, doctor Aroca informs us. With Law 100 access to treatment improved for the final stage of renal failure and dialysis patients. However, “the best treatment is prevention, and it requires management programs to control kidney disease risk factor”, says the researcher. In his view, although there are programs for patients over 18 years, things should go even further, including children and adolescents. How? He suggests encouraging “a healthy eating policy at schools all over the country, and to encourage physical education not only as a simple curricular demand, but as a life choice.” Also to “include the prohibition of salt on school tables and decrease the sales of all sorts of soft drinks“. Another key issue is medical undergraduate and graduate education, with an emphasis on preventive aspects.
“Insurers and providers should promote continued education programs for primary care doctors, within their workday. Physician should not be evaluated plainly by how many patients they attend to, but by how many patients they have controlled well”. He also stresses that “prevention programs should be directed by qualified independent professionals, according to the stage of the disease.” Making it clear if they can be seen by the general practitioner or the internist. “Nephrology referral criteria should be clear and, ideally, written down. While stages 4 and 5 are clearly for the nephrologist care”. As for the screening, “it should include urinalysis, albuminuria and creatinine. Renal and urinary tract ultrasonography should be reserved for men over 50, or it can be left to the medical judgment. Laboratories must include the creatinine value and the calculated filtration rate”. Finally, he suggested reviewing the calculations of renal function in patients over 70, doctors should not confuse renal aging with renal failure.
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MEDICINA PREPAGADA PROMOTES
TO SLEEP SAFELY, babies should sleep face up
June • 2016
S
udden infant death syndrome (SIDS) is the leading world.cause of juvenile death every year. And particularly in Colombia, a baby dies daily due to this syndrome. Even though according to Sociedad Colombiana de Pediatría (SCP), in the country there is a underreporting as high as 95%. However, the Santi Foundation study group made MSI a recognizable public health problem and has put It in the national agenda.
The campaign ‘Baby’s Safe Sleep’ was launched worldwide in 1992, and the child mortality rate has fallen by 80% in Colombia, babies still die due to lack of information. Only 0.1% of over one million children have survived sudden infant death syndrome. “A knowledgeable parent is the best protector of children’s health”, says Paula Jaramillo, Santi’s mother, she survived SIDS, and her severe neurological sequel reminds the world that babies should sleep on their backs, when alone in the crib,
and be in the parent’s room up to a year after birth. We want join this campaign to guarantee children’s right to life while sleeping, not only state mandate included in the Constitution, it is also a governmental priority, involving several entities nationwide, as well as scientific societies, doctor, the health care sector, indigenous communities, private enterprise, the media, celebrity foundations, the civil society, parents and families. ¡And you can also join this initiative!
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THE SCP RECOMMENDATIONS
S
ociedad Colombiana de Pediatría formed Grupo de Trabajo para el Estudio y Prevención de la Muerte Súbita, operating nationwide. Its aim is to promote ‘safe sleep’ for babies, reduce deaths by this cause, working all over the country so that babies will allways sleep face up. But what is Sudden infant death syndrome (SIDS)? According to Sociedad Colombiana de Pediatría, through its November 2015 publication of Crianza y Salud, it is defined as “the death of an infant younger than 1 year (even though most happen before they are six months old) that happens suddenly and unexpectedly, with an unknown cause, after a thorough investigation of the clinical history, an autopsy and scene study of the death. The age at which this syndrome occurs is usually between two and four months of age”. And they also offer some recommendations in order to avoid this tragic situation, which are endorsed by the American Academy of Pediatrics. These are: 1. Put your baby to sleep on the backs is the safest position to prevent suffocation. 2. Do not lay him to sleep on the side. 3. The baby should sleep on a firm surface: soft surfaces, mattresses, blankets, pillows are associated with a higher occurrence SIDS. The mattress should be covered with a sheet that fits properly. Avoid quilts and dolls. 4. Adults and babies should not share the bed. 5. Do not allow the baby to get to hot when sleeping nor cover him excessively. 6. Do not smoke during pregnancy. Exposure to smoke is one of the risk factors most closely associated to the sudden infant death syndrome. Also do not use alcohol nor psychoactive substances. 7. Feed the baby with breast milk. 8. Vaccines should be up to date. 9. Use the pacifier only while sleeping. 10. Do not use cardiorespiratory monitors at home. 11. Talk about this to other people. It contributes because others close to you will also become aware of this problem, and put their babies to sleep on their backs, reducing sudden infant death syndrome even more. Share this information with other parents, grandparents, nannies and other caregivers who are in constant contact with babies. Putting them to sleep upside down increase the sudden death risk.
33 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
June • 2016
Source: Crianza y Salud. For more information see https://issuu.com/ suenosegurodelbebe/docs/plegable2
OUR PLUS
NEW! MEDICAL ORDER SERVICE AUTHORIZATIONS
CAN NOW BE DONE THROUGH THE WEB
THIS CHANNEL WILL REPLACE THE CURRENT CHOICE OF SERVICE AUTHORIZATIONS REQUESTED SENDING AN E MAIL.
June • 2016
C
oomeva Medicina Prepagada thinks on the time saved by its users, and the ease of processing medical authorizations, so it opened a new channel through its website where patients can handle these tasks quickly and without leaving home or the office. This new channel will replace the requests via E mail. Start the new application following these simple steps: 1. Login to http://medicinaprepagada. coomeva.com.co 2. Click the button ‘Autorizaciones médicas’. 3. Scan the medical order, and the medical history, the doctor gave the patient, and store them in PDF or JPEG * format. 4. Fill in the request digital form, and attach scanned files.
5. Finally, click the ‘Guardar ‘ button, and keep the registration number, in case you need to track the request later on. 6. Clicking on the tab ‘Consultar solicitud’ you can check the status of your request in two ways: a) with the request number the system gave you after recording it. b) with the patient’s ID document. But if the request is for printed acetates of X-ray diagnostic aids, the procest must be made personally at Puntos de Experiencia de Coomeva Medicina Prepagada. The request status can be: a) ‘Radicado’: when the request has been successfully recorded in the list to process the application.
b) ‘En trámite’: if the request is under review, and medical audit. c) ‘Listo’: means there is already an answer to the request. When the order is approved you will receive an E mail with the authorization documents so that you can print them. And remember to take into account the deadlines set depending on the services required. Also note that each test or procedure generates an individual authorization document, therefore, you must print them all. Finally it is important to remember that when attending the appointment, the patient should have all printed copies of the authorizations, along with the medical orders, and the medical history, given to him by his physician.
34 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
THE BEST COVERINGS
BECAUSE YOU ARE A COOMEVA COOPERATIVA ASSOCIATE
R
emember Coomeva Medicina Prepagada has additional coverage and exclusive benefits for the programs Oro Asociado and Tradicional Especial, because you are a Cooperativa Coomeva associate. PROGRAMA ORO Coverage
Blood transfusión
Unlimited
Osteosynthesis material
Up to 20 SMMLV
Psychiatric hospitalization
From the first day of the second month
Land ambulance service
5 events per year per user
Maternity coverage for the single user of the contract
From the first day of the second month
PROGRAMA ASOCIADO Benefit
Coverage
Complex diagnostic procedures
Indefinite from the first day of the 13th month
High-risk sport injuries
Complete from the first day of the 4th month
Psychiatric hospitalization
20 days per user / year contract
Osteosynthesis material
Up to 15 SMMLV per general disease
Airlift service
Up to 15 SMMLV, by reimbursement
PROGRAM TRADICIONAL ASOCIADO Benefit Direct access to 8 medical specialties: - Gynecology - Obstetrics - Otorrynolaryngology - Internal Medicine - Dermatology - Traumatology - Psychiatry - Pediatrics
Coverage Up to 3 specialized consultations per user / year contract outside the network through reimbursement at Coomeva Medicina Prepagada tariffs for specialties not included in the program (only consultations)
For more information, send us your name, ID number, city, email and phone to asociado_medicinaprepagada@coomeva.com.co
¡New online services
will make your life easier! For your convenience soon we will soon launch a new service in the provider’s website that will allow you to consult your monthly balance. There you will find a detailed and consolidated summary of your medical fees. With this new service, and others soon to come, you will be able to keep a permanent contact with Coomeva Medicina Prepagada in an agile and timely manner. 35
A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
June • 2016
Benefit
MEDICAL
WORLD
EVENTS XII LATIN AMERICAN MEETING OF HIP AND KNEE SURGEONS LAMHKS Date and place: August 3rd through 6th, Cartagena Information: Sociedad Colombiana de Cirugía Ortopédica Phone number: (1) 625 7445 Email: dirección@elccr.org Website: www.elccr.org
V SYMPOSIUM ON UPDATES IN PEDIATRICS Date and place: July 7th through the 9th, Cartagena Information: Sociedad Colombiana de Pediatría Phone numbers: (1) 649 5352 - 746 4706/07 Email: eventos@scp.com.co Website: www.scp.com.co
FOR A WORLD WITHOUT DENTAL CAVITIES
XL COLOMBIAN CONGRESS OF PATHOLOGY Date and place: August 10th through 13th, Cali Information: Asociación Colombiana de Pathología Phone numbers: 315 716 2884 - 315 724 3347 Email: 41congresoasocolpat@gmail.com Website: www.asocolpat.com Photo: PIMPUN TAWAKOON / SHUTTERSTOCK.COM
D
June • 2016
ental cavities are a chronic disease currently unattended in many countries. This led to the creation of Alliance for a Cavity Free Future. This initiative brings together a wide range of experts from all over the world, in order to promote health actions that will stop the onset and progression of cavities in all age groups. Also this is a campaign that involves international, regional and local leaders, and in the Colombian case, it gathers representatives from several universities endorsed by Asociación Colombiana de Facultades de Odontología (ACFO), as well as public sector delegates, health care workers and Colgate Palmolive, a leading company on dental health care campaigns, organized by the private sector. Likewise, Colombian participation has been supported by Ministerio de Salud y Protección Social, following the goals of the alliance. For more information see: www.alianzaporunfuturolibredecaries.org
36 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
BOOKS Colleagues authors
BODY IMPERFECTIONS: AN EVOLUTIONARY STANCE PEDIATRIC CARDIOLOGY
‘PULMONARY HYPERTENSION IN CHILDREN’
Authors*: Gabriel F. Diaz, Julio Sandoval and Augusto Sola
I
n past decades there has been a lot of progress in the knowledge about pulmonary hypertension, both regarding its diagnosis and its treatment, even though there is room for improvement, and that perhaps is due to the fact that knowledge has been mainly acquired through studies in adults. But this book contains an updated review of different aspects of the disease in children, including its classification, its genetics, and its overall characteristics, elements that will help doctors in their clinical practice.
Authors*: Gabriel Diaz Gongora, Juan Fernando Velez, Néstor Sandoval Reyes.
T
he chapters that make this book are related to the most important topics, and their advances, in the field of pediatric cardiology. It includes current topics like genetics, embryology and the molecular bases of congenital heart diseases, as well as clinical aspects like invasive and noninvasive diagnosis, for instance three-dimensional echocardiography, nuclear magnetic resonance, interventional cardiology, cardiovascular surgery and pediatric heart transplant. It is a broad contribution to pediatric cardiology written in Spanish.
Authors*: Antonio Vélez and William Álvarez
T
hrough different examples, this book shows the reader a wide variety of design errors, if they could be called like that, that are found in humans, and probably, like every bodily feature, they are vestiges of our phylogenic past. These authors argument in favor of the idea that in our species, like in all others, there are traits that can be considered errors, sometimes glaring, in the anatomical, physiological and psychological designs of the evolutionary process, an idea difficult to accept if the reader has the notion that we are creatures that emerged through the intelligent design of a superior being, instead of blind natural selection.
FACADES
Author: Eric Lundgren Author: Henry Kissinger
T
his book is dazzling, interesting and controversial. It contains thoughts on the nature of the countries and their history. You can agree or not with the former Secretary of State of the United States, but everybody recognizes his political intelligence, his historical culture and his analytical capabilities. Undoubtedly, this is must read book for leaders and people interested on the subject.
T
rude is an imaginary town in the American Midwest. An architect, a Central European immigrant, drew its streets according to his modernist fantasy, but today what used to be Baroque facades are crumbling ruinous buildings. Travelers who venture in there only find labyrinthine shopping malls, a library, a great opera house and a mayor who banned books and reading. So one night the most notorious mezzo soprano disappears during a rehearsal, and when the police investigation fails, her grieving husband, a court official called Sven Nordberg, acts on the matter, and things change.
37 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
June • 2016
WORLD ORDER
MEDICAL
WORLD
MUSIC
MOVIES
THIS IS WHAT THE TRUTH FEELS LIKE Gwen Stefani has been quite some time since Iatthe American singer uses music as marvelous language to express her feelings. And this new work is also a break from Gavin Rossdale that allows her to develop her new pop. This is certainly an album full of sadness, passing through laughter, which finally reaches the pinnacle with its 17 songs, including Misery, You’re my favorite, Truth, Used to love and Send me a picture. t has been several Iman years since a who used to
be known as Tarzan left the African jungle THE LEGEND OF TARZAN in order to live a good Director: David Yates life under the name of Cast: Margot Robbie, Alexander John Clayton III, together with his beloved wife, Skarsgård and Samuel L. Jane. Now, recently he has Jackson been invited to Congo as messenger from the Parliament not knowing that he is no more than an instrument in a deadly plot of greed and revenge planned by the Belgian captain Leon Rom. But those behind this murderous scheme have no idea
LEMONADE Beyoncé his is the sixth studio Tsinger, album by the American and several artists
accompanied her, like James Blake, Kendrick Lamar, The Weeknd and Jack White. The album has been huge success, as a matter of fact all the songs in Lemonade immediately became Billboard top 100, year after deceiving the FBI and becoming after all, it truly shocked fans. popular because of their performances Among its 12 singles you will of a Robin Hood-style magic trick, the four find Pray you catch me, Hold characters reappear with an even more impressive up, Sorry, Daddy lessons, performance, hopping to expose the unethical Freedom, All night and practices of a technology mogul. The man behind Formation. the disappearing act is none other than Walter Mabry, a technology prodigy that endangers them, a situation that leads them to commit a dangerous heist. Their only hope is to carry out one last trick, an unprecedented spectacle, in order to clear their names and expose the real mastermind behind it all. THE ILLUSIONISTS 2 Director: Jon M. Chu Starring: Daniel Radcliffe, Lizzy Caplan, Jesse Eisenberg, Mark Ruffalo and Morgan Freeman
June • 2016
A
38 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
Hospital en Casa es la institución pionera en la prestación de servicios de salud, hospitalización y cuidados integrales domiciliarios, que contribuye a la recuperación del paciente con la calidad y tecnología de una clínica, pero en la comodidad y la seguridad del hogar.
Recomiende a sus pacientes Hospital en Casa. Conozca nuestros servicios: • Extensión Hospitalaria • Terapias de rehabilitación • Clínica de heridas • Suministro de medicamentos, insumos, dispositivos y equipos biomédicos • Cuidado del paciente crónico • Ventilación mecánica • Cuidado paliativo • Nutrición y dietética Ingrese a nuestra página web www.hospitalencasa.com.co o comuníquese a nuestras líneas de atención:
Cali: 321 12 19 - Resto del país: 01 8000 934 046 Encuentre nuestras sedes en: • Bogotá • Cali • Palmira • Buga • Tuluá • Popayán • Pasto • Medellín • Ríonegro • Montería • Barranquilla • Cartagena • Sabanalarga