Resumen Este artículo pretende identificar las dificultades administrativas y judiciales en el proceso de adopción en Colombia a partir del análisis de las sentencias de la Corte Constitucional durante los años 2011 al 2016. Se parte de una investigación de tipo socio jurídica, utilizando el método analítico descriptivo basado en el estudio de las sentencias, identificadas desde preguntas orientadas a las dificultades en el proceso de adopción. Esta investigación permitió identificar la adopción como un mecanismo orientado primordialmente a satisfacer el interés superior de los niños cuando la familia no garantiza las condiciones para la realización y ejercicio de sus derechos; y evidenció que aún falta precisión y efectividad a la hora de aplicar la normatividad y los principios señalados en la Convención de los Derechos del Niño.

Abstract This article aims to identify the administrative and judicial difficulties in the adoption process in Colombia, from the analysis of the Constitutional Court’s judgments during the years 2011 to 2016. Taking as a basis the socio-legal type research and using an analytical descriptive method based on the study of judgments, defined from questions oriented to the difficulties in the adoption process. This research identified the adoption as a mechanism oriented towards satisfying the best interests of children when the family does not guarantee the conditions for the realization and exercise of their rights. Finally, it showed that there is still a lack of precision and effectiveness in applying the regulations and principles set forth in the Convention on the Rights of the Child.

Abstract Background: Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. Objectives: To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). Methods: An analytical study that monitored 2 cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. Results: The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). Conclusions: The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied.

Resumen Antecedentes: Debido a la carga global de la enfermedad renal crónica (ERC), la Organización Mundial de la Salud fomentó programas de protección renal (PPR) para impactar en su incidencia con medidas de prevención y control. Objetivos: Evaluar la efectividad de un PPR en Colombia sobre el progreso de estadio en ERC y el requerimiento de terapia de reemplazo renal (TRR). Métodos: Estudio analítico de seguimiento a 2 cohortes de pacientes con diagnóstico de ERC, que compara el comportamiento de indicadores clínicos y de deterioro renal entre pacientes expuestos a un PPR versus el tratamiento convencional (TC). Como tamaño de muestra se tuvo en cuenta el censo de la población de ambas aseguradoras. Se calculó la tasa de incidencia, la supervivencia (Kaplan Meier) y la influencia de la exposición al PPR sobre los desenlaces entre PPR y TC mediante un análisis multivariado (Cox). Resultados: Los pacientes expuestos al PPR se demoraron más en hacer el primer progreso de estadio y en requerir TRR. La tasa de incidencia para progreso es mayor en TC (0,050; IC 95%: 0,040-0,064) que en PPR (0,034: IC 95%: 0,030-0,039). Razón de tasas de incidencia: 1,480 (IC 95%: 1,21-1,90). El riesgo instantáneo de progreso fue menor en PPR (HR: 0,855; IC 95%: 0,74-0,98), al igual que el riesgo de requerir TRR (HR: 0,797; IC 95%: 0,606-1,049). Conclusiones: El PPR representa una estrategia de prevención secundaria en ERC que impacta en el progreso de estadio y requerimiento de TRR. La captación temprana de pacientes mejora dichos desenlaces.

Introducción. Parece existir una relación de causalidad entre la infección por el virus humano herpes 8 ( human Herpesvirus 8, HHV-8) y el desarrollo de sarcoma de Kaposi, especialmente en la población positiva para virus de inmunodeficiencia humana (VIH). Objetivo. Fue determinar la relación entre los resultados serológicos positivos para HHV-8 y el sarcoma de Kaposi en pacientes positivos y negativos para VIH de Medellín, buscando la relación con distintas variables. Materiales y métodos. Es un estudio descriptivo, de cohorte, prospectivo, del suero de 98 pacientes de diferentes instituciones de salud de Medellín, los cuales se dividieron en cuatro grupos para determinar por inmunofluorescencia su seropositividad frente a HHV-8 y poder asociar en forma univariada y bivariada con diferentes variables. Resultados. Se estudiaron 98 sueros. En el grupo de pacientes con sarcoma de Kaposi y VIH, 83,3% fueron positivos para HHV- 8, en el grupo sin sarcoma de Kaposi pero con sífilis, 20,8% fueron positivos para HHV-8, en el grupo sin sarcoma de Kaposi pero VIH positivos, 8% fueron positivos para HHV-8 y en el grupo de sueros de banco de sangre, 4% fueron positivos para HHV-8. La presencia de sarcoma de Kaposi no tuvo relación con la evolución de la enfermedad por VIH ni con el recuento de CD4/ml. Conclusiones. El HHV-8 circula en nuestro medio y existe una relación entre la infección por este virus y el desarrollo de sarcoma de Kaposi, especialmente en pacientes con enfermedades de transmisión sexual y VIH positivos.

Background: Apparently, there is a relationship between human Herpesvirus 8 (HHV-8) infection and Kaposi´ sarcoma, especially in HIV-positive population. Objectives: To define the relationship between seropositivity against HHV- 8 and Kaposi´ sarcoma in an HIV positive and negative population from Medellín, looking for its relationship with different variables. Methods: It is a descriptive, cohort, prospective study which included sera from 98 HIV-positive and negative patients from different health institutes in Medellín. Sera were divided in 4 groups to determinate, by immunofluorescence, their seropositivity against HHV-8 and look for univariate and bivariate association with different variables. Results: We studied 98 sera. In patients with Kaposi´ sarcoma and HIV 83.3% were positive for HHV-8, in patients without Kaposi´ sarcoma but with syphilis 20.8% were positive for HHV-8, in patients without Kaposi´ sarcoma but HIV-positive 8% were positive for HHV-8, and in blood donors 4% were positive for HHV-8. The presence of KS did not have any relationship with HIV evolution and CD4 cells count. Conclusions: We have HHV-8 in our city, and there is a relationship between this virus infection and Kaposi´ sarcoma, especially in people with sexually transmitted diseases and HIV-positive patients.

Relato dos dois primeiros casos de pacientes colombianos com AIDS e paracoccidioidomicose. Os pacientes, ambos masculinos, não tinham conhecimento do fator de risco por HIV, embora tivessem no passado trabalhado no campo onde poderíam ter sido infectados por fungos. Eles tiveram o tipo juvenil da doença em vários orgãos com sintomas de curta duração. Eles estavam profundamente imunodeprimidos, com menos de 100 CD4 T linfócitos por mL; todavia, os testes sorológicos revelaram anticorpos circulantes anti-Paracoccidioides brasiliensis em um dos pacientes e os primeiros indícios diagnósticos vieram destes testes. Em um caso, a micose precedeu o diagnóstico da AIDS enquanto que no outro, ambas patologias foram descobertas simultaneamente. A terapia antimicótica com itraconazole, foi dada por 10 meses, começando com 200mg/dia e seguida por 100 mg/dia: foi notada pronunciada melhora nos sintomas e sinais da micose, sem recorrência. A melhora dos pacientes provavelmente também foi devido à combinação do tratamento retro-viral que foi ministrado. Embora rara a associação de AIDS com paracoccidioidomicose, médicos que atuam em áreas endêmicas devem considerar a presença de micoses em pacientes imunodeprimidos como diagnóstico imediato e instaurar o tratamento combinado antimicótico/antiretroviral,que resultaria em melhora e sobrevivência dos pacientes. Parece que é possível que o tempo de sobrevida longo visto nestes pacientes com AIDS dará tempo para o fungo quiescente ressurgir, multiplicar e produzir a doença de forma expressiva.

The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for HIV although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-Paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients´ improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.