Euthanasia in Colombia: Experience in a palliative care program and bioethical reflections.

The increased prevalence of advanced-stage chronic diseases has augmented the need for palliative care teams. In Colombia, although the legislation promotes palliative care development, people still die without receiving management from a palliative care team. In addition, judiciary regulations regarding euthanasia have generated public confusion and ethical conflicts among members of the palliative care teams. Therefore, this study aimed to perform a bioethical reflection on the relationship between palliative care and euthanasia supported by data on euthanasia requests in a palliative care program. This reflection is based on retrospective and descriptive observational data, collected in two highly complex hospitals in Bogotá, Colombia. A total of 50 euthanasia requests were identified, of which 62% met the defined criteria, 16% did not, and 22% were not considered by the interdisciplinary committee for the right to die with dignity due to early death. All patients were treated and followed up by a palliative care team until their death. This study considered that palliative care could be a complement management for patients requesting euthanasia based on their experience by supporting the decision-making, alleviating suffering, and providing emotional support in the last days of life.

[Artificial intelligence fuzzy system for the design of confinements during quarantines]. / Aplicación de sistemas fuzzy para la toma de decisiones del Plan Paso a Paso: análisis de los indicadores para la comuna de Valdivia.

BACKGROUND: Different modalities of quarantines were one of the main measures implemented worldwide to avoid the spread of SARS-CoV2 virus. AIM: To analyze and compare retrospectively the implementation of the Step- to-Step plan devised by the Chilean Ministry of Health during the pandemic. To propose a decision-making path based on an artificial intelligence fuzzy system to determine confinements in specific territories. MATERIAL AND METHODS: The Step-to-Step Plan threshold values such hospital network capacity, epidemic spreading, testing and contact tracing capability were modeled using fuzzy numbers and fuzzy rule-based systems. RESULTS: Ministry of Health's decision-making opportuneness were unrelated with the Step-to-Step Plan indicators for deconfinement. Such disagreements undermined epidemiological indicators. CONCLUSIONS: Using an artificial intelligence system could improve decision-making transparency, emergency governance, and risk communication to the population.

[Virtual and in-person accompaniment of hospitalized patients during the COVID-19 pandemic in ColombiaAcompanhamento virtual e presencial de pacientes hospitalizados durante a pandemia de COVID-19 na Colômbia]. / Acompañamiento virtual y presencial a pacientes hospitalizados durante la pandemia de COVID-19 en Colombia.

OBJECTIVE: To describe the results of a virtual and in-person accompaniment strategy based on person-centered care of patients hospitalized for suspected or confirmed disease due to the novel 2019 coronavirus (COVID-19). METHOD: Retrospective descriptive observational study conducted in five health facilities of the Colsanitas clinic network that implemented an accompaniment strategy with seven modalities: virtual information, personal mobile devices, virtual visits, contacts by other means, round-the-clock companion, in-person visit, and compassionate contact. Descriptive statistics were used for data analysis. RESULTS: The accompaniment strategy was used with 871 patients with hospital stays ranging from 1 to 90 days; 70% were positive for COVID-19. The families of 764 patients were contacted through 3984 calls in the virtual information modality; an average of 71 virtual visits per day occurred; 428 letters, voice messages, and videos, among others, were received; 114 patients had a round-the-clock companion; 154 patients had an in-person visit; and 20 families made a posthumous in-person visit to the patient. CONCLUSION: The results of the virtual and in-person accompaniment strategy with a person-centered approach showed that family involvement is important to patient care and improves communication and interaction among patients, families, and the healthcare team.

OBJETIVO: Descrever os resultados de uma estratégia de acompanhamento virtual e presencial, baseada no cuidado centrado na pessoa, durante o atendimento de pacientes internados por doença do novo coronavírus de 2019 (COVID-19) suspeita ou confirmada. MÉTODOS: Estudo observacional descritivo retrospectivo realizado em cinco instituições de saúde da rede clínica Colsanitas, que implementaram uma estratégia de acompanhamento com sete modalidades: informação virtual, dispositivos móveis pessoais, visitas virtuais, contatos por outros meios, acompanhante permanente, visita presencial e contato solidário. Foram utilizadas estatísticas descritivas para análise dos dados. RESULTADOS: A estratégia de acompanhamento foi aplicada em 871 pacientes com 1 a 90 dias de internação, dos quais 70% positivaram para COVID-19. Na modalidade de informação virtual, as famílias de 764 pacientes foram contatadas por meio de 3.984 ligações; em média, foram realizadas 71 visitas virtuais por dia; foram recebidas 428 cartas, mensagens de voz e vídeos, entre outros meios; 114 pacientes contaram com um acompanhante permanente; 154 pacientes receberam visita presencial; e 20 famílias fizeram uma visita presencial póstuma ao paciente. CONCLUSÕES: Os resultados da estratégia de acompanhamento virtual e presencial com abordagem centrada na pessoa mostraram que a participação da família é importante no cuidado ao paciente e melhora a comunicação e a interação entre paciente, família e equipe de saúde.

Psychometry and empathy levels and its dimensions in postgraduate students of dental specialties.

BACKGROUND: Empathy is an attribute that has an important role in the dentist-patient therapeutic relationship, clinical care and adherence to treatment, amongst other benefits. The aim of this research was to determine empathy in dentists in the process of specialisation. MATERIALS AND METHODS: Through an observational and cross-sectional study, all postgraduate students of Dentistry Faculty of Universidad Andrés Bello (Chile) were analysed (N = 195). The Jefferson Scale of Physician Empathy Scale was applied. RESULTS: The results show an adequate reliability of the empathy measure (α = 0.819, ω = 0.928). A three-factor structure is evidenced by confirmatory factor analysis (χ2 /df = 1.445, GFI = 0.952, RMSEA = 0.047) and adequate factor invariance between men and women. Women showed greater empathy on the global scale and in the perspective adoption dimension, with no gender differences found in the dimension Compassionate care and putting oneself in the other's shoes (POOS). The median empathy reaches 120 points. Below, are placed, the specialty of oral rehabilitation (Med = 114.5), surgery (Med = 117) and periodontics (Med. = 117.5). With superior scores, temporomandibular disorder (Med. = 121), endodontics (Med. = 121), Orthodontics and dentofacial orthopedics Med. = 122), Implantology (Med. = 125) and Pediatric dentistry (Med. = 127.5) are located. CONCLUSION: Women were more empathetic than men. In general, empathy levels are relatively high, but the common feature in which all students examined in different specialties have low levels in dimension POOS.

Lidocaine infusion for malignant visceral pain: case report.

BACKGROUND: Visceral pain accounts for nearly 28% of cancer-related pain, and its effective management poses significant challenges. The diverse pathways of neurotransmission, neurotransmitters, channels, and receptors suggest the need for individualized analgesic therapy. Our objective is to explore a therapeutic alternative for managing malignant visceral pain in advanced cancer. CASES: In this report, we present two patients with malignant bowel obstruction and severe visceral pain, despite receiving opioid treatment, necessitating an alternative approach. Surgical interventions were considered but promptly ruled out. Paracentesis was performed as necessary. Pain management was initiated using a combination of opioids and co-analgesics. However, both patients required opioid dose escalation without achieving adequate pain control or tolerating the associated side effects. Consequently, a lidocaine infusion was administered to alleviate pain. OUTCOME: Following 24-48 hours of lidocaine infusion, both patients achieved satisfactory symptom control, enabling a reduction in opioid doses and improvement in intestinal transit. No side effects were reported during the treatment. DISCUSSION: Lidocaine infusions may be beneficial for pain management in patients with malignant bowel obstruction and visceral pain. The extent of pain control achieved in comparison to other therapeutics remains challenging to ascertain. We posit that lidocaine infusions, with their potential impact on visceral hypersensitivity, can enhance pain control and facilitate the recovery of bowel transit. Further studies are warranted to validate these findings.

Use of complementary and alternative medicine by cancer patients in Colombia.

BACKGROUND: The use of complementary and alternative medicines (CAM) among cancer patients varies greatly. The available data suggest an increasing use of CAM over time and a higher prevalence in low- and middle-income countries. However, no reliable data are available from Latin America. Accordingly, we examined the prevalence of CAM use among cancer patients from six Colombian regions. METHODS: We conducted a survey on cancer patients attending comprehensive cancer centres in six capital cities from different regions. The survey was designed based on a literature review and information gathered through focus groups on CAM terminology in Colombia. Independent random samples of patients from two comprehensive cancer centres in every city were obtained. Patients 18 years and older with a histopathological diagnosis of cancer undergoing active treatment were eligible. The prevalence of CAM use is reported as a percentage with the corresponding confidence interval. CAM types are reported by region. The sociodemographic and clinical characteristics of CAM users and non-users were compared using Chi square and t tests. RESULTS: In total, 3117 patients were recruited. The average age 59.6 years old, and 62.8% were female. The prevalence of CAM use was 51.7%, and compared to non-users, CAM users were younger, more frequently women, affiliated with the health insurance plan for low-income populations and non-Catholic. We found no differences regarding the clinical stage or treatment modality, but CAM users reported more treatment-related side effects. The most frequent types of CAM were herbal products, specific foods and vitamins, and individually, soursop was the most frequently used product. Relevant variability between regions was observed regarding the prevalence and type of CAM used (range: 36.6% to 66.7%). The most frequent reason for using CAM was symptom management (30.5%), followed by curative purposes (19.5%). CONCLUSIONS: The prevalence of CAM use among cancer patients in Colombia is high in general, and variations between regions might be related to differences in cultural backgrounds and access to comprehensive cancer care. The most frequently used CAM products and practices have little scientific support, suggesting the need to enhance integrative oncology research in the country.

[Rothia mucilaginosa pneumonia in an immunocompromised patient after kidney transplant]. / Neumonía por Rothia mucilaginosa en un paciente inmunocomprometido posterior a un trasplante renal.

Rothia mucilaginosa is a bacterium derived from the upper respiratory tract microbiota, which is rarely associated with infections in immunocompromised patients suffering chronic lung diseases, mainly pneumonia and bacteremia. Its treatment is generally based on the use of ß-lactams. The case study of a kidney transplant patient using immunosuppressive drugs, who developed a disseminated Cryptococcus neoformans infection, is described. After starting antifungal therapy, he presented with fever, appearance of new radiological infiltrates and acute respiratory failure, demonstrating a positive culture for R. mucilaginosa in a study with bronchoalveolar lavage, ruling out other etiologies. He evolved favorably after the use of meropenem, with good clinical response and resolution of radiological infiltrates.

Tyrosine kinase A receptor (trkA): a potential marker in epithelial ovarian cancer.

OBJECTIVES: To evaluate the role of trkA receptor as a potential tumor marker in serous epithelial ovarian cancer and its relationship with the angiogenic factors expression as vascular endothelial growth factor (VEGF) and nerve growth factor (NGF). Additionally, to examine whether NGF and VEGF secreted by epithelial ovarian cancer (EOC) explants and from epithelial ovarian cancer cell line (A2780) are involved in the process of angiogenesis, such as cellular proliferation, migration and differentiation of the human endothelial cell line (EA.hy926). METHODS: The mRNA levels of VEGF, NGF and trkA receptors were measured using PCR in 60 ovarian samples. Cellular localization and semi-quantitative estimation of VEGF, NGF, total trkA and p-trkA was performed using IHC in epithelial cells. NGF, total trkA and p-trkA protein were also evaluated in endothelial cells from the same tissues. Human endothelial cell line EA.hy926 was cultured with conditioned media obtained from both EOC explants and from the A2780 cell line, with or without NGF stimulus. RESULTS: Significantly higher levels of NGF, total trkA and p-trkA protein expressions were observed in epithelial and endothelial cells in poorly differentiated EOC versus normal ovary. Interestingly, the p-trkA receptor expression level showed the most significant difference and its presence was only found in borderline tumor and EOC samples indicating the importance of trkA receptor in EOC as a potential tumor marker. A significant increase in proliferation, migration and differentiation of EA.hy926 cells was observed with NGF, and this effect was significantly reverted when NGF was immuno-blocked and when a trkA inhibitor was used, showing that NGF is an important angiogenic factor in EOC by activating its trkA receptor. CONCLUSION: These results indicate that p-trkA may be considered as a new potential tumor marker in EOC, and that NGF may also act as a direct angiogenic factor in EOC.

Detection of Leishmania RNA Virus in Clinical Samples from Cutaneous Leishmaniasis Patients Varies according to the Type of Sample.

Leishmania RNA virus (LRV) is a double-stranded RNA virus belonging to the Totiviridae family detected as cytoplasmic inclusions in some strains of the human parasite Leishmania spp. Experimental evidence supports the hypothesis that human coinfection with Leishmania spp.-LRV triggers an exacerbated immune response in the host that can be responsible for the observed complicated outcomes in cutaneous leishmaniasis (CL), such as mucosal leishmaniasis (ML) and treatment failure of CL. However, the reported frequencies of LRV associated with complicated outcomes in patient's series are highly variable, diminishing the relevance on the virus presence in the pathogenesis of the disease. To assess whether or not the inconsistent information about the frequency of LRV associated with CL complicated outcomes could be related to the virus detection approach, the present study evaluated the LRV presence in clinical samples using a diagnostic algorithm according to the type of the sample. In 36 samples with diagnosis of complicated forms of CL (15 of ML and 21 of CL antimony treatment failure) and six samples with non-Leishmania spp. infection, the LRV presence was assessed by RT-PCR, RT-qPCR, and nested RT-PCR. Viral load was estimated in parasite clinical isolates. By combining the methods, LRV1 presence was confirmed in 45% (9/20) of isolates and 37.5% (6/16) of the incisional biopsies. Remarkably, in some cases (4/8), LRV1 was undetectable in the isolates but present in their respective biopsies, and less frequently, the opposite was observed (1/8), suggesting the possibility of loss of parasites harboring LRV1 during the in vitro growth.

[Molecular typing of Leishmania (Leishmania) amazonensis and species of the subgenus Viannia associated with cutaneous and mucosal leishmaniasis in Colombia: A concordance study].

INTRODUCTION: Multilocus enzyme electrophoresis (MLEE) is the reference standard for the characterization of Leishmania species. The test is restricted to specialized laboratories due to its technical complexity, cost, and time required to obtain results. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is used to identify Leishmania species. OBJECTIVE: To establish the concordance between the two tests as identifying methods for circulating species in Colombia. MATERIALS AND METHODS: A total of 96 isolates from patients with cutaneous or mucosal leishmaniasis were selected and identified by MLEE and PCR-RFLP with miniexon and hsp70 as the molecular targets, which were used sequentially. Restriction enzymes HaeIII and BccI were similarly applied. Cohen's kappa coefficient and the 95% confidence interval (CI) were calculated. RESULTS: The kappa coefficient and the 95% CI between MLEE and PCR-RFLP displayed "very good" concordance with a coefficient of 0.98 (CI95%: 0.98 to 1.00). The identified species were Leishmania Viannia braziliensis, Leishmania Viannia panamensis, Leishmania Viannia guyanensis and Leishmania Leishmania amazonensis. A total of 80 of the 96 isolates were sequenced and the results obtained by PCR-RFLP were confirmed. CONCLUSION: Due to the concordance obtained between tests results with the amplification of the genes miniexon and hsp70, PCR-RFLP is proposed as an alternative for identifying circulating Leishmania species in Colombia.

Relación de lesiones cervicales: factores demográficos, Historia reproductiva y tamizaje / Cervical Lesions Relationship: Demographic Factors, Reproductive History, and Screening Tests

El cáncer cervical es una preocupación de salud pública en Ecuador y América Latina. Este artículo explora factores de riesgo y pruebas de detección como predictores de lesiones cervicales. Objetivo: Evaluar factores demográficos, historia reproductiva y pruebas de tamizaje como predictores de lesiones cervicales en mujeres que acudieron al servicio de Colposcopía del Hospital Universitario de Guayaquil entre los años 2021 y 2022. Materiales y Métodos: Se analizaron los registros de 1610 mujeres, excluyendo 129 por falta de información completa. Se utilizaron análisis estadísticos, como la prueba de Chi Cuadrado de Pearson, para examinar la asociación entre variables categóricas. Los resultados se expresaron en promedios y porcentajes. Resultados: 1118 mujeres (69.4%) tuvieron resultados negativos para lesiones cervicales, mientras que 332 mujeres (30.6%) presentaron lesiones intraepiteliales cervicales o cáncer cervical. (tabla 1) Se encontraron relaciones significativas entre un índice de masa corporal (IMC) elevado y las lesiones cervicales, así como entre la multiparidad y estas lesiones. Además, se identificaron correlaciones entre múltiples parejas sexuales, sinusorragia y lesiones cervicales. La colposcopía demostró ser efectiva en la evaluación de resultados citológicos. (tabla 2). Conclusiones: Factores como el IMC alto, la multiparidad, múltiples parejas sexuales y la sinusorragia se relacionaron significativamente con las lesiones cervicales. No se encontraron relaciones significativas con otras variables. Se resalta la importancia de futuras investigaciones para abordar limitaciones, como la falta de pruebas de genotipificación del virus del papiloma humano (VPH), para una comprensión más completa de estas patologías cervicales en la población ecuatoriana...(AU)

Aplicación de sistemas fuzzy para la toma de decisiones del Plan Paso a Paso: análisis de los indicadores para la comuna de Valdivia / Artificial intelligence fuzzy system for the design of confinements during quarantines

BACKGROUND: Different modalities of quarantines were one of the main measures implemented worldwide to avoid the spread of SARS-CoV2 virus. AIM: To analyze and compare retrospectively the implementation of the Step- to-Step plan devised by the Chilean Ministry of Health during the pandemic. To propose a decision-making path based on an artificial intelligence fuzzy system to determine confinements in specific territories. MATERIAL AND METHODS: The Step-to-Step Plan threshold values such hospital network capacity, epidemic spreading, testing and contact tracing capability were modeled using fuzzy numbers and fuzzy rule-based systems. RESULTS: Ministry of Health's decision-making opportuneness were unrelated with the Step-to-Step Plan indicators for deconfinement. Such disagreements undermined epidemiological indicators. CONCLUSIONS: Using an artificial intelligence system could improve decision-making transparency, emergency governance, and risk communication to the population.

Afectación en nariz o garganta en población del área de influencia de una obra de infraestructura vial en la Comuna 14 de Medellín, Colombia / Irritation of the nose or throat in the population of the area of influence of a road infrastructure project in Comuna 14 in Medellín, Colombia / Afetação no nariz ou na garganta da população na área de influência de um projeto de infraestrutura rodoviária na Comuna 14 de Medellín, Colômbia

Resumen Objetivo: identificar condiciones sociodemográficas, ambientales, de vivienda y entorno, relacionadas con afectación en nariz o garganta de población que habitaba el área de influencia de una obra de infraestructura vial urbana. Medellín, Colombia, 2017. Metodología: estudio transversal, con fuente primaria de información. Se aplicó encuesta asistida a 170 adultos, en viviendas seleccionadas mediante muestreo tipo bola de nieve, que habitaran en un perímetro hasta de 1,5 kilómetros del centro de la obra, que aceptaran participar y firmaran el consentimiento informado. Análisis: exploratorios cualitativos y cuantitativos. Cálculo de Razones de prevalencias (RP) y estadístico Chi2 de asociación. Proyecto aprobado por el Comité Institucional de Ética en Humanos de la Universidad CES. Resultados: la prevalencia de afectación en nariz y/o garganta fue del 35,88 %. Se identificó asociación (p<0,05) entre esta afectación, tener menor edad, y ser hombre (RP=0,50. IC=0,29; 0,84). También se asoció a mayor prevalencia de esta afectación, tener mala percepción de calidad del aire durante la obra, realizar actividad física al aire libre, tener hábito tabáquico y una mayor cercanía de la vivienda con la obra. Conclusiones: esta obra de infraestructura vial tuvo una repercusión negativa en la percepción de salud física de los habitantes de su área de influencia, sería necesaria la implementación de estrategias incidir positivamente en la salud pública.

Abstract Objective: To identify sociodemographic, environmental, housing and environmental conditions related to nose or throat involvement of the population that lived in the area of influence of an urban road infrastructure project in Medellín, Colombia, 2017. Methodology: Cross-sectional study, with primary source of information. An assisted survey was applied to 170 adults, in homes selected through snowball sampling, who lived in a perimeter of up to 1.5 kilometers from the center of the work and who agreed to participate and signed informed consent. Analysis: qualitative and quantitative exploratory. Prevalence ratio (PR) calculation and Chi2 statistic association. Project approved by the Institutional Committee for Human Ethics of Universidad CES. Results: Prevalence of irritation of nose and/or throat was of 35.88%. An association (p<0.05) was identified between this condition, being younger, and being male (RP=0.50, CI=0.29; 0.84). Higher prevalence of this condition was also associated with having poor perception of air quality during the construction work, doing physical activity outdoors, having a smoking habit, and the proximity of the home to the construction site. Conclusions: This road infrastructure project had a negative impact on the perception of physical health of the inhabitants of this area of influence. The implementation of strategies to positively impact public health would be necessary.

Resumo Objetivo: Identificar condições sócio-demográficas, ambientais, habitacionais e do ambiente, relacionadas com afetação no nariz ou na garganta da população que habitava na área de influência de um projeto de infraestrutura de estradas urbanas. Medellín, Colômbia, 2017. Metodologia: Estudo transversal, com fonte primária de informação. Uma pesquisa assistida foi aplicada a 170 adultos, em domicílios selecionados por amostragem de tipo de bolas de neve, que residiam em um perímetro de até 1,5 km do centro da obra, que concordaram em participar e assinaram o termo de consentimento informado. Análise: qualitativa e quantitativa exploratória. Cálculo da razão de prevalência (RP) e estatística de associação de Chi2. Projeto aprovado pelo Comitê Institucional de Ética Humana da Universidade CES. Resultados: Prevalência de afetação no nariz ou na garganta de 35,88%. Foi identificada uma associação (p<0,05) entre a variável estudada, ser mais jovem e ser homem (RP=0,50. IC=0,29; 0,84). Também foram associados à maior afetação no nariz ou na garganta, ter uma baixa percepção da qualidade do ar durante o trabalho, fazer atividade física ao ar livre, tabagismo e proximidade da casa com o trabalho. Conclusões: Este trabalho de infraestrutura viária teve um impacto negativo na percepção de saúde dos habitantes de sua área de influência; será necessária a implementação de estratégias para impactar positivamente a Saúde Pública.

Factors associated with mortality in COVID-19 patients admitted to an intensive care unit in Medellín, Colombia. March-December 2020 / Factores asociados a la mortalidad en pacientes con COVID-19 admitidos en una unidad de cuidados intensivos de Medellín, Colombia. Marzo-diciembre 2020

Abstract Introduction: COVID-19 is mild in 80% of cases; however, it progresses to severe disease in 5% of patients, thus requiring intensive care unit (ICU) admission. Objective: To identify demographic, clinical, and treatment-related factors associated with mortality in patients with COVID-19 treated at the ICU of a quaternary care hospital in Medellín, Colombia. Materials and methods: Retrospective cohort study. The medical records of 182 patients admitted to the ICU between March and December 2020 due to COVID-19 were analyzed. Bivariate analyses (chi-square, Fisher's exact, unpaired Student's t test, or Mann-Whitney U test) were performed to evaluate the association between demographic characteristics, presence of coexisting diseases, laboratory results, therapeutic interventions, ventilatory and hemodynamic support requirement, and mortality. In addition, a multivariate analysis was performed, in which simple and multiple binary logistic regressions were used, calculating crude and adjusted relative risks (RR). A significance level of p<0.05 was considered. Results: Mortality was reported in 47.80% of patients. In the multivariate analysis model, the following factors were protective factors: age <60 years (aRR: 0.154, 95%CI: 0.059-0.401; p=0.000), use of vasopressors (aRR: 0.082, 95%CI: 0.021-0.319; p<0.001), and use of renal replacement therapy (aRR: 0.205 95%CI 0.059 - 0.716; p=0.013). On the other hand, not performing tracheostomy was an independent protective factor for mortality (aRR: 14.959, 95%CI: 4.865-45.998; p<0.001). A lower platelet count during the ICU stay had a neutral effect, although it was a significantly associated quantitative variable (aRR: 0.999, 95%CI: 0.990-0.999; p=0.003). Conclusions: In the present study, age <60 years, the use of vasopressors, and renal replacement therapy were protective factors, while not performing tracheostomy was a risk factor for mortality. Furthermore, a lower platelet count during ICU stay was a significantly associated quantitative variable.

Resumen Introducción. La COVID-19 se manifiesta en el 80% de los casos de forma leve; sin embargo, en el 5% progresa a enfermedad severa con necesidad de manejo en unidad de cuidados intensivos (UCI). Objetivo. Identificar los factores demográficos, clínicos y de tratamiento asociados a la mortalidad en pacientes con COVID-19 atendidos en la UCI de un hospital de cuarto nivel de atención de Medellín, Colombia. Materiales y métodos. Estudio de cohorte retrospectivo. Se analizaron las historias clínicas de 182 pacientes admitidos a UCI por COVID-19 entre marzo y diciembre de 2020. Se realizaron análisis bivariados (pruebas de chi-cuadrado, exacta de Fisher, t-Student no pareada o U de Mann-Whitney) para evaluar la asociación entre, por un lado, características demográficas, presencia de enfermedades coexistentes, resultados de laboratorio, intervenciones terapéuticas, requerimiento de soporte ventilatorio y hemodinámico, y, por otro, mortalidad. Además, se realizó un análisis multivariado en el que se construyeron regresiones logísticas binarias simples y múltiples, calculando riesgos relativos (RR) crudos y ajustados. Se consideró un nivel de significancia de p<0.05. Resultados. La mortalidad fue de 47.80%. En el análisis multivariado, los siguientes factores se comportaron como protectores para mortalidad: edad <60 años (RRa: 0.154, IC95%: 0.059-0.401; p=0.000), uso de vasopresores (RRa 0.082, IC95%: 0.021-0.319; p<0.001) y uso de terapia de remplazo renal (RRa: 0.205, IC95%: 0.059-0.716; p=0.013). La realización de traqueostomía se comportó como un factor protector independiente para mortalidad (RRa: 0.073, IC95%: 0.012-0.827; p<0.001). El conteo más bajo de plaquetas registrado durante la estancia en UCI tuvo un efecto neutro, aunque fue una variable cuantitativa significativamente asociada (RRa: 0.999, IC95%: 0.990-0.999; p=0.003). Conclusiones. En el presente estudio, la edad <60 años y el uso de vasopresores y de terapia de remplazo renal se comportaron como factores protectores, mientras que la no realización de traqueostomía se comportó como factor de riesgo para mortalidad. Además, el conteo más bajo de plaquetas registrado durante la estancia en UCI fue una variable cuantitativa significativamente asociada.

Neumonía por Rothia mucilaginosa en un paciente inmunocomprometido posterior a un trasplante renal / Rothia mucilaginosa pneumonia in an immunocompromised patient after kidney transplant

Resumen Rothia mucilaginosa es una bacteria propia de la microbiota del tracto respiratorio superior, que se asocia en forma infrecuente a infecciones en pacientes inmunocomprometidos y con enfermedades pulmonares crónicas, principalmente neumonía y bacteriemia. Su tratamiento generalmente, se basa en el uso de antibacterianos β lactámicos. Se describe el caso de un paciente sometido a un trasplante renal con uso de fármacos inmunosupresores, que cursó con una infección diseminada por Cryptococcus neoformans. Tras el inicio de la terapia antifúngica, presentó un cuadro febril, con aparición de nuevos infiltrados radiológicos e insuficiencia respiratoria aguda, demostrándose en el estudio con lavado broncoalveolar, un cultivo positivo para R. mucilaginosa, descartándose otras etiologías. Evolucionó en forma favorable tras el uso de meropenem, con buena respuesta clínica y resolución de los infiltrados radiológicos.

Abstract Rothia mucilaginosa is a bacterium derived from the upper respiratory tract microbiota, which is rarely associated with infections in immunocompromised patients suffering chronic lung diseases, mainly pneumonia and bacteremia. Its treatment is generally based on the use of β-lactams. The case study of a kidney transplant patient using immunosuppressive drugs, who developed a disseminated Cryptococcus neoformans infection, is described. After starting antifungal therapy, he presented with fever, appearance of new radiological infiltrates and acute respiratory failure, demonstrating a positive culture for R. mucilaginosa in a study with bronchoalveolar lavage, ruling out other etiologies. He evolved favorably after the use of meropenem, with good clinical response and resolution of radiological infiltrates.

Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey.

OBJECTIVE: To determine the current use and potential acceptance (by tuberculosis experts worldwide) of novel rapid tests for the diagnosis of tuberculosis that are in line with World Health Organization target product profiles. METHODS: A multilingual survey was disseminated online between July and November of 2016. RESULTS: A total of 723 individuals from 114 countries responded to the survey. Smear microscopy was the most commonly used rapid tuberculosis test (available to 90.9% of the respondents), followed by molecular assays (available to 70.7%). Only a small proportion of the respondents in middle- and low-income countries had access to interferon-gamma-release assays. Serological and lateral flow immunoassays were used by more than a quarter (25.4%) of the respondents. Among the respondents who had access to molecular tests, 46.7% were using the Xpert assay overall, that proportion being higher in lower middle-income countries (55.6%) and low-income countries (76.6%). The data also suggest that there was some alignment of pricing for molecular assays. Respondents stated they would accept novel rapid tuberculosis tests if available, including molecular assays (acceptable to 86.0%) or biomarker-based serological assays (acceptable to 81.7%). Simple biomarker-based assays were more commonly deemed acceptable in middle- and low-income countries. CONCLUSIONS: Second-generation molecular assays have become more widely available in high- and low-resource settings. However, the development of novel rapid tuberculosis tests continues to be considered important by tuberculosis experts. Our data also underscore the need for additional training and education of end users.

Acompañamiento virtual y presencial a pacientes hospitalizados durante la pandemia de COVID-19 en Colombia

[RESUMEN]. Objetivo. Describir los resultados de una estrategia de acompañamiento virtual y presencial, con base en el cuidado centrado en la persona durante la atención a pacientes hospitalizados por sospecha o confirmación de enfermedad por el nuevo coronavirus 2019 (COVID-19, por su sigla en inglés). Método. Estudio observacional descriptivo retrospectivo realizado en cinco instituciones de salud de la red de clínica Colsanitas que implementaron una estrategia de acompañamiento con siete modalidades: información virtual, dispositivos móviles personales, visitas virtuales, contactos con otros medios, acompañante permanente, visita presencial y contacto compasivo. Se utilizó estadística descriptiva para el análisis de los datos. Resultados. La estrategia de acompañamiento se aplicó a 871 pacientes con estancia hospitalaria de 1 a 90 días, 70% fueron positivos para COVID-19; en la modalidad de información virtual, se contactaron a familias de 764 pacientes realizando 3984 llamadas; en promedio se realizaron 71 visitas virtuales al día; se recibieron 428 cartas, mensajes de voz y videos, entre otros; 114 pacientes tuvieron un acompañante permanente; 154 pacientes tuvieron visita presencial; y 20 familias realizaron visita presencial póstuma al paciente. Conclusión. Los resultados de la estrategia de acompañamiento virtual y presencial con enfoque centrado en la persona mostraron que la participación de las familias es importante en el cuidado del paciente y mejora la comunicación e interacción entre los pacientes, las familias y el equipo de salud.

[ABSTRACT]. Objective. To describe the results of a virtual and in-person accompaniment strategy based on person-centered care of patients hospitalized for suspected or confirmed disease due to the novel 2019 coronavirus (COVID-19). Method. Retrospective descriptive observational study conducted in five health facilities of the Colsanitas clinic network that implemented an accompaniment strategy with seven modalities: virtual information, personal mobile devices, virtual visits, contacts by other means, round-the-clock companion, in-person visit, and compassionate contact. Descriptive statistics were used for data analysis. Results. The accompaniment strategy was used with 871 patients with hospital stays ranging from 1 to 90 days; 70% were positive for COVID-19. The families of 764 patients were contacted through 3984 calls in the virtual information modality; an average of 71 virtual visits per day occurred; 428 letters, voice messages, and videos, among others, were received; 114 patients had a round-the-clock companion; 154 patients had an in-person visit; and 20 families made a posthumous in-person visit to the patient. Conclusion. The results of the virtual and in-person accompaniment strategy with a person-centered approach showed that family involvement is important to patient care and improves communication and interaction among patients, families, and the healthcare team.

[RESUMO]. Objetivo. Descrever os resultados de uma estratégia de acompanhamento virtual e presencial, baseada no cuidado centrado na pessoa, durante o atendimento de pacientes internados por doença do novo corona-vírus de 2019 (COVID-19) suspeita ou confirmada. Métodos. Estudo observacional descritivo retrospectivo realizado em cinco instituições de saúde da rede clínica Colsanitas, que implementaram uma estratégia de acompanhamento com sete modalidades: informação virtual, dispositivos móveis pessoais, visitas virtuais, contatos por outros meios, acompanhante permanente, visita presencial e contato solidário. Foram utilizadas estatísticas descritivas para análise dos dados. Resultados. A estratégia de acompanhamento foi aplicada em 871 pacientes com 1 a 90 dias de internação, dos quais 70% positivaram para COVID-19. Na modalidade de informação virtual, as famílias de 764 pacientes foram contatadas por meio de 3.984 ligações; em média, foram realizadas 71 visitas virtuais por dia; foram recebidas 428 cartas, mensagens de voz e vídeos, entre outros meios; 114 pacientes contaram com um acompanhante permanente; 154 pacientes receberam visita presencial; e 20 famílias fizeram uma visita presencial póstuma ao paciente. Conclusões. Os resultados da estratégia de acompanhamento virtual e presencial com abordagem centrada na pessoa mostraram que a participação da família é importante no cuidado ao paciente e melhora a comunicação e a interação entre paciente, família e equipe de saúde.

Dolor en pacientes hospitalizados en una institución de salud de tercer nivel / Pain in hospitalized patients in a third-level health care institution

Abstract Introduction: Pain is one of the major symptoms experienced by hospitalized patients. Objective: To establish the hospital care quality indicators associated with pain management (prevalence, intensity, and interference) in adult inpatients, following the implementation of strategies framed within the pain-free Hospital Policy at a third-level institution. Methodology: Observational, descriptive, cross-sectional trial. Patients over 18 years of age, hospitalized for more than 24hours, and who previously signed their informed consent were included. The Brief Pain Inventory - Short Form in Spanish was adminis tered for pain evaluation, and the sex and service differences were estimated using the Wilcoxon test for quantitative variables and x2 for qualitative variables. Results: Three hundred thirty-eight participants were includ ed. The prevalence of pain was 43.4%, with a higher percentage among females (52.1% vs 28.8%, P <0.001) and in the surgical services (48.0% vs 37.5%, P = 0.05). Women showed higher intensity in the "minimum pain" item (median 3 interquartile range 2-5 vs median 2 interquartile range 0-1, P=0.009). The activities with the highest interference were sleep and general activity in both sexes and services. Discussion: The hospital quality of care indicators herein measured allow for an enhanced approach to characterize pain in this population group, with a view to improving pain identifica tion and management in the future to provide a more comfortable experience for the patient.

Resumen Introducción: El dolor es uno de los principales síntomas que presentan los pacientes hospitalizados. Objetivo: Establecer los indicadores de la calidad del cuidado hospitalario relacionados con el manejo del dolor (prevalencia, intensidad e interferencia) en pacientes adultos hospitalizados posterior a la implementación de estrategias enmarcadas en la Política Clínica sin dolor de una institución de tercer nivel. Metodología: Estudio observacional descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años con más de 24 horas de hospitalización y previa firma de consenti miento informado, se aplicó el instrumento Brief Pain Inventory -Short Form (Inventario Breve de Dolor) en español para la evaluación del dolor. Las diferencias por género y servicio se estimaron a través del test de Wilcoxon para las variables cuantitativas y X2 para las variables cualitativas. Resultados: Se incluyeron 338 participantes. La prevalencia de dolor fue 43,4%, siendo más alta en mujeres (52,1% vs. 28,8%, p = < 0.001) y servicios quirúrgicos (48,0% vs. 37,5%, p = 0.05). Las mujeres presentaron mayor intensidad en el ítem "dolor mínimo" (mediana 3 Rango intercuartílico 2-5 vs. mediana 2 Rango intercuartílico 0-1, p = 0.009). Las actividades con mayor interferencia fueron el sueño y la actividad general en ambos sexos y servicios. Discusión: Los indicadores de la calidad del cuidado hospita lario medidos en este estudio permiten caracterizar de una mejor forma el dolor en este tipo de población, lo cual permite mejorar a futuro la identificación y manejo de éste síntoma para brindar mayor confort al paciente.

Molecular typing of Leishmania (Leishmania) amazonensis and species of the subgenus Viannia associated with cutaneous and mucosal leishmaniasis in Colombia: A concordance study / Tipificación molecular de Leishmania (Leishmania) amazonensis y especies del subgénero Viannia asociadas a la leishmaniasis cutánea y la mucosa en Colombia: un estudio de concordancia

Resumen Introduction: Multilocus enzyme electrophoresis (MLEE) is the reference standard for the characterization of Leishmania species. The test is restricted to specialized laboratories due to its technical complexity, cost, and time required to obtain results. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is used to identify Leishmania species. Objective: To establish the concordance between the two tests as identifying methods for circulating species in Colombia. Materials and methods: A total of 96 isolates from patients with cutaneous or mucosal leishmaniasis were selected and identified by MLEE and PCR-RFLP with miniexon and hsp70 as the molecular targets, which were used sequentially. Restriction enzymes HaeIII and BccI were similarly applied. Cohen's kappa coefficient and the 95% confidence interval (CI) were calculated. Results: The kappa coefficient and the 95% CI between MLEE and PCR-RFLP displayed "very good" concordance with a coefficient of 0.98 (CI95%: 0.98 to 1.00). The identified species were Leishmania Viannia braziliensis, Leishmania Viannia panamensis, Leishmania Viannia guyanensis and Leishmania Leishmania amazonensis. A total of 80 of the 96 isolates were sequenced and the results obtained by PCR-RFLP were confirmed. Conclusion: Due to the concordance obtained between tests results with the amplification of the genes miniexon and hsp70, PCR-RFLP is proposed as an alternative for identifying circulating Leishmania species in Colombia.

Abstract Introducción. La electroforesis de enzimas multilocus (Multilocus Enzyme Electrophoresis, MLEE) es el estándar de referencia para la tipificación de las especies de Leishmania. La prueba está restringida a laboratorios especializados por su complejidad técnica, sus costos y el tiempo necesario para obtener resultados. La PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) se utiliza para tipificar especies de Leishmania. Objetivo. Establecer la concordancia entre las dos pruebas como métodos de tipificación de las especies circulantes en Colombia. Materiales y métodos. Se seleccionaron 96 aislamientos de pacientes con leishmaniasis cutánea o mucocutánea y se tipificaron mediante MLEE y PCR-RFLP con los blancos moleculares miniexon y hsp70 usados en serie. Las enzimas de restricción aplicadas fueron la HaeIII y la BccI, respectivamente. Se calculó el coeficiente kappa y un intervalo de confianza (IC) de 95 %. Resultados. Se determinó que la concordancia fue "muy buena" al obtener un coeficiente de 0,98 (IC95%: 0,98-1,00). Las especies identificadas fueron: Leishmania Viannia braziliensis, L. (V.) panamensis, L. (V.) guyanensis y L. (L,) amazonensis. De los 96 aislamientos, 80 se enviaron a secuenciación y se confirmaron los resultados obtenidos mediante PCR-RFLP. Conclusión. Dada la concordancia obtenida con la PCR-RFLP amplificando los genes miniexon y hsp70, se propone esta prueba como alternativa para la tipificación de especies de Leishmania circulantes en Colombia.