Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study.

Tuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4-0.9; P = 0.009) and patients living in Cali's western zone (aOR: 0.5; 95% CI: 0.3-0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1-66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2-15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years and none of the eight persons living with HIV, reported preventive therapy initiation. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.

Glycemic Control and Hypoglycemia in Patients Treated with Insulin Pump Therapy: An Observational Study.

INTRODUCTION: Diabetes mellitus (DM) is a highly prevalent disease worldwide. It has been associated with an important morbimortality due to its complications and sometimes as a result of adverse events related to treatment. Insulin pump therapy (IPT) is one of the options used to control this disease and reduces one of the most frequent complication associated with treatment: hypoglycemia, which has also a great impact on life quality and clinical status of patients. MATERIALS AND METHODS: A descriptive and retrospective study was performed including patients treated and followed by the department of endocrinology from a high-complexity university hospital in Cali, Colombia, between 2012 and 2017. Patients were on IPT and continuous glucose monitoring (CGM): MiniMed Paradigm® Veo™ Insulin Pump (Medtronic®) and MiniMed 640G Insulin Pump-Enlite™ Sensor (Medtronic®). Presentation of hypoglycemia and variables associated with its development were evaluated. RESULTS: 51 patients were included. The main indication for IPT initiation was the report of hypoglycemic episodes and inappropriate metabolic control. Initiation of IPT was related with a decrease in glycosylated hemoglobin (HbA1c) and also a decrease in severe hypoglycemic events and hospitalization due to hypoglycemia. The risk factors linked with clinically significant hypoglycemia were male gender, and standard deviation of glucose measures calculated by CGM. A diminished glomerular filtration rate (GFR) (<60 mL/min/1.73 m2) was correlated with higher risk of severe hypoglycemia. CONCLUSION: IPT with CGM is a useful strategy in the management of patients with DM; it is associated with a reduction of adverse hypoglycemic events and hospitalizations due to hypoglycemia.

Riedel's Thyroiditis: Report of Two Cases and Literature Review.

Riedel's thyroiditis is a rare entity consisting of a fibrotic process of the thyroid which can generate gland destruction, infiltration of cervical structures and even airway obstruction. It has been associated with systemic fibrotic disorders, autoimmune diseases, and more recently with spectrum of diseases related to excess of Immunoglobulin G type 4 (IgG4). Two cases of Riedel's thyroiditis by IgG4, confirmed by immunohistochemistry and was managed surgically with favorable results during the follow-up time, are presented. These case descriptions highlight the diagnostic challenge of this disease, describe the response with surgical management, and make a brief update on the subject.