Historical trends in mortality from "older" vaccine-preventable diseases, Colombia: implications for elimination and control.

OBJECTIVE: This study aimed to describe the trends in mortality from eight vaccine-preventable diseases in Colombia in the last 40 years and their relationship with vaccination coverage. STUDY DESIGN: It is a population-based descriptive study. METHODS: The frequencies of deaths by decade, disease, sex, and the specific mortality rates by age group were calculated. Using a negative binomial regression model, the 10-year changes in mortality and their relationship with vaccination coverage were determined. RESULTS: The number of deaths and the adjusted rates decreased since 1989 in all diseases (incidence rate ratio <1 when compared with the 1979-1988 decade). Vaccination coverage below 90% is associated with an increase in mortality from diphtheria, measles, mumps, neonatal tetanus, and pertussis. CONCLUSION: Historical changes in mortality support the benefits of vaccination, but new efforts are required to sustain the elimination of diseases.

Multimodality imaging appearance of intrapericardial paragangliomas.

Paragangliomas are neuroendocrine tumours of the sympathetic and parasympathetic nervous systems originating from neural crest cells. Less than 1% of paragangliomas in the heart originate from intrinsic cardiac ganglia cells in the posterior wall of the atria, atrioventricular groove, and along the root of the great vessels. We describe the tumour characteristics, patient demographics, presentation, means of diagnosis, pathology correlation, management, and outcome in 11 patients with intrapericardial paragangliomas. To the authors' knowledge, this is the largest case series reported, with emphasis on multimodality imaging findings.

Laparoscopic treatment of giant hiatal hernia with or without mesh reinforcement: A systematic review and meta-analysis.

BACKGROUND: The use of mesh associated with cruroplasty is still controversial, especially in cases of giant hernias, due to possible complications of the prosthesis reported in the literature, such as infection, chest migration, shrinkage, esophageal and aortic erosion, stenosis and obstruction. This systematic review and meta-analysis aimed to compare the use or not of mesh as a reinforcement in the laparoscopic repair of giant hernias and to determine which technique has the best results in recurrence and complication rates. MATERIAL AND METHODS: A search was conducted using databases and included prospective and randomized studies. The studies should include patients with giant hernias who have undergone laparoscopic treatment comparatively analyzed between cruroplasty and suture associated with prosthetic reinforcement. RESULTS: Of the 768 articles analyzed, 8 were selected for systematic review, and 7 were included in the meta-analysis (3 randomized trials with higher evidence strength, 2 randomized trials with lower methodological quality, and 2 prospective cohorts). The meta-analysis showed no statistically significant differences in favor of any of the intervention methods (mesh versus suture cruroplasty) for the different outcomes evaluated: recurrence (RD -0.06, CI [-0.13,0.01], I2 22%, p 0.27); postoperative complications (RD 0.04, CI [-0.01,0.9], I2 5%, p 0.30); deaths (RD -0.01, CI [-0.04, 0.02], I2 0%, p 74); intraoperative complications (RD -0.03, CI [-0.07, 0.1]); reoperation (RD -0.04, CI [-0.10, 0.02], p 0.14). CONCLUSION: There is no evidence supporting that routine mesh reinforcement in laparoscopic repair of giant hernias decreases recurrence and other complications. Systematic review registration number at PROSPERO: CRD42019147468.

Percepción del ambiente para caminar según la localidad en Barranquilla, Colombia / Perception of the environment for walking according the locality in Barranquilla, Colombia

El objetivo fue estimar la percepción del ambiente del barrio para caminar según la localidad de la ciudad. Se realizó un estudio descriptivo transversal en 2103 personas entre 15 y 69 años de edad. Se aplicó el Cuestionario Internacional de Actividad Física (IPAQ), y el Módulo Ambiente del International Physical Activity Study. Se estimó la asociación entre la percepción de los atributos del barrio y la localidad donde reside la persona. Los residentes del sur de la ciudad tienen mayor riego de percibir pocos supermercados a poca distancia de sus casas [OR 1,29(IC 95% 1,10-1,65)], aceras en mal estado [OR 1,44(IC 95% 1,10-1,90)], pocas personas físicamente activas [OR 4,13(IC 95% 2,50-6,82)], peligro para pasear durante el día[OR 3,07(IC 95% 1,96-4,80)], y pocas cosas interesantes en el vecindario [OR 3,21(IC 95% 2,05-5,02)] (AU)

The objective was to estimate the perception of the neighborhood environment for walking according to the location of the city. A cross-sectional descriptive study was performed in 2103 people aged 15 to 69 years of age. We applied the International Physical Activity Questionnaire (IPAQ) and the Environment Module of the International Physical Activity Study. We estimated the association between perceived attributes of the neighborhood and the locality where the person lives. The residents of the South of the city have a higher risk of perceiving a few supermarkets within walking distance of their homes [OR 1,29 (95% CI 1,10-1,65)], presence of sidewalks in bad condition [OR 1,44 (95% CI 1,10-1,90)], few people physically active [OR 4,13 (95% CI 2,50-6,82)], danger to stroll during the day [OR 3,07 (95% CI 1,96-4,80)] and few interesting things in the neighborhood [OR 3,21 (95% CI 2,05-5,02)] (AU)

Comentarios al artículo «Tratamiento anestesiológico de la fractura de pelvis "en libro abierto" secundaria a explosión» / Comment on article «Anesthesiology treatment of an "open book" pelvic fracture due to an explosión»

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Simulation of risk of tuberculosis infection in healthcare workers in hospitals of an intermediate incidence country.

We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3-47·7] and 44% (95% CI 36·4-51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3-49·0) and 36% (95% CI 27·9-44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

Pentalogía de Cantrell: presentación de un caso clínico / Pentalogy of Cantrell: clinical case

La pentalogía de Cantrell es una enfermedad poco frecuente que resulta de alteraciones embriológicas del mesodermo, caracterizada por defecto en la porción baja esternal, defecto de la pared abdominal supraumbilical, defecto diafragmático anterior, defecto del pericardio diafragmático y anomalía cardiaca. Caso clínico: Se presenta el caso de un neonato de sexo masculino con diagnóstico prenatal de defecto de la pared abdominal, en quien posteriormente se realizó el diagnóstico de Pentalogía de Cantrell. Al presentar este caso se destaca la posibilidad diagnóstica en la vida fetal, y el pobre pronóstico de estos pacientes cuando su presentación clínica se asocia a hipoplasia pulmonar severa.

Pentalogy of Cantrell is a rare disease that results from alterations in embryo development. It is characterized by defects of the lower sternum, midline supraumbilical abdominal wall defect, deficiency of the anterior diaphragm, defects in the diaphragmatic pericardium and cardiac anomaly. Case Report: The case of a male neonate with a prenatal diagnosis of abdominal wall defect is presented, who was subsequently diagnosed with Pentalogy of Cantrell. This study emphasizes the prenatal diagnosis possibilities and the poor prognosis for these patients when their clinical presentation is associated with severe lung hypoplasia.

Pretransplant immediately early-1-specific T cell responses provide protection for CMV infection after kidney transplantation.

Cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although cytotoxic CMV-specific T cells play a crucial role controlling CMV survival and replication, current pretransplant risk assessment for CMV infection is only based on donor/recipient (IgG)-serostatus. Here, we evaluated the usefulness of monitoring pre- and 6-month CMV-specific T cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, using an IFN-γ Elispot, for predicting the advent of CMV infection in two cohorts of 137 kidney transplant recipients either receiving routine prophylaxis (n = 39) or preemptive treatment (n = 98). Incidence of CMV antigenemia/disease within the prophylaxis and preemptive group was 28%/20% and 22%/12%, respectively. Patients developing CMV infection showed significantly lower anti-IE-1-specific T cell responses than those that did not in both groups (p < 0.05). In a ROC curve analysis, low pretransplant anti-IE-1-specific T cell responses predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC > 0.70). Furthermore, when using most sensitive and specific Elispot cut-off values, a higher than 80% and 90% sensitivity and negative predictive value was obtained, respectively. Monitoring IE-1-specific T cell responses before transplantation may be useful for predicting posttransplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment.

Agentes etiológicos de infecciones del tracto urinario y su resistencia a antibióticos en población pediátrica; Medellín, Colombia / Etiologic agents of urinary tract infections and their resistance to antibiotics in the pediatric population; Medellín, Colombia

Antecedentes: La infección urinaria es una de las causas más frecuentes de consulta en la población pediátrica. En la mayoría de los casos manejada empíricamente,siendo el Trimetoprim/sulfametoxazol el antibiótico más utilizado. El propósito de esta investigación es establecer la frecuencia de los diferentes agentes etiológicos causantes de infecciones del tracto urinario (ITU), su resistencia y sensibilidad a los antibióticos en población pediátrica. Materiales y métodos: Se realizó un análisis retrospectivo de 180 historias clínicas de niños menores de 14 años que ingresaron a una unidad de segundo nivel de atenciónen salud, del Valle de Aburrá. Resultados: Escherichia coli causó el 52.0% de las ITU, seguida del Enterococcus sp(26%). La resistencia al Trimetoprim/Sulfametoxazol fue del 80%, seguida por Ampicilina(71.4%) y Ciprofloxacina (61.5%). Los antibióticos con mejor respuesta fueron laAmikacina (94.4%) y la nitrofurantoína (93.3%). Se estableció que existe una relaciónsignificativa (p=0.003; OR= 2.53) entre urocultivo positivo para E. coli y pacientes confiebre; el 6.11% de la población presentó malformación del tracto genitourinario. Conclusiones: Escherichia coli fue el agente más frecuente en infección del tractourinario, presentando alta resistencia al Trimetoprim/Sulfametoxazol. La malformación más frecuente fue el reflujo vesicoureteral principalmente en menores de dos años; además se mostró la importancia de conocer los datos epidemiológicos locales y el comportamiento de estas bacterias, para un adecuado manejo y seguimiento de niños con infección del tracto urinario...

Lensless microscopy technique for static and dynamic colloidal systems.

We present the application of a lensless microscopy technique known as digital in-line holographic microscopy (DIHM) to image dynamic and static colloidal systems of microspheres. DIHM has been perfected up to the point that submicrometer lateral resolution with several hundreds of micrometers depth of field is achieved with visible light; it is shown that the lateral resolution of DIHM is enough to resolve self-assembled colloidal monolayers built up from polystyrene spheres with submicrometer diameters. The time resolution of DIHM is of the order of 4 frames/s at 2048 x 2048 pixels, which represents an overall improvement of 16 times the time resolution of confocal scanning microscopy. This feature is applied to the visualization of the migration of dewetting fronts in dynamic colloidal systems and the formation of front-like arrangements of particles.

High resolution Talbot self-imaging applied to structural characterization of self-assembled monolayers of microspheres.

We report the observation of the Talbot self-imaging effect in high resolution digital in-line holographic microscopy (DIHM) and its application to structural characterization of periodic samples. Holograms of self-assembled monolayers of micron-sized polystyrene spheres are reconstructed at different image planes. The point-source method of DIHM and the consequent high lateral resolution allows the true image (object) plane to be identified. The Talbot effect is then exploited to improve the evaluation of the pitch of the assembly and to examine defects in its periodicity.

Deterministic SIR (Susceptible-Infected-Removed) models applied to varicella outbreaks.

Deterministic SIR models were applied to simulate Susceptible-Infected-Removed and to estimate the threshold condition for varicella outbreaks in children, reported in Medellín, Colombia. The expected numbers of susceptible, infected and removed individuals were compared with observed cases from notification of varicella outbreaks to the local Board of Health and from survey data. The threshold condition was estimated by the basic reproductive ratio and by the relative removal rate, through which measures for preventing and curtailing the outbreaks were identified. The model demonstrated a reasonable fit to the observations, except in two of the six outbreaks which probably reflected under-registration of cases. In order to have prevented these outbreaks, between 4.4% and 52.9% of the susceptible population should have been vaccinated assuming an 85% vaccine effectiveness. Similarly, isolation of affected children should have been increased to between 4.3% and 44.8% per week.

Comment on "Reconstruction algorithm for high-numerical-aperture holograms with diffraction-limited resolution".

We comment on a recent Letter by Zhang et al. [Opt. Lett. 31, 1633 (2006)] in which the authors proposed a reconstruction algorithm for high-numerical-aperture (NA) holograms. Such an algorithm has been available for in-line holography for more than a decade. The authors' "achievement" of high NA for digital in-line holography, NA=0.17, is below what was reported already several years ago (NA=0.30) and is considerably lower than what is routinely achieved now. We present reconstructions of holograms acquired with NAs above 0.4 in which we show maximal achievable resolution.

Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography.

PURPOSE: To determine the sensitivity and specificity of helical computed tomographic (CT) angiography in the diagnosis of carotid and vertebral arterial injuries caused by penetrating neck trauma. MATERIALS AND METHODS: A prospective study was conducted during 24 months in 60 patients with penetrating neck trauma who were referred for conventional angiography owing to clinical suspicion of arterial injury. In the patient population, 146 arteries (77 carotid, 69 vertebral) were studied by means of conventional angiography. In all patients, conventional angiography and helical CT angiography were completed within 6 hours. Two radiologists interpreted helical CT angiographic studies by means of consensus. Conventional angiography was the standard of reference for determining the sensitivity and specificity of helical CT angiography. RESULTS: Conventional angiograms showed arterial injuries in 10 (17%) of 60 patients. Conventional angiographic findings were arterial occlusion (n = 4), arteriovenous fistula (n = 2), pseudoaneurysm (n = 3), pseudoaneurysm with arteriovenous fistula (n = 1), and normal arteries (n = 136). Nine of 10 arterial injuries and all normal arteries were depicted adequately at helical CT angiography. Sensitivity of helical CT angiography was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 98%. CONCLUSION: The sensitivity and specificity of helical CT angiography are high for detection of major carotid and vertebral arterial injuries resulting from penetrating trauma.

Evaluacion de la anatomia arterial en donantes renales intrafamiliares: comparacion de angiografia por tomografia computada helicoidal y angiografia convencional / HCTA and conventional angiography for the evaluation of arterial anatomy in intrafamiliar renal donors

El propósito de este estudio es comparar los hallazgos de angiografía por tomografía computada helicoidal (TCH) con los de angiografía convencional y los hallazgos quirúrgicos en un grupo de donantes renales en el Hospital Universitario San Vicente de Paúl entre junio de 1996 y abril de 1998. Se realizó angiografía por TCH en 41 potenciales donantes renales quienes fueron remitidos al departamento de imágenes diagnósticas del H.U.S.V.R para evaluación con angiografía convencional. Para la angiografía por TCH, se inyectaron 100 ce de contraste intravenoso (iopamidol 300 mg/ml) y se hicieron reconstrucciones tridimensionales del árbol arterial. Los estudios de angiografía por TCH fueron evaluados por dos radiólogos en forma independiente; las diferencias de interpretación entre los observadores se resolvieron por consenso de ambos. Se compararon los hallazgos de ambas las entre sí y con los datos quirúrgicos en las unidades renales transplantadas. Utilizando la angiografía convencional como prueba de oro, la sensibilidad de la angiografía por TCH para la detección de variantes anatómicas arteriales fue del 100 por ciento y la especificidad del 97 por ciento , con una concordancia del 98 por ciento . Además, se demostraron anormalidades parenquimatosas y extrarenales, no visualizadas en la angiografía convencional. Los resultados permiten proponer el reemplazo de la angiografía convencional por la angiografía por TCH en la valoración de este tipo de pacientes, la cual se constituye en una herramienta rápida, segura, no invasora y menos costosa en nuestro medio. El uso de una menor cantidad de medio de contraste, con relación a los reportes ya publicados, podría contribuir a disminuir la nefrotoxicidad lo cual es deseable tanto en el donante como en el receptor