COOMTACTO VOL.9 (Versión en Inglés)

ISSN 2011-357 9

A MAGAZINE FOR COOMEVA MEDICINA PREPAGADA HEALTH CARE PROFESSIONAL VOL. 9 # 3 � SEPTEMBER 2016

HEALTH UPDATE CANCER PATIENT INTEGRAL CARE,

THE MOST EFFECTIVE STRATEGY

Directed therapies, straight on target, cancerous lung cells | PAG. 8

P P

Mammography myths and realities | PAG. 18

| PAG. 14

EBM To see, discharge the application QR Reader

The dangers of antibiotic abuse for children | PAG. 22

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

Content 26

MERITS A mastology visionary He has recieved several awards for his public campaigns in favor of breast cancer prevention, also for the implementation of techniques and procedures that used to be unthikable for the treatment of this disease, all these achievements have turned doctor elias quintero arango into a founding father and a reference for colombian mastology.

28

RESEARCH INTERVIEW Immune therapy is now a reality as a first line of treatment for cancer

18 5 6 8

MEDICAL ADVANCES Brief notes on recent and innovative medicine.

The genotype is known and also there are new treatments tools, but the initial diagnosis is not easy.

14

FRONTPAGE Cancer patient integral care, the most effective strategy

OUR PLUS A good company Coomeva medicina prepagada, in alliance with gea international, offers users of the gold and gold plus the assistance services through convalescence in case of discapacity.

EDITORIAL

HEALTH UPDATE Direct therapies on lung cancer cells, straight on target

FROM COOMEVA Now your loyalty plan from Coomeva Medicina Prepagada will be +ACTIVA The loyalty plan, a way to acknowledge fidelity, permanence and healthy habits, has changed its name in order to help you take better care of your health as well as your family’s.

33

34 36

COOMEVA BY THE NUMBERS MEDICAL WORLD Specialty congresses, academic and professional meetings, books and movies.

Colombia is a pioner in research, modern technology acquisition and forming multi and interdisciplinary groups, allowing for the timely and adequate cancer treatment, such is the case of oncólogos de occidente.

18

General Manager Coomeva Medicina Prepagada

Editorial board Pascual Estrada Garcés, MD National Health Director

Medical research has desciphered the molecular basis of cancer, and that allows us to develop therapeutic tools in order to treat malignant cells.

32

Jorge Zapata Builes

Martha Liliana Cifuentes National Coordinator of Relationships with the Health Care Professionals Bertha Lucía Varela, MD National Head of Medical Audit Julián Adolfo Villegas National Head of Medical Audit Ana María Correa National Quality Auditor Marco Emilio Ocampo National Medical Auditor Juan Fernando Saavedra National Head of Publicity and Marketing David Montes National Communications Coordinator

Editorial production and printing Legis S.A.

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

PROMOTION & PREVENTION Mammogram myths and realities Digital or conventional mammogram is key to cancer detection, and it also improves the prognosis.

September � 2016

22

EBM The danger of antibiotic abuse for children World health organization (who) is adamant on promoting education, particularly with smaller children, these practices can be very harmfull.

22

Cover foto: Oncólogos del Occidente

4 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

Editorial

A NEW STAGE BEGINS in the

relationship COOMEVA MEDICINA PREPAGADA has with its PROVIDER NETWORK

B

ecause we are aware of the importance of professional integral health care services with the highest quality standards, Coomeva Medicina Prepagada has launched an ambitious project updating and strengthening its management model.

The idea is simply to strengthen our relationship with our health care professional network. After all they are the ambassadors of the brand and fundamental elements of our daily work, allowing us to maintain our leadership throughout the whole country.

The first step was to revise the current dialogue model with our providers in major cities, like: Cali, Bogota, Medellin, Bucaramanga, Barranquilla and Pereira.

Knowing firsthand about their perceptions regarding Coomeva Medicina Prepagada, the brand, both in relation to its audit and contracting practices, as well as the available communication channels and the people that they have contact with, both have bearing in this new stage we have started, and it also gives us feedback, constructive criticism, together with many new ideas for the future.

Only in this way we can know about their expectations, and build value together with them, strengthening our relationships, loyalty, while also facilitating health risk management, strategies directed to our users, ensuring the endurance of our privileged position within the national health care system.

Jorge Alberto Zapata Builes General manager Coomeva Medicina Prepagada

Also we do not want to generate gaps between expectations and needs. Instead we want all of us to use the same language, the language of quality, satisfaction, excellence of the service provided, while fulfilling our duties with satisfaction.

Even as we continue growing, we also believe it is appropriate to review the managerial model in order to support our value proposal for providers and, consequently, guide their continual updating and strengthening programs. And this is why we are keen on this objective.

This process has started. It is part of the CMP strategic plan, in order to generate value from our health risk management model, which includes our provider’s memorable experiences.

However, it is not the first time we’ve done this. We are constantly working as a team in order to strengthen our processes, and redirect others, adjusting and innovating. And all this allows us to respond to the needs of our users, our main daily motivation, not only in order to design new managerial plans, but also to strengthen research, attention and service models.

It is noteworthy that CMP operates with the health care service providers through three components: accompanying, monitoring and relating. And regularly it also carries out surveys in order to measure satisfaction.

We are proud to acknowledge that the results of this assessment of provider’s satisfaction ranged between good and excellent. But we are also far from believing that we have achieved the complete goal. These findings also tell us we must consider new challenges in order to go farther and innovate on a daily basis.

As we have mentioned before, this ambitious project aims at analyzing the relevance, consistency and adequacy of the current model in order to achieve the purposes of the value proposition for providers and, finally, to formulate a proposal that will strengthen or even redefine our current model.

We are certain the project will benefit all of us. The new model, to be implemented, will increase the satisfaction and loyalty of the Coomeva Medicina Prepagada Network, fulfilling our commitment to offering more sustainable value with high ethical standards.

It will also strengthen even more the existing communication mechanisms within the provider’s network, together with the relationship between CMP and the health care professionals. It will allow us to know about their needs with more detail, as well as their preferences and expectations, building even more trust, and strengthening their loyalty.

In order to achieve all of this, we also want to tell you that the whole organization supports this project in order to continue operating effectively, while still remaining the leaders in the voluntary insurance system in Colombia.

5

A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

STEP BY STEP PERMANENT PROCESS

MEDICAL

DEVELOPMENTS

SCIENTISTS HAVE FOUND A WAY TO SILENCE, SORT OF SPEAK, CERTAIN GENES RELATED TO BREAST CANCER In the continued search to cope more effectively with cancer, researchers at Centro de Regulación Genética (CRG), at Barcelona, might have found a way to silence, sort of speak, breast cancer cells when they are hormone dependent, inhibiting gene replication, therefore malignant cell growth while promoting cellular death. This research showed that progesterone, a steroid derived hormone , as many as 1,000 genes could activate malignant cell lineages, while 650 could repress them. Chromatin, DNA in relation to histones and other proteins within the cell nucleus, was analyzed. According to these authors, although this research was done on cultured cancer cells, identifying these genes involved in silencing cancer cells will allow us to identify new targets that will certainly be the basis for future cancer treatments.

HEALING THE FATTY LIVER A re c e n t s t u d y c o n d u c ted by researchers at Unive rsida d d e S antiago d e Compostela (Spain) found in mice a brain mechanism that could cure steatohepatitis, or fatty liver, blocking opioid receptors in specific areas of the brain. The research team worked on the hypothesis that the opioid system in the hypothalamus might also regulate fat metabolism elsewhere in the body, for instance, in the liver.

So inhibiting these brain r e c e p to r s c o u l d r e d u c e inflammation and liver cellular stress, improving this condition.

SOURCE: ARTICLE, “THE PATHWAY ALLEVIATES HVPS34-SGK3 SUSTAINED PI3K / AKT INHIBITION BY MTORC1 STIMULATING GROWTH AND TUMOUR “, PUBLISHED IN THE SCIENTIFIC EMBO JOURNAL. GERMANY. JULY 2016.

CHALLAN GENES COULD BE LINKED TO DEPRESSION

September • 2016

Although depression is an increasingly common mental disorder, little is known about the genetic influence in it. A study conducted at Harvard University found 15 genes could be linked with an increased risk of developing it. Researchers analyzed 121,000 diagnosed or treated patients for the disorder, compared to more than 338,000 people with no history of it. And they found regions in the genome that could give us more understanding on the biology of depression, and will surely help us develop better future treatments.

SOURCE: ARTICLE “IDENTIFICATION OF 15 GENETIC LOCI ASSOCIATED WITH RISK OF MAJOR DEPRESSION IN INDIVIDUALS OF EUROPEAN DESCENT”, PUBLISHED IN THE SCIENTIFIC JOURNAL NATURE GENETICS. STATE UNITED. JULY 2016.

SOURCE: ARTICLE “A BRAIN MECHANISM WAS FOUND THAT OPENS THE DOOR TO THE CURE OF THE FATTY LIVER DISEASE” POSTED ON THE WEBSITE OF THE UNIVERSITY OF SANTIAGO DE COMPOSTELA. SPAIN. JULY 2016.

6 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

NIGHT WORK COULD INCREASE CANCER RISK

ALCOHOL INTAKE

For a long a time an increased risk of developing cancer among night workers has been suspected, even though no plausible cause has been established. A group of biologists at Massachusetts Institute of Technology claim to have found it. According to their research, everything would have to do with a disruption of the circadian cycle due to the overexposure to artificial lights. Two genes identified in mice were related to the cellular circadian cycle, and are also involved in tumoral suppression. Circadian cycle is related to the patterns of light and darkness. So, when these genes are altered by light cycles, cancer risk increases.

Much has been said about the negative effects of alcohol intake on the body, and now lung infection has been added this already long list. Researchers at Loyola University in Chicago (United States) arrived at this conclusion after studying the medical records of 12,000 adults. And they found that regular drinkers had lower nitric oxide levels in their breath, as well as the occasional drinkers, people who take more than four drinks at one time at least monthly. This colorless gas protects against certain types of bacteria, so its lowering could make the patient susceptible to lung infections.

SOURCE: ARTICLE “ WHY WORKING THE NIGHT SHIFT CAN POSE A CANCER RISK”, POSTED ON THE WEB SITE OF THE MASSACHUSETTS INSTITUTE OF TECHNOLOGY (MIT, IS ITS ACRONYM IN ENGLISH). U.S. JULY 2016.

S O U R C E : ARTICLE “ E XHALED NITRIC OXDE LE VELS AMONG ADULTS WITH EXCESSIVE ALCOHOL INTAKE”, PUBLISHED IN THE JOURNAL CHEST. SPAIN. U.S. JULY 2016.

SEVERE BRAIN INJURY COULD BE LINKED WITH PARKINSON’S DISEASE

SOURCE: ARTICLE “ASSOCIATION OF TRAUMATIC BRAIN INJURY WITH LATE-LIFE NEURODEGENERATIVE CONDITIONS AND NEUROPATHOLOGIC FINDINGS” POSTED ON THE SCIENTIFIC JOURNAL JAMA EUROLOGY. U.S. JULY 2016.

7 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

A recent research conducted at the Faculty of Medicine at Washington University suggests that traumatic brain lesions with loss of consciousness may increase the patient’s risk of developing Parkinson’s disease. They studied medical records belonging to 7,000 patients with an average age of 80 years, of whom 865 had suffered head injuries and lost consciousness. They found more than 1,500 suffered either from dementia or Parkinson’s. With this data they suggest there is a link between brain injures and consciousness loss for more than an hour, and the increased risks of these diseases, also a link was found with microscopic stroke risk.

HEALTH UPDATE

DIRECT THERAPIES

ON LUNG CANCER CELLS, STRAIGHT ON TARGET

September • 2016

L

ung cancer is considered worldwide the first death cause related to oncological pathology, both in man and in women. In Colombia, even though there are no consolidated statistics, it is estimated that it is the fourth most frequent neoplasia and the second overall mortality cause, right after gastric cancer.

Doctor Alejandra Cañas Arboleda, an associate professor of Internal Medicine and Pneumology at Hospital Universitario San Ignacio explains “when a patient is diagnosed he usually is in

a stage 4, and the death probability is high because it is an advanced situation. This has to do with several factors, among them, that symptoms usually manifest as other diseases”.

Doctor Andrés Felipe Cardona agrees, he is an oncologist at Clínica del Country and Fundación Santa Fe. He says, in general “6 or 7 out of 10 lung cancer patients debut with advanced forms of the disease”.

Only in smokers over 50 years and with more than 30 packs year, or that have quit smoking during the last 15 years, it is possible to make a crib with

Photos: ®2016 SHUTTERSTOCK PHOTOS

THE GENOTYPE IS KNOWN AND ALSO THERE ARE NEW TREATMENTS TOOLS, BUT THE INITIAL DIAGNOSIS IS NOT EASY.

8 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

9 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

HEALTH UPDATE a low radiation tomography, once a year, trying to identify the disease in its early stages. But for now an initial diagnosis is impossible, like in the cases of breast or cervical cancers.

Huge efforts are being done all over the world looking for blood and genetic markers, perhaps a circulating enzyme or a protein, something that could help.

Anyway, recent intense research has made lung cancer the most studied neoplasm during the last decade, and “it has revolutionized cancer genotypification. Today we know more than 75% of the lung cancer genome, and we now have a new treatment arsenal for it”, says doctor Cardona.

Studies allow us to take into account the digital traces referring to specific tumor genes, the gene receptor for the epidermal growth factor, a molecule discovered over 40 years ago, and also the purification and characterization of its surface cellular receptor, that was achieved in 1980.

Its activity was documented afterwards, mediated by a specific stimulus, and that interaction activates tyrosine quinase, v-erbB, identified as a homologous protein to the avail viral oncogene.

VARIED CAUSES According to doctor Adriana Rojas Moreno, PhD in Sciences and a teacher at Instituto de Genética Humana de la Universidad Javeriana, only 10% of the lung cancer cases can be explained through its genetic causes.

World Health Organization says “tobacco is the most important risk factor, it causes about 22% of the cancer related deaths worldwide, and also close to 70% of the deaths because of lung

THE KEY TO IDENTIFY RISK

September • 2016

T

he general physician is the access door to the health care system for the cancer patients. So that’s why it is so important to familiarize them with the topic. This means “they should be able to establish the patient’s risk factors, the qualities of the pain, if he has hemoptisis or other symptoms, all this in order to stratify the risk involved, and to study it with adequate paraclinical tests, such as X rays”, says doctor Cañas.

Usually, X rays have not been useful for screening purposes, but if the patient has a cough or other symptoms, it helps in the beginning of the study and follow up.

On the patient’s side, it is important go to the doctor if he has a cough for more than two weeks. “At that point he is considered a respiratory symptomatic patient, and should be studied. If he is a smoker, regular checkups should be performed and he should try to quit smoking. Other symptoms, like unexplained weight loss, coughing up blood, prolonged flu like symptoms should also be studied by the physician”.

Even if the patient has smoked he should be educated on the subject, because passive smokers have a 24% increased risk of developing lung cancer.

cancer”. In Latin America it represents the main risk factor, it explains close to 80% of the cases.

And, doctor Cardona continues “over the past two decades we have seen changes within the population, around 26% to 30% of the patients have never smoked or are light smokers who quit, especially among women over 65.

This is explained by exposure to environmental radon, mercury, chrome, nickel, ether and timber combustion smoke, especially in rural areas. We also believe there are associations with the human papillomavirus, the one that has also been linked to cervical cancer”.

Over all, there are some initial lung cancer early symptoms, such as cough, hemoptysis, dyspnea, thoracic pain, dysphonia, asthenia, fatigue and weight loss, but “well over 85% of the cases are diagnosed in stages 3 and 4, and it may also appear as other organ symptoms, which are frequently associated with metastases, such as hip pain or pathological fractures. Perhaps because lungs tend not to produce quick symptoms in the presence of a lump or a mass, because of their own nature and the tissue characteristics, also there are few pain receptors and there are two lungs, so one tends to compensate for the other’s deficiencies”, explains doctor Cañas.

10 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

HEALTH UPDATE DIRECTED THERAPIES For the last several decades, surgery has been predominant for diagnostic purposes, such as taking a biopsy and for the stratification of the lung cancer, as well as for the treatment, quimotherpy and radiotherapy.

But based on today’s genotypification there are directed treatments against specific targets, in other words, against dominant mutations or specific aspects of the tumor. These therapies have increased well over four years the life expectancy of patients with metastasic disease, while a decade ago they only survived six months. A tailor made therapy, says doctor Adriana Rojas, “is not intended for all the patients, because there are several lung cancer causes and they are not always genetic”.

Another change, explains doctor Cardona, “is the use of immunetherapy together with drugs directed to simulate, or eliminate the natural breaks for the immune system, so that it will attack the tumor. This group of treatments has altered cancer second line treatment history for squamocelular and adenocarcinoma, in mos profound ways. And also a new very important subsegment is coming”.

CAR-T cells, or adoptive lymphocyte T transference, are administered to the

patients in order to stimulate the immune system’s favorable responses.

Multidisciplinary treatment groups have been organized, groups that not only guarantee good diagnosis, but also a better treatment, and they include: a general practitioner, oncologist, pathologist, genetist, thoracic surgeon, radiotherapist, clinical psychologists, nutritionist, palliative care specialist, oncological psychologist, pneumologist, as well as other specialists.

“Not all tumor are referred to the same mutation panel. Each one has a different management, according to

WORLD AND LOCAL X RAY

September • 2016

A

nnual lung cancer deaths are equivalent to breast, colon and prostate cancers put together.

Globocan, the World Health Organization agency that reports cancer worldwide, shows a troubling landscape: the incidence/mortality ratio is 0.52, every two minutes a new case is diagnosed and every 4 minutes a patient dies.

Globocan in Colombia reports an increased incidence in Antioquia, the Coffee Region and Bogotá.

Doctor Andrés Felipe Cardona explains: there are around 5.400 new cases yearly, allowing for a 12% to 14% subregistration. The vast majority of the new patients are around 65 to 70 years”.

The most common histological type in Colombia is the big cell carcinoma, or non small cell, and within them the most frequent variety is the adenocarcinoma. The gland producing tumors represent around 63% to 67% of all the lung cancers. The rest are small cell lung cancer.

the tumor’s biology. That’s why group work is important. Treatment is not a standardized recipe. Age, sex, smoking habits, histology and other factors do matter. They allow us to establish a tailor made treatment”, explains doctor Cañas, who together with doctor Rojas, works with a research group on this topic.

“Together with the internal medicine department, the pneumology unit, the medical faculty at Universidad Javeriana and Hospital San Ignacio, we have formed a multidisciplinary group.

We are analyzing the epigenetic relevance on lung cancer progression, after all it is a pathology related to the environment. It doesn’t have to do with mutations, but with deregulated genes in favor of lung cancer”, says doctor Rojas.

REFERENCES AND RECOMMENDED READINGS 1. HT TP S: // W W W. M I N SALU D.GOV.CO/SITES/RI D/ LISTS/BIBLIOTECADIGITAL/RIDE/VS/ED/GCFI/OBSERVATORIO-NACIONAL-CANCER-COLOMBIA-OSPINA-HUERTAS-MONTANO-RIVILLAS.PDF 2. HTTP://WWW.SCIELO.ORG.CO/SCIELO.PHP?SCRIPT=SCI_ARTTEXT&PID=S0120-386X2015000200013 3. HTTP:// W W W.WHO. INT/MEDIACENTRE/FACTSHEETS/FS297/ES/ 4. HTTP://WWW.WHO.INT/CARDIOVASCULAR_DISEASES/ 15032013 _UPDATED_ REVISED_ DR AFT_ ACTION_PLAN_SPANISH.PDF 5. HTTP://GLOBOCAN.IARC.FR/PAGES/BURDEN_SEL. ASPX 6. HT TP : // W W W.C A N C ER .G OV/ES PA N O L / TI P OS/ P U LM O N / P RO/ TR ATA M I ENTO - P U LM O N - C ELU LAS-NO-PEQUENAS-PDQ 7. HTTPS://WWW.MINSALUD.GOV.CO/SITES/RID/LISTS/ BIBLIOTECADIGITAL/RIDE/IA/INCA/PLAN-NACIONAL-CONTROL-CANCER-2012-2020.PDF

12 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

FRONTPAGE

September • 2016

CANCER PATIENT INTEGRAL CARE,

THE MOST EFFECTIVE 14 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

COLOMBIA IS A PIONER IN RESEARCH, MODERN TECHNOLOGY ACQUISITION AND FORMING MULTI AND INTERDISCIPLINARY GROUPS, ALLOWING FOR THE TIMELY AND ADEQUATE CANCER TREATMENT, SUCH IS THE CASE OF ONCÓLOGOS DE OCCIDENTE.

What is the cancer situation in the Coffee Region and northern Valle?

Cancer epidemiology in the Coffee Region and Valle is pretty much the same as the rest of Colombia.

The most prevalent is breast cancer, 15

A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

STRATEGY

Photos: ONCÓLOGOS DEL OCCIDENTEHIVO PARTICULAR

I

n Colombia there are several enterprises that treat high complexity diseases with quality, technological and medical advances, much the same as anywhere else in the world.

“The point”, says César Daniel Aguirre, quality and medical director at Oncólogos de Occidente, a twenty year old organization in the Coffee Region and northern Valle, is “to fulfill the actual legislation requirements, that have been in place for several years now, particularly since 2010 with Ley Sandra Ceballos. It required patients to be handled in an integral manner”. That’s why the board of directors decided to develop units, institutions or clinics that could offer integral services, with “Science and technology with humanity”, is their motto. Today our IPS offers excellence programs in several regions of the country, leading in up-todate technology with its radiosurgery and radiotherapy Elektra Infinity lineal accelerator, and recently made the first cryobiopsy and bronchial cryorecanalization.

FRONTPAGE followed by prostate, gastric and cervix. High prevalence thyroid cancer is also increasing over the years.

And then there is colon cancer, other non melanoma skin malignant tumors, lung and bronchial cancers, rectum and non Hodgkin lymphomas (NH).

One of the short comings in cancer treatment is delayed diagnosis and the difficulty to continue with the treatment, how are these problems being addressed?

There is no doubt in my mind that these have been the main difficulties throughout the world, and Colombia isn’t the exception. It is no secret that depending on the health insurance plan patients have; there will be delays in their diagnosis. Ley Sandra Ceballos, and regulations that

CERTIFICATIONS ARE CRUCIAL PROCESSES

C

ancer innovation is the result of arduous work of large research groups.

They generate new therapies and other advances, while they are also certified as quality process.

“So we have also worked from the quality point of view. Today, Oncólogos de Occidente is certified in all its processes by SGS International, and also in the ISO 9001 norm since 2008, as a matter of fact we have been recertified twice already after that. Every new service we acquire, is included and certified afterwards, as the standard requires. We cover the Coffee Region with several different sites, but we handle them as an integrated network, with standardized processes, benefitting the patients”, says the medical director.

Also, since 2010 we have an Invima certification for the mix central at Manizales, where chemotherapy regimens are prepared for patients all over the Coffee Region. And last year we were certified by Invima in Good Clinical Practices, allowing us to research on drugs in humans. We are the first oncologic IPS in the region to get this recognition. A job that opens new therapeutic possibilities for the patients”, he adds.

September • 2016

came after that, are oriented towards stimulating institutions that handle high cost pathologies, mainly cancer, to use and develop integrality guidelines.

This includes diagnosis, all the therapeutical alternatives, specialized consultations, chemotherapy, radiotherapy, pain management, oncological surgery; with all the related specialties, palliative care, intensive care unit, hospitalization and a mix central offering adequate medicines, among other services.

In other words, we offer all possible services so that the patient’s care isn’t dispersed; the idea is to concentrate it all in one institution in order to guarantee continuity and better results.

But, is this happening in reality or is it just an idea, a law?

We have increased our services throughout the country in order to comply with present laws. We started at Armenia, and then expanded to Cartago, Pereira y Manizales. At Pereira we have a functional unit, and the rest will come afterwards. We have big projects to come.

16 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

PROFILE

Every year we treat more patients, going from 8.700 in 2010 to 18.000 in 2015, 4.600 of them were new cases. We cover 7% of the expected cancer patients in Colombia, grossly 70.000.

Has this brought international patient to your services?

Yes. We have had patients looking for treatment, coming from the United States, as well as from other countries. They are usually remitted by oncologists and various institutions. They arrive looking for high quality services, with adequate professional care and high technology, aspects we ensure with permanent growth and advance programs. For instance, by this year’s end we will have our first medulla transplant, completing our oncohematological cycle.

AN EXCELLENT TEAM

O

ncólogos de Occidente is a multidisciplinary group of psychologists, social workers, oncologists and geriatrics specialists, as well as many more experts in other medical areas. We like to think of them as a family that handles cancer patients in an integral manner.

Nelson Belalcazar Carvajal, is one of the members of the team. He studied medicine at Universidad Javeriana, then he graduated as a surgeon at Universidad Nacional de la Planta, Argentina, he is also trained as a radiotherapy oncologist at Instituto Nacional de Cancerología, and he specialized in brachitherapy also at Cancer Institute Medical University.

Juan Carlos Arbeláez Echeverri is a doctor from Escuela de Medicina Juan N Corpas, a radiotherapy oncologist graduated from Instituto Nacional del Cáncer, Universidad Javeriana, and he is a clinical oncologist. Also Marco Aurelio Franco Villegas, who studied medicine at Universidad de Caldas, is an oncology radiotherapist from Instituto Nacional del Cáncer, and works as a radiotherapist. Jaime Alberto González Díaz, a doctor from Universidad del Quindío, an internist specialized in clinical hematology and oncology at Hospital Militar Central, at Bogotá, and also a fellow in bone morrow transplant from Hospital Universitario de la Princes at Madrid, Spain. He heads the hospitalization service at Armenia.

Also, Diego Emilio López Cortés graduated as a doctor from Universidad del Quindío, he is an internist from Universidad de Antioquia, and a specialist in oncology and hematology, he coordinates hospitalization services at Manizales. Gustavo Adolfo Rojas Uribe is a doctor from Escuela de Medicina Juan N. Corpas, fellow of the departamento of urological oncology at the Tumor Institute at Milan, Italy, and an internal medicine professor in the internal medicine program of Universidad Tecnológica de Pereira.

But this is not the whole story, nine years ago we created Fundación Oncológica del Occidente, in order to offer social services, taking into account that “when a patient has cancer, he requires a psychosocial evaluation, after all his life cycle is being affected, for instance, by the economical aspects that unfortunately tend to interfere with the treatment or simply to get to where he is going to receive treatment, or the morbidity related to the treatment he is receiving, and won’t allow him to continue working, certainly a major issue”, comments doctor Aguirre.

“The Foundation supports these patients”, says doctor Aguirre, “through psychosocial and psychoemotional strategies for the patients and their families, also with economical assistance, musical and laugh therapy (theatrical techniques for laughter and tenderness) as well as yoga as an alternative therapy.

17 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

Are you researching now?

Cáncer research is crucial.

There are advances, innovations and new therapies that will be available to patients progressively. We have important research projects, particularly in lung cancer treatment drugs, one of the 10 most frequent, and unfortunately it is usually diagnosed in advanced stages.

Therapies are directed towards molecular damage causing cancer, so that patients will benefit.

We have around 100 lung cancer patients/year.

In the innovation and technology areas, doctors Jaime Alberto Echeverri and Jaime Sánchez Vallejo, pneumologists at Clínica de Occidente in Pereira, have performed the first bronchial cryobiopsy and cryorecanalization in Colombia, on a patient with a bronchogenic cancer.

And we were also pioneers with our radiosurgery accelerator, as a matter of fact; it is the first equipment of this type in Latin America.

PROMOTION

PREVENTION

MAMMOGRAM MYTHS AND REALITIES

Photos: ®2016 SHUTTERSTOCK PHOTOS

September • 2016

DIGITAL OR CONVENTIONAL MAMMOGRAM IS KEY TO CANCER DETECTION, AND IT ALSO IMPROVES THE PROGNOSIS.

A

mammogram is the pillar of breast cancer early diagnosis, because it is the only proven way in the medical literature of detecting subclinical cancer states”.

With these Words Doctor Luis Guzman Abi-Saab, breast surgeon at the Instituto Nacional de Cancerología (INC ESE), describes how important this test is. “It is crucial to emphasize it”, he insists.

Also it must always be accompanied by a doctor’s exam and by the monthly self-examination.

In Colombia the recommendation is to take a mammogram every two years from fifty to seventy years. However, “if the patient detects, a lump that was not there before, a bloody discharge, she should go to the doctor, so that he can diagnose and treat the case”, says doctor Guzmán.

Now, according to information provided by the INC, there are 38 cases of breast cancer per 100,000 inhabitants, with an age peek for its presentation of 57 years. “Cancer, defined as a clonal disease, that is hormone dependant, and resultsg from the disordered and uncontrolled proliferation of cells, covering the ducts or lobes of the mammary gland tissue” (Care of the cancer patient guidelines, INC–MinSalud)

WHAT IS IT ABOUT? A mammogram is a breast X ray that “is used as a selective test in order to detect, and also a diagnostic test”. Detection studies are performed in order to “search for changes in the breasts in women without breast cancer signs 18 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

YOU CAN’T FORGET A MONTHLY SELF-EXAM

E

xperts at National Cancer Institute, in the United Sates, and Instituto Nacional de Cancerología, in Colombia, recommend women to exam their own breasts, and that they should go to the doctor if they perceive changes. “Self-exam of the breast is intended to find lumps and other changes. Even though this type of exam does not replace selective detection mammograms nor any other clinical breast tests”, they insist.

Even though it is not an early breast cancer diagnostic technique, nor it prevents it, it should be associated with a mammogram and regular visits to the doctor.

Doctor Luz Yadira Nieto explains it should begin with the first menstrual period, and be performed monthly between five and eight days after the menstrual period or at fixed dates if menstrual period dates are unavailable because of the menopause or lactation.

“It must be remembered that all detected changes in the breasts, such as lumps, inflamed adenopathies, pain, warmth, changes in the breast skin color, liquid flow, are considered abnormal and require a visit to the doctor”, she explains.

19 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

and symptoms”. If the last detection mammogram found a change or if the patient finds a “lump that needs evaluation, a diagnostic mammogram is performed, allowing more X rays of the mammary tissue from different points of view”, say experts at National Cancer Institute, in the United States.

Usually a detection mammogram requires two X rays or images of each breast. This allows experts to detect tumors that can´t be palpated, they can even find mycrocalcifications that could suggest the presence of malignant cells, besides lumps and other changes within the breast, even though having them is not always a cancer.

“Early cancer detection with a selective mammogram means that the treatment can start sooner in the disease course, even before it disseminates. Random clinical trials suggest detection selective mammograms are key to reduce the number of breast cancer cases among women between 40 and 74 years, especially for those over 50, allowing for a quick and timely initiation of an adequate treatment of in situ ductal carcinoma (CDIS) that need to be treated”, experts at Instituto Nacional del Cáncer state clearly.

On the other hand, not using mammograms and the delay in the specialist remission are linked to advanced breast cancers, events that limit the possibility of treating and curing it. This is troubling if you take into account that breast cancer can be cured if it is diagnosed on time.

“It is clear that the X ray images allow improved and complete mammary gland visualization. And when abnormalities are identified complementary test are called for, such as sonograms and, in some cases, biopsies are required in order to typify the abnormalities”, explains doctor Luz Yadira Nieto Bustos, a public health specialist.

PROMOTION

PREVENTION

In other situations, magnetic resonance provides detailed images of areas within the breast, even though it doesn’t substitute the mammogram, instead they are complementary, especially in cases when women have greater risk of developing breast cancer, because of mutations in BRCA1 or BRCA2 genes, a breast cancer family history and other variables. Today, certain health

TREATMENT PILLARS

September • 2016

S

urgery, quimotherapy, radiotherapy and hormone therapy are part of the therapeutic alternatives for breast cancer. For instance, hormone therapy is the choice in patients with a positive hormonal receptor.

“Some tumor types can be treated with therapies on precise targets”, points doctor Guzmán, they are part of the treatment and diagnostic guidelines by the Instituto Nacional del Cáncer and Ministerio de Salud y Protección Social para Colombia.

Finally, it must be made clear that options such as the mammary rebuilding are also available for those cases where a mastectomy was performed. Doctor Steven Jacobson, a plastic surgeon at Mayo Clinic in Rochester, Minnesota, explains that this surgery is divided into two categories: the first one uses the patient’s own tissues, they are harvested from other regions of the body to form mammary mounds, and it is called autologous mammary reconstruction; while the second one uses mammary implants to build the breast.

care centers and hospitals offer conventional mammograms in prints, but they also offer digital mammogram. Experts say the process is similar, it only varies in “the way images are recorded and stored”.

An investigation sponsored by National Cancer Institute suggested that: “Digital mammograms and conventional mammograms are practically the same, in terms of their capacity to detect breast cancer. However digital mammograms can perform better

detecting cancers in women under 50 years, whose breasts are very dense or are in the premenopausal period or the perimenopause”. Anyway, even though it is a high sensitivity test, there can be false negatives, in other words, normal results when in reality the patient had a cancer. This could happen in women whose breasts have high densities. But, on the other hand, in a high percentage of the cases, in over an 80% of them, it has a high specificity.

YOU SHOULD KNOW

I

nstituto Nacional del Cáncer and Ministerio de Salud y Protección Social para Colombia have developed protocols, guidelines, books and other publications on cancer, particularly on breast cancer, such as “Protocolos para el manejo del cáncer” and “Guía de Práctica Clínica” (GPC) for early detection, integral treatment, follow up and rehabilitation of breast cancer patients (19th guide). And they can be found at http://www.cancer.gov. co/ or at www.minsalud.gov.co These publications establish “mammograms are still the screening pillars for breast cancer, and there’s little controversy, mammograms reduce by 23% the mortality risks related to breast cancer among women between 50 and 69 years, even though damage related with false positive and overdiagnosis decrease the mammogram’s net benefit”.

Screening is recommended on the base population classified according to the two projection mammographic results every two years in women between 50 and 60 years, included in a detection, diagnosis and opportune treatment program for breast cancer.

REFERENCIAS Y LECTURAS RECOMENDADAS 1. HTTP://WWW.CANCER.GOV/ESPANOL/TIPOS/SENO/INVESTIGACION/TAILORX-RIESGO-BAJO 2. HTTP://WWW.CANCER.GOV/ESPANOL/TIPOS/SENO/HOJA-INFORMATIVA-MAMOGRAFIAS 3. HTTP://WWW.CANCER.GOV.CO/CONTENT/GLOSARIO-CL%C3%ADNICA-DE-SENO-Y-TEJIDOS-BLANDOS 4. HTTP://CANCER-CODE-EUROPE.IARC.FR/INDEX.PHP/PT/12-FORMAS/RASTREIO/RASTREIO-DO-CANCRO-DAMAMA/1600-O-QUE-ACONTECE-SE-O-RESULTADO-DA-MINHA-MAMOGRAFIA-FOR-ANORMAL 5. GUÍAS DE PRÁCTICA CLÍNICA EN ENFERMEDADES NEOPLÁSICAS, INC – MINISTERIO DE SALUD Y PROTECCIÓN SOCIAL, EN: HTTP://WWW.CANCER.GOV.CO/FILES/LIBROS/ARCHIVOS/GUIAS 6. HTTP://WWW.CANCER.GOV.CO//FILES/LIBROS/ARCHIVOS/F670452CA9B4CCA55EFF025B8E8FFE2C_POTOCOLOS%20DE%20MANEJO%20DEL%20PACIENTE%20CON%20C%C3%A1NCER.PDF 7. HTTP://WWW.CANCER.GOV.CO/ 8. GUÍA DE PRÁCTICA CLÍNICA (GPC) PARA LA DETECCIÓN TEMPRANA, TRATAMIENTO INTEGRAL, SEGUIMIENTO Y REHABILITACIÓN DE PACIENTES CON CÁNCER DE MAMA. SISTEMA DE SEGURIDAD SOCIAL, COLOMBIA, 2013.

GUÍA NO. 19, EN: HTTP://GPC.MINSALUD.GOV.CO/DOCUMENTS/GUIAS-PDF-RECURSOS/MAMA/GPC_COMP_ MAMA.PDF

20 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

EBM

September • 2016

THE DANGER OF ANTIBIOTIC

ABUSE FOR CHILDR 22 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

Photos: ®2016 SHUTTERSTOCK PHOTOS

W

REN

ell used antibiotics can save lives, there’s no argument about that.

The problem lies in their misuse, causing serious difficulties yet to be measured.

So that’s why the World Health Organization (WHO) does not only research on the impact of antibiotics, but also on the effects of their indiscriminate use, and continually highlights poor practices in their use in order to educate. As a matter of fact, a few weeks ago the latest report appeared, intending to avoid antibiotic abuse on babies and young children, a practice that favors inflammatory bowel disease because it alters normal microorganism flora, and subsequent pathogen proliferation.

“WHO is an agency dedicated to promoting health, and has already alerted on the emergence of multiresistant bacteria, in some cases they can be resistant to all available antibiotics. This is important. They kill while we are helpless”, says professor Enrique Gutiérrez Saravia, pediatric infectologist, and a member of Sociedad Colombiana de Pediatría as well as Sociedad Colombiana de Infectología.

Results in two recently published papers in the journal Science Traslational Medicine agree on that. The first one came from a research group at New York University, following 43 babies for the first two years. They found altered normal microorganism flora, with genomes that make them resistant to antibiotics.

23

A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

WORLD HEALTH ORGANIZATION (WHO) IS ADAMANT ON PROMOTING EDUCATION, PARTICULARLY WITH SMALLER CHILDREN, THESE PRACTICES CAN BE VERY HARMFULL.

EBM ANTIBIOTICS ARE USEFULL AGAINST BACTERIA, BUT NOT VIRUS Another publication, from Massachusets University and the Broad Institute, studied 39 finnish children during the first three years. They also found resistance gene activation in the microorganisms, even though the babies fared well when they were treated.

RESISTANCE WHO, together with Ministerio de Salud y Protección Social and local Health secretaries in Colombia, have initiated campaigns and other initiatives to promote adequate use of medicines, particularly of antibiotics.

“In childhood”, says doctor Gutiérrez, president of the Andean chapter of Sociedad Latinoamericana de Infectología Pediátrica (SLIPE), “antibiotic

THE WHO REPORT

September • 2016

“A

ntimicrobial resistance: global report and surveillance” empathizes seven dangerous bacteria antibiotic resistances, because they are considered responsible for common and severe infections, for instance septicemia, diarrhea, pneumonia, urinary tract infections and gonorrhea.

The document includes aspects like: - Resistance to carbapenemic antibiotics, last resource medicines against potentially deadly infections like Klebsiella pneumonia, pneumonia, septicemia and newborn infections, and it is also used on intensive care unit patients. As a matter of fact, in some countries carbapenemic antibiotics are useless.

- Resistance has developed considerably since the 1980s, when fluoroquinolones widespread use started. It a class of antibacterials widely used for urinary tract infections by E coli.

Prior to this report, WHO had already analyzed regional antimicrobial resistances. They found in Africa increasingly resistant E coli and S aureus.

Meanwhile Organización Panamericana de la Salud, acting as a WHO regional office for the Americas, has collected data on antibiotic resistance in hospitals and laboratories in 21 countries in the region. For now, it is clear that: “There is a high incidence of resistant E coli to fluoroquines and third generation cephalosporines in the Americas. An it is troubling that these are two important and frequently used classes of antibacterials”, states the report.

misuse or abuse, induce and favor resistant bacteria generation, and worst yet, multiresistant strains”.

“Resistance is a bacterial mechanism that interferes with antibiotic’s action mechanisms, so they lose their effectiveness against infectious diseases they used to cure. Therefore, as time goes by, it turns out it is harder to control infectious diseases with antibiotics”, tells us doctor Darío Botero Cadavid, a pediatritian and a puericultor.

On top of the multiresistant bacteria generation, inadequate and indiscriminate antibiotic use is linked to adverse and secondary effects, such as diarrhea, since normal intestinal bacterial flora is also altered.

Regrettably, as stated in WHO’s “Antimicrobial Resistance: global report on surveillance”, a publication based observations on 114 countries, the most general and complete available document of this sort: “resistance affects many and varied infectious agents, and it is not just a future menace, it is a real

24 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

IDENTIFY ALERT SIGNS

A

ON THE RIGHT MOMENT In children, whom are developing their own defense system, “the vast majority of infectious diseases are viral, such as diarrhea, upper respiratory infections, meningitis, and they usually present themselves with fever, in spite of that many people, including some doctors, tend to use antibiotics, without a proper indication”, insists doctor Gutiérrez.

Antibiotics should be used only when they are required. “This is a group of invaluable medicines for the

treatment of bacterial infections. But most infectious diseases tent to be viral, so they don’t need antibiotics”, explains doctor Botero Cadavid.

Besides, “it is important to take into account that antibiotics should always be prescribed by a doctor who has evaluated the patient’s clinical condition. And the prescription should include the dosage, along with the duration of the treatment”, says doctor Pio López, a pediatric infectologist and the president of Asociación Colombiana de Infectología.

So, only when the doctor, not other people, nor an informal conversation,

deems it is a case of a bacterial infection it is prudent to use these type of therapeutic tools.

REFERENCES AND RECOMMENDED READINGS 1. HT TP:// W W W.WHO. INT/MEDIACENTRE /NEWS/ RELEASES/2014/AMR-REPORT/ES/ 2. HT TP : / / W W W.WH O. I N T/ B U L L E T I N / VOLUMES/89/8/10-084715-AB/ES/ 3. HT TP : //APP S .WH O. I NT/M ED I C I N ED O C S/ES/D/ JS2250S/3.2.HTML#JS2250S.3.

4. BOLETÍN DE MEDICAMENTOS ESENCIALES - NO. 28 Y 29. EN HTTP://APPS.WHO.INT/MEDICINEDOCS/ES/D/ JS2250S/ 5. QUICK JD, RANKIN JR, LAING RO, O’CONNOR RW, HOGERZEIL HV, DUKES MN, GARNETT A, (EDITORS).

1 9 97. MANAG ING DRUG SU PPLY. 2N D ED. WEST HARTFORD CT: KUMARIAN PRESS. 6. H T T P : / / S T M . S C I E N C E M AG . O R G / CONTENT/8/343/343RA82 7. H T T P : / / W W W.W H O . I N T/ B U L L E T I N / VOLUMES/88/11/10-031110/ES/

25 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

and present threat that could affect anybody in any country”.

A Colombian research by Universidad Nacional on the impact of antibiotic use and bacterial resistance, surveyed 17 hospitals linked to Red Distrital de Salud Bogotá. Their findings were troubling and surprising.

“Patient mortality and hospitalizations increased by 14%, and it was related to the use of this type of medicines”.

suggestion for health care professionals is to teach parents that “that they can learn to identify signs of severe illness, because parents know their child very well, and then go the medical facilities. If the child vomits, losses appetite, is sleepy or doesn’t wakeup easily, if he looks downtrodden or has been feverish for more than 3 days, if he has shortness of breath without a fever, it is prudent to go to the doctor”.

Also, the doctor points out that “a spoonful of kisses is important, together with hugs, patience, avoiding non prescribed drugs, especially unjustified antibiotics. Also follow the doctor’s indications regarding doses, and measuring them precisely with a syringe, and carefully follow the schedule, for as long as it takes, also do not force the child to eat beyond what he wants, nor take him to the nursery or school while sick, and always look for the alarm signs I mentioned above”.

According to different WHO publications, other important strategies in “preventing infections are improving hygiene and access to drinking water, also infection should be controlled in health care facilities, and use adequate vaccination schemes. All these measures reduce the need for antibiotic”.

Everybody can contribute with their own daily habits, such as “using only prescribed antibiotics, follow the recommendations for a complete treatment, never use non prescribed medicines nor recommend or give antibiotics to other people, also never use past prescription residues”, suggests the specialist.

On the other hand, pharmacists and other health care related workers suggest “it is also helpful to improve prevention and infection control, prescribing and dispensing antibiotics only when they are adequate and necessary in order to treat the specific disease.

So “well used antibiotics can save lives, however, when they are poorly used they favor the emergence of mutirresistant bacteria, limiting their usefulness when the time comes they are truly necessary. Resistance appears at any age, even in newborns. And if the antibiotic is used for a shorter period than the doctor prescribed, resistance is also generated”, explained doctor Pío López.

MERITS

A MASTOLOGY VISIONARY HE HAS RECIEVED SEVERAL AWARDS FOR HIS PUBLIC CAMPAIGNS IN FAVOR OF BREAST CANCER PREVENTION, ALSO FOR THE IMPLEMENTATION OF TECHNIQUES AND PROCEDURES THAT USED TO BE UNTHIKABLE FOR THE TREATMENT OF THIS DISEASE, ALL THESE ACHIEVEMENTS HAVE TURNED DOCTOR ELIAS QUINTERO ARANGO INTO A FOUNDING FATHER AND A REFERENCE FOR COLOMBIAN MASTOLOGY.

September • 2016

Photos: GERARDO GÓMEZ

E

ven though he used to have a fascination with architecture, his performance in mathematics was found wanting, so he desisted, and instead opted for medicine, his school grades were much better in science.

At first he thought of being a pediatric surgeon, in tumor area, but a problem with that particular program at Universidad de Caldas, where he studied his undergraduate years, and the advice of a roommate, helped him decide to travel to Bogotá to study breast surgery and soft tissue tumors at Universidad Javeriana, after his stay at Instituto Nacional de Cancerología, where he still works after 35 years.

As a matter of fact, it is self-evident that he always wants to help others, something he learned from his parents: Elias Quintero Vallejo and Leticia Arango, whom with good example and devotion for community work have always been loved at Manizales, his birth town. “We were six brothers and sisters, and I can still remember the line of people waiting for my mother to give them food. As a matter of fact, some people used to sit in the living room and have lunch. And that’s where I learned about charity”, tells us doctor Quintero. So it is not weird to find him leading breast cancer prevention campaigns three or four times a year, at San Andrés as well as in other places like Casanare or Meta.

Doctor Elias Quintero has received many awards. He was awarded ‘Maestro de la Mastología Latinoamericana’ by Asociación Colombiana de Mastología, an organization he founded, and by Federación Latinoamericana de Mastología, in 2015. He was also elected in 2001 as the best teacher at Instituto Nacional de Cancerología, and this is the award he appreciates the most. In 1996 the San Andrés, Providencia and Santa Catalina provincial government

chose him as an illustrious visitor to the archipelago, for the campaigns he has lead during the past 27 years together with Liga Contra el Cáncer, for breast cancer prevention in that region of the country, where these disease has a high incidence.

Also, he was awarded as a pioneer for his participation as a lecturer and as part of the oncology program in these Colombian islands. Among his achievements, he is the first doctor in the country to ever use breast ultrasound without being a radiologist,

WE INVITE OUR HEALTH CARE PROFESIONALS to share with us your research, academic or community experiences.

This way we can enrich this section, while publishing your professional achievements and developments. Write to us at prestadores_coomeva@coomeva.com.co 26 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

now with the approval in Congress of Ley de Radiología, that allowed trained physicians, other than radiologists, to use sonograms within their specialties, such as surgery, anesthesiology, ophthalmology, breast surgery.

He was also the first in the country to use the sentinel ganglion technique for melanoma and breast cancer treatment. Together with doctors Jaime Gómez, Rafael Gutiérrez and Emilio Forero he promoted in Colombia and Latin America mammary gland conservative surgeries.

Additionally, he worked on reconstruction with musculocutaneous grafts with doctors Miguel Orticoechea and José Robledo.

Inspite of his titles, awards and accomplishments, doctor Quintero assures his major achievement was precisely to transmit all that he has learned: “being able to educate

several generations of breast surgeons and oncologists in the country and abroad, teaching them chirurgical techniques and other things

I have been able to learn, has been my greatest achievement, an accomplishment that makes me proud”, he concludes.

RESEARCH

INTERVIEW

IMMNUNE THERAPY IS NOW A REALITY AS A FIRST LINE

OF TREATMENT FOR CANCER MEDICAL RESEARCH HAS DESCIPHERED THE MOLECULAR BASIS OF CANCER, AND THAT ALLOWS US TO DEVELOP THERAPEUTIC TOOLS IN ORDER TO TREAT MALIGNANT CELLS.

D

uring the past decades cancer diagnostic strategies and treatment alternatives have evolved dramatically because of the enormous advances in clinical research.

So it is not a utopia any more to aspire to know more about this disease. As a matter of fact, every day we learn a great deal about how normal cells change into malignant, and then proliferate “up to the point of forming a mass, in the case of solid tumors, or an increase that eventually interferes with blood cell production, like in the case of hematological tumors”, explains doctor Marcela Urrego, an oncohematologist and lead researcher at Centro Médico Imbanaco, in Cali.

Among these innovations we can count the discovery of the “molecular process” and then the “development of treatments directed against specific cellular targets, activating or blocking tumoral mechanisms in the cells that allows them to escape the processes that normally govern replication”, the researcher explains.

IMPROVED THERAPEUTIC TOOLS

September • 2016

But there have also been advances in the development of medicines against specific molecular WE INVITE OUR HEALTH CARE PROFESIONALS to share with us your research, academic or community experiences.

This way we can enrich this section, while publishing your professional achievements and developments. Write to us at prestadores_coomeva@coomeva.com.co 28 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

PERFIL

DAILY SPECIALIZATION

D

octor Marcela Urrego was born in Bogotá, and she is the mother of two children. She always strives to discover something new every day; she considers it the essence of life itself.

And also enthusiastically she says she discovered water skiing during the past decade, and now it is her favorite pastime, especially at Lago Calima.

She is an oncohematologist, a passion for her, and a topic she is always researching on. And it happens that a year ago she received her master’s degree on Molecular Oncology, the point of it was to strengthen even more the research team at Centro Médico Imbanaco. Doctor Urrego says: “it is important to be on the cutting edge of treatment alternatives in order to support the diagnostic area, that can already offer laboratory tests such as the flux cytometry, PCR and cytogenetics, as well as hybrid images like PET/CT, and very soon we will have a molecular pathology laboratory that will allow us to reunite all of our efforts for the benefit of cancer patients. But all this has been done with the basis of a team that is committed to the values of our institution, where quality and service are our major goals”. On the subject of her main contribution to the area, she considers it has been “to search and participate in the conformation of a model for integral attention at our institution, so in cooperation with specialist in other areas, particularly, in surgery, several academic interdisciplinary discussion groups have evolved, such as Oncologic Gynecological Meeting, Head and Neck Tumors, Breast Cancer and Lung Cancer.

Spaces where we have an opportunity to discuss complex cases, and decide on the best possible therapeutic alternative; and all of this is integrated with the goals of the Colombia for all integral attention model.

29 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

Photos: ®2016 SHUTTERSTOCK PHOTOS

mechanisms. For instance, some have achieved “that the tumor becomes unable of producing the vasculature that it would eventually need to form a nourishing network that would make it self-sufficient. These are molecules against the vascular endothelium growth factor”, explains the specialist.

Other advances allow us to “block membrane receptors, a strategy most frequently used in breast cancer treatment, for instance with therapies against the HER2 receptor, a biochemical highway that orders the cellular nucleus of the cancer cell to proliferate, to grow”, says doctor Urrego.

Furthermore, it is possible to say breast metastasic cancer treatment has been transformed; excellent news for patients because life expectancy, as well as quality of life have improved significantly.

The key is to develop “molecules with a molecular basis that can then be linked to chemotherapeutical drugs that would work cheating, sort of speak, malignant cells, much like a Trojan horse. It is the combination of a smart molecular mechanism with a less specific agent, such as chemotherapy”, she adds.

At Centro Médico Imbanaco, she explains, we have been able to work in a very special research facility, based on the scientific production and the analysis of our own data, thanks to the daily activities of our multidisciplinary specialized team with the patients. A challenge that has also been creative: for instance, a year ago Programa de Protección de Humanos en Investigación, an initiative to protects the wellbeing of patient participating in research, based on models used at hospitals and other organizations that work together with Yale, Tulane, Harvard and Kent.

With the collected data, for more than 6 years, they have been able to compile an interesting descriptive study based on 366 patients, and among them 20% are HER2 positive.

RESEARCH

INTERVIEW

“We have been able to establish how progress in pathology research allows us to improve our diagnostic ability for these histological subtypes, enabling our medical personnel to direct high technology therapies on to specific molecular targets, such as HER2 positive breast cancer”, concludes the researcher.

OTHER RESEARCH AREAS

C

ancer research processes and results have stimulated Centro Médico Imbanaco to create investigation lines in oncology under the tutelage of its Research Center.

“Since 2009 we have participated as a center in several research protocols on melanoma in patients with an alteration in a section called BRAF V600, using immunotherapy, considered, perhaps, the major hope for future oncology. In other words, we have been able to tinker with that complex milieu of the organism’s hematological defense system. With lymphocytes, modulating them, it is possible to activate them in ways that can destruct specific cellular lineages”, emphasizes doctor Urrego.

And she adds, “we have also participated in advances such as the applications of subcutaneous medicines, like in the case of trastuzumab, a drug widely known in breast cancer treatment. A molecule that can now be easily applied, comfortably and quickly, plus the patient doesn’t have to stay 1 or 2 hours at the chemotherapy waiting room, a time he could most probably use in a more fruitful way. Not to mention the anxiety that chemotherapy waiting rooms can cause with all their uncomfortable procedures”.

So, in a way, immunotherapy is already a reality as a first line alternative for melanoma treatment, even over chemotherapy, also with less secondary effects, and a much more acceptable toxicity profile.

A LOOK AT MOLECULAR ONCOLOGY

September • 2016

D

octor Marcela Urrego participates actively in multicentric local, national and international research protocols involving clinical oncology and hematology.

The whole point is to provide sound scientific bases that will benefit future therapies that will certainly change the way cancer is treated, especially in advanced incurable stages, improving the patient’s life expectancy.

“Someday cancer will be controlled, particularly in the early stages, using molecular biology”, muses doctor Urrego.

It is her opinion “molecular oncology formation is not only useful for the treatment areas, it is also helpful for diagnosis and precise tumor detection, with specific therapeutic targets. These objectives make it

easier to use these very expensive technologies, and therefore very difficult to implement in a country like ours, with limited access to it; but also it is a situation that requires the commitment of all actors in order improve cancer treatment, be it government, scientific societies, health care providers, the pharmaceutical industry, physicians”.

For specialists “the objective is to use their knowledge in order to promote through their medical autonomy the possibility that the patient will be able to use all these tools, in order to offer the best alternatives available in the country, be it in the national health care system or creating a research culture in our institutions, so that scientifically useful molecules can be used by all cancer patients”, she concludes.

30 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

FROM

COOMEVA

MEDICINA PREPAGADA

NOW YOUR LOYALTY PLAN FROM COOMEVA MEDICINA PREPAGADA WILL BE THE LOYALTY PLAN, A WAY TO ACKNOWLEDGE YOUR FIDELITY, PERMANENCE AND HEALTHY HABITS, HAS CHANGED ITS NAME IN ORDER TO HELP YOU TAKE BETTER CARE OF YOUR HEALTH AS WELL AS YOUR FAMILY.

T

things, and therefore they take good care of their health. So they have the possibility to participate actively in our campaigns to improve healthy life habits through +ACTIVO. That’s why we want to invite you to ‘activate’ yourself with this loyalty plan, where you can even receive prices for participating in health campaigns.

On the same token, you will continue accumulating PINOS, and you will be able to redeem them afterwards as prices, such as experiencess or products.

REGISTER AND EXPLORE! 1. Go to our web page: https:// masactivo.pinoscoomeva.com or call the National land line 018000-189992, option 3.

2. Fill in the requested information, as well as your family’s, only if they are Coomeva Medicina Prepagada users.

3. Start participating in several campaigns.

Photo: ®2016 SHUTTERSTOCK PHOTOS

September � 2016

he new brand +ACTIVO is the result of a collective building process within Coomeva Medicina Prepagada, concerned with the vitality, wellbeing, opportunity, happiness, health and care. With this evolution we want to underscore the importance of having a more active attitude towards health care, with more actions, and overall prevention.

Our plan still acknowledges disciplined users that take periodical medical checkups, and also assist to promotion and prevention activities, among others

32 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

Photos: ®2016 SHUTTERSTOCK PHOTOS

OUR PLUS

A GOOD COMPANY COOMEVA MEDICINA PREPAGADA, IN ALLIANCE WITH GEA INTERNATIONAL, OFFERS USERS OF THE GOLD AND GOLD PLUS THE ASSISTANCE SERVICES THROUGH CONVALESCENCE IN CASE OF DISCAPACITY.

In case of a disability for more than three days, users are entitled to request the following services: • Transportation to medical appointments: up to six events per year.

• Company for appointments, laboratories and other tests, for up to three hours; the service is unlimited.

• Messaging convalescence: a journey per day, and this service is unlimited.

• Legal telephone orientation: limited.

PLUS, YOU MAY OBTAIN OTHER BENEFITS WITHOUT BEING DISABLED: Husband substitute TV installation, door repair, minimal painting and other minor chores: three events per year up to a combined total of $ 300,000.

Technological phone assistance* Telephone counseling in order to solve questions on the configuration, diagnostics and advice on issues

related to the PC, tablet or iPad: unlimited; 30 minutes maximum per event.

In order to request the service, you can communicate by telephone: From Bogotá: (1) 743 1222 National line: 018000-183222* *Conditions and restrictions apply. In some towns these services do not apply, so reimbursement is the way to go, prior authorization by GEA. * This service is provided Monday through Friday, 9:00 a.m. to 6:00 p.m. Calls received outside of the schedule will be programmed again according to the availability of the technician.

Find out more about conditions and restrictions of this service in our website: www.medicinaprepagada.coomeva.com.co

33 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

CONVALESCENCE ASISTANCE

COOMEVA BY THE NUMBERS INTEGRAL MEDICINE POPULATIONA UP TO JUNE 2016, BY SE

MEDICINA PREPAGADA

AMOUNT

106.141 AMOUNT

135.622 Program

ACTIVE POPULATION 76.828 UPTO JUNE 2016 MI 80.000 70.000 80.000 60.000 80.000 70.000 50.000 70.000 60.000 40.000 60.000 50.000 30.000 50.000 40.000 20.000 40.000 30.000 10.000 30.000 20.000 0 20.000 10.000 10.000 0 0

76.828 76.828

49.760

69.030 69.030

Gold Plus

29.857 29.857

10.583

Regional Cali Cali Regional Cali

5.668 37 10.583 5.668 10.583 Regional Regional 5.668 Regional Regional Regional 37 Medellín Santander Caribe Eje Internacional 37 Caribbean Cafetero Coffee International Medellín Santander Regional Regional Regional Regional Regional Caribe Eje Internacional Medellín Santander SUBTOTAL Cafetero

ACTIVE POPULATION UP TO JUNE 2016 CEM

241.763

35.667

35.000 28.282

30.000 35.000 25.000 35.000 30.000 20.000 30.000 25.000

35.667 35.667

28.282 28.282

15.000 25.000 20.000 10.000 20.000 15.000

12.990

5.000 0 0

Regional Bogotá Bogotá Regional Bogotá

10.542 7.939 4.942 4.852 4.577 4.207 1.996 1.128 1.120 550 68 241.763

11.463

12.990 12.990

5.000 15.000 10.000 0 10.000 5.000

Amount 155.408 44.434

Golden Years Gold Classical Traditional special HCM Traditional Associates Classical Golden Years Silver Silver Golden Years HCM Golden Years Total

49.760 49.760

29.857

Regional Bogotá Bogotá Regional Bogotá

69.030

Gold Young silver

11.463 11.463 Regional Cali Cali Regional Cali

Regional Caribe Caribbean Regional Caribe

11.467

6 6 Regional Eje 6 Coffee Cafetero Regional Eje Cafetero

Regional Medellín Medellín Regional SUBTOTAL Medellín

84.408

ACTIVE POPULATION UP TO JUNE 2016 SAO 12.000

10.000 12.000 12.000 8.000 10.000 10.000 6.000 8.000 8.000 4.000 6.000 6.000 2.000 4.000 4.000 0 2.000 2.000 0 0

7.157

11.467 11.467

6.491

7.157 7.157

4.273 4.273 4.273

Regional Bogotá Bogotá Regional Bogotá

Regional Cali Cali Regional Cali

Regional Caribe Caribbean Regional Caribe

2.452 2.452 2.452 Regional Eje Coffee Cafetero Regional Eje Cafetero

6.491 6.491 1.268 1.268 1.268 Regional Santander Santander Regional Santander

Regional Medellín Medellín Regional Medellín

SUBTOTAL

33.108

363.279

TOTAL

GENERAL AND SPECIALIZED MEDICINE CONSULTATIONS JANUARY THROUGH JUNE 2016 600

SPECIALIST CONSULTATIONS

100

500

TOTAL

0

March

April

May

June

95.877

June

14.334

May

13.495

402.510

April

14.826

68.493

March

14.036

68.831

February

20

25.856

67.257

January

40

13.330

69.050

0

75.434

100

53.445

September � 2016

200

60

TOTAL

500

80

400 300

GENERAL MEDICINE CONSULTATIONS

400 300 200 100 0

January February

TOTAL

January February March

April

May

June

TOTAL

34 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

Las líneas telefónicas de nuestro Call Center cambiarán a partir del

5 de octubre de 2016.

Las ciudades de Cali, Bogotá, Barranquilla y Medellín tendrán nuevos números.

Además, nuestros prestadores en Tuluá, Pereira, Valledupar, Cartagena y Bucaramanga contarán con líneas locales.

En el resto del país, podrán comunicarse a nuestra línea nacional 01 8000 931 666.

Estas son las nuevas líneas de atención telefónica: Bucaramanga

385 3165

Bogotá

743 5485

697 3350

489 0073

Cartagena

Medellín

Pereira

Tuluá

Barranquilla

693 9853

604 4507

340 2635

Valledupar

Resto del país

588 5699

Cali

235 9483

01 8000 931 666

Le recordamos que en estas líneas usted podrá encontrar los siguientes servicios: PRESTADORES

Validación de derechos de usuarios y autorizaciones cuando no es posible hacerlo por IVR. Confirmación de copagos.

Verificación de derechos administrativos cuando el usuario no presente la credencial, registra mora o cuando el audio informa que no existe credencial.

MEDICAL

WORLD

EVENTS ‘III INTERNATIONAL SYMPOSIUM ON COMPLICATIONS AND CARE OF THE DIABETIC FOOT’ Date and place: September 30th through October 1st, 2016, Cali Information: Sociedad Colombiana de Cirugía Ortopédica y Traumatología Phone: (1) 625 7445 Email: secretaria@sccot.org.co

‘IV CONGRESS ACTUALITY IN CARDIOLOGY AND CARDIOVASCULAR SURGERY’ Date and place: September 23erd through 24th, 2016, Bogotá Information: Fundación Universitaria Sanitas Phone: (1) 589 5377 ext. 5719902 Email: educacioncontinua@unisanitas. edu.co Website: www.unisanitas.edu.co

‘XVI INTERNATIONAL CONGRESS OF THE NATIONAL SCHOOL OF BACTERIOLOGY’ Date and place: November 4th through 7th, 2016, Bogotá Reports: Colegio Nacional de Bacteriología Phone: 310 3238275 - 320 4338027 Email: conference@cnbcolombia.org Website: www.cnbcolombia.org

September • 2016

‘VII NATIONAL CONGRESS ON PEDIATRIC NEPHROLOGY’ Date and place: October 27th through the 29th, 2016, Bucaramanga Reports: Asociación Colombiana de Nefrología Pediátrica Email: aconepe@gmail.com y logisticaaconepe@gmail.com Website: www.aconepe.net

36 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

BOOKS Colleagues authors

‘NEURODEVELOPMENT IN NEONATOLOGY’

Authors: Pablo Rosselli Cock and José Luis Duplat Lapides

T

his is certainly a practical guide. It can be used by health care professionals in charge of diagnostics, treatment and rehabilitation of children with conditions of the locomotor apparatus.

This textbook was written by a group of experienced professionals in this field who studied issues like nonsurgical treatment of spasticity, tendon transfers in the foot, abnormalities of the cervical spine, hip dysplasia in adolescents, among others. One of the experts is Luis Jose Cespedes, a specialist in orthopedics and traumatology, with a subspecialty in children orthopedics. He is the author of chapters like ‘Hip dysplasia in the toddler, preschooler and school children’ and also ‘Braquimetatarsys’. In these chapters, doctor Céspedes gives the reader very useful information.

Author: Jorge Eliécer Pardo

T

his book addresses unusual issues in current Colombian novel. The aesthetics of visceral violence has been elaborated in order to muse on why that violence exists, and even more, on why war. In this work Pardo challenges openly official history, which by tradition has hidden their hideous acts. This novel narrates the war from the point of view of common people, not from the powerful elite’s, as well as other aspects. It gives relevance to interesting small events that highlight, discover or reveal, a new historical narrative, mixing the particular and the general, underscoring realities within and around the characters. This is a work on life itself. On how subjective and objective reality bare facts most often related to the impotence of those who experience violence.

Authors: Ben Greenstein and Diana Wood

T

his useful textbook cleverly presents, with numerous illustrations, the principles and fundamental mechanisms of the specialty, along with the major endocrine glands, followed by sections on metabolic and reproductive endocrinology. Clinical cases provide the basic science context and show how they manifest, and also how they are diagnosed and treated.

Author: Graciela Basso

N

europrotection of the newborn is central to this text.

This book incorporates concepts of intrauterine life and the maternal environment, as well as a thorough overview on genetics, embryology, gestation, childbirth, early stages neonatal life in the intensive neonatal care unit and their discharge, focusing on the care of different aspects of the fragile growing brain. Furthermore, it includes other topics like developmental physiology, neurobiology of attachment, sinactive theory, sensory integration and It also provides advice on psychological care and counseling.

‘CONTORTIONIST MANUAL’ Author: Craig Clevenger

A

fter an almost fatal painkiller overdose, doctors at the emergency department of a hospital in Los Angeles, resuscitate Daniel Fletcher, and retain him for a submission to a psychiatric evaluation. However, doctors ignore that Fletcher actually is John Dolan Vincent, a brilliant young forger that continually reinvents himself to elude judicial and health authorities, avoiding long term imprisonment.

37

A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

September • 2016

‘CHILDREN ORTHOPEDICS’

‘MIGRANTSOR FROM THE LOST WAR ‘

‘BASIC ENDOCRINOLOGYAT A GLANCE’

MEDICAL

WORLD

MUSIC

MOVIES

‘LA SALVACIÓN DE SOLO Y JUAN’ Los Fabulosos Cadillacs his is the twelfth studio album of the T famous Argentinian band, and it is also marking their return after releasing their last album in 1999. This new work Is characterized by its particularity, he songs tell the story of Solo and John, two brothers raised by their father in a house at the beach, near a lighthouse. It is a rock opera that includes songs like: “Lighthouse overture”, “It was not meant for you”, “Christmas”, “The storm” and “1987”.

V

‘A GAME WITHOUT RULES: NERVE’ Director: Henry Joost and Ariel Schulman.

Starring: Dave Franco, Emma Roberts and Juliette Lewis.

ee Delmonico, an extraordinary student, is tired of her life as a secondary character, but when her friends enter Nerve, a popular game, she decides to take a chance into what seems harmless.

Suddenly, from one moment to another, she finds herself involved in the excitement of a competition full of adrenaline.

But the challenges become increasingly sinister and dangerous, up until even her own life is at stake.

‘DE-MASTERMIND’ Director: Jared Hess Starring: Zach Galifianakis, Owen Wilson, Kristen Wiig and Jason Sudeikis.

T

‘DES/AMOR’ Reik his mexican trio returns Tbeginning with this new record, the of a new phase for the group led by Jesús Navarro. In this album fans will find their typical ballads, as well as other rhythms, like reggae, folk and the urban genre in songs like “I already heard”. It was put together including the special collaboration of the urban musician Nicky Jam.

September • 2016

his action comedy is based on real events.

It tells how David Ghantt discovers the true sense of adventure, far beyond his wildest dreams. He has no major problems, he is trapped in a monotonous life routine, he drives an armored truck that carries millions of dollars belonging to other people, without any improvement prospect in sight. The only hint of emotion is his platonic love, Kelly Campbell, his co-worker, who will soon transform his ordered life.

38 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA