RESUMO
A comprehensive understanding of the virome in mosquito vectors is crucial for assessing the potential transmission of viral agents, designing effective vector control strategies, and advancing our knowledge of insect-specific viruses (ISVs). In this study, we utilized Oxford Nanopore Technologies metagenomics to characterize the virome of Aedes aegypti mosquitoes collected in various regions of Colombia, a country hyperendemic for dengue virus (DENV). Analyses were conducted on groups of insects with previous natural DENV infection (DENV-1 and DENV-2 serotypes), as well as mosquito samples that tested negative for virus infection (DENV-negative). Our findings indicate that the Ae. aegypti virome exhibits a similar viral composition at the ISV family and species levels in both DENV-positive and DENV-negative samples across all study sites. However, differences were observed in the relative abundance of viral families such as Phenuiviridae, Partitiviridae, Flaviviridae, Rhabdoviridae, Picornaviridae, Bromoviridae, and Virgaviridae, depending on the serotype of DENV-1 and DENV-2. In addition, ISVs are frequently found in the core virome of Ae. aegypti, such as Phasi Charoen-like phasivirus (PCLV), which was the most prevalent and showed variable abundance in relation to the presence of specific DENV serotypes. Phylogenetic analyses of the L, M, and S segments of the PCLV genome are associated with sequences from different regions of the world but show close clustering with sequences from Brazil and Guadeloupe, indicating a shared evolutionary relationship. The profiling of the Ae. aegypti virome in Colombia presented here improves our understanding of viral diversity within mosquito vectors and provides information that opens the way to possible connections between ISVs and arboviruses. Future studies aimed at deepening our understanding of the mechanisms underlying the interactions between ISVs and DENV serotypes in Ae. aegypti could provide valuable information for the design of effective vector-borne viral disease control and prevention strategies.IMPORTANCEIn this study, we employed a metagenomic approach to characterize the virome of Aedes aegypti mosquitoes, with and without natural DENV infection, in several regions of Colombia. Our findings indicate that the mosquito virome is predominantly composed of insect-specific viruses (ISVs) and that infection with different DENV serotypes (DENV-1 and DENV-2) could lead to alterations in the relative abundance of viral families and species constituting the core virome in Aedes spp. The study also sheds light on the identification of the genome and evolutionary relationships of the Phasi Charoen-like phasivirus in Ae. aegypti in Colombia, a widespread ISV in areas with high DENV incidence.
Assuntos
Aedes , Vírus da Dengue , Dengue , Animais , Humanos , Aedes/virologia , Dengue/transmissão , Vírus da Dengue/genética , Vírus de Insetos , Mosquitos Vetores/virologia , Filogenia , SorogrupoRESUMO
Using Oxford Nanopore technologies and phylogenetic analyses, we sequenced and identified the cosmopolitan genotype of dengue virus serotype 2 isolated from 2 patients in the city of Villavicencio, Meta department, Colombia. This identification suggests the emergence of this genotype in the country, which warrants further surveillance to identify its epidemic potential.
Assuntos
Vírus da Dengue , Dengue , Humanos , Dengue/epidemiologia , Sorogrupo , Filogenia , Colômbia/epidemiologia , GenótipoRESUMO
We describe a recent case of lymphatic filariasis in Colombia caused by Wuchereria bancrofti nematodes. Our study combines clinical-epidemiologic findings with phylogenetic data. Resurgence of lymphatic filariasis may be linked to increasing urbanization trends and migration from previously endemic regions. Fieldwork can be a beneficial tool for screening and containing transmission.
Assuntos
Filariose Linfática , Wuchereria bancrofti , Filariose Linfática/epidemiologia , Colômbia/epidemiologia , Wuchereria bancrofti/genética , Humanos , Animais , Filogenia , Masculino , Adulto , Feminino , Pessoa de Meia-IdadeRESUMO
Dengue cases rose to record levels during 2023-2024. We investigated dengue in Valle del Cauca, Colombia, to determine if specific virus serotypes or lineages caused its large outbreak. We detected all 4 serotypes and multiple lineages, suggesting that factors such as climatic conditions were likely responsible for increased dengue in Colombia.
Assuntos
Vírus da Dengue , Dengue , Surtos de Doenças , Sorogrupo , Colômbia/epidemiologia , Humanos , Dengue/epidemiologia , Dengue/virologia , Vírus da Dengue/genética , Vírus da Dengue/classificação , Filogenia , História do Século XXIRESUMO
In early 2024, explosive outbreaks of Oropouche virus (OROV) linked to a novel lineage were documented in the Amazon Region of Brazil. We report the introduction of this lineage into Colombia and its co-circulation with another OROV lineage. Continued surveillance is needed to prevent further spread of OROV in the Americas.
Assuntos
Infecções por Bunyaviridae , Orthobunyavirus , Filogenia , Colômbia/epidemiologia , Humanos , Orthobunyavirus/genética , Orthobunyavirus/classificação , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/virologia , Surtos de Doenças , Brasil/epidemiologiaRESUMO
We estimated the incubation period for mpox during an outbreak in Pereira, Colombia, using data from 11 confirmed cases. Mean incubation period was 7.1 (95% CI 4.9-9.9) days, consistent with previous outbreaks. Accurately estimating the incubation period provides insights into transmission dynamics, informing public health interventions and surveillance strategies.
Assuntos
Mpox , Masculino , Humanos , Colômbia/epidemiologia , Período de Incubação de Doenças Infecciosas , Surtos de Doenças , Saúde Pública , Homossexualidade MasculinaRESUMO
High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018-2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having >1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.
Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Humanos , Colômbia/epidemiologia , Feminino , Sífilis Congênita/prevenção & controle , Sífilis Congênita/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Recém-Nascido , Adulto Jovem , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Cuidado Pré-Natal , Programas de Rastreamento , Sífilis/epidemiologia , Sífilis/prevenção & controle , Incidência , Adolescente , História do Século XXIRESUMO
Aedes aegypti vectors the pathogens that cause dengue, yellow fever, Zika virus, and chikungunya and is a serious threat to public health in tropical regions. Decades of work has illuminated many aspects of Ae. aegypti's biology and global population structure and has identified insecticide resistance genes; however, the size and repetitive nature of the Ae. aegypti genome have limited our ability to detect positive selection in this mosquito. Combining new whole genome sequences from Colombia with publicly available data from Africa and the Americas, we identify multiple strong candidate selective sweeps in Ae. aegypti, many of which overlap genes linked to or implicated in insecticide resistance. We examine the voltage-gated sodium channel gene in three American cohorts and find evidence for successive selective sweeps in Colombia. The most recent sweep encompasses an intermediate-frequency haplotype containing four candidate insecticide resistance mutations that are in near-perfect linkage disequilibrium with one another in the Colombian sample. We hypothesize that this haplotype may continue to rapidly increase in frequency and perhaps spread geographically in the coming years. These results extend our knowledge of how insecticide resistance has evolved in this species and add to a growing body of evidence suggesting that Ae. aegypti has an extensive genomic capacity to rapidly adapt to insecticide-based vector control.
Assuntos
Aedes , Genoma de Inseto , Resistência a Inseticidas , Inseticidas , Animais , Aedes/genética , Dengue , Resistência a Inseticidas/genética , Inseticidas/farmacologia , Mosquitos Vetores/genética , Mutação , Zika virus , Infecção por Zika virus , Genoma de Inseto/efeitos dos fármacos , Genoma de Inseto/genéticaRESUMO
The cefazolin inoculum effect (CzIE) has been associated with poor clinical outcomes in patients with methicillin-susceptible Staphylococcus aureus (MSSA) infections. We aimed to investigate the point prevalence of the CzIE among nasal colonizing MSSA isolates from ICU patients in a multicenter study in Colombia (2019-2023). Patients underwent nasal swabs to assess for S. aureus colonization on admission to the ICU, and some individuals had follow-up swabs. We performed cefazolin MIC by broth microdilution using standard and high inoculum and developed a modified nitrocefin-based rapid test to detect the CzIE. Whole-genome sequencing was carried out to characterize BlaZ types and allotypes, phylogenomics, and Agr-typing. A total of 352 patients were included; 46/352 (13%) patients were colonized with S. aureus and 22% (10/46) and 78% (36/46) with MRSA and MSSA, respectively. Among 36 patients who contributed with 43 MSSA colonizing isolates, 21/36 (58%) had MSSA exhibiting the CzIE. BlaZ type A and BlaZ-2 were the predominant type and allotype in 56% and 52%, respectively. MSSA belonging to CC30 were highly associated with the CzIE, and single-nucleotide polymorphism (SNP) analyses supported possible transmission of MSSA exhibiting the CzIE among some patients of the same unit. The modified nitrocefin rapid test had 100%, 94.4%, and 97.7% sensitivity, specificity, and accuracy, respectively. We found a high point prevalence of the CzIE in MSSA colonizing the nares of critically ill patients in Colombia. A modified rapid test was highly accurate in detecting the CzIE in this patient population.
Assuntos
Antibacterianos , Cefazolina , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas , Humanos , Colômbia/epidemiologia , Cefazolina/farmacologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Antibacterianos/farmacologia , Feminino , Masculino , Pessoa de Meia-Idade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Prevalência , Nariz/microbiologia , Idoso , Sequenciamento Completo do Genoma , AdultoRESUMO
Hip fracture is a public health problem recognized worldwide and a potentially catastrophic threat for older persons, even carrying a demonstrated excess of mortality. Handgrip strength (HGS) has been identified as a predictor of different outcomes (mainly mortality and disability) in several groups with hip fracture. PURPOSE: The aim of this study was to determine the association between low HGS and 1-year mortality in a cohort of older patients over 60 years old with fragility hip fractures who underwent surgery in the Colombian Andes Mountains. METHODS: A total of 126 patients (median age 81 years, women 77%) with a fragility hip fracture during 2019-2020 were admitted to a tertiary care hospital. HGS was measured using dynamometry upon admission, and data about sociodemographic, clinical and functional, laboratory, and surgical intervention variables were collected. They were followed up until discharge. Those who survived were contacted by telephone at one, three, and 12 months. Bivariate, multivariate, and Kaplan-Meier analyses with survival curves were performed. RESULTS: The prevalence of low HGS in the cohort was 71.4%, and these patients were older, had poorer functional and cognitive status, higher comorbidity, higher surgical risk, time from admission to surgery > 72 h, lower hemoglobin and albumin values, and greater intra-hospital mortality at one and three months (all p < 0.01). Mortality at one year in in patients with low HGS was 42.2% and 8.3% in those with normal HGS, with a statistically significant difference (p = 0.000). In the multivariate analysis, low HGS and dependent gait measured by Functional Ambulation Classification (FAC) were the factors affecting postoperative 1-year mortality in older adults with hip fractures. CONCLUSION: In this study of older people with fragility hip fractures, low HGS and dependent gait were independent predictive markers of 1-year mortality.
RESUMO
Most protected area (PA) planning aims to improve biota representation within the PA system, but this does not necessarily achieve the best outcomes for biota retention across regions when we also consider habitat loss in areas outside the PA system. Here, we assess the implications that different PA expansion strategies can have on the retention of species habitat across an entire region. Using retention of forest habitat for Colombia's 550 forest-dependent bird species as our outcome variable, we found that when a minimum of 30% of each species' habitat was included in the PA system, a pattern of PA expansion targeting areas at highest deforestation risk (risk-prevention) led to the retention, on average, of 7.2% more forest habitat per species by 2050 than did a pattern that targeted areas at lowest risk (risk-avoidance). The risk-prevention approach cost more per km2 of land conserved, but it was more cost-effective in retaining habitat in the landscape (50%-69% lower cost per km2 of avoided deforestation). To have the same effectiveness preventing habitat loss in Colombia, the risk-avoidance approach would require more than twice as much protected area, costing three times more in the process. Protected area expansion should focus on the contributions of PAs to outcomes not only within PA systems themselves, but across entire regions.
La mayor parte de la planificación de áreas protegidas (AP) tiene como objetivo mejorar la representación de la biota dentro del sistema de AP, pero esto no necesariamente logra los mejores resultados para la retención de biota a nivel de paisaje cuando también consideramos la pérdida de hábitat en áreas fuera del sistema de AP. Aquí evaluamos las implicaciones que diferentes estrategias de expansión de AP pueden tener en la retención del hábitat de las especies en toda una región. Utilizando la retención de hábitat forestal para las 550 especies de aves dependientes de bosque de Colombia como nuestra variable de resultado, encontramos que cuando un mínimo del 30% del hábitat de cada especie es incluido en el sistema de AP, se observó que un patrón de expansión de AP dirigido a áreas con mayor riesgo de deforestación (prevención de riesgos) condujo a la retención, en promedio, de un 7.2% más de hábitat por especie para 2050 que un patrón enfocado en áreas con menor riesgo (evasión de riesgos). El enfoque de prevención de riesgos costó más por km2 de tierra conservada, pero fue más rentable para retener el hábitat en el paisaje (entre un 50% y un 69% menos costo por km2 de deforestación evitada). Para tener la misma eficacia en la prevención de la pérdida de hábitat en Colombia, el enfoque de evasión de riesgos requeriría más del doble de área protegida, lo que costaría tres veces más en el proceso. La expansión de las AP debería centrarse en las contribuciones de las AP a los resultados no sólo dentro de los propios sistemas de AP, sino en regiones enteras.
Assuntos
Biota , Florestas , ColômbiaRESUMO
The FMR1 5' regulation gene region harbors a CGG trinucleotide repeat expansion (CGG-TRE) that causes Fragile X syndrome (FXS) when it expands to more than 200 repetitions. Ricaurte is a small village in southwestern Colombia, with an FXS prevalence of 1 in 38 men and 1 in 100 women (~100 times higher than the worldwide reported prevalence), defining Ricaurte as the largest FXS cluster in the world. In the present study, using next-generation sequencing of whole exome capture, we genotype 55 individuals from Ricaurte (49 with either full mutation or with premutation), four individuals from neighboring villages (with either the full mutation or with the premutation), and one unaffected woman, native of Ricaurte, who did not belong to any of the affected families. With advanced clustering and haplotype reconstruction, we modeled a common haplotype of 33 SNPs spanning 83,567,899 bp and harboring the FMR1 gene. This reconstructed haplotype was found in all the men from Ricaurte who carried the expansion, demonstrating that the genetic conglomerate of FXS in this population is due to a founder effect. The definition of this founder effect and its population outlining will allow a better prediction, follow-up, precise and personalized characterization of epidemiological parameters, better knowledge of the disease's natural history, and confident improvement of the clinical attention, life quality, and health interventions for this community.
Assuntos
Síndrome do Cromossomo X Frágil , Masculino , Humanos , Feminino , Síndrome do Cromossomo X Frágil/epidemiologia , Síndrome do Cromossomo X Frágil/genética , Efeito Fundador , Epidemiologia Molecular , Proteína do X Frágil da Deficiência Intelectual/genética , Expansão das Repetições de Trinucleotídeos , MutaçãoRESUMO
OBJECTIVE: To obtain breast cancer survival estimates in Manizales, Colombia, considering socioeconomic level, health insurance regime and residential area, while adjusting for age, histology and stage at diagnosis. METHODS: Analytical cohort study based on breast cancer incident cases recorded by the Population-based Manizales Cancer Registry between 2008-2015. Patients were followed-up for 60 months. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the Wilcoxon-Breslow-Gehan test for differences. Cox multivariate regression models were fitted. RESULTS: 856 breast cancer cases were included. The 5-year cause-specific survival for the entire cohort was 78.2%. It was higher in women with special/exception health insurance, high socioeconomic level, <50 years old, ductal carcinoma, and stages I and II. Residential area did not impact survival. In Cox models, the subsidized health insurance regime (HR: 4.87 vs contributory) and low socioeconomic level (HR: 2.45 vs high) were predictors of the hazard of death in women with breast cancer, adjusted for age, histology, stage and interactions age-stage and insurance-stage. A positive interaction (synergistic effect modification) between health insurance regime and stage regarding to survival was observed. CONCLUSION: Socioeconomic factors significantly contribute to the inequities in breast cancer survival, independent of the stage at diagnosis. This suggests the need for comprehensive interventions to remove barriers to accessing the health system. This research provides evidence of survival gaps mediated by certain social determinants of health and generates data on the overall performance of the Colombian health system.
Assuntos
Neoplasias da Mama , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Neoplasias da Mama/diagnóstico , Colômbia/epidemiologia , Estudos de Coortes , Mama , Desigualdades de SaúdeRESUMO
BACKGROUND: Cervical cancer (CC) is a significant global public health concern, particularly in developing countries such as Colombia. The main risk factor involves high-risk HPV types (HR-HPV) infection, coupled with population-specific variables. The Caribbean region in Colombia lacks research on HR-HPV-type frequencies. Therefore, this study aims to establish the prevalence of type-specific HR-HPV and its association with sociodemographic factors among women undergoing cervical cytology screening. METHODS: A cross-sectional study involving voluntary women who provided informed consent and completed a questionnaire capturing sociodemographic, clinical, and sexual behavior information was conducted. All participants underwent cervical cytology and molecular analysis. Generic HPV detection employed three simultaneous PCRs (GP5+/6+, MY09/11, and PU1R/2 M), and positive samples were genotyped using the Optiplex HPV Genotyping kit. The analysis encompassed the 12 types of high-risk HPV (HR-HPV-16,-18,-31,-33,-35,-39,-45,-51,-52,-56,-58, and - 59). Frequencies were reported based on geographic subregions within the Córdoba department, and disparities were made between single and multiple infections. Sociodemographic and clinical variables were subjected to ordinal logistic regression, with statistical significance at a p-value < 0.05. The statistical analyses utilized STATA 14® and R-Core Team-software. RESULTS: We included 450 women, mean age 40 (SD±11.44). PCR analysis revealed 43% HPV-positive (n=192). GP5+/6+ detected the most positives at 26% (n=119), followed by PU1R/2 M at 22% (n = 100) and MY09/11 at 15% (n=69). Multiple infections occurred in 87.3% (n=142), primarily 2 to 4 types (47.37%, n=90). Dominant types were HPV-18 (15.6%, n=61), HPV-16 (14.9%, n=58), HPV-31 (13.0%, n = 51), and HPV-45 (11.5%, n=45). Logistic regression identified age above 60 as a risk for concurrent multiple types (OR=6.10; 95% CI 1.18-31.63). Menopause was protective (OR=0.31; 95% CI 0.11-0.89). CONCLUSIONS: Our study reveals a notable prevalence of multiple (2-4) high-risk HPV infections among adult women engaged in CC detection initiatives. Predominantly, α7 species constitute the prevalent HR-viral types, with the Medio Sinú subregion showing elevated prevalence. Menopausal status confers protection against diverse HR-HPV infections. Nevertheless, advancing age, particularly beyond 60 years, is linked to an increased susceptibility to simultaneous infections by multiple HPV-types.
Assuntos
Detecção Precoce de Câncer , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Humanos , Feminino , Adulto , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/diagnóstico , Colômbia/epidemiologia , Estudos Transversais , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Pessoa de Meia-Idade , Prevalência , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Papillomaviridae/classificação , Genótipo , Adulto Jovem , Fatores de Risco , Idoso , Alphapapillomavirus/genética , Alphapapillomavirus/isolamento & purificação , Alphapapillomavirus/classificação , Região do Caribe/epidemiologiaRESUMO
BACKGROUND: In Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia. METHODS: A qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research. RESULTS: This research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes. CONCLUSION: Participants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.
Assuntos
Pesquisa Qualitativa , Estigma Social , Pessoas Transgênero , Humanos , Colômbia , Feminino , Adulto , Pessoas Transgênero/psicologia , Pessoa de Meia-Idade , Adulto Jovem , Acessibilidade aos Serviços de Saúde , Masculino , Entrevistas como Assunto , NarraçãoRESUMO
Improving models of species' distributions is essential for conservation, especially in light of global change. Species distribution models (SDMs) often rely on mean environmental conditions, yet species distributions are also a function of environmental heterogeneity and filtering acting at multiple spatial scales. Geodiversity, which we define as the variation of abiotic features and processes of Earth's entire geosphere (inclusive of climate), has potential to improve SDMs and conservation assessments, as they capture multiple abiotic dimensions of species niches, however they have not been sufficiently tested in SDMs. We tested a range of geodiversity variables computed at varying scales using climate and elevation data. We compared predictive performance of MaxEnt SDMs generated using CHELSA bioclimatic variables to those also including geodiversity variables for 31 mammalian species in Colombia. Results show the spatial grain of geodiversity variables affects SDM performance. Some variables consistently exhibited an increasing or decreasing trend in variable importance with spatial grain, showing slight scale-dependence and indicating that some geodiversity variables are more relevant at particular scales for some species. Incorporating geodiversity variables into SDMs, and doing so at the appropriate spatial scales, enhances the ability to model species-environment relationships, thereby contributing to the conservation and management of biodiversity. This article is part of the Theo Murphy meeting issue 'Geodiversity for science and society'.
Assuntos
Biodiversidade , Mudança Climática , Animais , Clima , Ecossistema , MamíferosRESUMO
BACKGROUND: Tailoring asthma interventions based on biomarkers could substantially impact the high cost associated with asthma morbidity. For policymakers, the main concern is the economic impact of adopting this technology, especially in developing countries. This study evaluates the budget impact of asthma management using sputum eosinophil counts in Colombia patients between 4 and 18 years of age. METHODS: A budget impact analysis was performed to evaluate the potential financial impact of sputum eosinophil counts (EO). The study considered a 5-year time horizon and the Colombian National Health System perspective. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which EO is reimbursed, from the cost of the conventional therapy without EO (management based on clinical symptoms (with or without spirometry/peak flow) or asthma guidelines (or both), for asthma-related). Univariate one-way sensitivity analyses were performed. RESULTS: In the base-case analysis, the 5-year costs associated with EO and no-EO were estimated to be US$ 532.865.915 and US$ 540.765.560, respectively, indicating savings for Colombian National Health equal to US$ 7.899.645, if EO is adopted for the routine management of patients with persistent asthma. This result was robust in univariate sensitivity one-way analysis. CONCLUSION: EO was cost-saving in guiding the treatment of patients between 4 and 18 years of age with persistent asthma. Decision-makers in our country can use this evidence to improve clinical practice guidelines, and it should be replicated to validate their results in other middle-income countries.
Assuntos
Asma , Eosinófilos , Guias de Prática Clínica como Assunto , Escarro , Humanos , Asma/economia , Asma/terapia , Criança , Adolescente , Colômbia , Pré-Escolar , Escarro/citologia , Contagem de Leucócitos , Feminino , Masculino , Redução de Custos/estatística & dados numéricos , Países em DesenvolvimentoRESUMO
BACKGROUND: Shewanella putrefaciens is a gram-negative, nonfermenting, oxidase-positive, hydrogen sulfide-producing bacillus and a halophilic bacterium, known for causing unusual infections in humans and often regarded as an opportunistic pathogen. Its diverse symptoms have a significant impact on human health, with 260 documented disorders reported in the literature over the last 40 years, highlighting its potential danger. CASE PRESENTATION: We present the case of a previously healthy 15-year-old male patient who sustained a self-inflicted sharp-object injury while working in the field, resulting in secondary septic monoarthritis due to Shewanella putrefaciens. CONCLUSIONS: This case highlights the bacteriological and clinical characteristics, as well as the antibiogram, of Shewanella spp. Given the recent increase in notifications of Shewanella infections, predominantly by S. algae and S. putrefaciens, it is essential to consider these pathogens in patients with a history of contact with bodies of water. Special attention must be paid to their resistance patterns in patient management to prevent the development of intrinsic antimicrobial resistance.
Assuntos
Antibacterianos , Artrite Infecciosa , Infecções por Bactérias Gram-Negativas , Shewanella putrefaciens , Humanos , Shewanella putrefaciens/isolamento & purificação , Masculino , Adolescente , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/tratamento farmacológico , Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Articulação do Joelho/microbiologiaRESUMO
The effect of the health insurance type on the prognosis of heart failure (HF) patients in Colombia and Latin America is poorly known. We aimed to analyze the characteristics of HF patients that participated in the Colombian Heart Failure Registry (RECOLFACA) as stated by their health insurance type and their relationship with the immediate prognosis of these patients. Patients with HF diagnosis were included in the RECOLFACA registry between 2017-2019. The registry was conducted in 60 centers in Colombia. All-cause mortality was the principal outcome. To evaluate the impact of health insurance on mortality, a Cox proportional hazards regression model was used. The Kaplan-Meier analysis was performed to compare survival probabilities according to insurance type. All statistical analyses were two-tailed and were considered significant with a p value < 0.05. Of the 2,528 participants enrolled in the registry, 99% held details about their health insurance. Of those, 897 patients (35.6%) were covered by public insurance. These patients were significantly younger, with a lower proportion of men, more frequently from rural origin, and lower prevalence of most comorbidities (omitting hypertension, chronic obstructive pulmonary disease (COPD), and Chagas disease) than those with private insurance. Furthermore, patients with public insurance had a worse functional class, as well as a poorer quality of life, and lower frequency of use of implantable devices, while exhibiting similar prescription rates of triple medical therapy for HF. Finally, no differences in short-term mortality were observed between the two groups (HR 1.09; 95% CI 0.79, 1.51). The type of health insurance represents a condition related with relevant differences in the profile of patients with HF in Colombia. Despite this, no significant differences were detected in the short-term prognosis of these patients based on the type of health insurance.
RESUMO
PURPOSE: To describe the epidemiology, clinical features, and classification of uveitis in a large cohort of Colombian patients. METHODS: Data were collected from seven ophthalmological referral centers in the four main cities in Colombia. The study included patients with a confirmed diagnosis of uveitis from January 2010 to December 2022. Information on demographics, ophthalmic examination findings, uveitis classification, and etiology was recorded. RESULTS: The study reviewed 3,404 clinical records of patients with uveitis. The mean age at diagnosis was 41.1 (SD 19.0) years, and 54.2% of the patients were female. Overall, 1,341(39.4%) were infectious, 626 (18.4%) non-infectious, and four masquerade syndromes (0.1%). The most common types of uveitis were unilateral (66.7%), acute (48.3%), and non-granulomatous (83%). Anterior uveitis was the most common anatomical localization (49.5%), followed by posterior uveitis (22.9%), panuveitis (22.3%), and intermediate uveitis (5.2%). A diagnosis was established in 3,252 (95.5%) cases; idiopathic was the most common cause (27.7%), followed by toxoplasmosis (25.3%) and virus-associated uveitis (6.4%). The age group between 30 and 50 exhibited the highest frequency of uveitis. CONCLUSION: This multicenter study comprehensively describes uveitis characteristics in Colombian patients, providing valuable insights into its demographic and clinical features. The study findings emphasize the need to continue updating the changing patterns of uveitis to improve diagnosis and treatment strategies for diseases associated with intraocular inflammation.