Prevalence of communicable and non-communicable diseases among adult immigrants from Venezuela at a university hospital in Colombia from 2017 to 2018.

Since 2015 immigration has increased significantly into Colombia. As immigrants who are not insured to the national health system present to public hospitals for medical care. However, there is little knowledge about the prevalence of communicable and non-communicable diseases amongst them. Ours was a cross-sectional study at a university hospital reviewing 154 medical records of Venezuelan immigrants treated by the Internal Medicine Specialty between 2017 & 2018. Non-communicable diseases representing 66.3% are the main cause of hospitalization, possibly owing to poor primary care.

Malaria among migrants in a university hospital in Colombia during 2018: A case series.

Imported malaria has increased in Colombia since 2015 and has been attributed to migrants coming from Venezuela. We present a series of malaria cases, nested in a retrospective cross-sectional study between 2017 and 2018, aimed at calculating the prevalence of medical diseases among immigrants in a University Hospital in Colombia. Among 154 immigrants admitted for medical causes between 2017 and 2018, 8 were diagnosed with malaria, all due to Plasmodium vivax. Of these, seven had uncomplicated malaria, five had a previous history of malaria, one was critically ill, but none died. We highlight that, similar to other case series of imported malaria, Latin American migrants were young, with similar clinical profiles, having a low proportion of severe cases, and P. vivax was the most frequent cause.

Systematic review and meta-analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes.

BACKGROUND: Routine treatment for asymptomatic bacteriuria (ASB) after renal transplantation (RT) represents nowadays a controversial topic, being unknown its impact on the overall prognosis of the transplanted patient. METHODS: Studies published during 1970-2019 that evaluated the benefit of treating ASB after RT regarding the risk of renal complications were included. The primary outcome was to assess whether the treatment is associated with a lower risk of symptomatic urinary tract infection (UTI) or an improved renal function at the end of the follow-up period. The secondary outcome was the risk of acute graft rejection (AGR). A meta-analysis with a random-effect model was performed. Heterogeneity was assessed with the I2 measure. RESULTS: Fifteen studies were included. The incidence of ASB in the first month and the first year after RT was 22% and 30%, respectively. ASB was not correlated to AGR (OR 1.18; 95% CI, 0.78-1.79). Eight studies compared the outcomes of ASB treatment, finding no benefit of treating regarding the risk of symptomatic UTI (OR 1.08; 95% CI, 0.63-1.84; I2  = 35%) or the change in renal function (mean difference in serum creatinine concentration-0.03 mg/dL,95% CI-0.15-0.10; I2  = 53%). CONCLUSIONS: Asymptomatic bacteriuria represents a frequent finding after RT, highlighting the need for appropriate management of this condition. Considering that its treatment did not decrease the risk of the studied complications, antibiotic therapy should start to be questioned, as it has been related to higher rates of antimicrobial resistance and high economic costs.

Risk of Surgical Site Infection in Patients with Asymptomatic Bacteriuria or Abnormal Urinalysis before Joint Arthroplasty: Systematic Review and Meta-Analysis.

BACKGROUND: Routine screening and treatment for pre-operative asymptomatic bacteriuria (ASB) before joint arthroplasty are controversial. This systematic review and meta-analysis aimed to evaluate the impact of ASB and other bacterial colonization markers (BCM) observed in abnormal urine analyses, such as positive nitrites, leukocyturia, or positive leukocyte esterase in the risk of surgical site infections (SSIs) of joint arthroplasty patients. METHODS: Studies published between 1970 and 2017 that reported data on SSI and prosthetic joint infection (PJI) in patients after joint arthroplasty of the hip, knee, or shoulder with pre-operative ASB or BCM were included. A meta-analysis with random effect model was performed. RESULTS: Eleven studies were included (29,371 patients and 35,323 joints). The main procedures were total hip replacements (53.3%) and the mean follow-up period was 21.5 months, with 12 months being the minimum time of follow-up. A total of 2,400 cases (9.5%) reported pre-operative BCM (15%) or ASB (85%). The proportion of SSI was higher in patients with ASB (2.3% vs. 1.1%) (p < 0.001) and was related to a higher risk of SSI (odds ratio [OR] 2.89; 95% confidence interval [CI] 1.36-6.17), however, in only six cases (12.7%) was the SSI micro-organism correlated with the urine culture. Finally, antibiotic treatment for ASB did not reduce the SSI risk (OR = 0.82; 95% CI 0.34-1.97). CONCLUSIONS: Asymptomatic bacteriuria represent a relatively common finding among these patients and is related to a higher risk of SSI. However, the poor microbiologic correlation suggests that ASB could represent a surrogate marker for other conditions correlated with bacterial infection. Therefore, systematic urinalysis screening should be discouraged, whereas a complete risk assessment that considers comorbidities and past medical history should be promoted.

Accidentes biológicos en estudiantes de Medicina de la Universidad Industrial de Santander, Bucaramanga, Colombia / Biological accidents among Medical students from Universidad Industrial de Santander, Bucaramanga, Colombia

Introducción: Los accidentes biológicos representan un riesgo ocupacional significativo para los trabajadores de la salud, y para los estudiantes de medicina. Objetivos: Establecer la prevalencia de accidentes biológicos y los factores y comportamientos asociados en la población de estudiantes de medicina. Materiales y métodos: Se encuestaron los estudiantes de medicina del área clínica de la Universidad Industrial de Santander. El instrumento de encuesta preguntaba sobre utilización de elementos de protección, caracterización y comportamientos asociados al último accidente biológico sufrido. La información obtenida fue analizada mediante porcentajes y promedios. Para evaluar los factores asociados al accidente se calcularon Razones de Prevalencia y sus IC 95%. Resultados: Se encuestaron 330 estudiantes. El uso rutinario de guantes se reportó en un 99,3%, de doble guante en 13,9%, tapabocas en 77,4% y de gafas en 30,7%. La prevalencia de accidentes biológicos fue de 18%, la cual aumentaba de acuerdo al año de estudio. El accidente no fue reportado en 48% de los casos. Se encontró una asociación positiva entre el sufrimiento de al menos un accidente biológico durante lo cursado de la carrera y el uso completo de medidas de protección en tercer y cuarto año, RP=2,92 (IC 95% 0,95 – 8,93); y negativa para quinto y sexto año, RP=0,84 (IC 95% 0,50-1,41, p=0,0479). Conclusiones: Los accidentes biológicos son frecuentes en nuestros estudiantes de medicina. Se debe insistir desde los primeros semestres en la importancia del uso de elementos de protección, el reporte del accidente y los protocolos postexposición.

Introduction: Biological accidents represent a significant occupational risk to healthcare workers including medical students. Objectives: To establish the prevalence of biological accidents, and its associated factors and behaviors among medical students. Materials and methods: Medical students in clinical clerkships from Universidad Industrial de Santander were surveyed. The survey instrument asked about the use of protective elements, the characteristics and behaviors associated to the last biological accident suffered by the student. Gathered data were analyzed as percentages and means. To evaluate associated factors, Prevalence Ratios and its CI 95% were calculated. Results: Three hundred thirty students were surveyed. Routine use of gloves was reported by 99.3%, double gloving by 13.9%, disposable masks by 77.4% and protective eyewear by 30.7%. Prevalence of biological accidents was 18.0%, which increased with seniority. Accidents were not reported to the occupational health office in 48% of cases. A positive association was found between suffering at least one accident during the career and the complete use of protective elements in third and fourth year students, PR=2.92 (CI 95% 0.95-8.93); while for fifth and sixth year students it was negative, PR=0.84 (CI 95% 0.50-1.41, p=0.0479). Conclusions: Biological accidents are frequent among our medical students. The importance of using protective elements must be emphasized during the first years of training. Medical students must be educated about the key role of reporting accidents and about post-exposure protocols.

Fiebre amarilla: a propósito de la alerta / Yellow Fever: a reason to be alert

La infección por el virus de la fiebre amarilla es una fiebre hemorrágica aguda inmunoprevenible, potencialmente peligrosa a viajeros no vacunados en áreas enzoóticas, con una elevada mortalidad en los casos sintomáticos. El arbovirus es transmitido en un ciclo involucrando primates y mosquitos, pero el ser humano puede ser utilizado como huésped intermediario. Durante el año 2003, Colombia reportó a la Organización Panamericana de la Salud (OPS) 106 casos de fiebre amarilla selvática1. En las primeras semanas del 2004 se notificaron en ciudades consideradas centros turísticos, con altos índices de infestación por Aedes aegypti, unidos a factores como los problemas sociales y de conflicto armado en la región, lo cual representa un alto riesgo de urbanización de la enfermedad. Estas circunstancias ponen de manifiesto la importancia de mantener una vigilancia activa para impulsar medidas de prevención y control integrales que permitan anticiparse a situaciones de mayor gravedad. El Ministerio de Salud se encuentra vacunando masivamente a la población de las áreas afectadas, con el fin de controlar la epidemia. Fundamentado en ésta alerta epidemiológica nacional, hace una revisión teórica de la información clínica, diagnostica y tratamiento disponible para el manejo de la Fiebre Amarilla.

The infection by the virus of the Yellow Fever is an immunological, as well as a preventable acute hemorragic febrile syndrome, which is potentially dangerous to non-vaccinated travellers in zoonotic areas, presenting high mortality among symptomatic cases. Arbovirus is transmitted through a cycle involving primates and mosquitos, but humans act as an intermediary guests. During the year 2003, Colombia reported to the Pan-American Organization of Health (OPS) 106 cases of the jungle yellow fever. In the first weeks of the 2004 new cases were notified to Tourist Centers in many cities, with high indices of infestation by Aedes aegypti, together with factors like the social problems and armed conflict ever present on those regions. This situation represent a high risk for the disease to become urban. These circumstances show the importance to keep a close monitoring to implement tough measures for prevention and control, in order to anticipate serious situations. Nowdays The Colombian Ministry of Health is involved in massive vaccination programs among people in affected areas. Taking in consideration this epidemiological alert we have decided to conduct a medical review of the clinical information, as well as, its diagnosis and its best possible treatment for the Yellow Fever.

Dolor Lumbar Crónico, Reto Diagnóstico: Un Caso de Tuberculosis Espinal del Hospital ESE San Juan de Dios, Girón / Chronic lumbar pain diagnostic challenge: a case of spinal tuberculosis at The San Juan de Dios Hospital, Giron

El dolor lumbar crónico es uno de los motivos más frecuentes de la consulta médica y su prevalencia ha sido calculada en un 70 por ciento en los países intustrializados. Presentamos un caso clínico cuyo diagnóstico final fue tuberculosis espinal; todo un reto, dadas las condiciones de presentación clínica en que predomina el dolor lumbar acompañado de síntomas sistémicos. La tuberculosis espinal es uno de los problemas que ha aquejado a la población mundial de una manera silente durante años. Las principales dificultades clínicas son: el retraso de los médicos para realizar el diagnóstico de tuberculosis espinal (promedio 3 meses), su largo periodo de recuperación (12 meses o más) y el alto costo de dicho tratamiento. Su presentación semiológica es dolor lumbar, acompañado de síntomas inespecíficos como fiebre y pérdida de peso, además, deformidad de la columna vertebral y complicaciones neurológicas como la paraplejía, hasta en un 50 por ciento. Su diagnóstico necesita la comprobación bacteriológica y del aislamiento de la Mycobacteria. La evaluación inicia con la radiografía simple de columna vertebral, luego tomografía axial computarizada (TAC), y/o resonancia nuclear magnética (RNM), permitiéndonos así una mejor valoración del proceso patológico y su compromiso. Actualmente, el tratamiento antibiótico junto al manejo quirúrgico han contribuido dramáticamente a alterar la historia natural de esta enfermedad