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Introduction: The female sex has been systematically identified as one of the predictors of poor quality of life in patients with cirrhosis. However, the relationship between quality of life and sexual function in women with cirrhosis has not been widely studied. Aim: To determine the relationship between quality of life and sexual function in women with cirrhosis. Materials and methods: A cross-sectional observational study. Female patients aged 18 to 69 years were included. The SF-36-V2 survey assessed health-related quality of life, and the IFSF-6 evaluated sexual function. Univariate and multivariate linear regression was used to identify the relationship between quality of life and sexual function. Statistical significance was set at a p-value < 0.05. Results: 36 patients were available for analysis. The average age was 61 years. In the SF36-V2 survey, the physical component summary mean was 58, and the mental component summary mean was 56. The IFSF-6 had an average of 10. Sexual dysfunction occurred in 80% of patients. The IFSF-6 score was positively related to health-related quality of life. Factors associated with the deterioration of sexual function were age and menopause. The Child-Pugh score and body mass index were the main determinants of health-related quality of life. Conclusions: Sexual function could be a determinant of quality of life in women with cirrhosis.
Introducción: El sexo femenino se ha identificado de forma sistemática como uno de los predictores de mala calidad de vida en pacientes con cirrosis. Sin embargo, la relación de la calidad de vida con la función sexual en mujeres con cirrosis no ha sido ampliamente estudiada. Objetivo: Determinar la relación entre la calidad de vida y la función sexual de mujeres con cirrosis. Métodos: Estudio observacional de tipo transversal. Se incluyó a pacientes femeninas de 18 a 69 años. Se utilizó la encuesta SF-36-V2 para evaluar la calidad de vida relacionada con la salud y la IFSF-6 para valorar la función sexual. Para identificar la relación entre calidad de vida y función sexual se utilizó una relación lineal uni- y multivariante. La significación estadística se fijó con un valor p < 0,05. Resultados: 36 pacientes estuvieron disponibles para el análisis. La media de edad fue de 61 años. En la encuesta SF36-V2, la media del resumen del componente físico fue de 58 y la media del resumen del componente mental fue de 56. El IFSF-6 tuvo una media de 10. La disfunción sexual se presentó en un 80% de las pacientes. El puntaje IFSF-6 se relacionó de forma positiva con la calidad de vida relacionada con la salud. Los factores relacionados con deterioro de la función sexual son la edad y la menopausia. La escala Child-Pugh y el índice de masa corporal se identificaron como los principales determinantes de la calidad de vida relacionada con la salud. Conclusiones: La función sexual podría ser un determinante de calidad de vida de las mujeres con cirrosis.
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Introduction: Liver cirrhosis is the fourth cause of death in the world. Fatty liver disease is the most common cause of chronic liver disease (CKD) in most countries. Identifying risk factors for liver fibrosis in a population with end-stage renal disease (ESRD) may facilitate early diagnosis of this complication and allow the activation of follow-up protocols to reduce morbidity and mortality in these patients. Materials and methods: A cross-sectional and analytical study was carried out. Patients on hemodialysis, older than 18 years with a diagnosis of diabetes mellitus and ESRD were included. The hypotheses were contrasted through the chi-square test and Student's T-test, as appropriate. Statistical significance was established at a p-value = 0.05. Results: A prevalence of significant liver fibrosis and cirrhosis of 17% was found. Factors associated with liver fibrosis were a history of cerebrovascular disease, peripheral vascular disease, body mass index (BMI), total cholesterol, glycosylated hemoglobin, sodium, and aspartate aminotransferase (AST). No relationship was observed between the NAFLD (non-alcoholic fatty liver disease) score, the APRI index (AST to Platelet Ratio Index), and fibrosis. Conclusion: The prevalence of significant liver fibrosis in patients with diabetes and ESRD is similar to that reported in other populations of patients with diabetes. However, some factors, such as BMI, could behave differently and favor the appearance of liver injury with lower degrees of obesity than previously reported in the literature.
Introducción: la cirrosis hepática es la cuarta causa de muerte en el mundo. Actualmente, la enfermedad hepática por depósito de grasa es la causa más frecuente de hepatopatía crónica en la mayoría de los países. La identificación de factores de riesgo para la presencia de fibrosis hepática en una población con enfermedad renal crónica terminal puede facilitar el diagnóstico temprano de esta complicación y permitir la activación de protocolos de seguimiento para disminuir la morbimortalidad en estos pacientes. Metodología: se realizó un estudio de corte transversal y analítico. Se incluyeron pacientes en hemodiálisis, mayores de 18 años con diagnóstico de diabetes mellitus y de enfermedad renal crónica terminal. El contraste de hipótesis se realizó a través de la prueba de chi cuadrado y la T de Student, según correspondiera. La significación estadística se estableció con un valor p = 0,05. Resultados: se observó una prevalencia de fibrosis hepática significativa y cirrosis del 17%. Los factores asociados a la presencia de fibrosis hepática fueron los antecedentes de enfermedad cerebrovascular, la enfermedad vascular periférica, el índice de masa corporal (IMC), el colesterol total, la hemoglobina glicosilada, el sodio y el aspartato-aminotransferasa (AST). No se observó relación entre el puntaje de NAFLD (enfermedad del hígado graso no alcohólico), el índice APRI (AST to Platelet Ratio Index) y la presencia de fibrosis. Conclusión: la prevalencia de fibrosis hepática significativa en pacientes con diabetes y ERCT es similar a la reportada en otras poblaciones de pacientes con diabetes. Sin embargo, algunos factores, como el IMC, podrían comportarse de forma diferente y favorecer la aparición de lesión hepática con grados menores de obesidad a los reportados previamente en la literatura.
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INTRODUCTION: Historic disruption in health infrastructure combined with data from a recent vaccine coverage survey suggests there are likely significant immunity gaps to vaccine preventable diseases and high risk of outbreaks in Timor-Leste. Community-based serological surveillance is an important tool to augment understanding of population-level immunity achieved through vaccine coverage and/or derived from prior infection. METHODS AND ANALYSIS: This national population-representative serosurvey will take a three-stage cluster sample and aims to include 5600 individuals above 1 year of age. Serum samples will be collected by phlebotomy and analysed for measles IgG, rubella IgG, SARS-CoV-2 antispike protein IgG, hepatitis B surface antibody and hepatitis B core antigen using commercially available chemiluminescent immunoassays or ELISA. In addition to crude prevalence estimates and to account for differences in Timor-Leste's age structure, stratified age-standardised prevalence estimates will be calculated, using Asia in 2013 as the standard population. Additionally, this survey will derive a national asset of serum and dried blood spot samples which can be used for further investigation of infectious disease seroepidemiology and/or validation of existing and novel serological assays for infectious diseases. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Research Ethics and Technical Committee of the Instituto Nacional da Saúde, Timor-Leste and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, Australia. Co-designing this study with Timor-Leste's Ministry-of-Health and other relevant partner organisations will allow immediate translation of findings into public health policy, which may include changes to routine immunisation service delivery and/or plans for supplementary immunisation activities.
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COVID-19 , Enfermedades Prevenibles por Vacunación , Humanos , Estudios Seroepidemiológicos , Timor Oriental/epidemiología , Estudios Transversales , COVID-19/epidemiología , COVID-19/prevención & control , SARS-CoV-2 , Inmunoglobulina G , Northern TerritoryRESUMEN
Timor-Leste is a small nation of 1.3 million people which shares a land border with Indonesia and is 550 km from Darwin, Australia. It is one of the poorest nations in Asia. The National Health Laboratory (NHL) and its network of smaller laboratories in Timor-Leste had limited capacity to perform molecular diagnostic testing before the coronavirus disease 2019 (COVID-19) pandemic began. With the support of international development partners, the NHL rapidly expanded its molecular testing service. From March 2020 to February 2022, over 200,000 molecular tests were performed; COVID-19 testing sites were established in hospital and community health center laboratories and all 13 municipalities, and the number of scientists and technicians at the molecular diagnostic laboratory at the NHL increased from five to 28 between 2019 and 2022. Molecular diagnostic testing for COVID-19 was successfully established at the NHL and in the municipalities. The molecular diagnostic laboratory at NHL is now equipped to respond to not only large-scale COVID-19 testing but also laboratory detection of other infectious diseases, preparing Timor-Leste for future outbreaks or pandemics.
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BACKGROUND: Lack of access to diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can limit disease surveillance in remote areas. Serological surveillance can indicate the true extent and distribution of infections in such settings. METHODS: This study monitored SARS-CoV-2 seroprevalence in residual serum samples salvaged from laboratories at five healthcare facilities across Timor-Leste from March to October 2021. RESULTS: Seroprevalence increased from 8.3% to 87.0% during the study period. Potential immunity gaps were identified among children aged 0-15 y (who had not been eligible for vaccination) and individuals aged >60 y. CONCLUSIONS: Efforts to vaccinate vulnerable individuals including older people should be maintained. Residual serum samples can be analysed to give local, contemporary information about the extent and distribution of antibodies to infections, especially SARS-CoV-2, in areas where epidemiological information is limited.
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COVID-19 , Niño , Humanos , Anciano , Timor Oriental , COVID-19/epidemiología , SARS-CoV-2 , Estudios Seroepidemiológicos , Anticuerpos , Anticuerpos AntiviralesRESUMEN
Resumen Introducción: la sarcopenia es una complicación frecuente de cirrosis y se ha relacionado con progresión de insuficiencia hepática y aumento de las complicaciones, incluida la mortalidad. El objetivo del presente estudió fue determinar los factores asociados a la masa y la fuerza muscular en pacientes cirróticos. Métodos: estudio de corte transversal, descriptivo y analítico. Se incluyó a todos los adultos que acudieron a valoración ambulatoria por hepatología con diagnóstico de cirrosis hepática. A todos se les realizó una valoración nutricional que incluyó mediciones antropométricas, bioimpedanciometría, fuerza de agarre y la escala de tamización Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Se realizó un análisis de regresión lineal o logística, según correspondiera. Resultados: se incluyó a 40 pacientes. La frecuencia de malnutrición fue de 17,5% de acuerdo con la fuerza de agarre. Los principales determinantes de la masa muscular en el análisis lineal multivariable fueron la edad, el valor de proteína corporal total y el agua corporal total. La fuerza de agarre también fue un predictor significativo en la regresión lineal univariable. Las variables relacionadas con fuerza muscular disminuida fueron el puntaje Child-Pugh, la historia de ascitis y de encefalopatía hepática, el consumo de terapias de disminución de amonio, la puntuación en la escala RFH-NPT y la masa libre de grasa. Conclusiones: la masa muscular esquelética del paciente cirrótico se asoció con la edad, cambios en la composición corporal y la fuerza de agarre. Los determinantes de la fuerza muscular fueron el estadio de la enfermedad, el consumo de terapias de disminución de amonio y la puntuación en la escala RFH-NPT.
Abstract Introduction: Sarcopenia is a frequent complication of cirrhosis and has been related to the progression of liver failure and increased complications, including mortality. This study aimed to determine the factors associated with muscle mass and strength in cirrhotic patients. Materials and methods: Cross-sectional, descriptive, analytical study. All adults who attended outpatient hepatology assessment with a diagnosis of liver cirrhosis were included. They underwent a nutritional examination that included anthropometric measurements, bioimpedanciometry, grip strength, and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) screening scale. A linear or logistic regression analysis was performed as appropriate. Results: 40 patients were included. The frequency of malnutrition was 17.5%, according to grip strength. The main determinants of muscle mass in the multivariate linear analysis were age, total body protein value, and total body water. Grip strength was also a significant predictor in univariate linear regression. Variables related to decreased muscle strength were the Child-Pugh score, history of ascites and hepatic encephalopathy, consumption of ammonium-lowering therapies, RFH-NPT score, and fat-free mass. Conclusions: The skeletal muscle mass of the cirrhotic patient was associated with age, changes in body composition, and grip strength. The muscle strength determinants were the disease's stage, the consumption of ammonium-lowering therapies, and the score on the RFH-NPT scale.
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Abstract Introduction: Cirrhosis of the liver is a significant cause of morbidity and mortality in Latin America; the increased prevalence of metabolic syndrome in our population could be changing the epidemiological profile of patients with advanced chronic liver disease. Aim: To characterize a group of patients with cirrhosis of the liver at an outpatient hepatology care center in Cartagena de Indias, Colombia, and determine the contribution of nonalcoholic steatohepatitis (NASH) as an etiological factor in this population. Materials and methods: Retrospective, cross-sectional, analytical study. All patients who attended the hepatology follow-up with a diagnosis of cirrhosis of the liver were in the six-monthly follow-up protocol that included screening for hepatocellular carcinoma (HCC) and esophageal varices. Results: 346 patients were included, most were women (54.3 %). The first and second causes of cirrhosis were cryptogenic (35 %) and NASH (30.9 %), respectively, followed by viral hepatitis (17 %) and autoimmune diseases (9 %). Of these patients, 87.4 % were within categories A and B of the Child-Turcotte-Pugh score, and only 12.5 % (33 patients) were in stage C. Also, 60 % had at least one clinical decompensation, 38 % a history of variceal hemorrhage, and 4 % a diagnosis of HCC; 80.6 % of patients with NASH cirrhosis had diabetes, and 46.7 % were overweight. Conclusion: NASH cirrhosis is an emerging cause of advanced chronic liver disease in Colombia.
Resumen Introducción: la cirrosis hepática es una importante causa de morbimortalidad en América Latina; el incremento de la prevalencia del síndrome metabólico en nuestra población podría estar cambiando el perfil epidemiológico de los pacientes con enfermedad hepática crónica avanzada. Objetivos: caracterizar un grupo de pacientes con cirrosis hepática y determinar la contribución de la esteatohepatitis no alcohólica (NASH) como factor etiológico de esta población en la ciudad de Cartagena de Indias, Colombia, en un centro de atención ambulatoria de hepatología. Métodos: estudio retrospectivo, transversal, analítico. Se incluyeron todos los pacientes que acudieron al seguimiento de hepatología con diagnóstico de cirrosis hepática que se encontraban en el protocolo de seguimiento semestral que incluía el cribado de hepatocarcinoma y várices esofágicas. Resultados: se incluyeron 346 pacientes. La mayoría fueron mujeres (54,3 %). La primera y segunda causa de cirrosis fue la criptogénica (35 %) y la NASH (30,9 %), respectivamente; seguidas de las hepatitis virales (17 %) y enfermedades autoinmunes (9 %). De estos pacientes, el 87,4 % se encontraba dentro de las categorías A y B de la escala pronóstica de Child-Turcotte-Pugh, y solo el 12,5 % (33 pacientes) en estadio C. El 60 % había presentado al menos una descompensación clínica, 38 % tenía antecedentes de hemorragia por várices y 4 %, diagnóstico de hepatocarcinoma. El 80,6 % de los pacientes con cirrosis NASH era diabético y el 46,7 % tenía exceso de peso. Conclusión: La cirrosis NASH es una causa emergente de enfermedad hepática crónica avanzada en Colombia.
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Humanos , Masculino , Femenino , Síndrome Metabólico , Enfermedad del Hígado Graso no Alcohólico , Hígado , Cirrosis Hepática , Várices , Hepatitis , HepatopatíasRESUMEN
BACKGROUND: A national drug resistance survey (DRS) was implemented for the first time in Timor-Leste (TL) in 2019. The primary objective of the survey was to assess the prevalence of drug resistance among new and previously treated pulmonary TB patients in the country. METHODS: This nation-wide cross-sectional survey was conducted in 2019 targeting all new and previously treated sputum smear-positive pulmonary TB patients. Sputum samples were submitted to the National TB Reference Laboratory for confirmation of TB and to determine resistance to rifampicin by Xpert MTB/RIF. Culture was performed on solid media, and culture isolates of confirmed TB cases were shipped to the WHO Supranational TB Reference Laboratory in Chennai, India for whole genome sequencing (WGS). Survey summary statistics, data cross-tabulations and analysis of potential risk factors of rifampicin-resistant TB (RR-TB) were conducted using R statistical software (version 3.5.2). RESULTS: A total of 953 sputum-smear positive patients were enrolled, of which 917 were confirmed as positive for TB by either Xpert MTB/RIF or culture. An electronic web-based system was used for entry and storage of the data. Rifampicin resistance was detected among 0.6% (95% CI 0.2-1.3) of new cases and 2.7% (95% CI 0.5- 8.2) of previously treated cases. WGS was conducted for validation purposes on 65 randomly selected isolates (29% of RR-TB (2/7) and 7% of RS-TB (63/910) by Xpert MTB/RIF or pDST). The original test results agreed with the WGS validation results for 62/64 isolates (97%). CONCLUSION: The prevalence of RR-TB in Timor-Leste is relatively low compared to the estimated proportions of RR-TB in the WHO South-East Asia Region (2.5% [95% CI 1.9-3.3] among new cases and 14% [95% CI 7.7-21] among previously treated cases). The rapid sputum collection and transportation mechanism implemented in the survey demonstrates its feasibility in low resource settings and should be replicated for routinely transporting TB specimens from microscopy labs to GeneXpert sites. Establishment of in-country capacity for rapid molecular diagnostics for both first- and second-line DST is an immediate need for achieving universal drug susceptibility testing (DST) to guide appropriate patient management.
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Antibióticos Antituberculosos , Mycobacterium tuberculosis , Tuberculosis Pulmonar , Antibióticos Antituberculosos/farmacología , Antibióticos Antituberculosos/uso terapéutico , Estudios Transversales , Farmacorresistencia Bacteriana , Humanos , India/epidemiología , Pruebas de Sensibilidad Microbiana , Mycobacterium tuberculosis/genética , Rifampin/farmacología , Rifampin/uso terapéutico , Sensibilidad y Especificidad , Timor Oriental/epidemiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiologíaRESUMEN
Background Serosurveillance can be used to investigate the extent and distribution of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a population. Characterisation of humoral immune responses gives insight into whether immunity is infection- or vaccine-derived. Methods A longitudinal study of health care workers (HCWs) in Dili, Timor-Leste, was conducted during vaccine rollout (ChAdOx1) and a concurrent SARS-CoV-2 outbreak. Results A total of 324 HCWs were included at baseline (April-May 2021). Out of those, 32 (9.9%) were seropositive for anti-nucleocapsid protein (anti-N) IgG antibodies, indicating a significant sub-clinical infection among HCWs early in the local outbreak. Follow-up was conducted in 157 (48.5%) participants (July-September 2021), by which time there had been high uptake of vaccination (91.7%), and 86.0% were seropositive for anti-spike protein antibodies. Acquisition of anti-N antibodies was observed in partially vaccinated HCWs (30/76, 39.5%), indicating some post-dose-1 infections. Discussion Serosurveillance of HCWs may provide early warning of SARS-CoV-2 outbreaks and should be considered in non-endemic settings, particularly where there is limited availability/uptake of testing for acute infection. Characterisation of humoral immune responses may be used to assess vaccine impact and coverage. Such studies should be considered in national and international efforts to investigate and mitigate against future emerging pathogens.
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COVID-19 , Vacunas , Anticuerpos Antivirales , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Brotes de Enfermedades/prevención & control , Personal de Salud , Humanos , Estudios Longitudinales , SARS-CoV-2 , Timor Oriental , VacunaciónRESUMEN
Introducción: en el hígado, el factor de crecimiento hepático (FCH) es conocido por ser un potente agente mitogénico tanto in vivo como in vitro. Sin embargo, el papel del FCH en la cirrosis no está completamente claro y algunos estudios lo señalan como un marcador de severidad en la cirrosis, en la insuficiencia hepática aguda y en la hepatitis crónica. Objetivos: determinar la relación entre el FCH y el estadio de la cirrosis hepática e identificar los factores asociados con los niveles de FCH en esta población. Metodología: se evaluaron todos los pacientes con cirrosis hepática atendidos desde enero a marzo de 2014. La elastografía transitoria (ET), la recopilación de la información clínica y la extracción de la muestra para la determinación del FCH se realizó de forma simultánea en el momento de la inclusión. Resultados: no se encontró relación entre los niveles de FCH y la clasificación de Child-Pugh; sin embargo, se observaron niveles más elevados en pacientes con enfermedad descompensada. Se determinó una asociación lineal positiva entre el FCH y la dureza hepática estimada por elastografía (b = 0,53; r2 = 0,26; p = 0,002) y una asociación lineal negativa con la albúmina (b = -0,62; r2 = 0,39; p <0,001). Únicamente la albúmina conservó esta asociación en el análisis multivariante. Conclusión: el FCH es un marcador de severidad en la cirrosis hepática. La albúmina y el grado de fibrosis determinada por ET se asociaron con niveles de FCH
Introduction: Hepatocyte growth factor (HGF) is known to be a potent mitogenic agent both in vivo and in vitro. The role of HGF in cirrhosis is not completely clear, but some studies point to it as a marker of severity in cirrhosis, acute liver failure and chronic hepatitis. Objective: The objective of this study was to determine the relationship between HGF and the stage of hepatic cirrhosis and to identify factors associated with HGF levels in this population. Methodology: All patients with hepatic cirrhosis treated from January to March 2014 were evaluated. At the time patients were enrolled in the study their clinical histories were taken and they underwent transient elastography and extraction of samples for measurement of HGF. Results: No relationships were found between HGF levels and Child-Pugh classifications, however, higher levels of HGF were observed in patients with decompensated disease. A positive linear relations was found between HGF and hepatic hardness estimated by elastography (b = 0.53, r2 = 0.26, p = 0.002) and a negative linear relation was found between HGF and albumin (b = -0.62, r2 = 0.39, p <0.001). Only albumin retained this association in the multivariate analysis. Conclusion: HGF is a marker of severity in liver cirrhosis. Albumin and the degree of fibrosis determined by transient elastography were associated with HGF levels.
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Diagnóstico por Imagen de Elasticidad , Cirrosis Hepática , Factor de Crecimiento de HepatocitoRESUMEN
Resumen Introducción: los datos sobre calidad de vida en pacientes con hepatitis C son escasos en nuestro medio. A la fecha, no hay estudios que hayan determinado la carga de la enfermedad en esta población en el territorio colombiano. Objetivos: determinar la calidad de vida en pacientes con hepatitis C crónica e identificar sus factores determinantes utilizando la encuesta SF-36 V2. Metodología: estudio transversal analítico realizado desde el 1 de junio de 2015 hasta el 31 de agosto de 2015. Un encuestador entrenado aplicó la encuesta SF-36 V2 en su versión en castellano (Qualitimetric Inc.). La regresión lineal multivariante identificó los factores relacionados con la calidad de vida relacionada con la salud (CVRS). El índice de Charlson estimó el peso de las comorbilidades de la muestra. Resultados: 41 pacientes estuvieron disponibles para el análisis. La media de edad fue de 57 años (desviación estándar [DE]: 12,6). El 50% de los sujetos presentaban cirrosis/fibrosis avanzada. El Resumen del componente físico (RCF) y el Resumen del componente mental (RCM) fueron de 48,2 y 45,6 respectivamente. El análisis de regresión lineal univariante identificó al sexo, la edad, el índice de Charlson y la presencia de cirrosis hepática como los principales determinantes de la calidad de vida. El índice de Charlson expresado como la probabilidad de supervivencia a 10 años fue el único predictor independiente del SF-6D. Conclusión: la edad, el sexo y la cirrosis hepática se identificaron como determinantes de la CVRS. El índice de Charlson fue el único predictor independiente de SF-6D. La implementación de programas multidisciplinarios es necesaria para el tratamiento integral de los pacientes infectados.
Abstract Introduction: Data on quality of life in patients with hepatitis C are scarce in our country. To date, no study has determined the burden of chronic hepatitis C in the population of Colombia. Objectives: The objective of this study was to determine the quality of life in patients with chronic hepatitis C and to identify its determinants using the SF36V2 survey. Methodology: This cross-sectional analytical study was conducted between June 1,2015 and August 31, 2015. A trained interviewer used the Spanish version of the SF-36 V2 survey (Quality Metric Inc.). Then multivariate linear regression identified factors related to Health Related Quality of Life (HRQL). The Charlson Comorbidity Index was used to estimate the weights of comorbidities found in the sample. Results: Forty-one patients were available for analysis. The mean age was 57 years (SD 12.6). Fifty percent of the subjects had advanced cirrhosis and/or fibrosis. The physical component summary (PCS) and mental component summary (MCS) were 48.2 and 45.6, respectively. Univariate linear regression analysis identified sex, age, Charlson Comorbidity Index and presence of liver cirrhosis as the main determinants of quality of life. The Charlson Comorbidity Index 10-year survival probability was the only independent predictor of SFD6. Conclusion: Age, sex and hepatic cirrhosis were identified as determinants of HRQoL. The Charlson index was the only independent predictor of SFD6. The implementation of multidisciplinary programs is necessary for comprehensive treatment of infected patients.
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Hepatitis C , Calidad de Vida , Hepatitis , América Latina , Cirrosis HepáticaRESUMEN
La calidad de vida es un concepto que refleja los aspectos positivos y negativos de la vida de un individuo. El impacto de la salud física y mental sobre la sensación de bienestar se conoce como calidad de vida relacionada con el estado de salud (CVRS). La cirrosis ocasiona un gran número de síntomas y de complicaciones que pueden tener un profundo impacto negativo sobre la CVRS, como la fatiga, el prurito, la pérdida de autoestima o la depresión, entre otros. Hasta el momento se han realizado pocos estudios en Latinoamérica sobre CVRS en la cirrosis hepática (9) y no se ha estudiado en detalle cuáles son sus factores determinantes en nuestra población. El objetivo de este estudio es identificar los predictores de calidad de vida en una cohorte de pacientes con cirrosis hepática en Cartagena, Colombia, a través de la escala SF-36 V2. Pacientes y métodos: estudio transversal analítico realizado desde el 01 de Junio de 2014 hasta el 31 de Agosto de 2014. Se evaluaron de forma consecutiva a 49 pacientes con cirrosis hepática a través de la encuesta SF-36 V2 en su versión en castellano y se recolectó información epidemiológica, clínica y analítica actualizada a la fecha de inclusión en el estudio. Para identificar los factores determinantes de la calidad de vida se realizó inicialmente un análisis univariante utilizando la t-student para comparación de medias en el caso de variables independientes dicotómicas y el coeficiente de correlación de Pearson en el caso de variables independientes numéricas. La relación se consideró estadísticamente significativa con un p <0,05. Resultados: la etiología (viral versus no viral) se asoció con una disminución de la CVRS en todas las escalas de la SF-36V2, especialmente en la subescala PF (-21,2 puntos; p = 0,017), al igual que en los pacientes con enfermedad hepática crónica secundaria a EHNA en las subescalas DC (-6,18; p= 0,44) y VT (-3,7; p= 0,57). El sexo femenino se asoció con puntuaciones inferiores en casi todas las áreas (FF, DC, VT, PF, FS, PE, SM, RCF y el RCM), esta relación fue estadísticamente significativa en el 40% de las escalas de la encuesta. El child pugh, la elastrografía transitoria y la albumina tuvieron un impacto negativo en CVRS. Conclusión: el sexo femenino y la albumina fueron las variables que se asociaron de forma frecuente con la CVRS en nuestra población. La implementación de programas integrales de atención para el paciente con hepatopatía crónica avanzada es necesaria para disminuir el impacto de la enfermedad sobre la calidad de vida de estos enfermos.
Quality of life is a concept that reflects the positive and negative aspects of the life of an individual. The impact of physical and mental health on feelings of personal welfare are known as health-related quality of life (HRQOL). Cirrhosis causes a number of symptoms and complications that can have a profound negative impact on HRQOL as fatigue, pruritus, loss of self-esteem or depression, among others. So far there have been few studies in Latin America on HRQOL for patients with liver cirrhosis, (9) and those that exist have not studied its determining factors in our population in any detail. The aim of this study is to identify predictors of quality of life in a cohort of patients with liver cirrhosis in Cartagena, Colombia using Version 2 of the 36-Item Short Form Health Survey (SF-36 V2). Patients and Methods: This cross-sectional study was conducted from June 1, 2014 to August 31, 2014. A Spanish language version of the SF-36 V2 survey was used to consecutively evaluate 49 patients with liver cirrhosis. Epidemiological and clinical information was gathered and analyses were updated at the moment of data entry. Univariate analysis using the t-student test to compare means in the case of dichotomous independent variables and the Pearson correlation coefficient in the case of numerical independent variables was used for initial identification of the determinants of quality of life. The relationship was considered statistically significant at p <0.05. Results: The etiology (viral versus non-viral) was associated with decreased HRQOL in all scales of SF-36 V2 especially in the PF subscale (- 21.2 points; p = 0.017). This was also true in patients with chronic liver disease secondary to NASH in the DC subscales (-6.18; p = 0.44) and VT (-3.7; p = 0.57). Female patients had lower scores in almost all areas (FF, DC, VT, PF, SF, PE, SM, RCF and the RCM). This relationship was statistically significant in the 40% of the scale areas of the survey. The severity of the disease also had a negative impact estimated by the Child-Pugh classification, transient elastography, and albumin. Conclusion: Being female and albumin were the variables that were frequently associated with HRQL in our population. The implementation of comprehensive care programs for patients with advanced chronic liver disease is necessary to reduce the impact of disease on the quality of life of these patients.
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Humanos , Masculino , Femenino , América Latina , Cirrosis Hepática , Calidad de VidaRESUMEN
Introducción: Garantizar prácticas quirúrgicas seguras es un problema de gran interés en salud pública. La hemorragia es uno de los predictores más significativos de desenlaces intraoperatorios. El método más usado para determinarlo es la estimación visual, pese a que es impreciso y puede sobre- o subestimar las pérdidas sanguíneas. Objetivos: Determinar la concordancia entre la estimación visual y el volumen de sangre real impregnada en material absorbente quirúrgico, por un grupo de anestesiólogos de la ciudad de Cartagena. Establecer los factores determinantes de la concordancia entre los volúmenes estimados y reales en el periodo perioperatorio. Métodos: Estudio observacional analítico diseñado para determinar la concordancia entre la estimación visual de la hemorragia, utilizando fotografías de compresas y gasas impregnadas con diferentes volúmenes de sangre, y la magnitud real de la hemorragia perioperatoria. La muestra de estudio fue extraída de los miembros de la Sociedad de Anestesiología de Bolívar, incluyendo a sujetos de diferente grado de formación y experiencia (41 anestesiólogos, 15 residentes). Se solicitó a cada participante que estimara el volumen de sangre contenido (ml) en gasas y compresas quirúrgicas impregnadas con sangre, basándose en imágenes fotográficas de alta resolución. Para la estimación de la concordancia se utilizó el coeficiente de correlación intraclase y para identificar los factores asociados a la precisión de la estimación se realizó un análisis por regresión logística. La estimación visual se consideró adecuada cuando difería menos de ± 10 ml con respecto al volumen real conocido. Resultados: La estimación visual fue el método de elección utilizado por el 100% de los participantes para determinar la magnitud de la hemorragia perioperatoria. Sin embargo, su concordancia con los volúmenes reales de sangre es subóptima y las estimaciones visuales de los sujetos para un mismo volumen de sangre muy heterogéneas. (CCI: 0,582; IC: 95%: 0,28-0,74), se observó una tendencia a la sobrestimación de la hemorragia entre los participantes al utilizar la estimación visual (65,2%). El análisis de regresión logística identificó como determinantes independientes de la concordancia el nivel de formación (OR 1,76; IC 95%: 1,04-2,969; p = 0,033) y volúmenes superiores a 75 ml de sangre fresca total en el material de absorción (OR 1,55; IC 95%: 1,04-2,32; p = 0,029). Conclusiones: La estimación visual es un método subóptimo para la determinación de la hemorragia perioperatoria. La medición objetiva del sangrado debe ser el método de elección en este escenario clínico.
Introduction: Ensuring Safe Surgery is a problem of great interest in public health. Bleeding isone of the most significant predictors of intraoperative outcomes. Visual estimation is the most frequently practiced method, although it is imprecise and may over or underestimate blood loss. Objectives: To determine the correlation between visual estimation and the actual volume of blood soaked in surgical absorbent material, by a group of anaesthetists in the city of Cartagena. Also, to establish the determinants of the correlation between estimated and actual volumes in the perioperative period. Methods: Observational study designed to estimate the correlation between visual estimation of blood loss, using photographs of gauze pads and sponges impregnated with different volumes of blood, and the actual extent of perioperative bleeding. The study sample was drawn from members of the Bolivar Anaesthesia Society, including subjects with different levels of training and experience (41 anaesthetists, 15 residents). Each participant was requested to estimate the volume of blood content (ml) in gauze pads and surgical sponges impregnated with blood, based on high-resolution photographic images. To estimate the agreement coefficient the intraclass correlation was used, and to identify factors associated with the accuracy of the estimate, a logistic regression analysis was performed. The visual estimate was considered adequate when it differed less than 10% compared to the actual known volume. Results: The visual estimate was the method of choice used by 100% of the participants to determine the extent of perioperative bleeding. However, its correlation with the actual volume of blood is suboptimal and visual estimates of the same volume of blood by different subjects were very heterogeneous (ICC: 0.582, 95% CI 0.28-0.74). A tendency to overestimate bleeding among participants using visual estimation (65.2%) was observed. The logistic regression analysis identified the level of training (OR 1.76, 95% CI 1.04-2.969, P = 0.033) and volumes greater than 75 ml of whole fresh blood in the absorbent material (OR 1.55,95% CI 1.04-2.32, P = 0.029) as independent determinants of agreement. Conclusions: Visual estimation is suboptimal as a method for determining perioperative bleeding. The objective measurement must be the method of choice in this clinical setting.
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HumanosRESUMEN
INTRODUCTION AND OBJECTIVE: Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. METHODS: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included. RESULTS: We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively. CONCLUSION: HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/terapia , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Hemodinámica , Hígado/irrigación sanguínea , Hígado/patología , Biopsia/métodos , Presión Sanguínea , Humanos , Venas YugularesRESUMEN
Antecedentes: La prevalencia de la Enfermedad inflamatoria intestinal (EII) en el mundo se encuentra alrededor de los 396 casos por 105 habitantes. Sin embargo se ha considerado una patología de baja incidencia y prevalencia en poblaciones hispanoamericanas. Existen a la fecha pocos datos epidemiológicos publicados sobre la EII en Suramérica. Objetivos: Estimar la prevalencia de la EII en una población adulta afiliada a una EPS en la ciudad de Cartagena, Colombia. Métodos: Se identificaron todos los casos confirmados de EII que recibían atención médica en COOMEVA EPS a 01 de junio de 2006 mediante la revisión de sus historias clínicas. La prevalencia se estimó teniendo en cuenta la población mayor de 15 años afiliada en el momento de la recogida de datos. Resultados: Se estudiaron 26 pacientes con EII para calcular la prevalencia en nuestra población. Seis individuos tenían EC y 20 diagnósticos de CU. La prevalencia general estimada para la EII fue de 29 x 105 (IC 95% 17-40). Conclusión: Nuestros resultados sugieren que la EII es una patología infrecuente en Cartagena, y estos concuerdan con datos recientes provenientes de otras comunidades hispánicas. Para conocer con certeza la prevalencia de la EII en Cartagena y otras regiones de la geografía colombiana se necesitan estudios prospectivos diseñados específicamente con este fin.
Background: Globally, prevalence of inflammatory bowel disease (IBD) is around 396 cases per 105 inhabitants. However, it has been considered to have low incidence and prevalence in Hispanic populations. To date there is little published epidemiological information on IBD in South America. Objectives: Estimate the prevalence of IBD in an adult population affiliated to an EPS in the city of Cartagena, Colombia. Methods: All patients with confirmed IBD who received medical care in COOMEVA EPS up until June 01, 2006 were identified through reviewing their medical records. Prevalence was estimated in relation to the over age 15 patient population enrolled in the EPS at the time of data collection. Results: 26 patients with IBD were the basis for calculating prevalence in our population. Six individuals had CD and 20 were diagnosed with UC. The estimated overall prevalence of IBD was 29 x 105 (95% CI: 17-40). Conclusion: IBD still seems to be a rare disease in South America. Its incidence may be increasing according to recent data from other Hispanic communities. Our results are consistent with studies in other populations where IBD is an emerging disease.