Abstract Background: Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. Methods: We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. Results: The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40-94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were - 3.02 (1.23) at the lumbar spine and - 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. Conclusions: This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.

El dolor neuropático es una patología cuya prevalencia requiere proponer guías de manejo. Su severidad y, en algunos casos, dificultad para el tratamiento deterioran la calidad de vida. La prevalencia reportada en Europa es del 5%, y en dolor crónico post-operatorio varía entre 5 y 85% dependiendo del tipo de cirugía. El objetivo del presente artículo es revisar las alternativas farmacológicas para el manejo de dolor neuropático de acuerdo con su fundamento fisiopatológico, y presentar sugerencias para el manejo con medicamentos disponibles en Colombia, incluidos y no incluidos en el Plan Obligatorio de Salud.

The prevalence of neuropathic pain requires proposals for management guidelines. In some cases, the degree of severity and the difficulty of treating this disorder has resulted in poor quality of life. In Europe, reported prevalence is 5%, and chronic postoperative pain ranges between 5% and 85%, depending on the type of surgery. The purpose of this paper is to review the pharmacological options for treating neuropathic pain depending on the pathophysiology, and suggest therapeutical approaches with medications available in Colombia, included or not in the Mandatory Health Plan.

Se evaluó el efecto de tres concentraciones de NaCl (0, 30 y 60 mM) sobre el comportamiento de iones presentes en tejido foliar de la planta de lulo, en lixiviados y sustratos utilizados para el cultivo. El experimento se estableció en un invernadero ubicado en Bogotá a 2.556 msnm, con temperatura promedio de 15,6 °C y humedad relativa promedio de 61%. Plántulas de lulo (Solanum quitoense var. quitoense) de dos meses de edad se transplantaron en materas con los sustratos: turba rubia (Klassman®), arena cuarcítica y mezcla de suelo, turba y arena en proporción 3:1:1 en peso; además se hizo un tratamiento adicional en suelo, con sistema de fertirriego. Se observó una relación inversa entre las concentraciones de NaCl y la magnitud de los cambios producidos en las plantas. La altura se redujo entre 4% y 16% para plantas en turba y mezcla y 65% para plantas en arena; para las plantas en turba, el área foliar se redujo entre 14% y 17% y para plantas en arena, 65%. La masa seca decreció entre 38% y 50% para plantas en turba. El contenido foliar de nutrientes se afectó por las concentraciones de NaCl. En lixiviados, los iones Ca2+, K+ y Mg2+ incrementaron sus concentraciones en los sustratos orgánicos (turba y mezcla). En los sustratos los contenidos de N se incrementaron, con respecto a las muestras iniciales; lo mismo ocurrió con el Na+, mientras que las concentraciones de K+, Ca2+ y Mg2+ disminuyeron, al compararlas con las obtenidas en las muestras iniciales.

The effect of three concentrations of NaCl (0, 30 and 60 mM) on the behavior of mineral ions in lulo plants was evaluated in leaf tissue, leachates and substrates of the culture. The experiment was realized in a plastic greenhouse located in Bogotá (2,556 masl, 15.6 °C mean temperature and 61% relative humidity). Two-months old lulo plants (Solanum quitoense var. quitoense) were transplanted in pots with the following substrates: bleached peat (Klassman®), sand and soil mixture, peat and sand at a 3:1:1 (w/w) ratio; also, an additional treatment (soil) with fertirrigation. As a basic fertilization, a slow liberation fertilizer with minimum salinity effect was applied. An inverse relation was observed between the concentrations of NaCl and the magnitude of growth changes of plants. The height was diminished between 4% and 16% in plants grown in peat and mixture, and 65% for plants in sand. Plants in blond peat diminished their leaf area between 14 and 17% and 65% for plants in sand. The dry mass decreased between 38 and 50% for plants in peat. The content of leaf nutrients was affected by NaCl concentrations. In leachates, Ca2+, K+ and Mg2+ ions increased their concentrations in the organic substrates (peat and mixture). The N concentrations in substrates increased compared to the initial sampling, the same occurred with Na, whereas Ca2+, K+ and Mg2+ decreased their concentrations.

Durante 12 semanas, foi estudado o efeito de 0; 30 e 60 mM de NaCl e dos substratos (turfa vermelha, ou de mistura de turfa, areia, ou solo 3:1:1 [w/w]) sobre o desenvolvimento vegetativo de lulo, uma espécie de fruto originária dos Andes. O experimento foi feito em condições de casa de vegetação, utilizando vasos plásticos de polipropileno de 2.000 cm³. Foram avaliadas as mudanças em altura de planta, número de folhas e nós, área foliar, massa seca total da planta (DM) e relação raiz parte aérea. Com o incremento da concentração salina, a altura de planta, o número de folhas e de nós, as áreas foliares e a massa seca da planta diminuíram, enquanto a relação parte aérea/raiz aumentou. As plantas de lulo cultivadas em areia foram as mais afetadas pela salinidade e apresentaram mortalidade total aos 60 mM de NaCl. Assim, as plantas mantidas em turfa ou na mistura de substratos apresentaram maiores alturas, número de folhas e nós, áreas foliares e conteúdo de massa seca. A relação parte aérea/raiz foi mais baixa no controle (solo) e nas plantas cultivadas em areia (30 mM NaCl).

The effects of 0, 30 and 60 mM NaCl and substrates (red peat, sand or 3:1:1 [w/w] mixture of peat, sand, or soil) on vegetative growth of lulo, an Andean fruit species, during 12 weeks were studied. The experiment was carried out by using 2000 cm³ of polypropylene plastic pots under greenhouse conditions. Plant height, number of leaves and nodes, leaf area, total plant dry matter (DM), and shoot/root ratio were evaluated. With the increase of salt concentration, the plant height, the number of leaves and nodes, the leaf areas and plant dry mass DM decreased, whereas shoot/root ratio increased. Sand grown lulo plants were most affected by salinity and presented total mortality at 60 mM NaCl. On the other hand, plants held either in peat or in substrate mixture developed larger height, greater leaf and node numbers, higher leaf area and dry matter content. Shoot/root ratio in control (soil) and sand-grown plants (30 mM NaCl) was lower.