Assessment of the anti-inflammatory and biological properties of Bioroot Flow: A novel bioceramic sealer.

INTRODUCTION: BioRoot Flow (BRF) is a novel premixed bioceramic sealer indicated for endodontic treatments, but the biological and immunomodulatory effects of this endodontic sealer on human periodontal ligament stem cells (hPDLSCs) have not been elucidated. METHODS: To ascertain the biological impact of BRF, TotalFill BC Sealer (TFbc), and AH Plus (AHP) on human Periodontal Ligament Stem Cells (hPDLSCs), assessments were conducted to evaluate the cytocompatibility, cellular proliferation, migratory capacity, osteo/cementogenic differentiation potential, the ability to form mineralized nodules, and the immunomodulatory characteristics of hPDLSCs following treatment with these endodontic sealers. RESULTS: Biological assays showed adequate cell metabolic activity and cell migration in BRF, while SEM assay evidenced that TFbc and BRF groups demonstrated a superior cell adhesion process, including substrate adhesion, cytoskeleton development, and spreading on the niche-like structures of the cement as compared to the AHP group. TFbc and BRF-treated groups exhibited a significantly lower IL6 and IL8 production than AHP (* p <.05). The bioceramic sealers stimulated heightened expression of BSP, CEMP-1, and CAP genes within a 7-14 day period. Notably, BRF and TFbc demonstrated a significant enhancement in the mineralization of hPDLSCs when compared to the negative control. Among these, cells treated with BRF showed a more substantial accumulation of calcium (*** p < .001). CONCLUSIONS: Taken together, these findings indicate that BRF can potentially enhance cell differentiation by promoting the expression of essential genes related to bone and cement formation. In addition, BRF and TFbc displayed anti-inflammatory effects.

Psychometric properties of the Kidney Disease Quality of Life short form 36 (KDQOL-36) scale for the assessment of quality of life in Colombian patients with chronic kidney disease on dialysis.

PURPOSE: Considering the importance of incorporating quality of life (QoL) construct during the health care of patients with stage 5 chronic kidney disease (CKD) on dialysis, it is necessary to have evidence on the clinimetric properties of the instruments used for its measurement. This study aimed to establish the clinimetric properties of the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) scale in patients with stage 5 CKD on dialysis in Colombia. METHODS: A scale validation study was conducted using the classical test theory methodology. The statistical analysis included exploratory factor analysis (EFA) and confirmatory (CFA) techniques performed on two independent subsamples; concurrent criterion validity assessments; internal consistency using four different coefficients; test-retest reliability; and sensitivity to change using mixed model for repeated measures. RESULTS: The KDQOL-36 scale was applied to 506 patients with a diagnosis of stage 5 CKD on dialysis, attended in five renal units in Colombia. The EFA endorsed the three-factor structure of the scale, and the CFA showed an adequate fit of both the original and empirical models. Spearman's correlation coefficient values ≥0.50 were found between the domains of the CKD-specific core of the KDQOL-36 scale and the KDQ. Cronbach's alpha, McDonald's omega, Greatest lower bound (GLB), and Guttman's lambda coefficients were ≥0.89, indicating a high degree of consistency. A high level of concordance correlation was found between the two moments of application of the instrument, with values for Lin's concordance correlation coefficient ≥0.7. The application of the instrument after experiencing an event that could modify the quality of life showed statistically significant differences in the scores obtained. CONCLUSION: The KDQOL-36 scale is an adequate instrument for measuring QoL in Colombian patients with stage 5 CKD on dialysis.

Function-guided selection of salivary antigens from Ornithodoros erraticus argasid ticks and assessment of their protective efficacy in rabbits.

The identification of new protective antigens for the development of tick vaccines may be approached by selecting antigen candidates that have key biological functions. Bioactive proteins playing key functions for tick feeding and pathogen transmission are secreted into the host via tick saliva. Adult argasid ticks must resynthesise and replace these proteins after each feeding to be able to repeat new trophogonic cycles. Therefore, these proteins are considered interesting antigen targets for tick vaccine development. In this study, the salivary gland transcriptome and saliva proteome of Ornithodoros erraticus females were inspected to select and test new vaccine candidate antigens. For this, we focused on transcripts overexpressed after feeding that encoded secretory proteins predicted to be immunogenic and annotated with functions related to blood ingestion and modulation of the host defensive response. Completeness of the transcript sequence, as well as a high expression level and a high fold-change after feeding were also scored resulting in the selection of four candidates, an acid tail salivary protein (OeATSP), a multiple coagulation factor deficiency protein 2 homolog (OeMCFD2), a Cu/Zn-superoxide dismutase (OeSOD) and a sulfotransferase (OeSULT), which were later produced as recombinant proteins. Vaccination of rabbits with each individual recombinant antigen induced strong humoral responses that reduced blood feeding and female reproduction, providing, respectively, 46.8%, 45.7%, 54.3% and 31.9% protection against O. erraticus infestations and 0.7%, 3.9%, 3.1% and 8.7% cross-protection against infestations by the African tick, Ornithodoros moubata. The joint protective efficacy of these antigens was tested in a second vaccine trial reaching 58.3% protection against O. erraticus and 18.6% cross-protection against O. moubata. These results (i) provide four new protective salivary antigens from argasid ticks that might be included in multi-antigenic vaccines designed for the control of multiple tick species; (ii) reveal four functional protein families never tested before as a source of protective antigens in ticks; and (iii) show that multi-antigenic vaccines increase vaccine efficacy compared with individual antigens. Finally, our data add value to the salivary glands as a protective antigen source in argasids for the control of tick infestations.

Fragmentation of Care and Its Association With Survival and Costs for Patients With Breast Cancer in Colombia.

PURPOSE: Breast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system. MATERIALS AND METHODS: A retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model. RESULTS: A total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26). CONCLUSION: Fragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.

Assessment of the operational characteristics of the National Comprehensive Cancer Network distress management tool, v. 2.2018, in patients seen at the Instituto Nacional de Cancerología, Bogotá / Evaluación de las características operativas de la versión 2.2018 del instrumento de evaluación del malestar emocional de la National Comprehensive Cancer Network en pacientes atendidos en el Instituto Nacional de Cancerología, Bogotá

Introduction: Cancer patients have significant levels of emotional distress. The National Comprehensive Cancer Network (NCCN) developed the distress management tool to quickly assess significant distress in oncological patients who require intervention. For its use in Colombia, we made its cross-cultural adaptation and validation. Objective: To determine the operative characteristics of the distress management tool, version 2.2018, in patients seen at the Instituto Nacional de Cancerología (INC) in Colombia. Materials and methods: Counting with the authorization from the NCCN, we translated, made the cross-cultural adaptation, and evaluated the operational characteristics of the tool. We included 343 cancer patients seen at the INC, who filled out the cross-culturally adapted instrument. A diagnostic test study was carried out with a semi-structured interview as a reference. Results: The patients had an average age of 49.7 years (SD=15) and the majority were women (67%). The instrument had an area under the ROC curve of 0.81 (95% CI: 0.77 -0.86); its optimal cut-off point was 3.5 approached to 4 when using integers on the scale; its sensitivity was 0.81 (95% CI: 0.76 - 0.85), and its specificity, 0.69 (95% CI: 0.64 - 0.74). The agreement percentage between the result of the interview and the instrument was 73% (kappa = 0.64; p< 0.001). Conclusions: The distress management tool allowed for the detection of moderate to severe distress requiring intervention and management. This instrument was adapted and validated in cancer patients in Colombia keeping the cutoff point at ≥ 4 as in the original version.

Introducción. Los pacientes con cáncer presentan niveles significativos de malestar emocional. La National Comprehensive Cancer Network (NCCN) desarrolló un instrumento (Distress Management) para evaluarlo de forma rápida en pacientes oncológicos. Para su utilización en Colombia, se hizo la adaptación transcultural y se validó. Objetivo. Determinar las características operativas del instrumento de malestar emocional, versión 2.2018, en pacientes atendidos en el Instituto Nacional de Cancerología. Materiales y métodos. Previa autorización de la NCCN, se procedió a la traducción, adaptación transcultural y evaluación de las características operativas del instrumento. Se incluyeron 343 pacientes con diagnóstico de cáncer atendidos en el Instituto Nacional de Cancerología, quienes diligenciaron el instrumento adaptado transculturalmente. Se efectuó un estudio de prueba diagnóstica como patrón de referencia mediante una entrevista semiestructurada. Resultados. Los pacientes tenían una edad promedio de 49,7 años (DE=15) y la mayoría (67 %) eran mujeres. El instrumento tuvo un área bajo la curva ROC de 0,81 (IC95% 0,77-0,86); el punto de corte óptimo fue de 3,5, el cual se aproximó a 4; la sensibilidad fue de 0,81 (IC95% 0,76-0,85) y la especificidad de 0,69 (IC95% 0,64-0,74). El porcentaje de acuerdo entre el resultado de la entrevista y el instrumento fue de 73 % (kappa=0,64; p<0,001). Conclusiones. El instrumento de malestar emocional permitió detectar el malestar emocional moderado a grave que requiere intervención y manejo. Este instrumento fue adaptado y validado en pacientes con cáncer en Colombia, conservándose el punto de corte en ≥4 como en la versión original.

Evaluación de las características operativas de la versión 2. 2018 del instrumento de evaluación del malestar emocional de la National Comprehensive Cancer Network en pacientes atendidos en el Instituto Nacional de Cancerología, Bogotá / Assessment of the operational characteristics of the National Comprehensive Cancer Network distress management tool, v. 2.2018, in patients seen at the Instituto Nacional de Cancerología, Bogotá

Resumen | Introducción. Los pacientes con cáncer presentan niveles significativos de malestar emocional. La National Comprehensive Cancer Network (NCCN) desarrolló un instrumento (Distress Management) para evaluarlo de forma rápida en pacientes oncológicos. Para su utilización en Colombia, se hizo la adaptación transcultural y se validó. Objetivo. Determinar las características operativas del instrumento de malestar emocional, versión 2.2018, en pacientes atendidos en el Instituto Nacional de Cancerología. Materiales y métodos. Previa autorización de la NCCN, se procedió a la traducción, adaptación transcultural y evaluación de las características operativas del instrumento. Se incluyeron 343 pacientes con diagnóstico de cáncer atendidos en el Instituto Nacional de Cancerología, quienes diligenciaron el instrumento adaptado transculturalmente. Se efectuó un estudio de prueba diagnóstica como patrón de referencia mediante una entrevista semiestructurada. Resultados. Los pacientes tenían una edad promedio de 49,7 años (DE=15) y la mayoría (67 %) eran mujeres. El instrumento tuvo un área bajo la curva ROC de 0,81 (IC95% 0,77-0,86); el punto de corte óptimo fue de 3,5, el cual se aproximó a 4; la sensibilidad fue de 0,81 (IC95% 0,76-0,85) y la especificidad de 0,69 (IC95% 0,64-0,74). El porcentaje de acuerdo entre el resultado de la entrevista y el instrumento fue de 73 % (kappa=0,64; p<0,001). Conclusiones. El instrumento de malestar emocional permitió detectar el malestar emocional moderado a grave que requiere intervención y manejo. Este instrumento fue adaptado y validado en pacientes con cáncer en Colombia, conservándose el punto de corte en ≥4 como en la versión original.

Abstract | Introduction: Cancer patients have significant levels of emotional distress. The National Comprehensive Cancer Network (NCCN) developed the distress management tool to quickly assess significant distress in oncological patients who require intervention. For its use in Colombia, we made its cross-cultural adaptation and validation. Objective: To determine the operative characteristics of the distress management tool, version 2.2018, in patients seen at the Instituto Nacional de Cancerología (INC) in Colombia. Materials and methods: Counting with the authorization from the NCCN, we translated, made the cross-cultural adaptation, and evaluated the operational characteristics of the tool. We included 343 cancer patients seen at the INC, who filled out the cross-culturally adapted instrument. A diagnostic test study was carried out with a semi-structured interview as a reference. Results: The patients had an average age of 49.7 years (SD=15) and the majority were women (67%). The instrument had an area under the ROC curve of 0.81 (95% CI: 0.77 - 0.86); its optimal cut-off point was 3.5 approached to 4 when using integers on the scale; its sensitivity was 0.81 (95% CI: 0.76 - 0.85), and its specificity, 0.69 (95% CI: 0.64 - 0.74). The agreement percentage between the result of the interview and the instrument was 73% (kappa = 0.64; p< 0.001). Conclusions: The distress management tool allowed for the detection of moderate to severe distress requiring intervention and management. This instrument was adapted and validated in cancer patients in Colombia keeping the cutoff point at ≥ 4 as in the original version.

Dental Treatments under General Anesthesia on Children with Special Health Care Needs Enrolled in the Spanish Dental Care Program.

The purpose is to analyze the medical characteristics of children with special health care needs (CSHCN) recommended for dental treatment under general anesthesia (GA), postoperative complications, and dental treatment outcomes under the regulation of the Spanish Dental Care Program (PADI). 111 clinical records were selected. The study population was divided into three age groups. The quantitative data was specified as the mean ± SD. For the qualitative variables, the Chi-Square test was used. One-way ANOVA and Bonferroni tests were used to examine the effect of the "age group" and the number of treatment procedures. A total of 1473 treatment procedures were performed, of which 110 (7.5%) were cleanings, 898 (61%) were restorative procedures, 332 (21.7%) were extractions, 22 (1.6%) were endodontic treatments, 62 (4.2%) were pulpotomies, and 59 (4%) were stainless steel crowns. Regarding the mean number of incisor root canal treatments (RCT), age group 3 received a significantly higher mean number of incisor RCTs than age group 1 (p = 0.02). Age group 1 received a higher average of pulpotomies and stainless-steel crowns (p = 0.00) compared to groups 2 and 3. GA is a safe procedure for the dental treatment of CSHCN, with minimal postoperative complications, which should be included among dental public programs.

Barreras para la eliminación de la malaria en Guapi-Cauca, Colombia / Obstacles to malaria elimination in Guapi-Cauca, Colombia

RESUMEN Objetivo Explicar las barreras para la eliminación de la malaria en Guapi (Cauca, Colombia), según la percepción de la comunidad. Método Se realizó un estudio cualitativo descriptivo de tipo exploratorio en Guapi, de octubre a noviembre de 2016, a través del análisis de contenido de grupos focales de ocho mujeres voluntarias y de análisis inductivo e interpretativo. Resultados Basadas en las respuestas de las voluntarias, se construyeron tres categorías, de las cuales se originaron cinco subcategorías relacionadas con barreras (tema) para la eliminación de la malaria que incluyen determinantes sociales del municipio tales como las barreras ambientales, culturales y de atención en salud. Todas ellas requieren de la intervención integral por parte de las diferentes dependencias del Estado, con la inclusión de las características propias de la comunidad guapireña. Conclusión Se identificó que la falta de planeación e infraestructura deficiente en el municipio obstaculiza no solo la eliminación de la malaria sino también la de otras enfermedades transmisibles. El desarrollo de actividades económicas como la minería, las prácticas de automedicación, la poca adherencia a las medidas de prevención por parte de la comunidad, la falta de contratación de profesionales y microscopistas y el difícil acceso a los servicios de salud constituyen las principales barreras para la eliminación de la malaria en este municipio de la región pacífica colombiana.

ABSTRACT Objetive To explain the obstacles for malaria elimination in Guapi (Cauca, Colombia), considering the community perception. Method A qualitative, descriptive and exploratory research was carried out in Guapi, from October to November 2016, through the content analysis of eight female volunteer's focus groups. Inductive and interpretive analyses were also performed. Results Based on the volunteers' responses, three categories were built, from which five subcategories related to obstacles (issue) for malaria elimination emerged; these included municipality social determinants such as environmental, cultural and health care barriers. All of them require of comprehensive interventions by different state agencies and inclusion of the specific characteristics of the local community. Conclusion We found that lack of planning and municipal poor infrastructure limits the elimination of malaria and other communicable diseases alike. Economic activities such as mining, self-medication practices, community poor adherence to prevention measures, lack of professional and microscopists hiring and the difficulties for accessing to health services are the main obstacles for malaria elimination in this municipality of the Colombian Pacific Coast.

In silico selection of functionally important proteins from the mialome of Ornithodoros erraticus ticks and assessment of their protective efficacy as vaccine targets.

BACKGROUND: New candidate protective antigens for tick vaccine development may be identified by selecting and testing antigen candidates that play key biological functions. After blood-feeding, tick midgut overexpresses proteins that play essential functions in tick survival and disease transmission. Herein, Ornithodoros erraticus midgut transcriptomic and proteomic data were examined in order to select functionally significant antigens upregulated after feeding to be tested as vaccine candidate antigens. METHODS: Transcripts annotated as chitinases, tetraspanins, ribosomal protein P0 and secreted proteins/peptides were mined from the recently published O. erraticus midgut transcriptome and filtered in a second selection step using criteria based on upregulation after feeding, predicted antigenicity and expression in the midgut proteome. Five theoretical candidate antigens were selected, obtained as recombinant proteins and used to immunise rabbits: one chitinase (CHI), two tetraspanins (TSPs), the ribosomal protein P0 (RPP0) and one secreted protein PK-4 (PK4). RESULTS: Rabbit vaccination with individual recombinant candidates induced strong humoral responses that mainly reduced nymph moulting and female reproduction, providing 30.2% (CHI), 56% (TSPs), 57.5% (RPP0) and 57.8% (PK4) protection to O. erraticus infestations and 19.6% (CHI), 11.1% (TSPs), 0% (RPP0) and 8.1% (PK4) cross-protection to infestations by the African tick Ornithodoros moubata. The joint vaccine efficacy of the candidates was assessed in a second vaccine trial reaching 66.3% protection to O. erraticus and 25.6% cross-protection to O. moubata. CONCLUSIONS: These results (i) indicate that argasid chitinases and RPP0 are promising protective antigens, as has already been demonstrated for ixodid chitinases and RPP0, and could be included in vaccines targeting multiple tick species; (ii) reveal novel protective antigens tetraspanins and secreted protein PK-4, never tested before as protective antigens in ticks; and (iii) demonstrate that multi-antigenic vaccines increased vaccine efficacy compared with individual antigens. Lastly, our data emphasize the value of the tick midgut as a source of protective candidate antigens in argasids for tick control.

[Strategies for malaria elimination: an Afro-Colombian perspective]. / Estrategias para la eliminación de malaria: una perspectiva afro-colombiana.

OBJECTIVE: To describe strategies for malaria elimination based on the perception of Afro-Colombian residents in Guapi, in the context of the Integrated Management Strategy for the Promotion, Prevention and Control of Vector-Borne Diseases in Colombia (EGI-ETV). MATERIALS AND METHODS: Qualitative study based on focus group discourse analysis. Eight participants from the urban area of Guapi were divided into two groups. The first group included three female nursing assistants, and was called "women with more experience"; they were workers in the current health system and former Malaria Eradication Service officers. The second group was made up of female nursing assistants, and was called "women with limited experience"; they were workers in the current health system and were not directly trained in the malaria program. An inductive and interpretative analysis was performed. RESULTS: Eight subcategories emerged, framed in the EGI-EVT, making emphasis on promotion and prevention aimed at reducing malaria, especially in rural areas. This problem must be addressed comprehensively, including other health issues and social determinants that affect them, such as: basic sanitation, access to health services, lack of education, use of popular treatments, and lack of infrastructure, among others. CONCLUSION: Participants consider that malaria in Guapi can be reduced but not eliminated. This problem needs to be addressed from an institutional and community perspective, taking into account cultural differences, based on strategies that include community empowerment and administrative and institutional strengthening of the program.

OBJETIVO: Describir las estrategias para la eliminación de la malaria a partir de la percepción de pobladores afro-colombianos residentes en Guapi en el contexto de la Estrategia de Gestión Integrada para la promoción, prevención y control de las Enfermedades Transmitidas por Vectores en Colombia (EGI). MÉTODOS: Estudio de tipo cualitativo basado en el análisis de discurso de grupos focales. Ocho participantes residentes en zona urbana de Guapi, divididas en dos grupos: el primero correspondió a tres mujeres auxiliares de enfermería, denominadas "mujeres con mayor experiencia", trabajadoras en el actual sistema de salud y funcionarias del antiguo Servicio de Erradicación de la Malaria. El segundo correspondió a cinco mujeres auxiliares de enfermería, denominadas "mujeres con limitada experiencia", trabajadoras en el actual sistema de salud y no tuvieron formación directa con el programa de malaria. Análisis inductivo e interpretativo. RESULTADOS: Emergieron ocho subcategorias enmarcadas en la EGI, con énfasis en la promoción y prevención orientadas a disminuir la malaria, especialmente en el área rural. El abordaje del problema debe hacerse de forma integral incluyendo otras problemáticas en salud y determinantes sociales que los afectan como: saneamiento básico, acceso al servicio de salud, falta de educación, uso de tratamientos populares, fragilidad de infraestructura, entre otros. CONCLUSIÓN: Las participantes consideran que la malaria en Guapi se puede reducir pero no eliminar. Se requiere abordar este problema desde una perspectiva institucional y comunitaria, teniendo en cuenta las diferencias culturales, a partir de estrategias que incluyan el empoderamiento comunitario y fortalecimiento administrativo e institucional del programa.

Cross-cultural adaptation of the PedsQL questionnaire Cancer Module, version 3. 0 for use in Colombia / Adaptación transcultural del cuestionario PedsQL Cancer Module version 3. 0 para su uso en Colombia

Abstract Introduction: Quality of life is an important outcome in paediatric cancer patients. Its evaluation at different times during the clinical course of the disease is essential for clinical practice focused on the needs of the patients. There is not a specific assessment tool for this purpose in Colombia. Objective: To perform the cultural adaptation of the quality of life scale PedsQL (Paediatric Quality of Life) Cancer Module, version 3.0 for use in Colombia. Methods: Permission for use of the scale was obtained and the algorithm steps of the Mapi Research Trust group were followed: Direct and independent translations of scale by two native Colombian Spanish speaking translators, obtaining a preliminary version from the translations. This was followed by a back translation by a native English speaking translator and a review of the process by the author of the scale, inclusion of suggestions, and implementation of the pilot study. Results: Direct translations were similar in the instructions and response options; a consensus meeting in 8 of the 27 items was required to choose the best translation. The author made no suggestions and gave his endorsement to the implementation of the pilot, in which, 2 items were modified in order to improve their understanding. Conclusions: There is a Colombian Spanish version of the PedsQL questionnaire 3.0 Cancer Module, to be submitted for a validation study prior to its use in the assessment of quality of life in paediatric cancer patients.

Resumen Introducción: La calidad de vida es un objetivo importante para los pacientes pediátricos con cáncer. Su evaluación en distintos momentos del curso clínico de la enfermedad es indispensable para un ejercicio clínico centrado en las necesidades de los pacientes. En Colombia no se cuenta con un instrumento específico de evaluación para tal fin. Objetivo: Realizar la adaptación transcultural del cuestionario de calidad de vida infantil transcultural Pediatric Quality of Life Cancer Module version 3.0 (PedsQL) para su uso en Colombia. Métodos: Se obtuvo el permiso para el uso de la escala y se siguieron las etapas del algoritmo del grupo Mapi Research Trust: traducciones directas e independientes de la escala por dos traductores hablantes nativos del español colombiano, obtención de una versión preliminar a partir de las traducciones, retrotraducción por un traductor hablante nativo del inglés, revisión del proceso por el autor de la escala e inclusión de sugerencias y realización de la prueba piloto. Resultados: Las traducciones directas fueron similares en las instrucciones y opciones de respuesta; en 8 de los 27 ítems se requirió una reunión de consenso para escoger la mejor opción de traducción; el autor no hizo propuestas y dio su aval para la aplicación de la prueba piloto, en la cual 2 ítems sufrieron modificaciones con el fin de mejorar su comprensibilidad. Conclusiones: Se cuenta con la versión en español colombiano de la escala PedsQL 3.0 Cancer Module, para someterla a un estudio de validación previo a su uso en la evaluación de la calidad de vida en población pediátrica con cáncer.

[Cross-cultural adaptation of the community-acquired pneumonia score questionnaire in patients with mild-to-moderate pneumonia in Colombia].

INTRODUCTION: One of the strategies for the rational use of antibiotics is the use of the score for community-acquired pneumonia (CAP Score). This instrument clinically evaluates patients with community-acquired pneumonia, thereby facilitating decision making regarding the early and safe withdrawal of antibiotics. OBJECTIVE: To generate a translation and cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire in Spanish. MATERIALS AND METHODS: Authorization for cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire was obtained; the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the European Organisation for Research and Treatment of Cancer (EORTC) were carried out through the following stages: forward translation, reconciliation, backward translation, harmonization, obtaining a provisional questionnaire, and applying the questionnaire in a pilot test. The pilot test was conducted at a second-level public hospital in Bogotá after the study was approved by the ethics and research institutional boards. RESULTS: The changes suggested by the forward translators were applied. There were no discrepancies between the backward and forward translations, consequently, no revisions were necessary. Five items had modifications based on suggestions made by eleven patients hospitalized with a diagnosis of community-acquired pneumonia during the pilot test. CONCLUSIONS: A Spanish version of the Community-Acquired Pneumonia (CAP) Score was crossculturally adapted and is now available.

Adaptación transcultural del cuestionario de puntuación de la neumonía adquirida en la comunidad en pacientes con neumonía leve a moderada en Colombia / Cross-cultural adaptation of the community-acquired pneumonia score questionnaire in patients with mild-to-moderate pneumonia in Colombia

Resumen Introducción. Entre las estrategias para el uso racional de antibióticos se encuentra el cuestionario de puntuación de la neumonía adquirida en la comunidad, instrumento de evaluación clínica de los pacientes que ayuda a tomar la decisión de retirar los antibióticos de forma segura y temprana. Objetivo. Traducir al español y hacer la adaptación transcultural del cuestionario de puntuación de la neumonía adquirida en la comunidad. Materiales y métodos. Se obtuvo la autorización para la adaptación transcultural del cuestionario de puntuación de la neumonía adquirida en la comunidad; se acogieron las recomendaciones del International Society for Pharmacoeconomics and Outcomes Research y de la European Organisation for Research and Treatment of Cancer, siguiendo las siguientes fases: traducción directa, conciliación, traducción inversa, armonización, obtención de la versión provisional en español y aplicación de esta en una prueba piloto. La prueba piloto se hizo en un hospital público de segundo nivel en Bogotá, previa aprobación de los comités de ética e investigación. Resultados. Se introdujeron las modificaciones sugeridas por los traductores en la fase de traducción directa; en la traducción inversa no se encontraron discordancias que requirieran la revisión de la traducción inicial. Se modificaron cinco ítems del cuestionario, con base en las sugerencias de los 11 pacientes hospitalizados con diagnóstico de neumonía adquirida en la comunidad participantes en la prueba piloto. Conclusiones. Se dispone de una versión en español del cuestionario de puntuación de la neumonía adquirida en la comunidad adaptada a las condiciones culturales locales.

Abstract Introduction: One of the strategies for the rational use of antibiotics is the use of the score for community-acquired pneumonia (CAP Score). This instrument clinically evaluates patients with community-acquired pneumonia, thereby facilitating decision making regarding the early and safe withdrawal of antibiotics. Objective: To generate a translation and cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire in Spanish. Materials and methods: Authorization for cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire was obtained; the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the European Organisation for Research and Treatment of Cancer (EORTC) were carried out through the following stages: forward translation, reconciliation, backward translation, harmonization, obtaining a provisional questionnaire, and applying the questionnaire in a pilot test. The pilot test was conducted at a second-level public hospital in Bogotá after the study was approved by the ethics and research institutional boards. Results: The changes suggested by the forward translators were applied. There were no discrepancies between the backward and forward translations, consequently, no revisions were necessary. Five items had modifications based on suggestions made by eleven patients hospitalized with a diagnosis of community-acquired pneumonia during the pilot test. Conclusions: A Spanish version of the Community-Acquired Pneumonia (CAP) Score was crossculturally adapted and is now available.

New salivary anti-haemostatics containing protective epitopes from Ornithodoros moubata ticks: Assessment of their individual and combined vaccine efficacy.

Ornithodoros moubata is the main vector of the pathogens causing African swine fever and human relapsing fever in Africa. The development of an efficient vaccine against this tick would facilitate its control and the prevention of the diseases it transmits to a considerable extent. Previous efforts to identify vaccine target candidates led us to the discovery of novel salivary proteins that probably act as anti-haemostatics at the host-tick interface, including a secreted phospholipase A2 (PLA2), a 7DB-like protein (7DB-like), a riboprotein 60S L10 (RP-60S), an apyrase (APY), and a new platelet aggregation inhibitor peptide, designated mougrin (MOU). In this work, the corresponding recombinant proteins were expressed in Escherichia coli and their individual vaccine efficacy was tested in rabbit vaccination trials. All of them, except the less immunogenic RP-60S, induced strong humoral responses that reduced tick feeding and survival, providing vaccine efficacies of 44.2%, 43.2% and 27.2%, 19.9% and 17.3% for PLA2, APY, MOU, RP-60S and 7DB-like, respectively. In the case of the more protective recombinant antigens (PLA2, APY and MOU), the immunodominant protective linear B-cell epitopes were identified and their combined vaccine efficacy was tested in a second vaccine trial using different adjuvants. In comparison with the best efficacy of individual antigens, the multicomponent vaccine increased vaccine efficacy by 13.6%, indicating additive protective effects rather than a synergistic effect. Tick saliva inoculated during natural tick-host contacts had a boosting effect on vaccinated animals, increasing specific antibody levels and protection.

[Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá]. / Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá

INTRODUCTION: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. OBJECTIVE: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. RESULTS: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. CONCLUSION: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.

Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá / Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá

Introducción. Las infecciones por microorganismos resistentes, especialmente las que involucran el torrente sanguíneo, se asocian a un mayor uso de recursos. Sus estimaciones son variables y dependen de la metodología utilizada. Staphylococcus aureus es el agente de sangre aislado con mayor frecuencia en nuestro medio. No existe información sobre el costo asociado con la atención de bacteriemias por S. aureus resistente a meticilina en nuestro país. Objetivo. Presentar una aproximación del costo de atención de las bacteriemias por S. aureus resistente a la meticilina en nueve hospitales de Bogotá. Materiales y métodos. Se incluyeron 204 pacientes en un estudio de cohortes multicéntrico en una razón de 1:1 según la resistencia. Se aproximaron los costos médicos directos con base en las facturas del período de hospitalización; en cuanto al período de la bacteriemia, los costos detallados se calcularon aplicando las tarifas estandarizadas. Resultados. No se encontraron diferencias significativas en las características clínicas y demográficas de los grupos, salvo en los antecedentes de la bacteriemia. El 53 % de los sujetos falleció durante la hospitalización. La estancia y el valor total facturado por la hospitalización fueron significativamente mayores en el grupo con bacteriemia por S. aureus resistente a la meticilina, así como los costos de la estancia en cuidados intensivos, de los antibióticos, los líquidos parenterales, los exámenes de laboratorio y la terapia respiratoria. El incremento crudo del costo de la atención asociado con la resistencia a meticilina fue de 31 % y, el ajustado, de 70 %. Conclusión. Este estudio constituye un respaldo a los tomadores de decisiones para la búsqueda y la financiación de programas de prevención de infecciones causadas por microorganismos resistentes.

Introduction: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. Objective: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. Results: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. Conclusion: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.

Situación actual de la vigilancia de infecciones intrahospitalarias en hospitales de Lambayeque: Propuestas de mejora / Current status of surveillance of nosocomial infections in hospital in Lambayeque: Ideas for improvement

Introducción: Las infecciones intrahospitalarias (IIH) representan un serio problema de salud pública en el Perú y el mundo, sobre todo en países en vías de desarrollo que presentan deficiencias en los servicios de salud. El 2013 se reportó 80 IIH captadas por el sistema de vigilancia de los hospitales del Ministerio de Salud; mientras que la Seguridad Social (Hospital Nacional Almanzor Aguinaga Asenjo) se encontró 52% de los servicios hospitalarios presentaron IIH (tasa de prevalencia=9,34%). Situación actual de la vigilancia infecciones intrahospitalarias en Lambayeque: Para su identificación se realizó un grupo focal con los responsables de los sistemas de vigilancia de hospitales para recoger toda la información posible sobre las percepciones del proceso de vigilancia. Problemas identificados: Recursos humanos (insuficiente cantidad recursos humanos, rotación constante, insuficiente capacitación y resistencia del personal asistencial a colaborar a la vigilancia); normas (normatividad desactualizada y desconocida); sensibilización (falta de sensibilización de autoridades del centro asistencial, percepción como actividad fiscalizadora, ausencia de conformación de comités, y los existentes no son funcionales, vigilancia incompleta de los servicios priorizados según factores de riesgo estipulado por normatividad y realización de vigilancia pasiva); logística (insuficiente capacidad resolutiva de los laboratorios para identificación de agentes causales y cantidad insumos para bioseguridad disminuidos). Propuestas de mejora: Lograr una buena gestión y apoyo a la vigilancia de las IIH, asegurar un buen desempeño del recurso humano para la vigilancia de IIH, asegurar suficiente cantidad de RR HH para las IIH y asegurar logística en recursos de laboratorio y bioseguridad.

Valoración de la ansiedad y depresión en cuidadores informales del adulto mayor dependiente del Policlínico Chiclayo - Oeste durante julio - diciembre 2012 / Valuation of anxiety and depression in older informal caregivers dependent Policlinico Chiclayo - Oeste during july-december 2012

Objetivo: Estimar el nivel de ansiedad y depresión en los cuidadores informales del adulto mayor dependiente del policlínico Chiclayo - Oeste. Material y Métodos: Se realizaron entrevistas individuales a 107 cuidadores de adultos mayores dependientes, empleándose en cada uno de ellos los test correspondientes para medir ansiedad rasgo - estado y depresión ( Inventario de Beck). Resultados: Se tuvo 107 cuidadores informales, predominio sexo femenino (94.4%) entre 18 y 80 años. Predomino la ansiedad como estado en un 54.2% de la población estudiada y depresión leve en el 50.5% de la misma. Se encontró asociación con factores del cuidador informal tales como edad y tiempo de cuidado con depresión; y horas de cuidado y tiempo de cuidado con ansiedad estado. Conclusión: En toda la población estudiada se encontró depresión, siendo la de mayor frecuencia la depresión leve (50,5 %).El perfil típico de la persona cuidadora informal es el de una mujer

Frecuencia y costos de hospitalización en una población de pacientes en diálisis en Colombia / Hospitalisation frequency and costs in a population of Colombian dialysis patients

Antecedentes. Los eventos de hospitalización son frecuentes en pacientes con enfermedad renal crónica terminal. Objetivo. Medir la frecuencia, duración de los eventos de hospitalización y el peso económico de ellas en estas población. Métodos. Estudio de cohorte dinámica retrospectiva, de pacientes prevalentes en terapia dialítica durante el año 2010. Se midió la frecuencia de hospitalización, tanto en hemodiálisis (HD) como en diálisis peritoneal (DP), El número de días de hospitalización, el monto total de la cuenta hospitalaria y el costo promedio del día de hospitalización. Se evaluaron los factores relacionados con el costo de hospitalización mediante análisis multivariable con un modelo lineal generalizado gama con enlace log. Resultados. La tasa de hospitalización fue 0,72 hospitalizaciones por pacienteaño, con 6,32 días hospitalarios por pacienteaño y media de 8,68 días por hospitalización. No hubo diferencias en estas tasas entre pacientes de hemodiálisis y de diálisis peritoneal. El monto total de la cuenta tuvo una mediana de $2.567.680. Conclusion. La población de estudio tuvo unas tasas de hospitalización y de días de estancia hospitalaria menores que en otros reportes. No se encontraron diferencias en estas tasas entre los pacientes de HD y DP.

Background and objectives. Chronic renal disease patients are often hospitalised. The present study was carried out as no studies have measured such population's hospitalisation frequency and duration in Colombia nor has their economic burden been analysed. Methods. This was a dynamic retrospective cohort study of patients receiving dialysis therapy during 2010. Haemodialysis (HD) and peritoneal dialysis (PD hospitalisation frequency was measured, as were the number of days spent in hospital, total hospital bill and average cost per day of hospitalisation. Multivariate analysis was used for evaluating factors related to hospitalisation cost (i.e. a generalised linear model with log link). Results. Hospitalisation rate was 0.72 hospitalisations per patient/ year, 6.32 days were spent in hospital per patient/year and average hospitalisation rate was 8.68 days. No differences were observed between haemodialysis patients and peritoneal dialysis regarding such rates. Average hospitalisation bill was $2,567,680. Conclusion. The study population had higher hospitalisation rates and spent less days in hospital than that stated in other reports. No differences were observed between HD and PD patients regarding these rates.

Factores pronóstico de sobrevida de los cánceres prioritarios en el seguro social ESSALUS Lambayeque Perú / Prognostic factors in the superlife of priority cancer in the social security ESSALUD Lambayeque Perú

Describir las características clínico epidemiológicas, determinar factores pronósticos de sobrevida de pacientes con cánceres prioritarios en el Seguro Social Essalud Lambayeque 2007-2010. Estudio analítico de cohorte retrospectivo, usando pacientes del registro hospitalario de cáncer. Se analizó con ANOVA, para comparar medias y curvas de Kaplan-Meier comparándolas con el test log rank. Para factores pronósticos se usó la regresión de Cox con el cálculo de hazard ratio. Se usó un nivel de significancia de P<0,05. Por cada año adicional de edad riesgo de morir se incrementa en 3,6%. Los tiempos de atención de tratamiento (P<0,05), diagnóstico (P<0,05) y referencia (P<0,05) disminuyeron comparando 2007 al 2010. Las curvas de sobrevida en el tiempo de referencia (log rank<0,05) y tratamiento (log rank<0,05). Los pacientes con cáncer de colon tienen 2,7 veces más riesgo (HR: 2,7 IC95% 1,5-5,1) de morir, las mujeres con cáncer de mama, presentan 62% menos riesgo de morir (HR: 0,38 IC95% 0,21-0,67) comparado con las mujeres con cáncer de cuello uterino. El número de casos incidentes y prevalentes de cáncer han aumentado del año 2007 al 2010. Los tiempos de atención (tiempo de tratamiento, diagnóstico y de referencia) han disminuido en el 2010 tomando como referencia el 2007. La sobrevida se encontró asociada a tener tiempo de referencia y tratamiento menor al estándar. Los factores pronósticos encontrados fueron: tiempo de tratamiento, edad, grado de instrucción, tipo de cáncer prioritario, grado histológico de diferenciación

The objective of this work is to describe the epidemiological and clinical characteristics and to determine the prognostic factors for survival of patients with cancers priority in the Lambayeque Essalud Social Security to 2007-2010. We realized a retrospective cohort analytic study in patients using hospital cancerregistry. They were analyzed with ANOVA to compare means and Kaplan-Meier log rank test comparing them. For the prognostic factors we used Cox regression to calculate hazard ratios. We used a significance level of P<0.05. For each additional year of age the risk of death increases by 3.6%. The service time of treatment(P<0.05), diagnosis (P<0.05) and baseline (P<0.05) decreased comparing 2007 to 2010. The survival curves in the reference time (log rank <0.05) and treatment (log rank <0.05). Patients with colon cancer are 2.7 times greater risk (HR: 2.7 95% CI 1.5 to 5.1) of dying, while women with breast cancer have 62% lower risk of dying (HR: 0.3895% CI 0.21 to 0.67) compared with women with cervical cancer. The number of incident and prevalent cases of cancer has increased from 2007 to 2010. Service times (time of treatment, diagnostic and reference) have decreased in 2010 by reference to the 2007. Survival was found to be associated reference time and lower the standard treatment. The prognostic factors found were: treatment time, age, education level, primary cancer type, histological grade of differentiation