Caracterización clínica y tratamiento de pacientes ingresados por la COVID-19 en terapias intensivascubanas

RESUMEN Introducción: La pandemia por la COVID-19 fue declarada emergencia de salud pública internacional. El conocimiento de los síntomas, comorbilidades y el riesgo según el tratamiento recibido puede contribuir a una mejor clasificación y atención de los pacientes. Objetivo: Caracterizar clínicamente a los pacientes de COVID-19 atendidos en las unidades de terapia intensiva cubanas. Métodos: Estudio observacional retrospectivo de todos los pacientes atendidos en las unidades de terapia intensiva de Cuba en el periodo comprendido entre el 11 de marzo y el 30 de julio de 2020. Se recolectaron datos demográficos, clínicos y de resultados. Se compararon los pacientes fallecidos y recuperados de acuerdo a la prevalencia de las covariables a través de una prueba estándar de chi-cuadrado. Se realizó regresión logística para evaluar las variables predictoras de la mortalidad hospitalaria. Resultados: Se atendieron 175 pacientes, de ellos 106 graves y 69 críticos. Predominó el sexo masculino (52,0 %), mayores de 60 años (67,2 %) con hipertensión arterial (57,0 %). La edad (mayores de 80 años, OR= 9,62, IC95%: 3,16-29,2), el estado al ingreso (OR= 8,32, IC95%: 2.30-30,10) y la inestabilidad hemodinámica (OR=6,9, IC95%:2,96-16,37), se asociaron a un mayor riesgo de fallecimiento. Los pacientes tratados con kaletra, cloroquina, itolizumab o jusvinza incrementaron la supervivencia. El riesgo de fallecimiento en los críticos disminuyó de 80 a 25% con el uso de jusvinza. Conclusiones: La caracterización clínica realizada demuestra la efectividad de los protocolos clínicos empleados en las unidades de terapia intensiva del país.

ABSTRACT Introduction: COVID-19 pandemic was declared an international public health emergency. The knowledge of the symptoms, comorbidities, and the risk associated with the treatment received could contribute to better classification and care of patients. Objective: To clinically characterize COVID-19 patients admitted to the Cuban intensive care units Methods: A retrospective observational study of all patients treated in the Cuban intensive care units from March 11 to July 30, 2020. Demographic, clinical and outcome data were collected. The prevalence of fatal and recovery cases was compared by covariables using the standard chi-square test. A logistic regression was performed to evaluate the predictor variables for in-hospital mortality. Results: A total of 175 patients were treated, including 106 acutely ill and 69 critically ill. Patients were predominantly male (52.0%), over 60 years old (67.2%) and had hypertension (57.0%). Age (over 80 years old, OR= 9.62, 95% CI: 3.16-29.2), health status at admission (OR= 8.32, 95% CI: 2.30-30.10), and hemodynamic instability (OR=6.9, 95% CI: 2.96-16.37) were associated with an increased risk of death. Patients treated with Kaletra, chloroquine, Itolizumab, or Jusvinza increased survival. Mortality risk in critically ill patients decreased from 80% to 25% with the use of Jusvinza. Conclusions: The clinical characterization performed demonstrates the effectiveness of the clinical protocols used in the country's intensive care units.

Propuesta de acciones para la formación de la habilidad diagnóstica en residentes de Anatomía Patológica / Proposal of actions to develop the diagnosis skills in Pathology residents

RESUMEN Introducción: el diagnóstico es una de las tareas fundamentales de los médicos en general y de los patólogos en particular, es la actividad que ocupa el mayor tiempo de este especialista. Objetivo: diseñar un sistema de acciones para optimizar el proceso de formación de la habilidad diagnóstica en los residentes de Anatomía Patológica. Métodos: se realizó una investigación descriptiva y cualitativa a través de acciones estratégicas encaminadas al perfeccionamiento del proceso de formación de la habilidad diagnóstica en los residentes de la especialidad de Anatomía Patológica de la Universidad de Ciencias Médicas de Pinar del Río. Resultados: se constató que la formación de la habilidad diagnóstica no se encuentra debidamente estructurada, se realiza de manera espontánea, no secuenciada y no posibilita que el residente sistematice las acciones necesarias para su dominio. La estrategia se estructuró a través de la capacitación al colectivo pedagógico de la carrera y talleres profesionales integradores para los residentes de cada año. Conclusiones: se diseñó un sistema de acciones dirigidas a docentes y residentes de Anatomía Patológica, lo que permitió estimular el perfeccionamiento del proceso de formación de la habilidad diagnóstica morfológica, elevar la responsabilidad ante la docencia, el aprendizaje y el nivel de compromiso social con esta función, donde los residentes deben ser capaces de integrar y aplicar los conocimientos adquiridos en los diferentes módulos para la resolución de problemas propios de la profesión.

ABSTRACT Introduction: diagnosis is one of the main activities of physicians in general and of pathologists in particular, and is the activity that occupies most of this specialist's time. Objective: to design a system of actions to optimize the training process for the development of diagnosis skills in Pathology residents. Methods: a descriptive and qualitative research was conducted by means of strategic actions aimed at improving the training process for the development of diagnosis skills in Pathology residents at Pinar del Rio University of Medical Sciences. Results: it was confirmed that the training for the development of diagnosis skills is not properly structured, without any planning, not arranged and it does not make possible the resident to systematize the required actions for the mastery of these skills. The strategy was structured through the training of the teaching staff of these specialty and comprehensive professional workshops for the residents of each academic year. Conclusions: a system of actions was designed to train the teaching staff and residents of Pathology, which allowed encouraging strategic actions to improve the teaching-learning process for the development of diagnosis-morphological skills and increase the responsibility toward the teaching-leaning activity, and the level of social commitment in relation to this function, where the residents should be able to integrate and apply the knowledge acquired by means of the different modules for the characteristic problem-solving of this profession.

Dengue and COVID-19, overlapping epidemics? An analysis from Colombia.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout Latin America, a region swept by multiple previous and ongoing epidemics. There are significant concerns that the arrival of COVID-19 is currently overlapping with other viruses, particularly dengue, in various endo-epidemic regions across South America. In this report, we analyzed trends for both viral infections in Colombia during the first 20 epidemiological weeks (EWs) of 2020. From 1st January to 16th May 2020 (EWs, 1-20), a total of 52 679 cases of dengue and 14 943 cases of COVID-19 have been confirmed in Colombia. As both conditions may potentially lead to fatal outcomes, especially in patients with chronic co-morbidities, overlapping infections, and co-occurrence may increase the number of patients requiring intensive care and mechanical ventilation. In regions, such as Valle del Cauca, intensified preparation for such scenarios should be pondered, and further studies should be performed to address this critical issue in a timely matter.

Recovery of COVID-19 acute respiratory distress syndrome with tocilizumab: successful outcome in two critically ill patients.

Background: Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice. Although there is no clarity in the principal mechanism of lung damage and ARDS development, it has been suggested that one of the main reasons of this pathology is the hyperactivation of the immune system, better known as cytokine storm syndrome. Tocilizumab has been proposed to treat COVID-19 severe cases associated to ARDS. Results & methodology: Here we present two successful cases of tocilizumab administration in two COVID-19 patients with prior administration of antiviral therapy (hydroxychloroquine, azithromycin, lopinavir and ritonavir) with adequate response and resolution of ARDS, septic shock and severe pneumonia within the first 72 h. Discussion & conclusion: This case supports the usage of tocilizumab as an effective therapy in COVID-19 associated cytokine storm syndrome. Further studies should be done in order to assess its effectiveness and security.

Predicción temporal de CD4+ en 80 pacientes con manejo antirretroviral a partir de valores de leucocitos / CD4+ temporal prediction in 80 patients with antiretroviral management from leukocyte counts

Objetivo: establecer una metodología predictiva de aplicación clínica de recuentos de CD4+ en rangos de interés clínico a partir del recuento absoluto de leucocitos. Metodología: a partir de los valores secuenciales de leucocitos y linfocitos CD4+ de 9 pacientes, se observaron patrones matemáticos que posteriormente fueron aplicados en un estudio ciego con 71 casos para confirmar su capacidad predictiva, midiendo porcentajes de especificidad y sensibilidad. Resultados: se determinaron cinco patrones matemáticos que predicen en el 99% de los casos los distintos recuentos de CD4+ a partir de recuentos de leucocitos con valores de especificidad y sensibilidad del 99%. Conclusiones: los patrones matemáticos encontrados entre recuento de leucocitos y CD4+ sugieren que este fenómeno prácticamente es determinista.

Objective: To establish a predictive methodology of CD4+ counts for clinical application in ranges of clinical interest based on the absolute leukocyte count. Methodology: From sequential values of leukocytes and CD4+ lymphocytes of nine patients, mathematical patterns were observed and applied in a blind study with 71 cases to confirm their predictive capacity, measuring percentages of specificity and sensitivity. Results: Five mathematical patterns were determined that predict 99% of the cases in which CD4+ counts are obtained from leukocyte counts with specificity and sensitivity values of 99%. Conclusions: The mathematical patterns found between leukocytes and CD4 counts suggest that this phenomenon is practically deterministic.

Clinical relevance of Zika symptoms in the context of a Zika Dengue epidemic.

BACKGROUND: The clinical characteristics of the most frequent arbovirosis (Dengue, Zika, Chikungunya) are very similar, which is a diagnostic challenge for clinicians. OBJECTIVE: To identify the presence of clinical characteristics related to Zika virus infection confirmed by the laboratory in patients during an epidemic of co-infection with Zika and Dengue viruses. METHOD: Cross-sectional descriptive study of patients with clinical - epidemiological suspicion of Zika virus infection, who were admitted in the Hospital "Joaquín Albarrán" (La Habana, Cuba), during June 1 to October 31 of 2017. Demographic and symptoms and signs were recorded. By PCR for Zika virus (in blood or urine) the disease was confirmed. RESULTS: 1541 patients were studied. The most frequent symptoms and signs were rash (93.8%), pruritus (77.9%), arthralgia (60.0%), headache (50.8%), myalgia (46.1%), fever (34.7%), asthenia (31.7%), and conjunctivitis (27.9%). Zika virus infection was confirmed in 279 patients (18.1%). Greater frequency of arthralgia, asthenia, and diarrhea was demonstrated in Zika confirmed patients. CONCLUSION: Minor clinical relevance was observed in the symptoms or signs of arboviral disease to support the clinical diagnosis of Zika virus infections by clinician during a Zika-Dengue epidemic. The assessment of the temporality of the onset of Zika and Dengue symptoms of these infections is recommended to assist clinicians in the differential diagnosis.

Plasmodium vivax infection due to percutaneous exposure in non-endemic area.

Malaria is an acute febrile disease due to Plasmodium species widely distributed in tropical areas of the world and it is a leading cause of death in developing countries. In 2018, 62.141 confirmed cases of malaria were reported in Colombia with P. vivax and Plasmodium falciparum being the causal species. Vectorial transmission is the most common way of acquiring the infection, however it can also occur by blood transfusion, transplacental route and percutaneous exposure. We describe a case of P. vivax infection by needle stick injury in a laboratory technician in Bogotá, Colombia.

Enfermedad de Creutzfeldt-Jakob. Presentación de un caso y revisión de la literatura / Creutzfeldt-Jakob Disease. Case Report and Literature Review / Doença de Creutzfeldt-Jakob. Apresentação de caso e revisão da literatura

Resumen: La enfermedad de Creutzfeldt-Jakob (ECJ) es una patología neurodegenerativa transmisible, producida por una proteína anómala infectante denominada prion. Junto con el kuru, el insomnio familiar fatal y el síndrome de Gerstmann-Stráussler-Scheinker, configura el grupo de las llamadas encefalopatías espongiformes. La ECJ es la forma más común en el ser humano: se calcula que afecta a una persona por cada millón, a nivel mundial, y la mayoría de los pacientes presenta síntomas clásicos de demencia y mioclonías, asociadas a cambios específicos en el electroencefalograma (EEG). Conforme la enfermedad progresa, el cuadro demencial empeora y pueden presentarse síntomas visuales, cerebelosos, piramidales y extrapiramidales. El diagnóstico definitivo se logra demostrando la degeneración espongiforme de las neuronas en histopatología. La ECJ siempre es mortal y no tiene tratamiento específico: cerca del 90% de los pacientes fallece dentro del primer año después del diagnóstico. En este artículo, se reporta el caso de un paciente con ECJ esporádica probable, de acuerdo con los criterios diagnósticos actuales de la OMS y se da a conocer una revisión de la literatura.

Abstract: Creutzfeldt-Jakob disease (CJD) is a transmissible neurodegenerative pathology produced by an infecting abnormal protein called prion. Together with kuru, fatal familial insomnia, and Gerstmann-Stráussler-Scheinker syndrome, it forms the group of so-called spongiform encephalopathies. CJD is the most common form in humans: it is estimated to affect one person per million worldwide and most patients have classic symptoms of dementia and myoclonus, associated with specific changes in the electroencephalogram (EEG). As the disease progresses, the dementia condition worsens and visual, cerebellar, pyramidal, and extrapyramidal symptoms may develop. The final diagnosis is achieved by proving the spongiform degeneration of neurons in the histopathology. CJD is always fatal and has no specific treatment: about 90 % of patients die within the first year of diagnosis. This article reports the case of a patient with probable sporadic CJD, following current who diagnostic criteria, and provides a literature review.

Resumo: A doença de Creutzfeldt-Jakob (DCJ) é uma doença patologia neurodegenerativa transmissível, produzida por uma proteína anormal infectante denominada prion. Juntamente com o kuru, a Insónia familiar fatal e a síndrome de Gerstmann-Stráussler-Scheinker, forma o grupo das chamadas encefalopatias espongiformes. A DCJ é a forma mais comum em humanos: estima-se que ela afete uma em cada um milhão de pessoas em todo o mundo, e a maioria dos pacientes apresenta sintomas clássicos de demência e mioclonia, associados a alterações específicas no eletroencefalograma (EEG). À medida que a doença progride, o quadro de demência piora e podem surgir sintomas visuais, ce-rebelares, piramidais e extrapiramidais. O diagnóstico definitivo é obtido por meio da demonstração da degeneração espongiforme dos neurónios na histopatologia. A dcj é sempre fatal e não possui tratamento específico: cerca de 90% dos pacientes morrem no primeiro ano após o diagnóstico. Neste artigo, é relatado o caso de um paciente com dcj esporádica provável, de acordo com os atuais critérios de diagnóstico da oms, e é apresentada uma revisão da literatura.

Participación de los pacientes en la prevención de las infecciones del sitio quirúrgico / Patient Involvement if Preventing Surgical Site Infections

RESUMEN Introducción: Las infecciones del sitio quirúrgico constituyen las más frecuentes infecciones relacionadas con los cuidados de la salud y la educación de los pacientes, y los cuidadores constituye un elemento esencial para su prevención. Objetivo: Evaluar los elementos esenciales relacionados con la participación de los pacientes en la prevención de las infecciones del sitio quirúrgico. Método: Utilizando como fuente de información PubMed y la Joint Comission International se sintetizaron los aspectos relacionados con la prevención de las infecciones del sitio quirúrgico. Desarrollo: La educación del paciente transcurre desde el periodo preoperatorio hasta la total recuperación del paciente y constituye un criterio requerido para acreditar los sistemas de gestión de la calidad en instituciones de salud. Debe enfocarse en la modificación positiva de riesgos como la higiene preoperatoria, la abstención del hábito de fumar, el control glicémico en pacientes diabéticos, el uso de medicación inmunosupresora, la movilización temprana de los pacientes, los cuidados de la herida y la identificación y manejo oportuno de infecciones. Conclusiones: Se debe promover la participación activa del paciente y su familia en los cuidados de salud y el uso de las tecnologías educativas disponibles(AU)

ABSTRACT Introduction: Surgical site infections are the most frequent infections associated with health care. The education of patients and caregivers is an essential element for their prevention. Objective: To evaluate the essential elements associated with the participation of patients in the prevention of surgical site infections. Method: Using PubMed and the Joint Commission International as a source of information, we synthesized aspects related to the prevention of surgical site infections. Development: Patient education is carried out from the preoperative period until the patient's full recovery and is a required criterion to accredit quality management systems in health institutions. It should focus on the positive modification of risks such as preoperative hygiene, abstention from smoking, glycemic control in diabetic patients, the use of immunosuppressive medication, early mobilization of patients, wound care, and identification and timely management of infections. Conclusions: The active participation of the patient and the family in health care and the use of available educational technologies should be promoted(AU)

Feocromocitoma maligno de presentación retroperitoneal / Retroperitoneal Malignant Pheochromocytoma

RESUMEN Introducción: la neoplasia más común y mejor conocida de la médula adrenal es el feocromocitoma benigno, que puede definirse como un paraganglioma de la médula suprarrenal, el cual puede secretar catecolaminas del tipo, norepinefrina, epinefrina o ambas. Presentación de caso: paciente femenina de 36 años, de raza blanca, con antecedentes de salud, valorada por dolor lumbar no irradiado, que se aliviaba espontáneamente, con cifras tensionales al ingreso de 170/100 mm de Hg, la ecografía informa la presencia de tumor retroperitoneal, se realiza exéresis quirúrgica del tumor, durante el transoperatorio la paciente sufre inestabilidad hemodinámica, con hipotensión, taquicardia y parada cardiorrespiratoria, que logra recuperarse. La paciente fallece en las primeras seis horas del postoperatorio en un cuadro de shock. Conclusiones: el feocromocitoma maligno constituye solo el 10 % de estas neoplasias, siendo una tumoración infrecuente en nuestro medio, motivo por el cual se consideró pertinente su presentación. El diagnóstico se realizó por estudio histológico, planteándose el feocromocitoma maligno. Se presentó un caso clínico de feocromocitoma maligno suprarrenal, pretendiendo con ello aportar un mayor conocimiento de esta neoplasia.

ABSTRACT Introduction: the most common and best-known neoplasm of the adrenal medulla is benign pheochromocytoma, which can be defined as a paraganglioma of the adrenal medulla, which may secrete catecholamine of the types of norepinephrine, epinephrine, or both. Clinical case: a 36-year-old, white race, female patient with a health history, assessed for a non-irradiated lumbar pain, which was spontaneously relieved, a blood pressure of 170/100 mm Hg at admission, the ultrasound reported the presence of a retroperitoneal tumor, the surgical exeresis of the tumor was performed, during the trans-operative stage the patient suffered from hemodynamic instability, hypotension, tachycardia and cardio-respiratory arrest, which was managed to her recovery. The patient dies in the first 6 hours as a consequence of a postoperative shock. Conclusions: malignant pheochromocytoma constitutes only 10 % of these types of neoplasm, being an infrequent tumor in our environment; its report was significant to be presented. The diagnosis was made by histological study, considering malignant pheochromocytoma. A clinical case of adrenal malignant pheochromocytoma was reported, with the intention of contributing to the acquisition of a better management in relation to this type of neoplasm.

Incidencia de infección del sitio quirúrgico y cumplimiento de prácticas de prevención en apendicectomía y cirugía herniaria / Incidence of the surgical infection site and fulfillment of preventive practices in appendicectomy and hernial surgery

Introducción: La vigilancia de infección del sitio quirúrgico en procederes quirúrgicos frecuentes es esencial para su prevención. Objetivo: Determinar la incidencia de infección del sitio quirúrgico y el cumplimiento de las prácticas de prevención en apendicectomía y cirugía de hernia. Método: Estudio descriptivo de pacientes intervenidos de estos procederes desde enero 2017 hasta marzo 2018 en Hospital Clínico Quirúrgico Universitario Joaquín Albarrán. La Habana, Cuba. Se recolectó información de las características demográficas de los pacientes, los procederes y el CPP (profilaxis antibiótica, normoglicemia, normotermia y eliminación del pelo). Se utilizaron técnicas de vigilancia durante el ingreso y posterior al egreso para identificar los pacientes con infección del sitio quirúrgico. Se calculó la tasa total de infección del sitio quirúrgico y según índice de riesgo (por cada100 procederes quirúrgicos), para cada proceder y el CPP por cada 100 procederes quirúrgicos. Resultados: Se evaluaron 174 pacientes con apendicectomía y 389 de cirugía de hernia, con tasas de infección de 13,8 por ciento y 5,7 por ciento, respectivamente. El cumplimiento del tiempo de administración del antibiótico profiláctico, la selección y dosis, y la discontinuación fueron respectivamente de 53,3 por ciento, 83,3 por ciento y 80,0 por ciento, en apendicectomía, y de 46,3 por ciento, 72,9 por ciento y 63 por ciento, en cirugía de hernia. La normotermia fue alcanzada en 32,4 por ciento y 27,1 por ciento de los casos. La mayoría de los pacientes con infección del sitio quirúrgico fueron diagnosticados utilizando métodos de vigilancia posterior al egreso. Conclusión: Se ha identificado la incidencia de infección del sitio quirúrgico y brechas en el cumplimiento de las prácticas de prevención que requieren acciones correctivas, que incluyan fortalecimiento del sistema de vigilancia y capacitación de los profesionales(AU)

Introduction: Surveillance of the surgical site infection in frequent surgical procedures is essential for its prevention. Objective: To determine the incidence of surgical site infection and the fulfillment of prevention practices in appendicectomy and hernial surgery. Method: Descriptive study of patients operated on by these procedures from January 2017 to March 2018 in "Joaquin Albarran" clinical, surgical and university hospital in Havana, Cuba. Data on demographic characteristics of patients, the types of procedures and the CPP (antibiotic prophylaxis, normoglycemia, normothermia and hair removal) were collected. The use of surveillance techniques during hospitalization and after discharge allowed identifying the patients with surgical site infection. The total surgical site infection rate and the risk index (per 100 surgical procedures) for each procedure and the CPP per 100 surgical procedures were all estimated. Results: One hundred and seventy-four patients with appendicectomy and 389 with hernial surgery were evaluated and their infection rates were 13.8 percent and 5.7 percent, respectively. The compliance with the time of administration of prophylactic antibiotic, selection and dosage, and discontinuation of treatment were 53.3 percent, 83.3 percent and 80 percent, respectively in appendicectomy where those of hernial surgery were 46.3 percent,72.9 and 63 percent, respectively. Normothermia was reached in 32.4 percent and 27.1 percent of cases. Most of the patients with surgical site infection were diagnosed by using the surveillance methods after discharge from hospital. Conclusions: The incidence of the surgical site infection and gaps in the fulfillment of prevention practices has been identified, which require corrective actions including strengthening of the surveillance system and professional training(AU)

Predicción espacio-temporal probabilista de la epidemia de dengue total y grave en Colombia / Probabilistic spatial-temporal prediction of total and severe epidemic of dengue in Colombia / Previsão probabilística espaço-temporal da epidemia de dengue total e grave na Colômbia

RESUMEN Objetivo Establecer una nueva metodología predictiva de la proporción de dengue grave respecto al total anual de infectados de dengue por departamento con base en la teoría de la probabilidad. Métodos Con base en los datos anuales de número de infectados por departamentos en el periodo 2005 -2010, se calculó la proporción entre casos de dengue grave respecto al total para cada año, y se construyeron espacios de probabilidad que evalúan estos eventos en rangos de 0,5 y 0,3. Se determinaron conjuntos de rangos y se calculó probabilidad, desviación media cuadrática y la diferencia entre ellas. Se realizó una predicción del rango de infectados para el 2011 con el promedio aritmético de los valores de los últimos dos años. Resultados Se predijo correctamente el rango en el que se encuentra incluida la proporción de número de infectados de dengue grave sobre el total en cada departamento con una efectividad del 93,3% para el rango de 0,5 y de 86,7% para el de 0,3. Conclusión Se evidenció una autoorganización matemática espacio temporal en la proporción de dengue grave respecto al total que permite establecer predicciones de utilidad para la toma de decisiones de salud pública.(AU)

ABSTRACT Objective To establish a new predictive methodology to determine the proportion of severe dengue with respect to the annual total of dengue infections per department based on the probability theory. Materials and Methods Based on annual data on the number of infected persons by department in the period 2005-2010, the proportion of cases of severe dengue was calculated with respect to the total for each year. Probability spaces were constructed to evaluate these events in the ranges 0.5 and 0.3. Sets of ranges were determined and probability, mean square deviation and the difference between them were estimated. A prediction of the range of infected people for 2011 was made using the arithmetic average of the values of the last two years. Results The range in which the proportion of the number of people infected with severe dengue is included with respect to the total amount in each department was correctly predicted, with an effectiveness of 93.3% for the 0.5 range and 86.7% for the 0.3 range. Conclusion A mathematical spatial-temporal self-organization was found in the proportion of severe dengue with respect to the total, which allows establishing useful predictions for decision-making in public health.(AU)

RESUMO Objetivo Estabelecer uma nova metodologia preditiva para a proporção de dengue grave em relação ao dengue total anual infectado por departamento com base na teoria da probabilidade. Métodos Com base nos dados anuais do número de infectados por departamentos no período 2005-2010, a proporção entre os casos de dengue grave em relação ao total foi calculada para cada ano, e foram construídos espaços de probabilidade que avaliam esses eventos em intervalos de 0, 5 e 0,3. Conjuntos de intervalos foram determinados e a probabilidade, o desvio médio quadrático e a diferença entre eles foram calculados. A previsão da faixa de infectados para 2011 foi feita com a média aritmética dos valores dos últimos dois anos. Resultados A faixa na qual a proporção do número de infectados por dengue grave sobre o total está incluída em cada departamento foi corretamente prevista com uma eficácia de 93,3% para a faixa de 0,5 e 86,7% para aquela de 0,3. Conclusão Evidenciou-se uma auto-organização matemática espaço-temporal na proporção de dengue grave em relação ao total, o que permite estabelecer previsões úteis para a tomada de decisões em saúde pública.(AU)

[Probabilistic spatial-temporal prediction of total and severe epidemic of dengue in Colombia]. / Predicción espacio-temporal probabilista de la epidemia de dengue total y grave en Colombia.

OBJECTIVE: To establish a new predictive methodology to determine the proportion of severe dengue with respect to the annual total of dengue infections per department based on the probability theory. MATERIALS AND METHODS: Based on annual data on the number of infected persons by department in the period 2005-2010, the proportion of cases of severe dengue was calculated with respect to the total for each year. Probability spaces were constructed to evaluate these events in the ranges 0.5 and 0.3. Sets of ranges were determined and probability, mean square deviation and the difference between them were estimated. A prediction of the range of infected people for 2011 was made using the arithmetic average of the values of the last two years. RESULTS: The range in which the proportion of the number of people infected with severe dengue is included with respect to the total amount in each department was correctly predicted, with an effectiveness of 93.3% for the 0.5 range and 86.7% for the 0.3 range. CONCLUSION: A mathematical spatial-temporal self-organization was found in the proportion of severe dengue with respect to the total, which allows establishing useful predictions for decision-making in public health.

OBJETIVO: Establecer una nueva metodología predictiva de la proporción de dengue grave respecto al total anual de infectados de dengue por departamento con base en la teoría de la probabilidad. MÉTODOS: Con base en los datos anuales de número de infectados por departamentos en el periodo 2005 -2010, se calculó la proporción entre casos de dengue grave respecto al total para cada año, y se construyeron espacios de probabilidad que evalúan estos eventos en rangos de 0,5 y 0,3. Se determinaron conjuntos de rangos y se calculó probabilidad, desviación media cuadrática y la diferencia entre ellas. Se realizó una predicción del rango de infectados para el 2011 con el promedio aritmético de los valores de los últimos dos años. RESULTADOS: Se predijo correctamente el rango en el que se encuentra incluida la proporción de número de infectados de dengue grave sobre el total en cada departamento con una efectividad del 93,3% para el rango de 0,5 y de 86,7% para el de 0,3. CONCLUSIÓN: Se evidenció una autoorganización matemática espacio temporal en la proporción de dengue grave respecto al total que permite establecer predicciones de utilidad para la toma de decisiones de salud pública.

Epididymo-orchitis caused by Histoplasma capsulatumin a Colombian patient

Abstract Although histoplasmosis is generally a self-limited disease, disseminated infection can occur in patients lacking effective cell-mediated immunity, reaching virtually every organ, even the genitourinary tract in rare cases. We report a case of epididymo-orchitis in an immunocompetent 38-year-old bricklayer from the rural area of Villeta, Cundinamarca, Colombia. The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confirmation of Histoplasma capsulatum.

Algunas consideraciones diagnósticas y terapéuticas del paciente con síndrome febril en Colombia / Some considerations regarding diagnosis and therapeutics of patients with febrile syndrome in Colombia

Sr. Editor, hemos leído con gran interés la revisión realizada por Cortés et al. respecto al enfoque clínico del síndrome febril agudo en Colombia, recientemente publicada en la revista INFECTIO. A manera de contribución, en primer lugar, quisiéramos resaltar la importancia de incluir y considerar la enfermedad de Chagas (en su fase aguda) como otro de los diagnósticos diferenciales a tener en cuenta y de suma importancia, en el contexto del síndrome febril agudo en Colombia, particularmente en los últimos años.

Mr. Editor, we have read with great interest the review by Cortés et al. on the clinical approach to acute febrile syndrome in Colombia, recently published in the journal INFECTIO. As a contribution, first of all, we would like to highlight the importance of including and considering Chagas disease (in its acute phase) as another of the differential diagnoses to be taken into account and of utmost importance in the context of acute febrile syndrome in Colombia, particularly in recent years.