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1.
Adv Mater ; 33(43): e2102301, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34514669

ABSTRACT

Exploring the vast compositional space offered by multicomponent systems or high entropy materials using the traditional route of materials discovery, one experiment at a time, is prohibitive in terms of cost and required time. Consequently, the development of high-throughput experimental methods, aided by machine learning and theoretical predictions will facilitate the search for multicomponent materials in their compositional variety. In this study, high entropy oxides are fabricated and characterized using automated high-throughput techniques. For intuitive visualization, a graphical phase-property diagram correlating the crystal structure, the chemical composition, and the band gap are introduced. Interpretable machine learning models are trained for automated data analysis and to speed up data comprehension. The establishment of materials libraries of multicomponent systems correlated with their properties (as in the present work), together with machine learning-based data analysis and theoretical approaches are opening pathways toward virtual development of novel materials for both functional and structural applications.

2.
Rev. colomb. cardiol ; 28(4): 389-396, jul.-ago. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1351938

ABSTRACT

Resumen Introducción: La enfermedad cerebrovascular es causa frecuente de morbimortalidad y, en ese sentido, el consumo de café tiene un impacto cardiovascular, por lo cual es importante evaluar la evidencia respecto a la asociación entre su consumo y la enfermedad cerebrovascular. Objetivo: Evaluar la asociación entre consumo de café y riesgo de morbimortalidad por enfermedad cerebrovascular. Método: Se realizó una búsqueda en las bases Medline, EMBASE, LILACS y Cochrane (enero de 1966 a junio de 2018) y se seleccionaron revisiones sistemáticas y metaanálisis evaluados de forma estandarizada y pareada. Se seleccionaron seis publicaciones. Resultados: Se encontró que el consumo de café en rango moderado (hasta cuatro tazas) se asocia a una reducción del riesgo de enfermedad cerebrovascular (riesgo relativo [RR] = 0.89, intervalo de confianza del 95% [IC95%]: 0.81-0.97, y RR: 0.83, IC95%: 0.75-0.91). Esta protección se mantiene en el subgrupo de mujeres, con reducciones del 13% (IC95%: 0.78-0.97) para una taza, del 16% (IC95%: 0.74-0.95) para dos tazas y 19% (RR: 0.81; IC95%: 0.70-0.93) (IC95%: 0.70-0.93) para cuatro o más tazas. Los hallazgos también son significativos para el subtipo isquémico (RR = 0.80; IC95%: 0.71-0.90). Conclusiones: El consumo de café reduce el riesgo de eventos cerebrovasculares entre un 11% y un 17%, y esto se mantiene en el subgrupo de mujeres y en el subtipo isquémico.


Abstract Introduction: Cerebrovascular disease is a frequent cause of morbidity and mortality and, in this sense, coffee consumption has a cardiovascular impact, which is why it is important to evaluate the evidence regarding the association between its consumption and cerebrovascular disease. Objective: To evaluate the association between coffee consumption and risk of morbidity and mortality due to cerebrovascular disease. Method: A search was carried out in the Medline, EMBASE, LILACS and Cochrane databases (January 1966 to June 2018), selecting systematic reviews and meta-analyzes evaluated in a standardized and paired way. Six publications were selected. Results: it was found that the consumption of coffee in a moderate range (up to 4 cups) is associated with a reduction in the risk of cerebrovascular disease (relative risk [RR] = 0.89, 95% confidence interval [95% CI]: 0.81- 0.97, and RR = 0.83, 95% CI: 0.75-0.91). This protection is maintained in the subgroup of women, with reductions of 13% (95% CI: 0.78-0.97) for a cup, 16% (95% CI: 0.74-0.95) for two cups, and RR = 0.81 (95% CI: 0.70-0.93) for four or more cups. The findings are also significant for the ischemic subtype (RR = 0.80; 95% CI: 0.71-0.90). Conclusions: Coffee consumption reduces the risk of cerebrovascular events between 11% and 17%, and this is maintained in the subgroup of women and in the ischemic subtype.


Subject(s)
Humans , Female , Coffee , Stroke , Risk , Morbidity , Mortality
3.
Rev. salud pública ; 19(2): 250-258, mar.-abr. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-903101

ABSTRACT

RESUMEN Objetivo Desarrollar y validar un índice compuesto de inequidad en salud basado en mortalidad por grupos de causas. Métodos Estudio ecológico en país de mediano ingreso latinoamericano, con indicadores agregados disponibles de municipios y departamentos, que se seleccionaron a partir de observatorios de salud, grupos de investigación y autoridades sanitarias. Se dividen en intolerables y "no completamente evitables" según el avance científico actual, y se agregan en categorías: accidente de tránsito, agresiones, enfermedad renal, infección por VIH, parasitosis intestinal, sífilis, enfermedad de transmisión fecal/oral, tuberculosis, enfermedad transmitidas por vectores, enfermedad respiratoria, eventos hemorrágicos/ isquémicos cerebrales, mortalidad materna, mortalidad menores 5 años, meningitis. Luego de análisis de componentes principales se obtiene índice compuesto multidimensional de inequidad en salud (IIS) para hombres y mujeres. Consistencia interna se evalúa mediante coeficiente Alpha de Cronbach. Se hace validación concurrente con proporción de personas en Necesidades Básicas Insatisfechas (NBI), Índice de Desarrollo Humano (IDH), Expectativa de Vida al Nacer (EVN) entre otros. Resultados Se construye IIS que muestra valores más altos para las mujeres en la mayoría de municipios y departamentos; y para lugares con IDH alto, EVN alta y NBI bajas. El alpha de Cronbach fue 0.6688, IIS-hombres y 0.725, IIS-mujeres. Conclusiones Se obtiene IIS factible, reproducible y mutidimensional. Se destaca el papel de las grandes ciudades en las inequidades en salud, probablemente por el efecto de los intolerables en salud.(AU)


ABSTRACT Objective To develop and validate a composite index of health inequity based on mortality by grouped causes. Methods An ecological study in a middle-income Latin American country, with aggregate indicators available from municipalities and departments, which were selected from health observatories, research groups and health authorities. They were divided into intolerable and "not completely avoidable" according to current scientific progress, and were added in categories: traffic accident, aggression, kidney disease, HIV infection, intestinal parasitic diseases, syphilis, fecal / oral transmission disease, tuberculosis, disease Vector-borne diseases, respiratory disease, cerebral hemorrhagic / ischemic events, maternal mortality, lower mortality 5 years, meningitis. After analysis of main components, a composite index of health inequity (IIS) is obtained for men and women. Internal consistency was evaluated using Cronbach's Alpha coefficient. Concurrent validation was done with proportion of people in Unsatisfied Basic Needs (UBN), Human Development Index (HDI), Life Expectancy at Birth (LEB), among others. Results IIS is built showing higher values for women in most municipalities and departments; And for sites with high HDI, high LEB and low UBN. Cronbach's alpha was 0.6688, IIS-men and 0.725, IIS-women. Conclusions An IIS was obtained, is valid and reproducible. The role of big cities in inequities in health is highlighted, probably due to the effect of intolerable health.(AU)


Subject(s)
Humans , Socioeconomic Factors , Health Equity/organization & administration , Community Health Status Indicators , Colombia , Ecological Studies
4.
Rev Salud Publica (Bogota) ; 19(2): 250-258, 2017.
Article in Spanish | MEDLINE | ID: mdl-30183969

ABSTRACT

OBJECTIVE: To develop and validate a composite index of health inequity based on mortality by grouped causes. METHODS: An ecological study in a middle-income Latin American country, with aggregate indicators available from municipalities and departments, which were selected from health observatories, research groups and health authorities. They were divided into intolerable and "not completely avoidable" according to current scientific progress, and were added in categories: traffic accident, aggression, kidney disease, HIV infection, intestinal parasitic diseases, syphilis, fecal / oral transmission disease, tuberculosis, disease Vector-borne diseases, respiratory disease, cerebral hemorrhagic / ischemic events, maternal mortality, lower mortality 5 years, meningitis. After analysis of main components, a composite index of health inequity (IIS) is obtained for men and women. Internal consistency was evaluated using Cronbach's Alpha coefficient. Concurrent validation was done with proportion of people in Unsatisfied Basic Needs (UBN), Human Development Index (HDI), Life Expectancy at Birth (LEB), among others. RESULTS: IIS is built showing higher values for women in most municipalities and departments; And for sites with high HDI, high LEB and low UBN. Cronbach's alpha was 0.6688, IIS-men and 0.725, IIS-women. CONCLUSIONS: An IIS was obtained, is valid and reproducible. The role of big cities in inequities in health is highlighted, probably due to the effect of intolerable health.


OBJETIVO: Desarrollar y validar un índice compuesto de inequidad en salud basado en mortalidad por grupos de causas. MÉTODOS: Estudio ecológico en país de mediano ingreso latinoamericano, con indicadores agregados disponibles de municipios y departamentos, que se seleccionaron a partir de observatorios de salud, grupos de investigación y autoridades sanitarias. Se dividen en intolerables y "no completamente evitables" según el avance científico actual, y se agregan en categorías: accidente de tránsito, agresiones, enfermedad renal, infección por VIH, parasitosis intestinal, sífilis, enfermedad de transmisión fecal/oral, tuberculosis, enfermedad transmitidas por vectores, enfermedad respiratoria, eventos hemorrágicos/ isquémicos cerebrales, mortalidad materna, mortalidad menores 5 años, meningitis. Luego de análisis de componentes principales se obtiene índice compuesto multidimensional de inequidad en salud (IIS) para hombres y mujeres. Consistencia interna se evalúa mediante coeficiente Alpha de Cronbach. Se hace validación concurrente con proporción de personas en Necesidades Básicas Insatisfechas (NBI), Índice de Desarrollo Humano (IDH), Expectativa de Vida al Nacer (EVN) entre otros. RESULTADOS: Se construye IIS que muestra valores más altos para las mujeres en la mayoría de municipios y departamentos; y para lugares con IDH alto, EVN alta y NBI bajas. El alpha de Cronbach fue 0.6688, IIS-hombres y 0.725, IIS-mujeres. CONCLUSIONES: Se obtiene IIS factible, reproducible y mutidimensional. Se destaca el papel de las grandes ciudades en las inequidades en salud, probablemente por el efecto de los intolerables en salud.

5.
J Exp Clin Cancer Res ; 35: 64, 2016 Apr 05.
Article in English | MEDLINE | ID: mdl-27044543

ABSTRACT

BACKGROUND: B-Acute lymphoblastic leukemia (B-ALL) represents a hematologic malignancy with poor clinical outcome and low survival rates in adult patients. Remission rates in Hispanic population are almost 30% lower and Overall Survival (OS) nearly two years inferior than those reported in other ethnic groups. Only 61% of Colombian adult patients with ALL achieve complete remission (CR), median overall survival is 11.3 months and event-free survival (EFS) is 7.34 months. Identification of prognostic factors is crucial for the application of proper treatment strategies and subsequently for successful outcome. Our goal was to identify a gene expression signature that might correlate with response to therapy and evaluate the utility of these as prognostic tool in hispanic patients. METHODS: We included 43 adult patients newly diagnosed with B-ALL. We used microarray analysis in order to identify genes that distinguish poor from good response to treatment using differential gene expression analysis. The expression profile was validated by real-time PCR (RT-PCT). RESULTS: We identified 442 differentially expressed genes between responders and non-responders to induction treatment. Hierarchical analysis according to the expression of a 7-gene signature revealed 2 subsets of patients that differed in their clinical characteristics and outcome. CONCLUSIONS: Our study suggests that response to induction treatment and clinical outcome of Hispanic patients can be predicted from the onset of the disease and that gene expression profiles can be used to stratify patient risk adequately and accurately. The present study represents the first that shows the gene expression profiling of B-ALL Colombian adults and its relevance for stratification in the early course of disease.


Subject(s)
Hispanic or Latino/genetics , Immunoglobulin J-Chains/genetics , Inhibitor of Differentiation Protein 1/genetics , Inhibitor of Differentiation Proteins/genetics , Neoplasm Proteins/genetics , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/ethnology , Up-Regulation , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , Gene Expression Profiling/methods , Gene Expression Regulation, Neoplastic , Humans , Male , Middle Aged , Oligonucleotide Array Sequence Analysis/methods , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Remission Induction , Survival Analysis , Treatment Outcome , Young Adult
6.
Biomedica ; 34(3): 345-53, 2014.
Article in Spanish | MEDLINE | ID: mdl-25504122

ABSTRACT

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.


Subject(s)
Bacteremia/economics , Critical Care/economics , Cross Infection/economics , Hospitals, Private/economics , Hospitals, Public/economics , Hospitals, Urban/economics , Intensive Care Units/economics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/economics , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/epidemiology , Bacteremia/microbiology , Clinical Laboratory Techniques/economics , Colombia , Costs and Cost Analysis , Critical Illness , Cross Infection/drug therapy , Cross Infection/epidemiology , Cross Infection/microbiology , Drug Costs , Female , Fluid Therapy/economics , Health Expenditures , Hospital Costs , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Middle Aged , Respiratory Therapy/economics , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology
7.
Biomédica (Bogotá) ; 34(3): 345-353, July-Sept. 2014. tab
Article in Spanish | LILACS | ID: lil-726784

ABSTRACT

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.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bacteremia/economics , Critical Care/economics , Cross Infection/economics , Hospitals, Private/economics , Hospitals, Public/economics , Hospitals, Urban/economics , Intensive Care Units/economics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/economics , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/epidemiology , Bacteremia/microbiology , Colombia , Costs and Cost Analysis , Critical Illness , Clinical Laboratory Techniques/economics , Cross Infection/drug therapy , Cross Infection/epidemiology , Cross Infection/microbiology , Drug Costs , Fluid Therapy/economics , Health Expenditures , Hospital Costs , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Intensive Care Units/statistics & numerical data , Length of Stay/economics , Length of Stay/statistics & numerical data , Respiratory Therapy/economics , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology
8.
Rev. colomb. cancerol ; 17(4): 142-148, oct.-dic. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-726877

ABSTRACT

Objetivo: Describir la experiencia de 14 años del Instituto Nacional de Cancerología de Colombia en el tratamiento de los estados avanzados de cáncer epitelial de ovario. Métodos: Estudio observacional retrospectivo tipo serie de casos que incluyó pacientes con cáncer epitelial de ovario en estados III y IV, las cuales fueron llevadas a tratamiento primario en el Instituto Nacional de Cancerología entre el 1 de enero de 1997 y el 31 de diciembre de 2011. Resultados: Se identificación 119 pacientes para el período de interés. Con una mediana de edad de 56 años, la mayoría de pacientes presentó compromiso en el estado funcional (63,9%) e hipoalbuminemia (82,4%). El tipo histológico más frecuente fue el adenocarcinoma seroso (62,2%), y el grado histológico mal diferenciado ocurrió en el 63,3% de los casos. Un 94,1% de los pacientes presentó compromiso de superficies peritoneales, con afectación de abdomen superior en un 38,7% y enfermedad extraabdominal un 29,4%. Se tuvo como intención de tratamiento la cirugía primaria más quimioterapia adyuvante en el 89,1% de las pacientes, logrando una citorreducción óptima en el 25,2% de los casos. El 29% presentó progresión durante el tratamiento y en un 57% se registró recaída. La mediana de supervivencia libre de enfermedad fue de 16,61 meses, y la de supervivencia global, de 28,93 meses. Conclusiones: Las pacientes con cáncer epitelial de ovario avanzado de nuestro medio se presentan con alta carga tumoral y con un comportamiento agresivo de la enfermedad reflejado en un pobre resultado oncológico.


Objective: To describe fourteen years of experience of in the treatment of advanced stages of epithelial ovarian cancer in the National Cancer Institute of Colombia. Methods: A retrospective observational case series including patients with epithelial ovarian cancer in stages III and IV, who received primary treatment in National Cancer Institute of Colombia between January 1st, 1997 and December 31th, 2011. Results: A total of 119 patients were identified durin the study period. With a median age of 56 years, most patients showed functional status compromise (63.9%) and hypolbuminemia (82.4%). The most common histological type was serous adenocarcinoma (62.2%) and there was poorly differentiated histological grade in 63.3% of cases. Almost all (94.1%) patients had peritoneal surfaces compromise with involvement of the upper abdomen in 38.7% and extra-abdominal disease in 29.4%. Treatment with primary surgery plus adjuvant chemotherapy was performed on 89.1%, achieving optimal cytoreduction in 25.2%; 29% of cases showed progression during treatment, and 57% of them relapsed. The median disease-free survival was 16.61 months, and the overall survival was 28.93 months. Conclusions: In our setting, patients with advanced epithelial ovarian cancer have a high tumor burden and aggressive behavior of the disease, reflected in a poor oncological outcome.


Subject(s)
Humans , Female , Middle Aged , Ovary , Therapeutics , Chemotherapy, Adjuvant , Carcinoma, Ovarian Epithelial , Survival , Behavior , Adenocarcinoma , Primary Treatment , Records , Hypoalbuminemia , Neoplasms
9.
Rev. panam. salud pública ; 32(5): 343-350, Nov. 2012. tab
Article in English | LILACS | ID: lil-659983

ABSTRACT

Objetivo. Evaluar los factores de riesgo asociados con la aparición de bacteriemia por Staphylococcus aureus resistente a la meticilina (MRSA), su pronóstico y los factores determinantes de la mortalidad en pacientes gravemente enfermos en Colombia. Métodos. Estudio retrospectivo multicéntrico de cohortes realizado en el período del 2005 al 2008 en 16 instituciones de atención de salud de referencia públicas y privadas de Bogotá, Colombia, que forman parte de una red nacional de vigilancia epidemiológica y de una red hospitalaria de 4 469 camas. Se analizaron la aparición de resistencia a la meticilina y la mortalidad mediante análisis descriptivos y de tiempo transcurrido hasta un suceso; se estableció un modelo multifactorial de regresión de riesgos proporcionales de Cox para evaluar la asociación entre la resistencia a la meticilina y la mortalidad. Resultados. Se estudiaron 372 pacientes: 186 con bacteriemia por MRSA, apareados aleatoriamente con 186 con bacteriemia por Staphylococcus aureus sensible a la meticilina (MSSA). La cirugía previa, el tratamiento con antibióticos y las infecciones intrahospitalarias se asociaron independientemente con la resistencia a la meticilina. El MRSA provocó hospitalizaciones más prolongadas en los sobrevivientes (mediana de 24 frente a 18 días, P = 0,014). Los factores predictivos de mortalidad fueron: la edad del paciente, un nivel de creatinina superior a 1,21 mg/dl al ingresar en la UCI, la septicemia grave y el requerimiento de inotrópicos. El tratamiento antimicrobiano apropiado y el cambio de tratamiento antimicrobiano constituyeron factores protectores independientes, igual que el sexo masculino. Conclusiones. La resistencia a la meticilina per se no fue un factor pronóstico independiente de la mortalidad. Las condiciones previas, como la edad, la insuficiencia renal inicial, la septicemia grave y el requerimiento de inotrópicos explicaron la mortalidad observada. El tratamiento antimicrobiano apropiado seguía siendo un factor protector. Es obligatorio hacer un llamamiento para mejorar las medidas de control de las infecciones en Colombia y en otros contextos similares.


Objective. To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. Methods. A multicenter, retrospective cohort study conducted in 2005–2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillinresistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. Results. A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. Conclusions. Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Bacteremia/microbiology , Bacteremia/mortality , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/mortality , Cohort Studies , Colombia/epidemiology , Critical Illness , Retrospective Studies
10.
Rev Panam Salud Publica ; 32(5): 343-50, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23338691

ABSTRACT

OBJECTIVE: To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. METHODS: A multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. RESULTS: A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21 mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. CONCLUSIONS: Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.


Subject(s)
Bacteremia/microbiology , Bacteremia/mortality , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/mortality , Adolescent , Adult , Aged , Cohort Studies , Colombia/epidemiology , Critical Illness , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
12.
Health Res Policy Syst ; 8: 7, 2010 Mar 06.
Article in English | MEDLINE | ID: mdl-20205926

ABSTRACT

OBJECTIVE: Few methodological studies address the prioritization of clinical topics for the development of Clinical Practice Guidelines (CPGs). The aim of this study was to validate a methodology for Priority Determination of Topics (PDT) of CPGs. METHODS AND RESULTS: Firstly, we developed an instrument for PDT with 41 criteria that were grouped under 10 domains, based on a comprehensive systematic search. Secondly, we performed a survey of stakeholders involved in CPGs development, and end users of guidelines, using the instrument. Thirdly, a pilot testing of the PDT procedure was performed in order to choose 10 guideline topics among 34 proposed projects; using a multi-criteria analysis approach, we validated a mechanism that followed five stages: determination of the composition of groups, item/domain scoring, weights determination, quality of the information used to support judgments, and finally, topic selection. Participants first scored the importance of each domain, after which four different weighting procedures were calculated (including the survey results). The process of weighting was determined by correlating the data between them. We also reported the quality of evidence used for PDT. Finally, we provided a qualitative analysis of the process. The main domains used to support judgement, having higher quality scores and weightings, were feasibility, disease burden, implementation and information needs. Other important domains such as user preferences, adverse events, potential for health promotion, social effects, and economic impact had lower relevance for clinicians. Criteria for prioritization were mainly judged through professional experience, while good quality information was only used in 15% of cases. CONCLUSION: The main advantages of the proposed methodology are supported by the use of a systematic approach to identify, score and weight guideline topics selection, limiting or exposing the influence of personal biases. However, the methodology was complex and included a number of quantitative and qualitative approaches reflecting the difficulties of the prioritization process.

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