Chronic disease prevalence in a population with structural hemoglobin disorders undergoing diabetes diagnosis: A bayesian approach.

Background: Structural disorders of hemoglobin are a group of rare and fatal genetic diseases that disrupt the transport and exchange of oxygen in the blood, causing tissue damage and ultimately leading to chronic conditions. The hemoglobin (Hb) S variant predominantly impacts individuals of Afro-descendant heritage. A significant concentration of the Afro-descendant population in Colombia, notably 12.5 %, is found in the city of Cali. Previous research has identified this city's structural hemoglobin disorders prevalence rate of 3.78 %. The aim of this study was to determine the prevalence of HbC, HbS, HbF, and HbA2 variants within a population who underwent HbA1c testing, as well as the prevalence of chronic diseases among patients with these hemoglobin alterations, at a high-complexity hospital in the city of Cali from 2015 to 2019. Methods: A descriptive observational study was conducted, involving a study population that comprised patients with both suspected and monitored diagnoses of diabetes. The cohort was selected from a high-complexity hospital in Cali. A total of 15,608 patients were included in the analysis, all of whom underwent HbA1C measurement through capillary electrophoresis, which also offers an indirect diagnosis of certain structural disorders of hemoglobin. Bayesian methods were employed for frequency analysis. Results: Among the 15,608 patients assessed, 63.6 % (n = 9920) were women. The overall prevalence of structural hemoglobin disorders was 1.98 % (n = 287, 95 % CI = 1.77 %-2.21 %). The co-occurrence of diabetes and kidney disease emerged as the most prevalent combination of pathologies observed in individuals with HbC, for both men and women across various age groups: 18-42 (58.3 % and 50.0 % respectively), 43-55 (50.0 % for both), 56-65 (50.0 % and 37.5 % respectively), and >65 years (66.7 % and 57.1 % respectively). Conclusions: The observed prevalence of the studied variants exceeded 1 %, a threshold underscored by the World Health Organization (WHO) as epidemiologically significant. Among HbC and HbS-positive patients, the elevated prevalence of diabetes and kidney disease is a guiding factor in developing proactive prevention strategies.

Molecular characterization of mucopolysaccharidosis type IVA patients in the Andean region of Colombia.

Colombia has a high prevalence of mucopolysaccharidosis (MPS) type IVA. Nevertheless, data regarding the mutation spectrum for MPS IVA in this population have not been completely characterized. Forty-seven families and 53 patients from seven different Colombian regions were tested for MPS IVA mutations. We compared the sequences with the N-acetylgalactosamine-6-sulfatase (GALNS) reference sequence NM_000512.4, and gene variants were reported. Bioinformatics analysis was performed using SWISS-MODEL. The mutant proteins were generated by homology from the wild-type GALNS 4FDJ template obtained from the PDB database, and visualization was performed using Swiss-PDBViewer and UCSF Chimera. The predictive analysis was run using different bioinformatic tools, and the deleterious annotation of genetic variants was performed using a neural network. We found that 79% and 21% of the cohort was homozygous and compound heterozygous, respectively. The most frequent mutation observed was p.Gly301Cys (78.3% of alleles), followed by p.Arg386Cys (10.4% of alleles). A novel mutation (p.Phe72Ile) was described and classified in silico as a pathogenic variant. This study reveals the mutation spectrum of MPS IVA in Colombia. The high prevalence of the p.Gly301Cys mutation suggests a founder effect of this variant in the Colombian population that causes diseases in the Andean region (via migration). These data can facilitate genetic counseling, prenatal diagnosis, and the design of therapeutic interventions.

Predicciones de un modelo SEIR para casos de COVID-19 en Cali, Colombia / Predictions of a SEIR model for COVID-19 cases in Cali-Colombia

RESUMEN Objetivo Predecir el número de casos de COVID-19 en la ciudad de Cali-Colombia mediante el desarrollo de un modelo SEIR. Métodos Se utilizó un modelo determinista compartimental SEIR considerando los estados: susceptibles (S), expuestos (E), infectados (I) y recuperados (R). Los parámetros del modelo fueron seleccionados de acuerdo a la revisión de literatura. En el caso de la tasa de letalidad, se usaron los datos de la Secretaría de Salud Municipal de Cali. Se plantearon varios escenarios teniendo en cuenta variaciones en el número básico de reproducción (R0) y en la tasa de letalidad; además, se comparó la predicción hasta el 9 de abril con los datos observados. Resultados A través del modelo SEIR se encontró que, con el número básico de reproducción más alto (2,6) y utilizando la letalidad calculada para la ciudad de 2,0%, el número máximo de casos se alcanzaría el primero de junio con 195 666 (prevalencia); sin embargo, al comparar los casos observados con los esperados, al inicio la ocurrencia observada estaba por encima de la proyectada; pero luego cambia la tendencia con una disminución marcada de la pendiente. Conclusiones Los modelos epidemiológicos SEIR son métodos muy utilizados para la proyección de casos en enfermedades infecciosas; sin embargo, se debe tener en cuenta que son modelos deterministas que pueden utilizar parámetros supuestos y podrían generar resultados imprecisos.(AU)

ABSTRACT Objective To predict the number of cases of COVID-19 in the city of Cali-Colombia through the development of a SEIR model. Methods A SEIR compartmental deterministic model was used considering the states: susceptible (S), exposed (E), infected (I) and recovered (R). The model parameters were selected according to the literature review, in the case of the case fatality rate data from the Municipal Secretary of Health were used. Several scenarios were considered taking into account variations in the basic number of reproduction (R0), and the prediction until april 9 was compared with the observed data. Results Through the SEIR model it was found that with the highest basic number of reproduction [2,6] and using the case fatality rate for the city of 2,0%, the maximum number of cases would be reached on June 1 with 195 666 (prevalence). However, when comparing the observed with the expected cases, at the beginning the observed occurrence was above the projected, but then the trend changes decreasing the slope. Conclusions SEIR epidemiological models are widely used methods for projecting cases in infectious diseases, however it must be taken into account that they are deterministic models that can use assumed parameters and could generate imprecise results.(AU)

Análisis espacio-temporal del SARS-COV-2 en Cali, Colombia / SARS-coV-2 spatio - temporal analysis in Cali, Colombia

RESUMEN Objetivo Describir la distribución espacio-temporal del COVID-19 en la ciudad de Cali durante el primer mes de epidemia. Métodos Se realizó un análisis exploratorio de datos espaciales, compuesto por un análisis de densidad de Kernel y se verificó la presencia de patrones espaciales por medio de la función K de Ripley. Resultados La distribución espacial de los casos tiende a concentrarse inicialmente en el norte y sur de la ciudad, con una dinámica cambiante hacia el oriente y occidente. Conclusiones El patrón espacial identificado puede estar influenciado por las medidas de aislamiento tomadas a nivel local y nivel nacional, además no se puede descartar el efecto del poco acceso que tiene la población general a las pruebas diagnósticas, los retrasos y represamientos para conocer los resultados de las mismas y aun los posibles sesgos por dificultades en la técnica de toma de la muestra o su conservación.(AU)

ABSTRACT Objective To describe the spatio-temporal distribution of the COVID-19 in the city of Cali during the first month of the epidemic. Methods An exploratory analysis of spatial data was carried out, consisting of a kernel density analysis and the presence of spatial patterns was verified by the K-Ripley function. Results The spatial distribution of the cases tends to initially concentrate in the north and south of the city, with a changing dynamic towards the east and west. Conclusions The identified spatial pattern may be influenced by the isolation measures taken at the local and national level, but the effect of the low access of the general population to diagnostic tests, delays and restraints to know the results cannot be ruled out and even possible biases due to difficulties in the technique of taking the sample or its conservation.(AU)

Objetivo: Descrever a distribuição espaço-temporal do COVID-19 na cidade de Cali durante o primeiro mês da epidemia. Métodos: Foi realizada uma análise exploratória de dados espaciais, consistindo em uma análise de densidade de kernel e a presença de padrões espaciais foi verificada pela função K-Ripley. Resultados: A distribuição espacial dos casos tende a se concentrar inicialmente no norte e no sul da cidade, com uma dinâmica mutante para o leste e oeste. Conclusões: O padrão espacial identificado pode ser influenciado pelas medidas de isolamento tomadas a nível local e nacional, mas não se pode descartar o efeito do baixo acesso da população em geral aos exames diagnósticos, atrasos e limitações para conhecer os resultados e mesmo possíveis vieses devido às dificuldades na técnica de coleta da amostra ou na sua conservação.(AU)

[Predictions of a SEIR model for COVID-19 cases in Cali-Colombia]. / Predicciones de un modelo SEIR para casos de COVID-19 en Cali, Colombia.

OBJECTIVE: To predict the number of cases of COVID-19 in the city of Cali-Colombia through the development of a SEIR model. METHODS: A SEIR compartmental deterministic model was used considering the states: susceptible (S), exposed (E), infected (I) and recovered (R). The model parameters were selected according to the literature review, in the case of the case fatality rate data from the Municipal Secretary of Health were used. Several scenarios were considered taking into account variations in the basic number of reproduction (R0), and the prediction until april 9 was compared with the observed data. RESULTS: Through the SEIR model it was found that with the highest basic number of reproduction [2,6] and using the case fatality rate for the city of 2,0%, the maximum number of cases would be reached on June 1 with 195 666 (prevalence). However, when comparing the observed with the expected cases, at the beginning the observed occurrence was above the projected, but then the trend changes decreasing the slope. CONCLUSIONS: SEIR epidemiological models are widely used methods for projecting cases in infectious diseases, however it must be taken into account that they are deterministic models that can use assumed parameters and could generate imprecise results.

[SARS-coV-2 spatio - temporal analysis in Cali, Colombia]. / Análisis espacio-temporal del SARS-COV-2 en Cali, Colombia.

OBJECTIVE: To describe the spatio-temporal distribution of the COVID-19 in the city of Cali during the first month of the epidemic. METHODS: An exploratory analysis of spatial data was carried out, consisting of a kernel density analysis and the presence of spatial patterns was verified by the K-Ripley function. RESULTS: The spatial distribution of the cases tends to initially concentrate in the north and south of the city, with a changing dynamic towards the east and west. CONCLUSIONS: The identified spatial pattern may be influenced by the isolation measures taken at the local and national level, but the effect of the low access of the general population to diagnostic tests, delays and restraints to know the results cannot be ruled out and even possible biases due to difficulties in the technique of taking the sample or its conservation.

Análisis de la distribución espacial y temporal de los virus del Dengue (2006-2017), Zika (2015-2017) y Chikungunya (2014-2017) en Colombia / Analysis of the spatial and temporal distribution of the Dengue virus (2006- 2017), Zika (2015-2017) and Chikungunya (2014-2017) in Colombia

Objetivo: describir la distribución espacial y temporal de los virus del dengue, zika y Chikungunya en Colombia e identificar si existe agregación espacial, temporal y espacio-temporal. Métodos: se desarrolló un estudio descriptivo de la distribución espacial y temporal de los virus del Dengue (2006-2017), Zika (2015-2017) y Chikungunya (2014-2017) en Colombia, utilizando los principios de la estadística espacial, específicamente en el análisis exploratorio de datos espaciales. Resultados: se identificaron zonas de Colombia donde se presenta una mayor densidad y prevalencia de casos. A partir de los 1124 municipios analizados para cada evento (casos de Dengue, Zika y Chikungunya), se comprobó con significancia estadística (p<0.05) la existencia de dos conglomerados espacio-temporales, en la zona sur-occidental de la región andina y en la región de la Orinoquia. Conclusiones: Se demostró la existencia de dos conglomerados para los eventos Dengue, Zika y Chikungunya que podría establecerse como zonas de mayor riesgo de co-infección.

Objective: to describe the spatial and temporal distribution of dengue, zika and Chikungunya viruses in Colombia and to identify clusters at spatial, temporal and space-temporal levels. Methods: A descriptive study was developed about the space and time distribution of the Dengue virus (2006-2017), Zika (2015-2017) and Chikungunya (2014-2017) in Colombia, using principles of spatial statistics, namely the spatial data exploratory analysis. Results: Areas of Colombia were identified where there is a higher density and prevalence of cases and were analyzed 1124 municipalities for each event (cases of Dengue, Zika and Chikungunya). Significant clusters (P<0.05) were proven in spatial, temporal and space-temporal analysis, in the south-western zone of the Andean region and in the Orinoquia region. Conclusions: Two conglomerates were confirmed for the Dengue, Zika and Chikungunya events, that could be established as areas of higher risk of co-infection.

Tendencia espacial y temporal de eventos climáticos extremos en el valle geográfico del río cauca / Spatial and temporal trends of extreme climate events in geographical valley of cauca river

Los eventos climáticos extremos pueden incrementar la ocurrencia del dengue y de enfermedades diarreicas agudas, en áreas altamente sensibles, con poco nivel de adaptación a condiciones cambiantes, bajo el escenario del cambio climático. El objetivo de este estudio fue describir la tendencia espacial y temporal de los eventos extremos de temperatura y de precipitación en el valle geográfico del río Cauca. Se controló la calidad y la homogenización de los datos climáticos. Se desarrolló un análisis robusto no paramétrico de tendencia de eventos climáticos extremos para precipitación y temperatura. Se analizaron 24 estaciones climatológicas en el Valle geográfico del río Cauca. El análisis regional para precipitación y temperatura mostró una tendencia al incremento de los índices de eventos extremos y el análisis local identificó una distribución no homogénea, en el área de estudio. Los resultados se discutieron en virtud de los posibles impactos en salud, específicamente, para dengue y enfermedad diarreica aguda. El aumento de los días lluviosos y de la cantidad de precipitación podrían generar un aumento en la densidad vectorial y la longevidad larval de Aedes aegypti, además causar el desbordamiento de ríos y canales, con combinación de aguas servidas y resuspensión de sólidos, produciendo el aumento de microorganismos patógenos en el agua de consumo. Adicionalmente, la tendencia al incremento de la temperatura podría acortar el ciclo de vida del Aedes y la replicación interna del virus con mayor probabilidad de transmisión del dengue, al mismo tiempo, que aumentaría la sobrevida de bacterias y de protozoos en aguas negras, superficiales y suelo, aumentando la ocurrencia de las EDA.

Extreme climate events can impact the occurrence of dengue and diarrheal diseases. The objective of this paper was to describe the spatial and temporal trend of extreme temperature and precipitation events in the geographical Valley of Cauca River. Quality and homogenization of climate data was monitored. Robust nonparametric trend analysis of extreme weather events for precipitation and temperature was developed. 24 weather stations were analyzed in the geographical Valle del Cauca River. The regional trend analysis showed a trend of increasing rates of extreme events for precipitation and temperature. Meanwhile, local analysis identified that this trend is not homogeneous in the study area. The rise in volume of precipitation and in the number of rainy days can increase Aedes aegypti, density and larval longevity and also cause overflowing of rivers and canals, with combination of sewage and resuspension of solids and pathogenic microorganisms in water. In addition, the rise in temperature shortens Aedes life cycle and viral replication in mosquitoes with higher probability of dengue transmission and meanwhile increases the survival of bacteria and protozoa in surface sewage and soil causing more occurrence of EDA.

[Spatial distribution of potential and positive Aedes aegypti breeding sites].

INTRODUCTION: The spatial distribution of Aedes aegypti is heterogeneous, and the interaction between positive and potential breeding sites located both inside and outside homes is one of the most difficult aspects to characterize in vector control programs. OBJECTIVE: To describe the spatial relationship between potential and positive breeding sites of A. aegypti inside and outside homes in Cali, Colombia. MATERIALS AND METHODS: We conducted an entomological survey to collect data from both indoor and outdoor breeding sites. The exploratory analysis of spatial data included location, spatial trends, local spatial autocorrelation, spatial continuity and spatial correlation of positive and potential breeding sites according to habitat. RESULTS: Spatial trends were identified, as well as clusters of potential and positive breeding sites outdoors using local spatial autocorrelation analysis. A positive correlation was found between potential and positive breeding sites, and a negative correlation existed between indoor and outdoor sites. CONCLUSIONS: The spatial relationship between positive and potential A. aegypti breeding sites both indoors and outdoors is dynamic and highly sensitive to the characteristics of each territory. Knowing how positive and potential breeding sites are distributed contributes to the prioritization of resources and actions in vector control programs.

Distribución espacial de criaderos positivos y potenciales de Aedes aegypti / Spatial distribution of potential and positive Aedes aegypti breeding sites

Resumen Introducción. La distribución espacial de Aedes aegypti es heterogénea, y la interacción entre criaderos positivos y potenciales en el intradomicilio y el extradomicilio es uno de los aspectos más difíciles de caracterizar en los programas de control vectorial. Objetivo. Describir la relación espacial entre los criaderos potenciales y positivos de A. aegypti en el intradomicilio y en el extradomicilio en un sector de Cali, Colombia. Materiales y métodos. Se hizo una encuesta entomológica con el objetivo de recolectar datos de los criaderos en el intradomicilio y el extradomicilio. El análisis exploratorio de los datos espaciales incluyó la localización, la tendencia espacial, la autocorrelación espacial local, la continuidad espacial y la correlación espacial de los criaderos positivos y potenciales según el hábitat. Resultados. Se determinaron las tendencias espaciales. Mediante el análisis de autocorrelación espacial local se ubicaron los conglomerados de criaderos potenciales y positivos del extradomicilio. Se encontró una correlación positiva entre los criaderos potenciales y los positivos y una correlación negativa entre el intradomicilio y el extradomicilio. Conclusiones. La relación espacial entre criaderos positivos y potenciales de A. aegypti en el intradomicilio y el extradomicilio es dinámica y muy sensible a las características de cada territorio, por lo que establecer su distribución en el espacio contribuye a la priorización de recursos y acciones en los programas de control vectorial.

Abstract Introduction: The spatial distribution of Aedes aegypti is heterogeneous, and the interaction between positive and potential breeding sites located both inside and outside homes is one of the most difficult aspects to characterize in vector control programs. Objective: To describe the spatial relationship between potential and positive breeding sites of A. aegypti inside and outside homes in Cali, Colombia. Materials and methods: We conducted an entomological survey to collect data from both indoor and outdoor breeding sites. The exploratory analysis of spatial data included location, spatial trends, local spatial autocorrelation, spatial continuity and spatial correlation of positive and potential breeding sites according to habitat. Results: Spatial trends were identified, as well as clusters of potential and positive breeding sites outdoors using local spatial autocorrelation analysis. A positive correlation was found between potential and positive breeding sites, and a negative correlation existed between indoor and outdoor sites. Conclusions: The spatial relationship between positive and potential A. aegypti breeding sites both indoors and outdoors is dynamic and highly sensitive to the characteristics of each territory. Knowing how positive and potential breeding sites are distributed contributes to the prioritization of resources and actions in vector control programs.

Cambio climático y salud: retos para Colombia / Climate changue and health: challengues for Colombia

El cambio climático impactará múltiples ámbitos de la sociedad, incluyendo la salud. Sus efectos en salud se deberán al aumento de la temperatura y al incremento/disminución de la precipitación y en especial al incremento de la frecuencia y magnitud de eventos climáticos extremos. El incremento de la morbilidad y mortalidad en salud se presentará a través de diversos mecanismos imbricados con elementos de los sistemas sociales y naturales de los socio - ecosistemas. La respuesta a dicha complejidad requiere abordajes y perspectivas interdisciplinarias que evalúen la vulnerabilidad de las poblaciones sensibles y que se piensen estrategias de adaptación adecuadas a los contextos locales. En este sentido el presente documento se propone describir los posibles efectos del cambio climático en la salud y plantea los principales retos para el estudio de dicha relación en el contexto Colombiano.

Climate change will affect multiple areas of society, including health. Its health effects will be due to rising temperatures and increased / decreased precipitation and especially the increased frequency and magnitude of extreme weather events. Increased morbidity and mortality in health will be presented through various intertwined with elements of social and natural systems of socio mechanisms - ecosystems. The answer to this complexity requires interdisciplinary approaches and perspectives to assess the vulnerability of sensitive populations and adaptation strategies appropriate to local contexts think. In this sense, this document is to describe the possible effects of climate change on health and pose major challenges for the study of the relationship in the Colombian context.

Análisis de la distribución espacial y temporal de los defectos congénitos registrados entre 2004 y 2008 en un hospital de tercer nivel en Cali, Colombia / Analysis of the spatial and temporal distribution of birth defects between 2004-2008 at a third-level hospital in Cali, Colombia

Objective: To describe the spatial and temporal distribution of major birth defects and to identify clusters at spatial, temporal and space-temporal levels.Methods: A descriptive study was developed about the space and time distribution of defects registered in Cali between March 2004 and October 2008 using principles of spatial statistics, namely the spatial data exploratory analysis.Results: Higher case density and prevalence was observed among neighborhoods of eastern Cali. Three districts (®communes¼) of the 21 in the city showed a larger probability (50 to 100% larger) of major birth defects. Significant clusters (p<0.05) were proven in spatial, temporal and space-temporal analysis.Conclusions: Birth defects were confirmed clustered in several communes at the poorest areas of the city. Occurrence of defects in this area may be associated, at least in part, to social and environmental inequities.

Objetivo: Describir la distribución espacial y temporal de los defectos congénitos mayores e identificar si existe agregación espacial, temporal y espacio-temporal.Métodos: Se desarrolló un estudio descriptivo de la distribución espacial y temporal de los defectos congénitos registrados en Cali, Colombia, entre marzo de 2004 y octubre de 2008 utilizando los principios de la estadística espacial, específicamente del análisis exploratorio de datos espaciales.Resultados: Se identificaron zonas en el oriente de Cali donde se presenta una mayor densidad y prevalencia de casos. Tres comunas de las 21 de la ciudad, presentaron una mayor probabilidad (entre 50% y 100% más alta) de presentar ocurrencia de defectos congénitos mayores y se comprobó con significancia estadística (p<0.05) la existencia de conglomerados espaciales, temporales y espacio-temporales.Conclusiones: Se demostró la existencia de conglomerados de defectos congénitos en varias comunas ubicadas en las zonas más pobres de la ciudad. La ocurrencia de los defectos en esta zona podría estar asociada, al menos en parte, con inequidad social y ambiental.