[Strategie of the "acute respiratory disease room" in two tertiary referral clinics: a retrospective multicenter cohort study]. / Estrategia de "sala enfermedad respiratoria aguda" en dos clínicas de referencia de tercer nivel de complejidad: estudio de cohorte multicéntrica retrospectiva.

Respiratory diseases are one of the main causes of morbidity and mortality in children under 5 years of age. The acute respiratory disease (ERA in Spanish) room strategy implemented in Colombia is an important tool to reduce hospitalization and mortality rates in this population. OBJECTIVE: To describe the health outcomes of the implementation of the ERA room strategy in two health institutions in Bogota. PATIENTS AND METHOD: Multicenter descriptive study including 1785 patients admitted to the ERA rooms of two institutions in Bogota, between December 2019 and 2022. Data on sex, age, admission diagnosis, length of stay in ERA room, education provided, and post discharge follow-up were collected. The main outcomes were evaluated through hospitalization requirement, ICU requirement, and post discharge improvement. RESULTS: 1785 patients were included during the study period. 57% were male; median age was 26.6 months (IQR: 11.8 to 40.6); length of stay in ERA room was 2.62 hours (IQR: 1.73 to 4.88); 91.65% of family members and/or caregivers received educational measures. CONCLUSIONS: This study describes the results of the implementation of the ERA room strategy; the low proportion of patients requiring hospitalization is evident. Additionally, the education provided to parents and caregivers on home management is relevant, as well as the post discharge follow-up of this cohort of patients with acute respiratory disease.

Comment on: "Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study".

We read with great interest the recent study by Naddi et al. in BMC Anesthesiology, which explores operator gender differences in major mechanical complications following central venous catheterization. The study identifies male operator gender as an independent risk factor for complications. However, our attempt to replicate these findings using Colombian data did not support this association. We caution against oversimplifying the influence of sex and gender on health outcomes, as numerous factors, including cultural norms, healthcare practices, and resource availability, significantly impact procedural outcomes. Differences in complication rates may reflect risk-taking behaviors and systemic healthcare disparities rather than inherent biological differences. We emphasize the need for a comprehensive approach to understand the multifaceted nature of central venous related complications. Replication studies across diverse populations are crucial for validating these findings and informing effective strategies for complication prevention and management.

Factores asociados con la infección por el virus de la hepatitis B en comunidades indígenas de Colombia.

Introducción. Colombia alberga dos millones de indígenas, que viven en condiciones de pobreza y tienen deficiencias en salud, por lo cual están expuestos a contraer infecciones virales como la hepatitis B. El departamento del Amazonas presenta una gran prevalencia del virus y barreras para acceder a la vacunación; por esto, parte de la población es propensa a la infección. Objetivo. Identificar factores asociados con la infección por el virus de la hepatitis B en indígenas colombianos. Materiales y métodos. Se llevó a cabo un estudio de casos y controles en mayores de 18 años de cuatro departamentos del país. Los casos se identificaron mediante el registro nacional de notificación de hepatitis B (2015-2022). Los controles seleccionados de manera concurrente fueron pareados con los casos por edad, sexo, etnia y departamento. En una encuesta se consignaron las características sociodemográficas, los factores asociados con el contacto con sangre y fluidos, las prácticas socioculturales y los antecedentes de vacunación. El proyecto fue aprobado por Comité de Ética de la Universidad de Antioquia. Resultados. Participaron 75 casos y 150 controles de 13 grupos étnicos. El departamento del Amazonas aportó el 49 % de los participantes (83 % mujeres) con una mediana de edad de 30 años (RIC = 27-37). Los factores asociados con una mayor probabilidad de contraer la infección fueron el antecedente de algún familiar infectado con el virus de la hepatitis B (OR ajustado = 2,61) (IC95%: 1,09-6,27) y número de embarazos en mujeres, (OR ajustado = 1,61) (IC95%: 1,02-2,54). La vacunación mostró un efecto protector sin asociación significativa. Conclusión. Los aspectos asociados con la convivencia familiar y el número de embarazos contribuyen a una potencial transmisión vertical y horizontal del virus. No se identificaron prácticas culturales asociadas. Se requieren estrategias novedosas y diferenciales para reducir la transmisión del virus de la hepatitis B en poblaciones indígenas.

Prevalencia de la resistencia a macrólidos y aminoglucósidos en los complejos Mycobacterium avium y M. abscessus y en Mycobacterium chelonae identificados en el Laboratorio Nacional de Referencia de Colombia entre el 2018 y el 2022.

Introducción. Mycobacterium chelonae y los complejos Mycobacterium avium y M. abscessus, son agentes patógenos emergentes causantes de micobacteriosis. El tratamiento de esta infección depende de la especie y la subespecie identificadas. Los fármacos de elección son los macrólidos y aminoglucósidos, contra los cuales se ha reportado resistencia; por esta razón, el determinar el perfil de sensibilidad le permite al médico tratante comprender mejor el pronóstico y la evolución de estas infecciones. OBJETIVO: Describir los perfiles de sensibilidad ante macrólidos y aminoglucósidos, de los cultivos identificados como complejo Mycobacterium avium, complejo M. abscessus o especie M. chelonae, en el Laboratorio Nacional de Referencia de Micobacterias durante los años 2018 a 2022. Materiales y métodos. Se llevó a cabo un estudio descriptivo del perfil de sensibilidad a macrólidos y aminoglucósidos, de los cultivos identificados como complejo M. avium, complejo M. abscessus o M. chelonae, mediante la metodología GenoType® NTM-DR. RESULTADOS: Los cultivos del complejo M. avium fueron 159 (47,3 %), de los cuales, 154 (96,9 %) fueron sensibles y 5 (3,1 %) resistentes a los macrólidos; todos fueron sensibles a los aminoglucósidos. Del complejo M. abscessus se estudiaron 125 (37,2 %) cultivos, 68 (54,4 %) resultaron sensibles y 57 (45,6 %) resistentes a los macrólidos; solo un cultivo (0,8 %) fue resistente a los aminoglucósidos. De M. chelonae se analizaron 52 cultivos (15,5 %), todos sensibles a los macrólidos y aminoglucósidos. CONCLUSIONES: En las tres especies de micobacterias estudiadas, la resistencia contra la amikacina fue la menos frecuente. La identificación de las subespecies y los perfiles de sensibilidad permiten instaurar esquemas de tratamiento adecuados, especialmente en las micobacteriosis causadas por M. abscessus.

Salud auditiva y exposición a ruido ambiental en población de 18 a 64 años de Bogotá, Colombia, entre el 2014 y el 2018.

Introducción. La salud auditiva es un tema de interés en salud pública que afecta la calidad de vida y que puede afectarse por la exposición continua al ruido, un factor de riesgo que genera síntomas auditivos y extraauditivos. OBJETIVO: Identificar el estado de salud auditiva de adultos que viven en Bogotá, y su asociación con factores de exposición a ruido ambiental, individuales y otológicos. Materiales y métodos. Se realizó un estudio transversal mediante el análisis de una base de datos con 10.311 registros, obtenidos entre los años 2014 y 2018, producto de una encuesta estructurada de percepción de ruido y tamizaje auditivo. Se hizo un análisis descriptivo bivariado y una regresión logística binaria. RESULTADOS: El 35,4 % de los participantes presentó disminución auditiva. En el componente de percepción: 13,0 % refirió no escuchar bien, 28,8 % informó síntomas extraauditivos, 53,3 % tenía antecedentes otológicos, y 69,0 % manifestó molestia por ruido extramural. En la regresión logística, las variables más asociadas con disminución auditiva fueron: de las ambientales, vivir en zonas de mayor ruido (OR = 1,50) (IC95%: 1,34-1,69); de las individuales, ser hombre (OR = 1,85) (IC95%: 1,64-2,09) y la edad (por cada año de vida, el riesgo de disminución auditiva aumentó 6 %); y de las otológicas, tener antecedente de síntomas otológicos (OR = 1,86) (IC95%: 1,66-2,08). CONCLUSIONES: La disminución auditiva es multicausal en la población evaluada. Los factores que aumentan su prevalencia son incremento de la edad, ser hombre, tabaquismo, medicamentos ototóxicos, vivir en zonas de mayor exposición a ruido y presentar síntomas extraauditivos.

Especies de flebotomíneos y sus fuentes de ingesta sanguínea en un nuevo foco de leishmaniasis en Los Montes de María (Bolívar) al norte de Colombia.

Introducción. En 2018, en la vereda El Alférez de Los Montes de María (Bolívar, Colombia), un macrofoco de leishmaniasis, se reportó el primer caso y se evidenciaron cambios en la distribución y ecoepidemiología de la enfermedad. No obstante, las interacciones entre vectores y fauna local aún son desconocidas. Objetivo. Evaluar la diversidad de flebotomíneos y sus fuentes de alimentación sanguínea en la comunidad de El Alférez del municipio de El Carmen de Bolívar (Bolívar, Colombia). Materiales y métodos. En el 2018, se recolectaron flebotomíneos mediante trampas de luz led ubicadas en el domicilio, el peridomicilio y en el área silvestre, y se identificaron a nivel de especie. Se utilizó la reacción en cadena de la polimerasa múltiple dirigida al gen mitocondrial citocromo B para analizar la sangre del aparato digestivo. Resultados. Lutzomyia evansi fue la especie más abundante (71,85 %; n = 485/675), seguida por Lu. panamensis, Lu. gomezi, Lu. trinidadensis, Lu. dubitans, Lu. abonnenci y Lu. aclydifera. El 25 % (n = 25/100) de las especies analizadas tuvieron como fuentes de ingesta sanguínea a Canis familiaris (36 %; n = 9/25), Ovis aries (36 %; n = 9/25), Bos taurus (24 %; n = 6/25), Sus scrofa (20 %; n = 5/25) y Homo sapiens (8 %; n = 2/25). Lutzomyia evansi fue la especie con la mayor frecuencia de alimentación (68 %; n = 17/25), predominantemente de una sola especie (44 %; n = 11/25) o de varias (24 %; n = 6/25).

Performance of risk scores in predicting mortality at 3, 6, and 12 months in patients diagnosed with community-acquired pneumonia.

BACKGROUND: Risk scores (RS) evaluate the likelihood of short-term mortality in patients diagnosed with community-acquired pneumonia (CAP). However, there is a scarcity of evidence to determine the risk of long-term mortality. This article aims to compare the effectiveness of 16 scores in predicting mortality at three, six, and twelve months in adult patients with CAP. METHODS: A retrospective cohort study on individuals diagnosed with CAP was conducted across two hospitals in Colombia. Receiver Operating Characteristic (ROC) curves were constructed at 3, 6, and 12 months to assess the predictive ability of death for the following scoring systems: CURB-65, CRB-65, SCAP, CORB, ADROP, NEWS, Pneumonia Shock, REA-ICU, PSI, SMART-COP, SMRT-CO, SOAR, qSOFA, SIRS, CAPSI, and Charlson Comorbidity Index (CCI). RESULTS: A total of 3688 patients were included in the final analysis. Mortality at 3, 6, and 12 months was 5.2%, 8.3%, and 16.3% respectively. At 3 months, PSI, CCI, and CRB-65 scores showed ROC curves of 0.74 (95% CI: 0.71-0.77), 0.71 (95% CI: 0.67-0.74), and 0.70 (95% CI: 0.66-0.74). At 6 months, PSI and CCI scores showed performances of 0.74 (95% CI: 0.72-0.77) and 0.72 (95% CI: 0.69-0.74), respectively. Finally at 12 months, all evaluated scores showed poor discriminatory capacity, including PSI, which decreased from acceptable to poor with an ROC curve of 0.64 (95% CI: 0.61-0.66). CONCLUSION: When predicting mortality in patients with CAP, at 3 months, PSI, CCI, and CRB-65 showed acceptable predictive performances. At 6 months, only PSI and CCI maintained acceptable levels of accuracy. For the 12-month period, all evaluated scores exhibited very limited discriminatory ability, ranging from poor to almost negligible.

Extended high-frequency hearing loss among Afro-Colombian adolescents from a rural area in Colombia: a cross-sectional study.

OBJECTIVES: Research trends concerning hearing loss within teen rural populations are limited and current evidence suggests that extended high-frequency audiometry can be a sensitive tool to detect subclinical hearing loss. Moreover, current research emphasises the importance of representing different ethnic populations in science. This study aimed to determine the prevalence of acquired hearing loss through conventional pure-tone (0.25-8 kHz) and extended high frequency (EHF) (9-20 kHz) audiometry in Afro-Colombian adolescents from a rural area in Colombia. DESIGN: Observational, cross-sectional study. PARTICIPANTS: 230 Afro-Colombian adolescents aged 13-17 years who attended high school in a rural population from Cartagena, Colombia. INTERVENTIONS: Otoscopic examination, conventional (0.25-8 kHz) and EHF (9-20 kHz) audiometry tests were performed during February-March 2021. Sociodemographic and associated factor questionnaires were also applied to assess probable factors associated with EHF hearing loss. MAIN OUTCOME MEASURES: Prevalence of acquired hearing loss using conventional and EHF audiometry, and factors associated with hearing loss. RESULTS: Of 230 adolescents who met the eligibility criteria, 133 (57.82%) were female. The mean age was 15.22 years (SD: 1.62). The prevalence of hearing loss in at least one ear assessed with conventional audiometry was 21.30% and with EHF audiometry 14.78%. The main abnormal otoscopic findings included: neotympanum (1.30%), myringosclerosis (0.87%) and monomeric scars (0.43%). Factors associated with a higher probability of EHF hearing loss found through logistic regression were older age (prevalence ratio (PR): 1.45; 95% CI 1.16 to 1.80), attending the 'Picó' four or more times a month (PR: 6.63; 95% CI 2.16 to 20.30), attending bars more than three times a month (PR: 1.14; 95% CI 1.03 to 1.59) and self-reported hearing difficulties (PR: 1.24; 95% CI 1.22 to 4.05). CONCLUSIONS: Our results suggest that acquired hearing loss is already widespread among this young rural population.

Lifestyles associated with malaria in pregnancy in northwest Colombia: a mixed study from Latin American critical epidemiology.

BACKGROUND: In the scientific literature on Malaria in Pregnancy (MiP), no studies have been conducted on lifestyles based on critical theory. The objective of this study was to analyse the lifestyles or singular processes of social determination of health in MiP in northwestern Colombia. METHODS: Mixed QUAN-QUAL convergent triangulation study. In the quantitative component, a psychometric evaluation and a cross-sectional design were conducted in 400 pregnant women to whom the Pender-Walker lifestyle scale and a survey on MiP prevention were applied. In the qualitative study, a critical ethnography was conducted with 46 pregnant women in whom their narratives and practices regarding lifestyles at home and healthcare were described. RESULTS: The frequency of MiP was 9%, and a higher occurrence of the disease was identified in those who did not control stagnant water (29%), did not use insecticide-treated net (16%) and went to the hospital (14%) or the microscopist (20%) when they had fever. This coincides with the presence of unhealthy lifestyles, little knowledge about malaria, and a low perception of the risk of getting sick, as well as meanings and experiences about MiP, maternity, and pregnancy that show a high clinical, cultural, and socioeconomic burden for the women studied. CONCLUSION: This epidemiological profile and the approach to lifestyles based on the postulates of critical theory in health evidence that pregnant women exposed to malaria suffer serious social, cultural and health injustices that are not possible to impact with the current health model of malaria control in Colombia guided by aetiopathogenic, biomedical, positivist and utilitarian theories.

Survival of patients with mucosal melanoma in Cali, Colombia: a retrospective cohort study.

BACKGROUND: Mucosa melanoma is a rare condition with aggressive behavior and a less favorable prognosis compared to cutaneous melanoma. The objective of this study was to estimate the overall survival and clinical outcomes of patients diagnosed with mucosal melanoma in a Colombian hospital. METHODS: A retrospective cohort study was conducted at Fundación Valle del Lili, a single center located in Cali, Colombia. Patients aged ≥ 18 years, both sexes, diagnosed with mucosal melanoma by histopathology study were included between 2010-2019. Patients who received extra-institutional treatment or whose vital status was unknown during follow-up were excluded. Demographic, clinical and laboratory data were obtained from medical records and laboratory and pathology databases. A descriptive analysis was performed. Survival analysis was conducted using the Kaplan-Meier method. RESULTS: A total of 23 patients were included. Median age was 63 years old (IQR: 57-68) and 52.2% were woman. Clinical stage was 34.8% early, 26.1% locally advanced and 39.1% metastatic. The main primary locations were nasopharynx (30.4%), genitals (26.1%), rectum (21.7%), oral cavity (13%) and paranasal sinuses (8.7%). The majority received surgery (30.4%) and immunotherapy (26.1%) as first line treatment. Overall survival at one year was 80.8%, at three years 44.3%, and at five years 36.9%. CONCLUSION: Mucosal melanoma is a rare, aggressive disease with adverse oncological outcomes due to late diagnosis and limited treatment options. This study provides real-world data in a single-center of Colombia.

Genomic diversity and evolutionary dynamics of Influenza A viruses in Colombian swine: implications for one health surveillance and control.

Influenza A viruses (IAV) impose significant respiratory disease burdens in both swine and humans worldwide, with frequent human-to-swine transmission driving viral evolution in pigs and highlighting the risk at the animal-human interface. Therefore, a comprehensive One Health approach (interconnection among human, animal, and environmental health) is needed for IAV prevention, control, and response. Animal influenza genomic surveillance remains limited in many Latin American countries, including Colombia. To address this gap, we genetically characterized 170 swine specimens from Colombia (2011-2017). Whole genome sequencing revealed a predominance of pandemic-like H1N1 lineage, with a minority belonging to H3N2 and H1N2 human seasonal-like lineage and H1N1 early classical swine lineages. Significantly, we have identified reassortant and recombinant viruses (H3N2, H1N1) not previously reported in Colombia. This suggests a broad genotypic viral diversity, likely resulting from reassortment between classical endemic viruses and new introductions established in Colombia's swine population (e.g. the 2009 H1N1 pandemic). Our study highlights the importance of a One Health approach in disease control, particularly in an ecosystem where humans are a main source of IAV to swine populations, and emphasizes the need for continued surveillance and enhanced biosecurity measures. The co-circulation of multiple subtypes in regions with high swine density facilitates viral exchange, underscoring the importance of monitoring viral evolution to inform vaccine selection and public health policies locally and globally.

Economic burden due to COVID-19 in a Colombian Caribbean state, 2020 and 2021.

OBJECTIVE: To estimate the economic burden associated with COVID-19 in Córdoba, Colombia, 2020 and 2021. METHODS: Economic burden study. Direct costs were analyzed from the third-party payer perspective using healthcare administrative databases and interviews from a cohort of confirmed COVID-19 cases from Córdoba. Costing aggregation was performed by the bottom-up method. Indirect costs were estimated using the productivity loss approach. Contrast tests and statistical models were estimated at 5% significance. RESULTS: We studied 1,800 COVID-19 cases. The average economic cost of COVID-19 per episode was estimated at US$ 2,519 (95%CI 1,980;3,047). The direct medical cost component accounted for 92.9% of the total; out-of-pocket and indirect costs accounted for 2% and 5.1%, respectively. CONCLUSION: COVID-19 economic cost was mainly due to direct medical costs. This study provided evidence of the economic burden faced by households due to COVID-19, with the most vulnerable households bearing much of the burden on their income.

One-year survival of patients admitted for sepsis to intensive care units in Colombia.

BACKGROUND: Sepsis is a frequent cause of admission to intensive care units (ICUs). High mortality rates are estimated globally, and in our country, few studies have reported one-year survival. The objective of this study is to determine one-year survival in patients with sepsis admitted to the ICU in Colombia, compared with the survival of patients admitted for other conditions. METHODS: Retrospective cohort study using administrative databases from the Ministry of Health of Colombia. One-year survival and the adjusted hazard ratio for survival, adjusted for comorbidities included in the Charlson Index, were determined using a Cox proportional hazards model for patients admitted for other causes as well as for those admitted for sepsis. This was then compared with an inverse propensity score weighting model. RESULTS: A total of 116.407 patients were initially admitted to the ICUs, with 12.056 (10.36%) diagnosed with sepsis. Within the first year, 4.428 (36.73%) patients died due to sepsis. Age and male gender were associated with an increased risk of death from sepsis, and the covariates associated with one-year mortality were as follows: age over 80 years with HR 9.91 (95% CI: 9.22-10.65), renal disease with HR 3.16 (95% CI: 3.03-3.29), primary tumoral disease with HR 2.07 (95% CI: 1.92-2.23), liver disease with HR 2.27 (95% CI: 2.07-2.50), and metastatic solid tumor with HR 2.03 (95% CI: 1.92-2.15). CONCLUSION: This study revealed a high one-year sepsis mortality rate in the population, associated with variables such as age over 80 years, the presence of renal disease, liver disease, connective tissue diseases, and cancer. Men exhibited higher mortality compared to women.

Treponema pallidum genetic diversity and its implications for targeted vaccine development: A cross-sectional study of early syphilis cases in Southwestern Colombia.

BACKGROUND: Venereal syphilis, caused by the spirochete Treponema pallidum subsp. pallidum (TPA), is surging worldwide, underscoring the need for a vaccine with global efficacy. Vaccine development requires an understanding of syphilis epidemiology and clinical presentation as well as genomic characterization of TPA strains circulating within at-risk populations. The aim of this study was to describe the clinical, demographic, and molecular features of early syphilis cases in Cali, Colombia. METHODS AND FINDINGS: We conducted a cross-sectional study to identify individuals with early syphilis (ES) in Cali, Colombia through a city-wide network of public health centers, private sector HIV clinics and laboratory databases from public health institutions. Whole blood (WB), skin biopsies (SB), and genital and oral lesion swabs were obtained for measurement of treponemal burdens by polA quantitative polymerase chain reaction (qPCR) and for whole-genome sequencing (WGS). Among 1,966 individuals screened, 128 participants met enrollment criteria: 112 (87%) with secondary (SS), 15 (12%) with primary (PS) and one with early latent syphilis; 66/128 (52%) self-reported as heterosexual, while 48 (38%) were men who have sex with men (MSM). Genital ulcer swabs had the highest polA copy numbers (67 copies/µl) by qPCR with a positivity rate (PR) of 73%, while SS lesions had 42 polA copies/µl with PR of 62%. WB polA positivity was more frequent in SS than PS (42% vs 7%, respectively; p = 0.009). Isolation of TPA from WB by rabbit infectivity testing (RIT) was achieved in 5 (56%) of 9 ES WB samples tested. WGS from 33 Cali patient samples, along with 10 other genomic sequences from South America (9 from Peru, 1 from Argentina) used as comparators, confirmed that SS14 was the predominant clade, and that half of all samples had mutations associated with macrolide (i.e., azithromycin) resistance. Variability in the outer membrane protein (OMP) and vaccine candidate BamA (TP0326) was mapped onto the protein's predicted structure from AlphaFold. Despite the presence of mutations in several extracellular loops (ECLs), ECL4, an immunodominant loop and proven opsonic target, was highly conserved in this group of Colombian and South American TPA isolates. CONCLUSIONS: This study offers new insights into the sociodemographic and clinical features of venereal syphilis in a highly endemic area of Colombia and illustrates how genomic sequencing of regionally prevalent TPA strains can inform vaccine development.

Fever of unknown origin: A 12-year case series in Colombia.

BACKGROUND: Fever of unknown origin (FUO) is a diagnostic challenge with highly heterogeneous causes. Its etiology can change according to the studied regions, and the chance of reaching a diagnosis depends on available resources. The aim of this study is to describe the clinical characteristics, etiology and the usefulness of diagnostic aids in cases of FUO managed over 12 years in a Colombian reference center. METHODOLOGY: Single-institution retrospective case series. All cases of FUO between 2006 and 2017 were identified with the help of an electronic medical record search software. Cases of adults with fever for more than three weeks who remained undiagnosed after three days of hospitalization are described. RESULTS: Of 1,009 cases evaluated, 112 cases met the inclusion criteria (median age 43 years, 66% men). The etiologies identified were infectious (31.2%), inflammatory (20.5%), neoplastic (14.3%), and miscellaneous (2.7%) diseases. 31.2% remained without etiological diagnosis. The most frequent conditions were tuberculosis (17%), Hodgkin's lymphoma (7.1%), systemic lupus erythematosus (6.3%), disseminated histoplasmosis, and adult Still's disease. Contrast tomography and biopsies were the studies that most frequently supported or confirmed the final diagnosis. CONCLUSIONS: This series of contemporary Latin American cases suggests that the categories of FUO etiologies are similar to those reported in studies from developed countries, with tuberculosis being the most frequent cause in our setting. Our results highlight the importance of tomography-guided invasive studies in the diagnostic approach to FUO.

Factors related to mortality in patients with chronic obstructive pulmonary disease in Colombian population / Factores relacionados con la mortalidad en pacientes con enfermedad pulmonar obstructiva crónica en población colombiana

Introduction. Data in low- and middle-income countries on mortality and its related risk factors in patients with chronic obstructive pulmonary disease are limited. Objective. To identify the incidence of death and its relationship with variables in a Colombian population during 12 months of follow-up. Materials and methods. We carried out a retrospective study in subjects diagnosed with chronic obstructive pulmonary disease in a third-level hospital in Colombia. Odds ratios were calculated using multivariable logistic regression analysis with the outcome variable "mortality at 12 months". Results. We included 524 patients, 18.1% (95 / 524) died. The average age was 69.7 (SD = 8.92), and 59.2% (310 / 524) were women. The variables associated with mortality were age (OR = 6.54; 95% CI = 3.65-11.36; p < 0.001), years of exposure to wood smoke (OR = 4.59; 95% CI = 1.64-2.82; p = 0.002), chronic heart failure (OR = 1.81; 95% CI = 1.13-2.91; p = 0.014), cerebrovascular disease (OR = 3.35; 95% CI = 1.04-10.75; p = 0.032), and chronic kidney disease (OR = 6.96; 95% CI = 1.15-41.67; p=0.015). When adjusting the variables in the multivariate analysis, only an association was found for sex (OR = 1.55; 95% CI = 0.95-2.54; p = 0.008) and age (OR = 5.94; 95% CI = 3.3-10.69; p < 0.001). Conclusion. Age, years of exposure to wood smoke, chronic heart failure, and cerebrovascular and chronic kidney disease were the clinical variables associated with a fatal outcome. However, age and sex were the only variables related to mortality when adjusted for confounding factors.

Introducción. En los países de medianos y bajos ingresos, los datos sobre la mortalidad y los factores de riesgo en pacientes con enfermedad pulmonar obstructiva crónica son limitados. Objetivo. Identificar la incidencia de muerte y sus variables relacionadas en una población colombiana durante 12 meses de seguimiento. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de sujetos con diagnóstico de enfermedad pulmonar obstructiva crónica en una clínica de tercer nivel en Colombia. Los cocientes de probabilidades se calcularon mediante un análisis de regresión logística multivariable con la variable de resultado "mortalidad a los 12 meses". Resultados. Ingresaron 524 pacientes, de los cuales el 18,1 % (95 / 524) murió. La edad promedio fue de 69,7 (DE = 8,92) y el 59,2 % (310 / 524) eran mujeres. Las variables asociadas con la mortalidad fueron la edad (OR = 6,54; IC95%: 3,65-11,36; p < 0,001), años de exposición al humo de leña (OR = 4,59; IC95%: 1,64-12,82; p = 0,002), insuficiencia cardiaca crónica (OR = 1,81; IC95%: 1,13-2,91; p = 0,014), enfermedad cerebrovascular (OR = 3,35; IC95%: 1,04-10,75; p = 0,032) y enfermedad renal crónica (OR=6,96; IC 95%:1,15-41,67; p = 0,015). Al ajustar las variables en el análisis multivariado únicamente se mostró asociación entre el sexo (OR = 1,55; IC95%: 0,95-2,54; p = 0,008) y la edad (OR = 5,94; IC95%: 3,3-10,69; p < 0,001). Conclusión. La edad, los años de exposición al humo de leña, la insuficiencia cardiaca crónica, la enfermedad cerebrovascular y la renal crónica fueron variables clínicas asociadas a un desenlace fatal. Sin embargo, la edad y el sexo fueron las únicas relacionadas con la mortalidad al ajustarlas por factores de confusión.

Relationship of quality and duration of sleep with arterial hypertension in a Colombian population / Relación de la calidad y la duración del sueño en población colombiana con hipertensión arterial

Introduction. Alterations in the quality and duration of sleep are risk factors for the development of arterial hypertension in Eastern countries. However, in Latin America there are few studies researching this association. Objective. To analyze the association between the quality and duration of sleep and the rate of arterial hypertension in a Colombian population. Materials and methods. An observational, longitudinal, prospective and analytical study nested in the INEFAC population-based cohort, was conducted with participants over 18 years of age from Bucaramanga (Colombia). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Sleep duration was assessed using standardized questions. Multivariate analysis was performed with logistic regression models adjusted for possible confounding variables. Results. A total of 1,306 non-hypertensive participants with a mean age of 40 ± 12 years were included. In this population, 92.8% had one or more sleep issues. 45.15% slept 6 hours or less and 28.6% slept 8 hours or more. Multivariate analysis showed a higher risk of hypertension in participants with diabetes (OR = 5.27; 95% CI: 2.27-12.26), obesity (OR = 2.81; 95% CI: 1.11-7.13), active smoking (OR = 2.02; 95% CI: 1.01-4.04) and higher socioeconomic level (OR = 4.94; 95% CI: 1.59-15.38 for level 4), but no higher risk was found in participants with poor sleep quality or short sleep duration. Conclusions. No association was found between the duration or quality of sleep and the rate of arterial hypertension in the Colombian population. More studies are required in this population to reach definitive conclusions.

Introducción: Las alteraciones en la calidad y la duración del sueño son factores de riesgo para el desarrollo de hipertensión arterial sistémica en los países orientales. Sin embargo, hay pocos estudios de los países de Latinoamérica para investigar esta asociación. OBJETIVO: Analizar la asociación entre la calidad y la duración del sueño, y la incidencia de hipertensión arterial sistémica en población colombiana. Materiales y métodos. Se llevó a cabo un estudio observacional, longitudinal, prospectivo y analítico, anidado en la cohorte de base poblacional INEFAC, desarrollado con participantes mayores de 18 años de Bucaramanga (Colombia). El sueño se evaluó mediante el índice de calidad del sueño de Pittsburgh y, su duración, mediante preguntas estandarizadas. Se realizó un análisis multivariado con modelos de regresión logística ajustados por las posibles variables de confusión. RESULTADOS: Se incluyeron 1.306 participantes no hipertensos con edad media de 40 ± 12 años. El 92,8 % de la población presentaba algún problema del sueño, el 45,15 % dormía 6 horas o menos y el 28,6 % dormía 8 horas o más. El análisis multivariado mostró un mayor riesgo de hipertensión en los participantes con diabetes (OR = 5,27) (IC95 %: 2,27-12,26), obesidad (OR = 2,81) (IC95 %: 1,11-7,13), tabaquismo activo (OR = 2,02) (IC95 %: 1,01-4,04) y mayor estrato socioeconómico (OR = 4,94) (IC95 %: 1,59-15,38 para estrato 4), pero no se encontró un mayor riesgo en los participantes con mala calidad o poca duración del sueño. CONCLUSIONES: No se demostró asociación alguna entre la duración o la calidad del sueño y la incidencia de hipertensión arterial sistémica en población colombiana. Se requieren más estudios en esta población para llegar a conclusiones definitivas.

Diabetes mellitus in patients with heart failure and effect modification of risk factors for short-term mortality: An observational study from the Registro Colombiano de Falla Cardíaca (RECOLFACA). / Diabetes mellitus en pacientes con insuficiencia cardiaca y modificación del efecto de los factores de riesgo de mortalidad a corto plazo: un estudio observacional del Registro Colombiano de Falla Cardíaca (RECOLFACA)

INTRODUCTION: Heart failure and type 2 diabetes mellitus are critical public health issues. OBJECTIVE: To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. MATERIALS AND METHODS: Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. RESULTS: A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. CONCLUSIONS: Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.

Introducción. La insuficiencia cardíaca y la diabetes mellitus de tipo 2 son problemas críticos de salud pública. Objetivo. Caracterizar los factores de riesgo de mortalidad en pacientes con insuficiencia cardíaca y la diabetes mellitus de tipo 2 de un registro grande en Colombia y evaluar las posibles modificaciones del efecto de la diabetes mellitus de tipo 2 sobre otros factores de riesgo. Materiales y métodos. Se incluyeron pacientes con insuficiencia cardíaca con y sin diabetes mellitus de tipo 2, inscritos en el Registro Colombiano de Insuficiencia Cardíaca (RECOLFACA). RECOLFACA incorporó pacientes adultos con diagnóstico de insuficiencia cardíaca de 60 centros médicos de Colombia durante 2017-2019. El resultado primario fue la mortalidad por todas las causas. El análisis de supervivencia se realizó utilizando modelos ajustados de riesgos proporcionales de Cox. Resultados. Se incluyeron 2.514 pacientes, la prevalencia de diabetes mellitus de tipo 2 fue del 24,7 % (n = 620). Encontramos siete predictores independientes de mortalidad a corto plazo para la enfermedad pulmonar obstructiva crónica del grupo sin diabetes mellitus de tipo 2, el ritmo sinusal, la terapia triple, el uso de nitratos, el uso de estatinas, la anemia y la hiperpotasemia. En el grupo de diabetes mellitus de tipo 2, solo el diámetro diastólico del ventrículo izquierdo fue un predictor de mortalidad independiente (HR = 0,96; IC95 %: 0,93 - 0,98). No hubo evidencia de modificación del efecto de la diabetes mellitus de tipo 2 sobre la relación entre ningún predictor independiente y la mortalidad por todas las causas. Sin embargo, se observó una modificación significativa del efecto de la diabetes mellitus de tipo 2 entre el tabaquismo y la mortalidad. Conclusiones. Los pacientes con diabetes mellitus de tipo 2 tuvieron mayor riesgo de mortalidad. Los resultados también sugieren que el diagnóstico de diabetes mellitus de tipo 2 no modifica el efecto de los factores de riesgo independientes de mortalidad en IC evaluados. Sin embargo, la diabetes mellitus de tipo 2 modifica significativamente la relación de riesgo entre mortalidad y tabaquismo en pacientes con insuficiencia cardíaca, posiblemente debido a un efecto sinérgico negativo que resulta en lesión vascular.

IgE-Mediated Sensitization to Blo t 21 and Blo t 5 Is Associated With Asthma in the Tropics: A Case-Control Study.

BACKGROUND AND OBJECTIVE: Sensitization to Blomia tropicalis is associated with asthma in various tropical and subtropical countries; however, information about the specific molecular components associated with this disease is scarce. Using molecular diagnosis, we sought to identify B tropicalis allergens associated with asthma in Colombia. METHODS: Specific IgE (sIgE) to 8 B tropicalis recombinant allergens (Blo t 2, 5, 7, 8, 10, 12, 13, and 21) was determined using an in-house ELISA system in asthma patients (n=272) and controls (n=298) recruited in a national prevalence study performed in several Colombian cities (Barranquilla, Bogotá, Medellín, Cali, and San Andrés). The study sample included children and adults (mean [SD] age, 28 [17] years). Cross-reactivity between Blo t 5 and Blo t 21 was evaluated using ELISA-inhibition. RESULTS: Specific IgE (sIgE) to 8 B tropicalis recombinant allergens (Blo t 2, 5, 7, 8, 10, 12, 13, and 21) was determined using an in-house ELISA system in asthma patients (n=272) and controls (n=298) recruited in a national prevalence study performed in several Colombian cities (Barranquilla, Bogotá, Medellín, Cali, and San Andrés). The study sample included children and adults (mean [SD] age, 28 [17] years). Cross-reactivity between Blo t 5 and Blo t 21 was evaluated using ELISA-inhibition. CONCLUSION: Although Blo t 5 and Blo t 21 are considered common sensitizers, this is the first report of their association with asthma. Both components should be included in molecular panels for diagnosis of allergy in the tropics.