Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

A case report of type 1 diabetes mellitus and factitious hypoglycemia in a patient with Munchausen Syndrome / Hipoglucemia facticia: el caso de un paciente con diabetes mellitus tipo 1 y síndrome de Munchausen

SUMMARY Munchausen syndrome is rarely considered as a first diagnosis, especially in a type 1 diabetic patient presenting with hyperinsulinemic hypoglycemia. The diagnosis should be considered when episodes of hypoglycemia are persistent, and tests suggest a possible exogenous source of insulin. We report a case of a 26-year-old man with multiple hypoglycemic episodes and a long known diagnosis of diabetes type 1 who was referred to our institution after multiple in and out patient consultations in other institutions. He arrived with persistent hypoglycemia, even after withdrawal of insulin therapy on medical record, but persistent self-administration and misuse, without health care professional knowledge, of insulin therapy. He was diagnosed with factitious hypoglycemia after psychiatric evaluation. The patient improved with psychotherapy and family support as well as strict vigilance of insulin administration.

RESUMEN El síndrome de Munchausen rara vez es considerado como primer diagnóstico, especialmente en pacientes diabéticos tipo 1 con cuadro de hipoglicemia hiperinsulinémica. Debe pensarse en este diagnóstico cuando los episodios de hipoglicemia sean persistentes y los exámenes paraclínicos sugieran una fuente exógena de insulina. El siguiente es un reporte de caso de un paciente masculino de 26 años con múltiples episodios de hipoglicemia y diagnóstico conocido de diabetes mellitus tipo 1, quien fue referido a nuestro hospital universitario después de haber consultado en varias ocasiones y haber sido hospitalizado y dado de alta en otras instituciones. Ingresa por múltiples episodios de hipoglicemias, y que incluso al retirar las insulinas por orden médica, persistían los síntomas. Se encontró auto-administración de uso de insulinas sin el conocimiento de los profesionales de la salud, llegando al diagnóstico de hipoglicemia facticia después de valoración por psiquiatría. El paciente presentó mejoría con psicoterapia y apoyo familiar, además de vigilancia estricta de la administración de insulinas.