Effectiveness of a prevention program in the incidence of cardiovascular outcomes in a low-income population from Colombia: a real-world propensity score-matched cohort study.

BACKGROUND: Cardiovascular diseases (CVDs) and diabetes mellitus (DM) are among the leading cause of morbidity and mortality in low-and-middle-income countries (LMICs) but evidence in these contexts regarding the effectiveness of primary prevention interventions taking into account patient adherence is scarce. We aimed to evaluate the effectiveness of a cardiovascular risk management program (De Todo Corazón - DTC program) in the incidence of the first cardiovascular outcome (CVO) in a low-income population from the Caribbean region of Colombia using adherence as the main variable of exposure. METHODS: A retrospective propensity score-matched cohort study was conducted. Adult patients with a diagnosis of hypertension (HTA), diabetes mellitus (DM), chronic kidney disease (CKD), or dyslipidemia affiliated to the DTC program between 2013 and 2018 were considered as the study population. Patients with 30 to 76 years, without a history of CVOs, and with more than 6 months of exposure to the program were included. The main outcome of interest was the reduction in the risk of CVOs (stroke, myocardial infarction, or congestive heart failure) based on the adherence to the intervention (attendance to medical appointments with health care professionals and the control of cardiovascular risk factors). Kaplan Meier curves and propensity score-matched Cox regression models were used to evaluate the association between adherence and the incidence of CVOs. RESULTS: A total of 52,507 patients were included. After propensity score matching, a sample of 35,574 patients was analyzed. Mean (SD) exposure time was 1.97 (0.92) years. Being adherent to the program was associated to a 85.4, 71.9, 32.4 and 78.9% risk reduction of in the low (HR 0.14; 95% CI 0.05-0.37; p < 0.001), medium (HR 0.28; 95% CI 0.21-0.36; p < 0.001), high-risk with DM (HR 0.67; 95% CI 0.43-1.04; p = 0.075) and hig-risk without DM (HR 0.21; 95% CI 0.09-0.48; p < 0.001) categories, respectively. CONCLUSIONS: The DTC program is effective in the reduction of the risk of CVOs. Population-based interventions may be an important strategy for the prevention of CVOs in underserved populations in the context of LMICs. A more exhaustive emphasis on the control of diabetes mellitus should be considered in these strategies.

First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor Colombian population: a cohort study.

BACKGROUND: According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. METHODS: We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan-Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. RESULTS: Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of follow-up. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43-2.00; p = 0.000), AMI (HR 1.79; 95% CI 1.45-2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18-2.02; p = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21-1.53; p < 0.001), 1.52 (1.12-2.08; p 0.004), and 1.20 (1.21-1.53; p < 0.001), respectively. CONCLUSION: Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events.

Prevalence of pulmonary arterial hypertension in the Colombian Caribbean.

In Latin America, there are no specific data on the prevalence of pulmonary arterial hypertension (PAH). For this reason, the Registro Latinoamericano de Hipertensión Pulmonar (RELAHP) is under development. The aim of this study is to estimate the prevalence of PAH in the Colombian Caribbean in 2015 based on data from a private health insurance company (PHIC) with coverage in that region. All the Individual Service Delivery Registries (RIPS) of all ambulatory care centers that serve the population of the Colombian Caribbean region affiliated with a PHIC selected for this research were reviewed. All patients who had a diagnosis of pulmonary hypertension (PH) were included (International Classification Diseases 10-Revision [ICD-10 I270, I272, I278, and I279]). Subsequently, the information on electronic medical records was reviewed. To estimate the prevalence of PAH, the total population of the PHIC and population projections of Colombian Caribbean by Departamento Administrativo Nacional de Estadisticas (DANE) was used. We identified 27 patients with a confirmed diagnosis of PH and 18 patients with a confirmed diagnosis of PAH. Taking into account the total population affiliated to the Caribbean Regional of the PHIC selected for the study in September 2015, a PAH prevalence of approximately 28 cases per million inhabitants is estimated. The mean of age was 22 ± 21.4 years (14.8% children) and 17 (62.9%) were girls/women. The majority of patients presented with PAH (Group 1) (66.6%). The estimated number of cases of PH in Colombian Caribbean in 2015 is approximately 292 cases or 1 in 35,760. Epidemiological estimates of PAH in the Colombian Caribbean are compatible with the definition of orphan or rare diseases. The majority of patients are female.

[Association between anemia and chronic obstructive pulmonary disease exacerbations in Cartagena Colombia: a prospective cohort study]. / Asociación entre anemia y exacerbaciones de enfermedad pulmonar obstructiva crónica en Cartagena Colombia: estudio de cohorte prospectivo.

BACKGROUND: The presence of anemia in chronic obstructive pulmonary disease is not an infrequent event. Exacerbations of this disease have been associated with an increase in mortality in these patients. It is not clear if the presence of anemia is associated with the risk of exacerbations. OBJECTIVE: To establish the association between anemia and the incidence of outcomes related to exacerbations of chronic obstructive pulmonary disease. METHODS: Analytical study of a dynamic or open concurrent prospective cohort of patients diagnosed with chronic obstructive pulmonary disease at two health care institutions in Cartagena, Colombia, between July 2010 and July 2011. RESULTS: 43.9% had anemia at the start of follow-up. The cumulative incidence of exacerbations was 63% in the anemic vs. 55.5% in the non-anemic group. The cumulative incidence of recurrence of exacerbations was 30.4% in the anemic vs. 38.8% in the non-anemic group. The rate of hospitalizations for exacerbations was 30.4% in the anemic vs. 33.3% in the non-anemic group. CONCLUSIONS: No significant association was established between anemia and the incidence of exacerbations of chronic obstructive pulmonary disease, the incidence of recurrence of first exacerbation, the rate of hospitalizations for chronic obstructive pulmonary disease exacerbations and the recurrence time of the first exacerbation of chronic obstructive pulmonary disease.

INTRODUCCIÓN: La presencia de anemia en la enfermedad pulmonar obstructiva crónica es un hecho frecuente. Las exacerbaciones de esta enfermedad se han asociado a un incremento de la mortalidad en estos pacientes. No es claro si la presencia de anemia se vincula al riesgo de exacerbaciones. OBJETIVO: Establecer la asociación entre anemia e incidencia de desenlaces relacionados con las exacerbaciones de la enfermedad pulmonar obstructiva crónica. MÉTODOS: Estudio analítico de una cohorte dinámica o abierta, prospectiva y concurrente de pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica de dos instituciones de atención en salud de Cartagena, Colombia, entre julio de 2010 y julio de 2011. RESULTADOS: De los casos revisados, 43,9% presentó anemia al inicio del seguimiento. La incidencia acumulada de exacerbaciones fue de 63% en el grupo de pacientes anémicos versus 55,5% en el grupo de no anémicos. La incidencia acumulada de recurrencia de exacerbaciones fue de 30,4% en el grupo de anémicos versus 38,8% en el grupo de no anémicos. La tasa de hospitalizaciones por exacerbaciones fue de 30,4% en el grupo de anémicos versus 33,3% en el grupo de no anémicos. CONCLUSIONES: No se estableció asociación significativa entre la anemia y la incidencia de exacerbaciones de enfermedad pulmonar obstructiva crónica, la incidencia de recurrencia de la primera exacerbación, la tasa de hospitalizaciones por exacerbaciones de enfermedad pulmonar obstructiva crónica y el tiempo hasta la recurrencia de la primera exacerbación de enfermedad pulmonar obstructiva crónica.

Progression of Chronic Kidney Disease in over 65-year-old Nephroprotection Program Patients in Colombia

Background: Studies evaluating chronic kidney disease in older adults are scarce despite the high prevalence of the disease in this age group. In this study we have tried to determine the factors associated with the progression of chronic kidney disease in a group of patients over 65 years old. Methods: An analytical observational study of a prospective non-concurrent cohort was performed. We included patients older than 65 years belonging to a nephroprotection program and then, we followed them for 12 months. The variables of interest were age, sex, history of diabetes mellitus, serum creatinine at baseline and at 12-month follow-up, blood pressure and use of antihypertensive drugs, high density lipoprotein and low density lipoprotein, cholesterol levels, proteinuria, and use of antiplatelet agents. The estimated glomerular filtration rate (eGFR) was calculated at baseline and at 12-month follow-up, lastly the progression of chronic kidney disease was established. Results: 200 patients were included with an average age of 78.9 + 7.6 years, 51 % (102) females, 33 % (66) with a history of diabetes mellitus, with a mean initial eGFR 38.8 + 12.1 mL/min/1.73 m2. The mean of the final eGFR was 36.4 + 11.0 mL/min/ 1.73 m2 ; 17.5 % (35) presented a decrease > 25 % of the initial eGFR (progression) and 37.5 % (75) showed a decrease > 5mL/min/1.73m2/ year (rapid progression). Progression and rapid progression were significantly associated with age (p = 0.03 and p = 0.001, respectively), male sex (p < 0.001 and p < 0.001, respectively) and proteinuria (p < 0.001 and p < 0.001, respectively). There were no significant associations with other variables of interest. Conclusion: In our study, the progression of chronic kidney disease in patients older than 65 years in a nephroprotection program was significantly associated with the increased age, male sex, and presence of proteinuria.

Antecedentes: los estudios que evalúan la enfermedad renal crónica en adultos mayores son escasos, a pesar de la alta prevalencia de esta enfermedad en este grupo de edad. En este estudio hemos intentado determinar los factores asociados a la progresión de la enfermedad renal crónica en un grupo de pacientes mayores de 65 años. Métodos: se realizó un estudio observacional analítico de una cohorte prospectiva no concurrente. Se incluyeron pacientes mayores de 65 años pertenecientes a un programa de nefroprotección y se les siguió durante 12 meses. Las variables de interés fueron edad, sexo, antecedentes de diabetes mellitus, creatinina sérica al inicio y a los 12 meses de seguimiento, presión arterial y uso de fármacos antihipertensivos, niveles de colesterol, lipoproteínas de alta densidad y lipoproteínas de baja densidad, proteinuria y uso de antiagregantes plaquetarios. La tasa de filtración glomerular estimada (TFGe) se calculó tanto al inicio como a los 12 meses de seguimiento y se estableció la progresión de la enfermedad renal crónica. Resultados: se incluyeron 200 pacientes con una edad promedio de 78,9 + 7,6 años, 51 % (102) mujeres, 33 % (66) con antecedentes de diabetes mellitus, con TFGe inicial promedio 38,8 + 12,1 mL/min/1,73 m2. La media del TFGe final fue de 36,4 + 11,0 mL/min/ 1,73 m2; El 17,5 % (35) presentó una disminución > 25 % del TFGe inicial (progresión) y el 37,5 % (75) presentó una disminución > 5mL/min/1,73m2/año (progresión rápida). La progresión y la progresión rápida se asociaron significativamente con la edad (p = 0,03 y p = 0,001, respectivamente), el sexo masculino (p < 0,001 y p < 0,001, respectivamente) y la proteinuria (p < 0,001 y p < 0,001, respectivamente). No hubo asociaciones significativas con otras variables de interés. Conclusión: en nuestro estudio, la progresión de la enfermedad renal crónica en pacientes mayores de 65 años en programa de nefroprotección se asoció significativamente con el aumento de la edad, el sexo masculino y la presencia de proteinuria.

[Skin reactivity in allergic conjunctivitis]. / Reactividad cutánea en conjuntivitis alérgica.

BACKGROUND: Allergic conjunctivitis is caused by an IgE-mediated mechanism or immediate hypersensitivity due to allergen direct contact on the conjunctival surface of sensitized patients, which elicits mastocyte activation and inflammatory mediators' release. Up to 47% of patients with allergic conjunctivitis can develop sensitization to perennial allergens; more than 24% of patients can experience sensitization to multiple allergens. OBJECTIVE: To estimate positive skin reactivity to allergens in patients diagnosed with allergic conjunctivitis in the allergology outpatient clinic of Centro de Especialistas Santo Domingo, in Cartagena, Colombia, during 2017. METHOD: Cross-sectional study of 92 patients aged between 3 and 74 years, included by convenience sampling. RESULTS: 70.65% had positive skin prick tests to at least one allergen. Most common allergens with positive skin reactivity were house dust mites (65.2%), animal epithelia (15.2%), insects (15.2%) and food (14.1%). Allergic rhinitis (51%), allergic asthma (23%) and atopic dermatitis (10%) were the most commonly associated allergic pathologies. CONCLUSIONS: Positive skin reactivity to the studied allergens was significantly higher in patients with allergic conjunctivitis and other associated conditions.

Antecedentes: La conjuntivitis alérgica es producida por un mecanismo mediado por IgE o hipersensibilidad inmediata por el contacto directo del alérgeno sobre la superficie conjuntival de pacientes sensibilizados, provocando activación mastocitaria y liberación de mediadores inflamatorios. Hasta 47 % de los pacientes con conjuntivitis alérgica puede presentar sensibilización a alérgenos perennes y más de 24 %, sensibilización a varios alérgenos. Objetivo: Estimar la reactividad cutánea positiva a alérgenos en pacientes con diagnóstico de conjuntivitis alérgica en la consulta de alergología del Centro de Especialistas Santo Domingo, en Cartagena, Colombia, durante 2017. Método: Estudio transversal de 92 pacientes entre tres y 74 años, incluidos por muestreo por conveniencia. Resultados: 70.65 % presentó reactividad positiva a las pruebas cutáneas al menos a un alérgeno. Los alérgenos con reactividad cutánea positiva más frecuentes fueron los ácaros del polvo domestico (65.2 %), epitelios de animales (15.2 %), insectos (15.2 %) y alimentos (14.1 %). La rinitis alérgica (51 %), asma alérgica (23 %) y la dermatitis atópica (10 %) fueron las patologías alérgicas asociadas más frecuentes. Conclusiones: La reactividad cutánea positiva a los alérgenos estudiados fue significativamente mayor en los pacientes con conjuntivitis alérgica con otras enfermedades asociadas.

[Prevalence of urticaria in Cartagena, Colombia]. / Prevalencia de urticaria en Cartagena, Colombia.

BACKGROUND: In Colombia, there have been studies on the prevalence of allergic diseases such as asthma, allergic rhinitis and atopic dermatitis. Prevalence studies of urticaria in Colombia are scarce. OBJECTIVE: Our objective objective of this study was to estimate the prevalence of urticaria in Cartagena (Colombia) in order to contribute to national epidemiological estimates of disease. METHODS: A multicenter cross-sectional study in the city of Cartagena was conducted and 547 patients aged 1-58 years treated at the Allergy specialist consultation in care centers selected for this study between April and July 2015 were included, through non-probabilistic sampling. RESULTS: The prevalence of urticaria in the care centers selected of city of Cartagena (Colombia) was 7.1 % (4 % children and adults 3.1 %). 3.4 % prevalence of acute urticaria and 3.6 % of chronic urticaria was estimated. CONCLUSION: 46.1 % reported having a poor quality of life associated with urticaria.

Antecedentes: En Colombia se han realizado estudios de prevalencia de enfermedades alérgicas como asma, rinitis alérgica y dermatitis atópica. Los estudios de prevalencia de urticaria en Colombia son escasos. Objetivo: Estimar la prevalencia de urticaria en Cartagena, Colombia, con el fin de contribuir a las estimaciones epidemiológicas nacionales de esta enfermedad. Métodos: Se realizó un estudio transversal multicéntrico en la ciudad de Cartagena y se incluyeron 547 pacientes entre 1 y 58 años atendidos en la consulta especializada de alergología en los centros de atención seleccionados para esta investigación entre abril y julio de 2015, mediante un muestreo por conveniencia. Resultados: La prevalencia de urticaria en los centros de atención seleccionados de la ciudad de Cartagena fue de 7.1 % (niños 4.0 % y adultos 3.1 %). Se estimó una prevalencia de 3.4 % de urticaria aguda y de 3.6 % de urticaria crónica. Conclusiones: El 46.1 % de los pacientes manifestó tener una mala calidad de vida asociada con la urticaria.

Relación entre el momento de la realización de la traqueotomía y la incidencia de neumonía asociada a ventilador, y la mortalidad en adultos en la Unidad de Cuidados Intensivos / Relationship between the tracheostomy and the incidence of ventilator-associated pneumonia and mortality in adults admitted to the Intensive Care Unit

Objetivos: Determinar la asociación entre la traqueotomía precoz (TP) (< 7 días) y la incidencia de neumonía asociada al ventilador (NAV). Materiales y métodos: Estudio observacional analítico de una cohorte retrospectiva de una población de pacientes que requirieron traqueotomía durante su ingreso en la Unidad de Cuidados Intensivos (UCI). Se compararon dos grupos de pacientes: a) traqueotomía precoz (TP) en los primeros siete días; b) traqueotomía tardía (TT) a partir del octavo día. Variables estudiadas: edad, género, compromiso, momento y duración de la intubación orotraqueal (IOT), microorganismos aislados en cultivos de secreción traqueal, incidencia de neumonía asociada a ventilación mecánica (NAV), duración de la estancia en la UCI y mortalidad. Se realizó un modelo de regresión logística multivariado, para determinar los factores asociados al desarrollo de neumonía. Resultados: Se estudiaron 85 pacientes. La media +/– desviación estándar de edad fue de 61,5 +/– 2 años. Los microorganismos aislados con mayor frecuencia fueron Klebsiella pneumoniae (10%), Enterobacter cloacae (6,6%) y Pseudomonas aeruginosa (6,6%). La mediana (rango intercuartílico) del momento (día) de realización de la traqueotomía (p 0,0000) y de la duración de la estancia (días) en la UCI (p 0,0010) fue estadísticamente mayor en el grupo sometido a traqueotomía tardía. La incidencia de NAV fue del 10,5% (9) y la mortalidad en adultos en la UCI fue del 27,3% (23). Conclusiones: La traqueotomía precoz no se asoció significativamente con la incidencia de NAV y la mortalidad, tanto en el análisis crudo como en el ajustado...

Objectives: To determine the association between early tracheostomy (TP) (< 7 days) and incidence of ventilator-associated pneumonia (VAP). Materials and Methods: Observational study of a retrospective cohort of a population of patients who required tracheostomy for admission to Intensive Care Unit (ICU). Data were compared in two groups of patients: a) early tracheostomy (PT) in the first 7 days, b) late tracheostomy (TT) from the 8th day. Variables studied: age, gender, commitment, time and duration of intubation (OTI), microorganisms isolated from tracheal secretion cultures, incidence of ventilator-associated pneumonia (VAP), duration of stay and ICU mortality. We performed a multivariate logistic regression model to determine factors associated with the development of pneumonia. Results: We studied 85 patients, the mean +/– SD age was 61.5 +/– 2.02 years. The most frequently isolated microorganisms were Klebsiella pneumoniae (10%), Enterobacter cloacae (6.6%) and Pseudomonas aeruginosa (6.6%). The median (interquartile range) of time (day) of performing tracheotomy (p 0.0000) and length of stay (days) in the ICU (p 0.0010) was statistically higher in the group receiving late tracheostomy. The incidence of VAP was 10.5% (9) and Adult Mortality in ICU was 27.3% (23). Conclusions: Early tracheotomy was not significantly associated with the incidence of VAP and mortality is crude analysis as the ajusted analysis...