ISSN 2011-357 9
A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA VOL. 9 # 1 • MARCH 2016
ZIKA SPECIAL HEALTH UPDATE Epidemiological implications of global climate change | PÁG. 8
P P
Zika virus, and maternity: prevention is the only way | PÁG. 18
MBE
Zika viral infection is related to Guillain-Barré syndrome | PÁG. 22
Enrique Jiménez Hakim
FROM THE SIMPLICITY OF EVERYDAY LIFE TO THE COMPLEXITY OF THE NEURONS
| PÁG. 14
Content
8 Jorge Zapata Builes General Manager Coomeva Medicina Prepagada
Editorial board Pascual Estrada Garcés, MD National Health Director
5 EDITORIAL 6 MEDICAL DEVELOPMENTS Brief notes on actual and medical innovations
26 RESEARCH REPORT Colombian innovation for drooping eyelids obtains a US patent
8 HEALTH UPDATE Epidemiological implications of global climate change
An ophthalmologist who designed new tweezers that allow better results for eyelid surgery, and her project turned into an innovative product about to be launched in the national and international markets
Global temperature increases, biodiversity deterioration, and ecosystem alterations strongly impact diseases patterns, challenging health care professionals.
28 MERITS Business excellence award for health care services
14 COVER Enrique Jiménez Hakim From the simplicity of everyday life to the complexity of the neurons His office is decorated with lots of curious objects that relax him and the patients. As a matter of fact, people might think they are walking into some other place, not a medical consultation room. The peculiar decoration helps them feel at ease. He is one of Colombia’s foremost neurosurgeons.
30 FROM COOMEVA A course that no dentist can miss
Martha Liliana Cifuentes National Coordinator of Relationships with Providers 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 MEDICAL WORLD Meetings of several specialties, academic and professional events, books, music and movies.
www.comunicaciongraficalegis.com
mercadeorelacional@legis.com.co Tels.: (1) 4255255, Exts.: 1314, 1393, 1552, 1516 Sales: María Cristina Arévalo Durán Cel.: 3112862724 maria.cristina.arevalo@gmail.com
18 PROMOTION,
AND PREVENTION Zika virus, and maternity: prevention is the only way The situation is hazardous, and most health care guidelines, and prevention strategies target childbearing age women, given the hypothetical relationship between this virus infection and the risk of mycrocephaly in unborn babies.
22 MBE
March • 2016
Zika viral infection is related to Guillain-Barré syndrome The Guillain-Barré prognosis has improved during past decades, but evidence suggests a relationship between Zika viral infections, and this neurological syndrome.
18 Cover photo: Gerardo Gómez
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Editorial
WORKING TOGETHER FOR HEALTH CARE OF COLOMBIANS
Jorge Alberto Zapata Builes General Manager Coomeva Medicina Prepagada
W
e are happy to inform our readers about the new partnership we signed between Grupo Empresarial Cooperativo Coomeva, and Christus Health, an American organization. This landmark agreement will enhance our capacity to offer health care services throughout our business organization, including Coomeva Medicina Prepagada. Christus is a worldwide health system based on the Catholic faith. A none profit organization with its headquarters in Dallas, Texas. It was founded in 1999 in order to unify the legacies of more than 150 years of operation of prestigious health care institutions, a network of 50 clinics, 175 outpatient services,
13,500 physicians, and 30,000 employees in different areas, with operations in 60 cities in Mexico, Chile, and the US. It is ranked among the top 10 health care systems in America. “Christus Health has been establishing a strong growth strategy in Latin America, and we looked for the best allies to help us expand our institutional mission in the region. We believe Coomeva is the ideal partner for us in Colombia, because it is highly committed to providing the best health care services to their members, and associates, from its origins as a cooperative venture”, said Ernie Sadau, Christus Health CEO. He refers to this momentous agreement that promises a brilliant future not only for Grupo Coomeva, but also for the whole community in our country, that benefits from our services. After two years of meetings and negotiations we successfully completed this alliance. We analyzed the proposal thoroughly, and convinced ourselves that both our organizations share their vision and objectives. Primarily, to improve the quality of people’s lives: users, their families, partners, affiliates, and in general to whole the population. Also this is an opportunity to strengthen our two organizations in order to achieve, and probably exceed, our growth expectations for the coming decades. This strategic alliance between these two major players in the health care industry in Colombia, implies confidence in Coomeva and its system. And it will most certainly generate significant benefits, improving quality indicators, risk management, as well as health promotion and prevention programs. A new chapter begins in the history for Coomeva Medicina Prepagada, and you are very welcome to this future.
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An alliance between two major players
MEDICAL
DEVELOPMENTS INTERLEUKIN-37 COULD IMPROVES SPINAL CORD INJURIES
IT IS NOW POSSIBLE TO FOLLOW THE HEARTBEAT FROM A DISTANCE Scientists at the Innovation Center of Kyoto University in Japan announced it is no longer necessary to put sensors directly on the patient’s body the way it used to be done with electrocardiographs. With a remote sensing system that uses radar technology based on algorithm analysis of millimetric radar wave signals, heartbeats can be identified from a distance of a particular body. And it also follows other signals, like breathing and movement. The system records the typical heartbeat waves on real time under controlled conditions.
A GROUP OF SPANISH RESEARCHERS CREATED A NEW SYSTEM TO TREAT SHOULDER INJURIES The shoulder is one of the most complex joints in the body, that’s why it has such a wide range of movement, but its treatment is also very complex. And now researchers at Universidad Politécnica de Madrid developed a robotic exoskeleton that promises to make rehabilitation much easier. The new device uses force, and motion sensors to evaluate the extent of the injury, as well as its evolution during the treatment. This is a simple system that adapts easily on the patient’s shoulder, and it is also rather inexpensive.
March • 2016
S O U R C E : A R T I C L E “ U N E XO E S Q U E L E TO ROBÓTICO PAR A REHABILITAR LESIONES DE HOMBRO”, POSTED ON THE WEB PAGE OF UNIVERSIDAD POLITÉCNICA DE MADRID, ESPAÑA, JANUARY 2016.
Spinal cord injuries could cause severe functional disabilities are complex, and usually are related to degeneration of the spinal pathways. Research on these ailments has been intensive. At Universidad Autónoma de Barcelona a group found that interleukin-37 suppresses the inflammatory response after trauma, minimizing medullar changes, and disabilities. Assays were performed on genetically modified mice, administering interleukin-37 immediately after the injuries, and some degree of mobility was recovered. It is a promising treatment for severe acute spinal trauma, and neurodegenerative diseases, even though much more research is yet to be done, especially on human beings. SOURCE: ARTICLE “BENEFICIAL EFFECTS OF IL-37 AFTER SPINAL CORD INJURY IN MICE”, PUBLISHED IN THE JOURNAL PNAS. UNITED STATES, JANUARY 2016.
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Photos: ®2016 SHUTTERSTOCK PHOTOS
SOURCE: ARTICLE “TO HEAR A PITTER PATTER FROM AFAR: CATCHING HEARTBEATS WITH MILIMETERWAVE WITH RADAR”, POSTED ON KYOTO UNIVERSITY’S WEB SITE. JAPAN. JANUARY, 2016.
A NEW METHOD TO DETECT BREAST CANCER WITH MORE ACCURACY
HEPATITIS C COULD INCREASE THE RISK OF DEVELOPING PARKINSON’S DISEASE
Researchers at Tohoku University (Japan) suggest that combining mammography and mammary ultrasound could increase their individual accuracies detecting early breast cancer. They arrived at this conclusion after studying 73,000 women. The detection rate of the disease was 1.5 times higher in those who were examined with both techniques, compared to those that underwent only one or the other test.
Researchers at China Medical University in Taiwan, analyzed data from the National Health Insurance Research Database involving 49,967 patients with hepatitis B, C, or both, and compared them to 199,868 people without the disease. Both groups were monitored for 12 years searching for signs and symptoms of Parkinson’s disease. The risk of developing Parkinson’s resulted higher in patients with hepatitis, compared to those who didn’t. So after ruling out other associated factors, researchers concluded that patients with hepatitis C are 30% more likely to develop Parkinson’s disease. SOURCE: ARTICLE “ HEPATITIS C VIRUS INFECTION AS A RISK FACTOR FOR PARKINSON DISEASE”, PUBLISHED IN NEUROLOGY. UNITED STATES, JANUARY 2016.
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SOURCE: ARTICLE “JAPANESE TEAM DEVELOPS PROMISING BREAST CANCER DETECTION METHOD”, POSTED ON THE WEB PAGE OF THE JAPAN TIMES. JAPAN, JANUARY 2016.
HEALTH UPDATE
EPIDEMIOLOGICAL IMPLICATI
March • 2016
OF GLOBAL CLIMATE CH
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HANGE
GLOBAL TEMPERATURE INCREASES, BIODIVERSITY DETERIORATION, AND ECOSYSTEM ALTERATIONS STRONGLY IMPACT DISEASES PATTERNS, CHALLENGING HEALTH CARE PROFESSIONALS.
Photos: ®2016 SHUTTERSTOCK PHOTOS
C
razy weather” is a common expression among people in different regions of the country, and even across borders. It is an undeniable reality. Temperature increases have worldwide consequences. And in health care this is an issue because new viruses emerge, while others considered controlled are activated. According to the World Wide Fund for Nature, “climate change, and the consequences of extreme temperatures, like floods and droughts, increase vector borne diseases like malaria and dengue, after all it is the same mosquito that transmits chikungunya and Zika, as well as outbreaks of other diseases, like cholera and meningitis”. “New breads, as well as those that move to regions of low, or no impact, or that reappear after being controlled, are known as ‘emerging diseases’, this is a whole new era in epidemiology -the science that studies health related phenomena in populations”, says Francisco Javier Díaz, a medical virologist, and a professor at the medical faculty at Universidad de Antioquia. This is a phenomenon that began in the late 70s, “with the appearance of unknown diseases like Ebola and AIDS, and with the reemergence of tuberculosis, and syphilis, as well as with increasing drug resistances of microorganisms to antibiotics, and pesticides, and only some of these changes are attributable to climate change”, explains the expert.
THE CRUX OF THE PROBLEM Global warming, and associated phenomena “impact societies,
particularly because of natural disasters, such as hurricanes, for instance Katrina, Andrew, Sandy, etc., tsunamis, like those infamously famous ones in Indonesia and Japan, as well as earthquakes, like those in China, Chile, Nepal, etc. These events have taught us about climate changes effects at several levels”, says doctor Alfonso Javier Rodríguez Morales, a tropicalist, and a senior researcher at Universidad Tecnológica de Pereira.
STRATEGIC ALLIANCES
W
HO and PNUD launched in 2010 the first global project for public health adaptation to climate change, initially with the health care ministries of Barbados, Bhutan, China, Fiji, Kenya, Jordan and Uzbekistan. In 2015, the World Health Assembly approved a new WHO work plan on climate change and health, including a partnership with the United Nations, governments, and other entities, for research, and reviews of scientific evidence, and prevention strategies. Similarly, the same organization published, together with the Convention on Biological Diversity, a report entitled Connecting Global Priorities: Biodiversity and Human Health - A State of Knowledge Review, setting new goals and raising awareness about the importance of protecting natural resources. 9
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IONS
SALUD AL DÍA They refer to changes in “the average state of various statistical parameters that may be due to natural internal processes, without a relationship to human activity”, he says. On the other hand, climate change “alludes to consequences that may be associated or not to persistent anthropogenic modification of the atmospheric composition”. Specifically, the Intergovernmental Panel on Climate Change defines it as “changes attributed directly, or indirectly, to human activity that alter the composition of the global atmosphere, in addition to natural climate variability”. Global warming is a phenomenon directly related to it. “In past decades the planet’s temperature has risen, with consequences for life and, of course, for diseases”, says doctor. Colombia, according to the UN, “is the third most vulnerable American country to climate change, only after Honduras and Haiti. Agriculture, ecosystems, food safety, water resources, and their cities, will face critical changes”.
March • 2016
KEY RESEARCH It is also important to consider vectors and other transmitters of tropical and subtropical diseases in intermediate climate migrate to other areas. “A vector that only survives in hot areas could benefit from climate changes, invading areas that used to uninhabitable because temperatures used to be low. Researchers think this is one reason for the increase in dengue, Zika, and chikungunya, they all share the same mosquito vector, the Aedes aegypti, and it has been able to extend its distribution during recent decades”. But the temperature is not the only problem. “Its population has increased, as well as its concentration in urban areas. International travel involves an increase in the spread potential, both for the vector and the infectious agent, together with other cultural and environmental variables, such as the accumulation of
VECTOR RELATED DISEASES
A
ccording to the World Health Organization (WHO), “many of the deadliest diseases are very sensitive to climate, and they are expected to exacerbate with climate change. The forecast is that between 2030 and 2050, about 250,000 additional deaths each year will be due to malnutrition, malaria, diarrhea, and heat stress”. In meraxenic or vector borne diseases changes are already visible. • Malaria is the most researched. Studies in Africa, Southeast Asia, and South America report how high temperatures increase the mosquito’s lifespan. • Dengue: studies in Venezuela, Colombia, Honduras, and other regions find “significant association between phenomena such as El Niño, rainfall, relative humidity, and increased resistance of the Aedes aegypti, and more new cases”. • Cutaneous, and visceral leishmaniasis: research in Brazil, Venezuela, Bolivia, and Colombia, particularly in Santander, Antioquia, Magdalena, and Risaralda, have established that the relative humidity, and rainfall, are associated with the presence of the vector. In Risaralda El Niño has been associated with a higher incidence of cutaneous leishmaniasis. • Others: yellow fever, encephalitis, meningococcal meningitis, and cholera still exist, and are related to climate change, and zoonoses. Similar associations were also found in Brazil, and Bangladesh, with regards to leptospirosis.
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SALUD AL DÍA non-biodegradable objects, like plastics, and tires, objects that can accumulate water where mosquitoes can breed”, adds doctor Diaz. This reality generates a movement around environmental issues, and more research groups are working on finding concrete answers and solutions to the problem. Doctor Diaz emphasizes, “it is fundamental to know the fauna in each region, including vertebrates, like rodents, bats, birds, as well as invertebrates, such as insects, and ticks, and other organisms that harbor microorganisms, like viruses, parasites, fungi, and bacteria. Likewise, it is important to understand climatic and
INCREASED MORTALITY AND MORBIDITY
I
March • 2016
n addition to vector borne diseases climate change has also been linked to cardiorespiratory diseases, alterations in blood pressure, because of modifications in blood viscosity, and heart rate. And in Argentina a “relationship was established between meteorological parameters and the incidence of bronchial asthma, leading to rethink the connections between some pathological conditions, and the effects of climate change on air pollution”, adds doctor Rodriguez. A WWF report lists five consequences on health care derived from climate change: dengue, malaria, and chikungunya, have acquired new geographic areas; malnutrition resulting from dramatic droughts, as it is happening in La Guajira right now; high accident rates, and environmental catastrophes associated geographical conditions in Colombia; increase in premature babies, and gastrointestinal diseases, because natural disasters destroy vital health care infrastructure.
other environmental factors that affect population sizes, distribution and behavior of the fauna; meanwhile developing new drugs, vaccines, and strategies based on environmental, and cultural interventions”. As a result, new disciplines like ecoepidemiology, the fusion of ecology and epidemiology, analyze, understand, and treat the effects of various environmental factors on human disease; while landscape epidemiology, satellite epidemiology, and medical ecology, offer scientific approaches crossing information
on climate variables, macro and microanalysis, both at quantitative and qualitative levels with the help of multiple regression models. The idea is to develop risk maps, and thematic maps that enable prediction and detection of epidemics, early warnings, and immediate action. The World Health Organization states, “the global climate is changing, and this can alter the geography, and infectious disease seasonality, but also disrupts food ecosystems and production, as the frequency of extreme events, like hurricanes, increases”.
FURTHER READINGS 1. HTTP://WWW.RPMESP.INS.GOB.PE/INDEX.PHP/RPMESP/ARTICLE/VIEW/1372/1 2. HTTP://WWW.WWF.ORG.CO/?256937/5-IMPACTOS-DEL-CAMBIO-CLIMATICO-SOBRE-LA-SALUD 3. HTTP://WWW.WWF.ORG.CO/QUE_HACEMOS/WWF_AL_CLIMA/ 4. HTTP://WWW.WHO.INT/TOPICS/CLIMATE/ES/ 5. HTTP://COLOMBIAMEDICA.UNIVALLE.EDU.CO/INDEX.PHP/COMEDICA/ARTICLE/VIEW/1487/2578 6. CONFERENCIA SOBRE CAMBIO CLIMÁTICO Y ZOONOSIS Y FIEBRES HEMORRÁGICAS, DICTADA EN EL XI CONGRESO COLOMBIANO DE ENFERMEDADES INFECCIOSAS DE LA ASOCIACIÓN COLOMBIANA DE INFECTOLOGÍA (ACIN), CARTAGENA, COLOMBIA, 24 DE MAYO DE 2013. SIMPOSIO ORGANIZADO POR EL COMITÉ DE ZOONOSIS Y FIEBRES HEMORRÁGICAS DE LA ACIN. 7. CONFERENCIA SOBRE CAMBIO CLIMÁTICO Y ZOONOSIS Y FIEBRES HEMORRÁGICAS, DICTADA EN EL XII CONGRESO COLOMBIANO DE ENFERMEDADES INFECCIOSAS DE LA ASOCIACIÓN COLOMBIANA DE INFECTOLOGÍA (ACIN), BOGOTÁ, COLOMBIA, 13 DE AGOSTO DE 2015. SIMPOSIO ORGANIZADO POR EL COMITÉ DE ZOONOSIS Y FIEBRES HEMORRÁGICAS DE LA ACIN: HTTP://DX.DOI.ORG/10.13140/RG.2.1.1952.3287 8. RODRÍGUEZ-MORALES AJ, ECHEZURIA L, RISQUEZ A. IMPACT OF CLIMATE CHANGE ON HEALTH AND DISEASE IN LATIN AMERICA. IN: SIMAR S, EDITOR. CLIMATE CHANGE AND VARIABILITY. CROATIA: SCIYO; 2010. CHAPTER 24: P. 463-86. AVAILABLE AT: HTTP://WWW.INTECHOPEN.COM/BOOKS/CLIMATE-CHANGE-AND-VARIABILITY/ IMPACT-OF-CLIMATE-CHANGE-ON-HEALTH-AND-DISEASE-IN-LATIN-AMERICA 9. RODRÍGUEZ-MORALES AJ. CAMBIO CLIMÁTICO Y SALUD HUMANA: ENFERMEDADES TRANSMISIBLES Y AMÉRICA LATINA. REV PERU MED EXP SALUD PUBLICA 2009;26(2):268-69. DISPONIBLE EN: HTTP://WWW.RPMESP.INS.GOB. PE/INDEX.PHP/RPMESP/ARTICLE/VIEW/1372 10. ZAMBRANO LI, SEVILLA C, REYES-GARCÍA SZ, SIERRA M, KAFATI R, RODRÍGUEZ-MORALES AJ, ET AL. POTENTIAL IMPACTS OF CLIMATE VARIABILITY ON DENGUE HEMORRHAGIC FEVER IN HONDURAS, 2010. TROP BIOMED 2012;29(4):499-597. DISPONIBLE EN: HTTP://WWW.MSPTM.ORG/FILES/499_-_507_RODRIGUEZ-MORALES_ AJ.PDF 11. MATTAR S, MORALES V, CASSAB A, RODRÍGUEZ-MORALES AJ. EFFECT OF CLIMATE VARIABLES ON DENGUE INCIDENCE IN A TROPICAL CARIBBEAN MUNICIPALITY OF COLOMBIA, CERETE, 2003-2008. INT J INFECT DIS 2013;17(5):E358-9. DISPONIBLE EN: HTTP://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S1201971212013148 12. LOWE S, BROWNE M, BOUDJELAS S, DE POORTER M. 100 OF THE WORLD’S WORST INVASIVE ALIEN SPECIES. A SELECTION FROM THE GLOBAL INVASIVE SPECIES. PUBLISHED BY THE INVASIVE SPECIES SPECIALIST GROUP (ISSG) A SPECIALIST GROUP OF THE SPECIES SURVIVAL COMMISSION (SSC) OF THE WORLD CONSERVATION UNION (IUCN), 12 P. FIRST PUBLISHED AS SPECIAL LIFT-OUT IN ALIENS 12, DECEMBER 2000. UPDATED AND REPRINTED VERSION: NOVEMBER 2004.
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‘Dondoctor’, a solution to
ADVERTORIAL
handling appointments in one click Immediate attention, the service every patient would like. And providing solutions according to your requirements and needs is as vital as a good professional. This innovative tool helps doctors and Specialized Centers (IPS) to optimize service times.
O
ne of the major shortcomings of public and private health are the time spans for appointment, a patient could have to wait for as long as 4 to 17 days to see a doctor, and in some cases it can be as long as three months. A determining factor when applying a treatment that could be urgent and lifesaving. And, on the other hand, many times specialists and providers do not have specialized systems that can help them handle efficiently their resources, and that’s why both parties are usually affected.
Is there is a solution? YES!
As in all work areas, technology and efficient developments have improved
notoriously. For instance, in medicine its contribution is such that today thousands of lives are saved, not only in the operating room during surgery, but also from the administrative units, thanks to service efficiency applications. This tool is designed to fit individual needs. Each health care professional or center is different, so it adapts to the daily life, and the particularities of each doctor or clinic. So it decreases missed appointments, and congestion that usually arise in telephone exchanges, especially during peak hours. And for the administrative staff it is an excellent tool, allowing them to be more efficien tending to these
‘Dondoctor’ is a web platform that brings together general practitioners, specialists, dentists, and Specialized Centers (IPS), with patients whom, with one click, can schedule an appointment. It works like a virtual directory. It is open to anyone, streamlinng medical appointments, including alarm systems that warn patients via text message (SMS), and email, about the appointments, cancellations, and reschedulings. cases, leaving them time and energy for other more pressing aspects of their daily workload. And ‘Dondoctor’ also has a rating systems for the patients to rate the doctor’s performance, and, in turn these results are usefull feedback for the professional.
FRONT PAGE
HIS OFFICE IS DECORATED WITH LOTS OF CURIOUS OBJECTS THAT RELAX HIM AND THE PATIENTS. AS A MATTER OF FACT, PEOPLE MIGHT THINK THEY ARE WALKING INTO SOME OTHER PLACE, NOT A MEDICAL CONSULTATION ROOM. THE PECULIAR DECORATION HELPS THEM FEEL AT EASE. HE IS ONE OF COLOMBIA’S FOREMOST NEUROSURGEONS.
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D
octor Enrique Jiménez Hakim comes from a family of neurosurgeons. And he is a renowned specialist, as well as a researcher in his own right; he is also a fine human, compassionate, and authentic. For him, it is important to feel at ease with the patients. Some have spinal illnesses, others brain lesions, and he communicates with them in a very special way, with simple language, in order to tell them about what’s happening. For him everybody deserves the best treatment he can possibly give. He knows people need help, and are very anxious about it. Indeed, this perspective led him to have an office that doesn´t look like a consulting room, with white walls and diplomas, it looks more like a souvenir shop. It is packed with memories, porcelains, backpacks, bottles, stuffed animals, puzzles, framed pictures, car plates, and many other objects. It is a treasure chest he shares with patients, convinced this awkward museum promotes confidence, peace, and understanding between them. To arrive at his unprecedented office 822, at Asociación Médica de Los Andes - Fundación Santa Fe, you have to walk through a corridor decorated with framed puzzles, as if they were priceless paintings, as well as a car
ENRIQUE JIMENEZ HAKIM
FROM THE SIMPLICITY
TO THE CO
OF THE NEU
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PROFILE
THE HUMBLE ˇBRAINˇ
E
URONS
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MPLEXITY
Photos: GERARDO GÓMEZ
OF EVERYDAY LIFE
nrique Jiménez Hakim graduated as a doctor at Universidad del Rosario (1980), and specialize in neurosurgery at Hospital Militar Central y la Escuela Militar de Medicina y Ciencias de la Salud, Universidad Militar Nueva Granada (1986). He was a visiting physician at the Surgery Department at Minnesota University (USA) and a researcher at the General Hospital of Harvard Medical School. Since 1987 to date he has worked as a neurosurgeon at Sección de Neurocirugía del Centro Médico de los Andes, Fundación Santa Fe de Bogotá. He has also worked at Clínica San Rafael, and Hospital Central de la Policía. And in 1997 he became associate professor of neurosurgery at Universidad El Bosque in Bogotá, D. C. He has written and published several research papers on topics ranging from traumatic brain aneurysms and epistaxis, to monitoring of intracranial pressure at Hospital Militar Central. This paper was discussed in 1984 at Encuentro Nacional de Residentes de Neurociencias, in Paipa, Boyaca, Colombia, and was awarded with the 2nd place. Also on microvascular practice in the laboratory, “The effect of prolactin bombesin on the growth of meningioma cells in monolayer culture”; spinal tumors; mad cow disease, dementia and transmissible prions; melanocytic tumors of the central nervous system; second place for the best exhibitor at XXI Simposio Internacional de Neurocirugía, Asociación Colombiana de Neurocirugía (Santa Marta, nov. 2007), among many other publications, conferences, and participations. He is an active member of the Sociedad Neurológica de Colombia (Asociación Colombiana de Neurocirugía) since 1986, and was its president between 1992 to 1994; he is an international member of the Congress of Neurological Surgeons since 1987; a member of the International Association for the Study of Pain since 1990; and an active member of the Sociedad Colombiana de Medicina y Cirugía con Láser (Socolaser) since 1990. Finally, Jiménez Hakim is married to Clemencia Ramírez, an ophthalmologist.
PORTADA plate, and a bus route sign. And there’s where we had the opportunity to talk with this doctor who defines himself as “an ordinary, simple man trying to do things the best he can possibly do in order to help people”. As we start the interview he establishes clearly that he is an animal lover, whom also enjoys reading, and cycling, even though he would like to do it more frequently, he simply adores Arab food, and his favorite soccer team is Santa Fe.
March • 2016
What has it meant for you to be part of a family of renowned neurosurgeons who contributed so much to the country? Since I was a child at home I heard my dad, Alejandro Jiménez, and my uncle, Solomón Hakim, whom always worked together, and both of them are now deceased; they used to talk about their patients, as well as their anecdotes. So medicine, especially neurosurgery, has always been a part of me even before being fully aware of it. But this context does not necessarily mean I wanted to be a neurosurgeon at first. Up until the last year at school I going to be an engineer. Blood used to make me dizzy. And in the last school year, I decided to study medicine, and became interested in the area of surgery. I had two options: neurosurgery or general surgery. And finally I chose the first alternative. In your opinion, what is your greatest contribution to medicine and society? I think perhaps it is to continue with the neurosurgical school founded by my dad, and my uncle. They arrived in the country on 1949, and started working as specialty. They were the second, and the third neurosurgeons in Colombia. They brought the school, and then founded satellite programs in several hospitals. And we have continued with their work up to this date, training young neurosurgeons and neurologists. My job is not only to care for patients, in
One of his greatest professional satisfaction is to have continued the educational legacy from his father and uncle through the training school in neurosciences.
surgery, but also to teach medicine. We have a residency training program with Universidad El Bosque. It started in 1996, and has graduated about 35 neurosurgeons. Everyone, in general, is doing well. I think it’s a good contribution. Tomorrow when we are not around, they will continue with the legacy of the school. It is unavoidable not to mention that you have had as patients former Bogotá mayor, Gustavo Petro, and the current Vice President, Germán Vargas Lleras. What does it mean to have those public figures as patients? The truth, and I always say this to the residents, they are ordinary people. If you to treat them differently because they are public or famous figures, for sure they will get complicated. So pretend it is simply Mr. so and so, who came from X or Y street. Do not treat anybody differently. The philosophy is that everyone should be treated equally, and in the best possible way.
Most of the time things go well, or very well. But like always in medicine, sometimes we have complications, unfortunate cases, even though they are very few. Is the odd decoration of your office part of your close relationship with the patients? I like my office. It belonged to my dad, and my uncle Solomon used to work on the neighboring one. He had white walls, and some pictures, but when I started working with him, I began hanging little things, one by one. Today I keep most of these objects, and as years have passed, patients have given me many more. When they come for the first time, they see the collection. When they return the second time, frequently they give me something. And by the third visit they want to see if I liked it, and where did I put it. But the fact is that patients who come to my office often have complex problems, and they relax as soon
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What is the greatest satisfaction of your career, and your life? My greatest satisfaction is to have the power to perform as a professional. That’s not only personal satisfaction, but also the possibility of making a difference in people’s lives. It means I know I am not here like a machine, consulting, and operating, I can help, and also leave behind a school of younger neurosurgeons who will continue with the work. When I’m no longer here, they’ll carry on with my legacy into the future, that also comes from long ago, from my family. And what is the challenge that you haven’t achieved yet, the goal to be reached? I think I’ve done pretty much everything in my life. I do not regret anything. If it works out, perfect; and when it goes wrong, I analyze what happened, and try to do everything in my power to prevent it from happening again. I don’t think I need this or that. I have still to live the rest of my life, hopefully with good health, my family, and my profession, for as long as I can do it well. Because the day will come when physically, and maybe even mentally, I will no longer be able to function. If my life ended right now, I’d be satisfied. What’s your message for future doctors, especially neurosurgeons? To be honest with themselves, and the patients. Doctor are not Gods. We cannot save everybody nor guarantee anybody anything, but always try to do things the best you can. That way you
will live with a clear conscience. Try to do good to people, not only from the medical point of view, but also from the human aspect. The patient should feel he has a friend. There are people who come to my office with severe surgical problems, and besides their illnesses, they are anxious, and sometimes what they need, besides a doctor, is a friend to support them.
NEUROSURGERY STANDS OUT How is Colombia in the field of neurosurgery? Colombia is fine. Not only at Fundación Santa Fe, but in general, in Colombia, we have a very good level of neurosurgery, and research in the field. And, of course, very good specialists. Neurosurgery is a specialty that requires fourth level hospitals, with equipment, and the cooperation of a good number of professionals in other areas, like nursing, pathology, laboratory, anesthesiology, radiology. It is a team’s work. It is a satisfaction to know that things are working very well in our country What are the most common problems? I would say half of my patients have problems related to the column, such as pain, hernias, pinched nerves; and the other half are brain problems, tumors, effusions, intracerebral hemorrhages, accumulation of fluid, called hydrocephalia, trauma, accidents, both in the head and spine. That’s more or less what we do. Yesterday, for example, we operated on a lady with a large tumor in the head, today we will operate on another lady with a spinal problem, a pinched nerve that makes the leg painful, tomorrow we will operate a brain aneurysm. That’s our life.
BE HONEST WITH THEMSELVES AND WITH THEIR PATIENTS. WE ARE NOT GOD. WE CANNOT GUARANTEE ANYTHING TO ANYBODY. BUT DO THE BEST POSSIBLE TO HELP PEOPLE“.
Is there a new generation of Jiménez, and Hakim doctors? No. My son is a lawyer, and my daughter is a chef in Australia. Both of them are very happy. My dad was a doctor, my mom’s dad was also a doctor, and perhaps I’ll have to be the last of the family. Everything is a cycle, maybe I was meant to close it. If nothing unforeseen happens I probably have 10 years to go. 70 years that I think made history of neurosurgery in Colombia, not mine, but my dad’s, and my uncle’s.
Si usted es profesional de la salud o usuario de Coomeva Medicina Prepagada A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
piense siempre en
17
March • 2016
as the see it. Almost everyone likes this collection. Tensions in the doctor patient encounters are lowered, and that’s good. I like to work in this environment, it’s different.
…
PREVENTION
Photos and illustration: ®2016 SHUTTERSTOCK PHOTOS
PROMOTION
March • 2016
ZIKA VIRUS, AND MATERNITY:
PREVENTION IS THE ONLY WAY 18 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
THE SITUATION IS HAZARDOUS, AND MOST HEALTH CARE GUIDELINES, AND PREVENTION STRATEGIES TARGET CHILDBEARING AGE WOMEN, GIVEN THE HYPOTHETICAL RELATIONSHIP BETWEEN THIS VIRUS INFECTION AND THE RISK OF MYCROCEPHALY IN UNBORN BABIES. Protección Social announced it expected as many as 5,000 to 6,000 cases per week during the peak of the epidemic. In a briefing during the 138th meeting of the WHO Executive Board its general director, Margaret Chan, expressed great concern about this issue. She gave four reasons: the association of the infection with congenital malformations, and neurological syndromes, like Guillain-Barré; the potential for further international spread given the wide geographical distribution of the vector, a mosquito; the lack of immunity within the population in most affected areas; and the absence of vaccines, specific treatments and rapid diagnostic tests.
MATERNITY PATIENTS ARE AT RISK Doctor Luis Guillermo Uribe R., an internist, epidemiologist, and infectious disease specialist, whom works as chief of the infectious diseases department at Fundación Cardiovascular de Colombia explains, “there is a potentiality that during pregnancy the virus can be transmitted from the mother to the fetus causing brain damage. As a matter of fact, so far it has only been related to mycrocephaly”. “That is a cranial circumference smaller than two standard deviations below the average for age, gender, and gestational age of the baby”, says doctor Alfonso Javier Rodríguez
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March • 2016
T
his virus was first identified in the Zika forest near Kampala, Uganda, almost 70 years ago, in 1947. That’s why it carries the same name. But now things have changed, there is a worldwide alert because of it. As a matter of fact, on February 1st, 2016, the World Health Organization (WHO) declared it a global health emergency. Unusual benign outbreaks occur in Southeast Asia, the Pacific Islands, and Latin America, but this one has grown drastically. In May 2015 Brazil reported its first case, and the disease has spread to more than 22 countries. And in Colombia, Ministerio de Salud y
March • 2016
PROMOTION
PREVENTION
Morales, a tropicalist and a senior researcher at Universidad Tecnológica de Pereira (UTP). And he also clarified, “WHO offers simplified tables that show, for instance, that a full-term male newborn with a cephalic perimeter less than 31,9 centimeters is classified as mild to moderate mycrocephaly. But also severe cases have been diagnosed with measurements well below three standard deviations, less than 30,7 cm”. The decrease in skull size has multiple causes, and it is associated with neurodevelopmental disorders that affect the baby’s learning and motor skills, among other problems. And because of that relationship with mycrocephaly, women have been the focus of most prevention strategies. In Colombia, Ministerio de Salud y Protección Social even made the recommendation to consider postponing pregnancy a few months until the peak has passed around June this year. “This is an unusual but necessary warning”, said Alejandro Gaviria, the health minister at that time. He explained that this suggestion emerged from dialogues with public health authorities all over the world, as well as with epidemiologists and other experts. He also said, “until we find a more effective way to the reduce risk, this is not an improvised recommendation, we are reacting the way we should”. This recommendation was also issued soon afterwards in El Salvador, Honduras, Ecuador, and even in the UK. Also the Centers for Disease Control and Prevention, in the United States, issued recommendations to postpone pregnancy when traveling to Latin America, and the Caribbean, where Zika virus transmission is common. And the American Society of Reproductive Medicine reiterated that since the virus has implications for reproduction and can be transmitted through sexual activity, and reproductive tissues, pregnant women should
DETAILS ABOUT THE ZIKA VIRUS
“T
he Zika virus fever (ZIKV) is an emergent zoonotic febrile disease with a benign acute self-limited course. It has a wild origin, caused by the Zika virus. Its symptoms are unspecific, so it can be confused with other febrile syndromes and, on occasions, can be asymptomatic, or clinically moderate”, is the way Instituto Nacional de Salud al Zika, in its Protocolo de Vigilancia en Salud Pública - Enfermedad por Virus Zika, defined the deseas in its January 21st, 2016, publication, focusing on case definition, surveillance, the state of the art and other subjects. Meanwhile, doctor Alfonso Javier Rodríguez Morales refers to Zika as an emerging disease, and one of the many threats that exist in Latin America and the world, including other virus, like Mayaro, that could also trigger dengue like symptoms. In 1952 the first human Zika virus infection was reported. The pathogen was already identified in 1947, while researchers were studying the causes of yellow fever. The Zika virus is an icosahedral capsid, and its genome is a non-segmented RNA single positive strand. There are two strains of the virus: Africa and Asia. And the Asia strain is the one circulating right now, it has been identified in very diverse places, like Suriname, the French Polynesia, and Sucre, Colombia. The disease has an incubation period between 2 and 12 days after the mosquito bite. And immune response could protect for life, but it is unknown whether it offers cross-protection between the two lineages. The virus has not been found in breast milk. But, on the other hand, evidence suggests it could be sexually transmitted. A case found in Dallas, Texas, suggesting this possibility. However, this is not the main transmission route, it is the mosquito bite.
20 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
IN SEARCH FOR A VACCINE
T
ON HOW TO PREVENT THE AEDES AEGYTPI BITE Prevention is crucial to stop the Zika virus. • The mosquito lives in clean water inside the house, where it can lay its eggs on hard surfaces, but also in areas nearby. • Eliminate mosquito breeding sites in and around the house.
• Clean regularly water storage tanks and pools, and keep them covered. • Wear long sleeves. • Install mosquito nets, use repellent, and put screens on the windows in order to stop the mosquito from circulating. • If you are traveling to a place with Zika virus outbreaks, take extra precautions, stay indoors, with screens, recommends doctor James M. Steckelberg, a physician at the division of infectious diseases in the Mayo Clinic, in U.S. • Get medical attention if you think you, or another member of your family, could have the Zika virus, especially if you have recently traveled to areas where outbreaks have occured. • Remember, many infected patients are asymptomatic, only 1 in 4 is symptomatic. “Some have reported low fever, rash, and muscle pain; others headache, red eyes, conjunctivitis, and malaise”, explains doctor Steckelberg.
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• Sy m p t o m a t i c t re a t m e n t w i t h medicines along with bed rest, and plenty of fluids relieve symptoms, and help coping with the disease.
REFERENCES AND FURTHER READINGS 1. H T T P : // W W W.W H O. I N T/ M E D I AC E N T R E / FAC TSHEETS/ZIKA/ES/ 2. 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 TION=COM_CONTENT&VIEW=ARTICLE&ID=11585&IT EMID=41688&LANG=ES 3. H T T P : / / W W W . P A H O . O R G / H Q / I N D E X . P H P ? O P T I O N = C O M _ D O C M A N & TA S K = D O C _ VIEW&ITEMID=&GID=30177&LANG=ES 4. FILE: /// C: /USERS/PANAMERICANA/DOWNLOADS/ FLASOG.PDF 5. HTTPS://WWW.MINSALUD.GOV.CO/SALUD/PUBLICA/PET/PAGINAS/VIRUS-ZIKA.ASPX 6. HT TP S: // W W W. M I N SALU D.GOV.CO/SITES/RI D/ L I S T S / B I B L I OT E C A D I G I TA L / R I D E / I A / I N S / Z I KA-MAYO-2015-LABORATORIO.PDF 7. HTTPS://WWW.YOUTUBE.COM/WATCH?V=MM2NQYB71Q 8. HTTP://WWW.INS.GOV.CO/LINEAS-DE-ACCION/ SUBDIRECCION-VIGILANCIA/SIVIGILA/PROTOCOLOS%20SIVIGILA/PRO%20ZIKA.PDF
Llame ya al
18000 961338
March • 2016
be cautious if they are planning to become pregnant or participate as donors or recipients of reproductive tissues”. So far, there are only partial results of the preliminary stages of several investigations conducted in different institutions around the world, looking for solutions for this public health problems. Since there is no vaccine nor “a drug that prevents the transfer of the virus to the fetus, there is no other way, for now, other than prevention,” says doctor Uribe.
here are indications that by the year’s end the vaccine against the Zika virus could be available. After documenting cases in many countries, like Colombia, Mexico, Brazil, Panama, Dominican Republic, Haiti, Venezuela, Ecuador, Bolivia, and Paraguay, the interest of researchers and the pharmaceutical industry has grown. For instance, on February 2nd, 2016, Sanofi Pasteur vaccines division announced its plans to research, and development a vaccine aimed at preventing the infection, and the disease caused by the Zika virus.
lo atiende de 7:30 a.m. a216:00 p.m. en jornada continua.
MBE
ZIKA VIRAL INFECTION IS RELATED TO
GUILLAIN-BARRÉ SYNDROME THE GUILLAIN-BARRÉ PROGNOSIS HAS IMPROVED DURING PAST DECADES, BUT EVIDENCE SUGGESTS A RELATIONSHIP BETWEEN ZIKA VIRAL INFECTIONS, AND THIS NEUROLOGICAL SYNDROME.
March • 2016
A
ccording to the World Health Organization (WHO), Guillain-Barré has a prevalence of 0.4 to 4.0 cases per 100,000 inhabitants per year, and “even though it is frequent in adult men, it can affect all age groups”. And the statistical association between Zika viral infection and Guillain-Barré is a major concern worldwide. As a matter of fact, in Colombia it affects 1 to 3 people per 100,000 per year, according to Ministerio de Salud y Protección Social, says Alejandro Gaviria, and weekly Zika viral infections could peek at 5,000 t o 6,0 0 0, m a k ing a grand total of 6 5 0,0 0 0 p r o b a b l e new cases during 2016. While, on the other hand, 1,512 patients with Guillain-Barré have been identified in Cúcuta and Ibagué, and many more are expected in the rest country.
So since last January educational campaigns throughout the country have been directed to health care personnel, in order to prepare them to adequately handle Guillain-Barré patients, and also to raise awareness in the general population about the importance of this complication.
WHAT IS IT? Guillain-Barré is a known syndrome since the mid-nineteenth century. But French doctors, Georges Charles Guillain and Jean-Alexandre Barré, described it during World War I. And since 1937 it has been considered a syndrome with well-known signs and symptoms, even though its causes remain elusive. Doctor Leonardo Palacios, neurology professor at Universidad del Rosario, says “60 to 70% of the people diagnosed with Guillain-Barré have had infectious diseases weeks before”.
22 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
and body proteins could trigger an immunological attack against the nervous system. So it is safe to say that with Zika probably the same thing happens, even though it’s mechanism is largely unknown”. Anyway, if 100,000 people are Zika infected, 24 could develop Guillain-Barré. This conclusion is based on research on blood samples of 42 patients during a Zika outbreak in the French Polynesia, in a paper recently published in the Lancet. “Our results are consistent with that data. They support the idea of adding Zika virus to the list of pathogens capable of causing Guillain-Barré”, said doctor Arnaud Fontanet, professor at the Pasteur Institute, in Paris, France. 23
A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
March • 2016
Photos and illustration: ®2016 SHUTTERSTOCK PHOTOS
Several microorganisms are associated with the syndrome, like gastrointestinal Campylobacter jejuni, and Mycoplasma pneumoniae, but it is also linked with viral infections, such as cytomegalovirus, and Epstein-Barr, that causes mononucleosis, as well as hepatitis, herpes, and even HIV. And now the Zika virus, together with the dengue virus, have been included in this list. And in spite of all this, 30% of the cases have an unknown origin. Doctor Antonio Schlesinger Piedrahita, a neurologist at Clínica Shaio explains that the physiopathological mechanism is yet to be established”. A cross reaction between the virus or the bacteria,
MBE TWO OPTIONS TO HAND
S
March • 2016
everal treatments are available for Guillain-Barré. Plasmapheresis, and intravenous immunoglobulins can reduce the severity of the syndrome, and speed up the recovery of the patient, with good cost benefit ratios. In essence, in plasmapheresis the patient is connected to a machine, very similar to dialysis, that separates blood cells, and plasma, which is then discarded, it is where the damaging antibodies can be found. But, on the other hand, it is a procedure with risks such as electrolyte imbalance, and hypoalbuminemia. Also intravenous immunoglobulins are immune system modulating agents that neutralizes antibodies against myelin, stopping the disease. “These treatments are used when the patient has significant compromise. If it is moderate and can move, the treatment is observation, physical therapy and constant monitoring. But if mobility is impossible, and there is a risk of respiratory complications, then these therapies are indicated”, emphasizes doctor Schlesinger. “Modern resources, like plasmapheresis and intravenous immunoglobulins, and access to intensive care units have reduced mortality rates. Before these treatment modalities, mortality ranged between 10 and 12%, today it has decreased to 4%”, says doctor Palacios.
IT IS AN AUTOIMMUNE SYNDROME Guillain-Barré is an autoimmune disease. “The body develops antibodies against myelin, the outer covering of the peripheral nerves. And this causes an upward and rapidly progressive paralysis, also known as acute demyelinating polyradiculoneuropathy or acute ascending autoimune demyelinating polyneuropathy”, explains doctor Palacios. About 80% of the cases begin with muscle weakness, usually of the lower limbs. And within 5 to 7 days it can affect the trunk, arms, and head. It is an extensive paralysis with paresthesia. Since it is a progressive ascending paralysis, between 4 and 5% of patients can be affected in their respiratory muscles, such as the diaphragm and the intercostals, leading to respiratory arrests. “For all these reasons, when there is a Guillain-Barré suspicion, patients should be referred to a hospital with a high complexity level, where neurologist, intensivist, physiotherapist, and an intensive care unit are available. Some patients may require ventilatory support, and others even a tracheostomy “, says doctor Palacios. Two key diagnostic features of Guillain-Barré are flaccid paralysis, that is muscles atrophy and significantly reduced tone, in opposition to spastic paralysis, and also hiporreflexia, a decline or an absence of muscle tendon reflexes. “In some cases cardiac arrhythmias, and changes in blood pressure, hypotension or hypertension, worsen the patient’s condition, and even cause cardiopulmonary arrest, therefore respiratory and cardiac care is required”, says doctor Enrique Melgarejo, a cardiologist, electrophysiologist, and the
president of Colegio Panamericano del Endotelio. As Guillain-Barré progresses, it usually stabilizes between 4 weeks to 2 months later. Consider this situation requires a hospitalization of up to two months, with rehabilitation and health care. A n y w a y, t h e s y n drome has a better prognosis today than just a few decades ago, although no vaccine nor specific treatment are available. Symptomatic treatment is used, with constant monitoring of the signs and symptoms, in order to avoid complications, and give the patient access to complex support measures, like rehabilitation, caring for the position of the body and limbs, monitoring of the heart and respiratory rates, as well as blood pressure. All this in order to be ready in
24 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
case ventilatory assistance is needed, no matter what time of the day, or the night it is, preventing death by suffocation”, says doctor Palacios.
ADEQUATE CARE FOR PATIENT Doctor Schlesinger points that if a patient arrives with weakness, especially of the legs, and paresthesia of the hands or legs, feeling forceless to the point that walking is difficult, and has also had a recent gastrointestinal infection or a viral disease, the physician must consider the possibility of Guillain-Barré, and start monitoring the patient. Some people cannot even brush their teeth, use the toothpaste tube or drink a glass of water. while others fall down because their legs are too weak. All of these can be symptoms related to diseases like neuropathies, liver ailments, and
diphtheria, but also Guillain-Barré must be considered as part of the differential diagnosis. “The recommendation is to stabilize the patient, install an intravenous line, and refer him quickly to a high level of complexity medical center. It is possible that the conditions deteriorate within the next 24 hours. Ideally to avoid submitting the patient to the
intensive care unit within 4 or 5 days”, argues doctor Palacios. And when the patient is in the clinic several tests are indicated: electromyography, measuring muscular electrical activity, together with nerve conduction speeds, that establish the velocity of the electrical impulse conducted through the nerve. Tests done by neurophysiologists. Also lumbar puncture is used to extract a sample of cephaloraquid fluid, circulating within the nervous system, with characteristic findings of Guillain-Barré. With timely and specialized care patients usually get better, with 100% recovery in most cases. Only few may have some sequelae, like limb weakness, and distal muscular atrophy. Guillain-Barré does not affect mental nor brain function, because it does not involve body of the neuron, only the extensions, the peripheral nerves. Finally, emotional support is important: “They are fully alert patients, but cannot move, communicate nor express their feelings and needs; so a support groups are indispensable”, says doctor Schlesinger.
REFERENCES AND RECOMMENDED READINGS
1. HTTP://CITESEERX.IST.PSU.EDU/VIEWDOC/DOWNLOAD?DOI=10.1.1.460.1123&REP=REP1&TYPE=PDF 2. HTTP://WWW.TELESURTV.NET/NEWS/VENEZUELA-255- CASOS-DE- GUILLAIN-BARRÉ-RELACIONADOS-CON-EL-ZIKA-20160131-0013.HTML 3. HTTP://WWW.BLURADIO.COM/122489/ESPERAMOS-MAS-DE-MIL-PERSONAS-CON-GUILLAIN-BARRÉ-RELACIONADO-CON-ZIKA-MINSALUD 4 HTTP://WWW.ACNWEB.ORG/ACTA/2006_22_2_201.PDF 5. HTTPS://WWW.NLM.NIH.GOV/MEDLINEPLUS/SPANISH/GUILLAINBARRÉSYNDROME.HTML 6. HTTPS://WWW.MINSALUD.GOV.CO/DOCUMENTOS%20Y%20PUBLICACIONES/GU%C3%ADAS%20PARA%20 MANEJO%20DE%20URGENCIAS%20-TOMO%20III.PDF#SEARCH=%252CGUILLAIN%2520BARE 7. HTTP://WWW.WHO.INT/MEDIACENTRE/FACTSHEETS/GUILLAIN-BARRÉ-SYNDROME/ES/ 8. TELLERÍA DIAZ A, CALZADA SIERRA DJ. GUILLAIN-BARRÉ SYNDROME. REVISTA DE NEUROLOGÍA 2002; 34 (10): 966-76. 9. VAN DER MECHÉ FG, SCHMITZ PI. A RANDOMIZED TRIAL COMPARING INTRAVENOUS IMMUNE GLOBULIN AND PLASMA EXCHANGE IN GUILLAIN-BARRÉ SYNDROME. N ENGL J MED 1992; 326 (17): 1123-9.
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March • 2016
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RESEARCH
REPORT
COLOMBIAN INNOVATION FOR DROOPING EYELIDS
OBTAINS A US PATENT
March • 2016
AN OPHTHALMOLOGIST WHO DESIGNED NEW TWEEZERS THAT ALLOW BETTER RESULTS FOR EYELID SURGERY, AND HER PROJECT TURNED INTO AN INNOVATIVE PRODUCT ABOUT TO BE LAUNCHED IN THE NATIONAL AND INTERNATIONAL MARKETS.
Photos: ®2016 SHUTTERSTOCK PHOTOS
I
n office 211 at Clínica de Oftalmología de Cali we can find doctor Ángela María Dolmetsch Cuevas. A thin not too tall lady, concerned with research, and devoted to her profession. She specialized in ocular plastic surgery, and ocular pathology, with a subspecialty in eyelid, orbit and lacrimal surgery, and she has been awarded several times, both nationally and internationally, for her academic achievements, and also for her valuable contributions to ophtalmology. In mid-2015 she received the patent for he innovative design of a tweezers that corrects drooping eyelids, changing dramaticaly the approach to these cases. “Clamps were already in the market. Doctor Allen Patterman, an important oculoplastic, had invented them and patented them in 1976. My innovation consisted in changing its design easing its handling”, says the ophthalmologist. Doctor Dolmetsch Cuevas recalls she learned to use the tweezers during her subspecialty in Canada. “I used them a lot, but found them difficult, cumbersome, traumatic. Although results were good, I thought they lacked a little, sometimes the contour was very flat. So I said to myself: ‘Let’s change the design’, and that’s what I did”. More than eight years ago she began using the modified tweezers: “It’s another tool used to correct ptosis, or
drooping eyelid, a problem that could affect vision”. Dolmetsch Cuevas explains there are two ways to correct drooping eyelids: one externally, on the skin, a surgery that takes about an hour; and the other way is by a posterior approach, which she performs with her creative instrument, a procedure that takes 15 to 20 minutes per eyelid, and can be combined with other surgeries.
In addition to lifting the eyelids, the clamps are also used for blefaroplasty, a surgery that removes excess skin. “In short, the tweezers are versatile, and easy to use,” explains the surgeon. In her daily practice achieving an eyelid brim as natural as possible is very demanding. And her vast professional experience showed her that “what the patient wouldn’t tolerate is lifting the eyelid, if it ends up flat. But
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PROFILE
GETTING THE AMERICAN PATENT “One day a colleague said to me: ‘And why don’t you patent the tweezers’. I asked in Bogota everything about how to do it, but it was extremely expensive, it required a lawyer, and many formalities. And I thought, “I’m not gonna do it”. Then it occurred to her husband to patent the tweezers in the States: “It was much easier, and less bureaucratic. Everything could be done online. We payed and then we just waited, because they have to do a comprehensive analysis of what is already in the market. And finally after 19 months I got a letter saying: ‘Yes, your tweezers are an original design’, and they gave me the patent”. It is clear that the patented instrument is only to be used in oculoplastics, it was created for that specific purpose.
HISTORY OF THE CLAMP Once doctor Dolmetsch Cuevas engineered the new design of the more manageable tweezers, she looked for whom would make the actual instrument with the best quality. “The first four samples were made in Colombia”, she says. Later she participated in a meeting in the States where
she contacted representatives of an Indian Factory. She ordered 10 units. “They were perfect”, she remembers excited. And right now they are in the hands of colleagues, and students. Then, it was only a matter of dynamics, trial and error, and further improvement, until finally their use in clinical practice will be widespread. “Now with this patent, the design is standardized. There is already interest from some companies to manufacture them in series, two of them are making the prototype with German stainless steel, with everything needed. I’m waiting for the results to finally know who is going to make them”, says the surgeon. While talking about the success of the tweezers and the patent achieved, she also notes that she is participating in several researches in the lachrymal, and with children with developmental visual problems, among others. “The most important thing is to find what can be done for the patients, and how can we contribute to the improvement of their quality of life”, he says. So there is no coincidence that the institution for which she works, Clínica de Oftalmología de Cali, is constantly visited by ophthalmologists from abroad who want to learn about these remarkable innovations. “Here we perform surgeries that unseen in other parts of the world”, the specialist concludes proudly.
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B
orn in Cali, she graduated as a doctor in 1989 at the Universidad del Valle, then she specialized in ophthalmology at the same school. She traveled to Canada for two subspecialties, ocular plastic surgery, and ocular pathology at McGill University in Montreal. When she returned, she started working at Clínica de Oftalmología de Cali. She is a member of the American Society of Plastic and Reconstruction Ocular Surgery. She has received several awards, like the Gillingham Scholarship in Ophthalmology in 2004 by the American Association of Ophthalmology. In 2007 the American Academy of Ophthalmology gave her the International Ophthalmology in Education Award. Her is commitment to the welfare, and quality of life of the patients, and she received the Award for Best Scientific Video in 2008, a recognition of Sociedad Colombiana de Oftalmología.
Photos: ARCHIVO PARTICULAR
since the tweezers are round, much like the eyelid, results are usually very good”. Doctor Dolmetsch is passionate about research, and recognizes that she likes to find new methods, and techniques that improve the quality of life for patients, while they are also tools that simplify the surgeon’s task.
ÁNGELA MARÍA DOLMETSCH CUEVAS, MD
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G
March • 2016
ood business practices in health care are essential for responsible quality services, after all patients need to be taken care of in a humane and conscientious manner. And doctors Roberto and David Sabbag, heads at Sabbag Radiologists, in Barranquilla, Atlántico, Colombia, received the ‘Entrepreneur of the Year Award’, acknowledging them as outstanding health care service providers. This distinction was awarded on November 5th, 2015, by María Isabel Mejía, viceminister of Technology and Information Systems, in a ceremony called ‘Premio al Mérito Empresarial’, organized by Universidad Simón Bolívar, honoring entrepreneurs from all over the Caribbean region. They are role models for a whole new generation. Doctor Roberto Sabbag is a general practitioner graduated from Universidad del Norte, in Barranquilla, with a specialization at Universidad
Nacional Autónoma de México e Instituto Mexicano del Seguro Social (IMSS), with subspecialties in neuroradiology at Centro Médico de la Raza del IMSS and Massachusetts General Hospital. On the other hand, David, his brother, is also a general practitioner from Universidad del Norte, and a specialist in Radiology from Universidad Nacional Autónoma de México e IMSS, but with a subspecialty on mammography, and magnetic resonance from Mount Sinai Hospital, at Miami, FL. And profession leadership comes in the veins of the Sabbag family. Their father founded the company in 1957, and after 30 years, Roberto and David started working there as radiologists, and then, as the years passed, they became directors of the diagnostic center, which now operates in two separate sites, providing excellent health care services.
And also part of this legacy has passed on to the next generation of Sabbag doctors. Seven grandsons of the founder of Sabbag Radiólogos are studying right now at the best universities worldwide in order to continue with the enterprise. Soon they will be sharing their knowledge with us, helping all sorts of patients in areas such as radiology, nuclear medicine, and other specialties. Beyond providing quality services, doctors Sabbag have directed their main efforts to give patients a place where they can find adequate and professional treatment. Doctor David Sabbag acknowledges that this award is also for those who work with them, day in, and day out, at the diagnostic imaging centers with such care and commitment. “We receive this award with immense gratitude all we have done is to try to keep our medical services at the highest level”. For Coomeva Medicina Prepagada it is a privilege to work with such accomplished professionals, and to celebrate with them this very important award.
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
FROM
COOMEVA
MEDICINA PREPAGADA
A COURSE THAT NO DENTIST CAN MISS
P
atient safety should always be the most important aspect while working in health care services. So we decided to invite all dental professionals to participate in the intensive 30 hour course called “Handling patient safety in dentistry, and primary care”. It is designed to sensitize the audience on their commitment with the patient’s safety, in order to prevent accidents and adverse events, while strengthening the service culture. It is intended for professionals who work in the health care sector in areas such as assistance, administrative management, quality or control in the public or private sectors,
benefit plans administrators, providers of health care services or independent clinics. Professionals enrolled in the course will have access to seven academic modules:
PROGRAM The course will be conducted in Pereira: Thursday, Friday, and five cities, and professionals will have Saturday from 8:00 a. m. to 6:00 p. m. a choice between several dates: on one weekend. Bogotá: Thursday, Friday, and Saturday, 8:00 a. m. through 6:00 p. m. during one weekend. Course B1 B2 B3 B4 B5 B6 B7 B8
Date April 28 May 26 June 23 July 28 August 25 September 22 October 20 November 24
Course
Date
P1
June 9
Barranquilla: Thursday, Friday and Saturday from 8:00 a. m. to 6:00 p. m. on one weekend. Course
Date
Q1
July 7
Bucaramanga: Thursday, Friday and Saturday from 8:00 a. m. to 6:00 p. m. on one weekend. Course
Date
March • 2016
U1 August 18 Cali: Friday from 2:00 p.m. to 7:00 p. m., and on Saturday from 8:00 a. m. Medellín: Thursday, Friday and to 6:00 p. m. during two weekends. Saturday from 8:00 a. m. to 6:00 p. m. on one weekend. Course Date C1
April 1
Course
Date
C2
May 5
M1
September 8
1. Legal aspects 2. Basics 3. Adverse events prevention 4. Search and notification 5. Causal analysis 6. Patient Safety Program 7. Safe practices
REGISTRATION For those interested, the registration fee is COP$457.000 plus tax. However, Coomeva Medicina Prepagada members. as well as associates to Federación Odontológica Colombiana Seccional Valle del Cauca (FocValle) have an exclusive discount, the price is COP$405.500 plus tax. Bookings can be done contacting the phone numbers 317 8564011 or 318 4722277, and via E mail tutorialsalud@gmail.com, with the participant’s name, identity number, mobile phone number, E mail, course number, and sponsor’s name, either Coomeva Medicina Prepagada or FOC if applicable. After sending the data, you will receive instructions to proceed with the registration and payment. For more information, visit: www.visitaodontologica.com/TutorialSalud.html
30 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
MEDICAL
WORLD
EVENTS
BOOKS ‘A STRANGE FEELING’
‘XVI INTERNATIONAL SYMPOSIUM ON PEDIATRIC NEUMOLOGY AND ALLERGIES’ Date and place: April 22nd and 23rd, Cartagena Information: Clínica Respiratoria y de Alergias Phone: (5) 662 8620 - 674 5182 Email: simposio@clinialergias.com Website: www.simposio.clinialergias.com
‘36TH COLOMBIAN CONGRESS OF OCCUPATIONAL MEDICINE AND OCCUPATIONAL HEALTH ‘ Date and place: May 18th through 20th, Cartagena Information: Sociedad Colombiana de Medicina del Trabajo Phone: (1) 622 0120 - 622 4916 Email: scmt14@outlook.com Website: www.medicinadeltrabajo.org
‘XXXVIII NATIONAL CONGRESS OF OTORHINOLARYNGOLOGY’ Date and place: May 18th through 21st, Medellin Information: Asociación Colombiana de Otorrinolaringología, Cirugía de Cabeza y Cuello, Maxilofacial y Estética Facial Phone: (1) 619 4809 - 619 4702 Email: gerente@acorl.org.co Website: www.acorl.org.co
‘V INTERNATIONAL SYMPOSIUM ON PEDIATRIC UPDATES’
March • 2016
Date and place: July 7th through 9th, Cartagena Information: Sociedad Colombiana de Pediatría Phone: (1) 649 5352 - 746 4706/07 E-mail: eventos@scp.com.co Website: www.scp.com.co
‘THE GREAT DIVIDE’ Author: Joseph E. Stiglitz his time the author emphasizes the great gap between the very rich and the rest. Today this inequality is right in the center of the economic debates, and has become an increasingly pressing issue, even for the privileged 1%, because they are also aware of the impossibility of achieving sustained economic growth if the vast majority of the population has a small income. Inequality is the greatest threat to prosperity.
T
‘A SHIFT IN NEONATOLOGY’ Authors: Manuel Moro Serrano, and Máximo Vento Torres his publication is intended to be a guide for health care professionals on the most innovative aspects of the diagnosis, and treatment in neonatology. It has a quick and easy to read content. Likewise, it is structured through protocols and clinical guidelines designed for action, with reliable tables, and illustrations, as well as up to date references. This is an ideal book for young physicians, and also for those looking to refresh their knowledge.
T
Author: Orhan Pamuk his book tells the story of Mevlut Karatas. A street vendor who lives in Istanbul. From the first moment he is captivated by the old city, as it constantly changes, and a whole new metropolis emerges almost imperceptibly. This vivid narration shows it to the reader, while Mevlut grows, falls in love, and makes a living as a street Boza vendor. However, fate conspires against him. Until a new twist of fate helps Melvut to finally understand what it is he has been longing unknowingly for his whole life.
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‘ULTRASOUND IN THYROID DISEASES’ Athors: José Ignacio Jaen Diaz, Julia Sastre Marcos, and Eugenio Cerezo López rom Editorial Médica Panamericana, this book shows us how, second to diabetes, thyroid diseases are the most frequent illnesses of the endocrine system and, therefore, many people should be involved in its prevention, diagnosis, and treatment. So the purpose of this textbook is to share knowledge about the diseases of the thyroid, and parathyroid glands, using ultrasound. In addition, it offers access to more information through a website where you can find videos and real clinical cases.
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32 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA
MEDICAL
WORLD
MUSIC MOVIES
‘X-MEN: APOCALYPSE’ Director: Bryan Singer Starring: Jennifer Lawrence, Michael Fassbender, James McAvoy, Olivia Munn
‘LOVE AFFAIRS’ Silvio Rodríguez
T
he Cuban songwriter comes along with this new album, his eighteenth, six years after he launched his last work. It included 14 unpublished songs written between 1967 and 1980, and he decided to use a jazz quartet, as well as the symphony orchestra of Universidad de las Artes de Cuba. This album includes songs like “You are right”, “With teen melody”, “Water day”, and “What a distraction.”
Apocalypse, the first and most powerful mutant in the universe, has acquired the powers of many other mutants, becoming immortal, and invincible. Upon awakening after thousands of years, he is upset by the world as it is, and recruits a group of powerful mutants, including the crestfallen Magneto, to purify humanity, and create a new world order, where he would rule. The fate of the Earth is dangling by a thread. So Raven, with the help of Professor X, leads a group of young X-Men to stop the nemesis, and save humanity from destruction.
‘FRENCH SUITE’ Director: Saul Dibb Starring: Michelle Williams, Kristin Scott Thomas, Margot Robbie
‘WONDERFUL CRAZY NIGHT’ Elton John
T
his is an eagerly awaited record by all of the fans of this controversial English musician, whom arrived at his thirty third album. It was recorded at The Village, in Los Angeles, and he himself produced it with T-Bone Burnett. The album has 10 songs, all of them composed by him and Bernie Taupin. It includes songs like “Looking up”, “Blue wonderful”, “Tambourine”, and “In the name of you”.
March • 2016
This is a story based on the bestseller by Irene Nemirovsky. It is set during the German occupation of France in the 1940s. It tells the story of Lucile Angellier, a young woman awaiting news from her husband, a prisoner of war, while living a stifling existence with her mother, a control freak. And a group of German soldiers camp in the city. Bruno, an officer and a gentleman, will with them. Even though Lucile initially tries to ignore Bruno, love will unite them in the midst of the tragedy of war.
34 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA