Blood eosinophils levels in a Colombian cohort of biomass-and tobacco-related COPD patients.

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of illness and death among adults. In 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy incorporated blood eosinophils as a biomarker to identify patients at increased risk of exacerbations which, with the history of exacerbations during the previous year, allows identification of patients who would benefit from anti-inflammatory treatment to reduce the risk of future exacerbations. The aim of this study was to describe demographic and clinical characteristics, eosinophil counts, and exacerbations in a cohort of COPD patients stratified by clinical phenotypes (non-exacerbator, frequent exacerbator, asthma-COPD overlap) in a Colombian cohort at 2600 meters above sea level. Methods: A descriptive analysis of a historical cohort of patients with a confirmed diagnosis of moderate to severe COPD (FEV1/FVC < 0.7 and at least one risk factor for COPD) from two specialized centers with comprehensive disease management programs was performed from January 2015 to March 2019. Data were extracted from medical records 1 year before and after the index date. Results: 200 patients were included (GOLD B: 156, GOLD E: 44; 2023 GOLD classification); mean age was 77.9 (SD 7.9) years; 48% were women, and 52% had biomass exposure as a COPD risk factor. The mean FEV1/FVC was 53.4% (SD 9.8), with an FEV1 of 52.7% (20.7). No differences were observed between clinical phenotypes in terms of airflow limitation. The geometric mean of absolute blood eosinophils was 197.58 (SD 2.09) cells/µL (range 0 to 3,020). Mean blood eosinophil count was higher in patients with smoking history and frequent exacerbators. At least one moderate and one severe exacerbation occurred in the previous year in 44 and 8% of patients, respectively; during the follow-up year 152 exacerbations were registered, 122 (80%) moderate and 30 (20%) severe. The highest rate of exacerbations in the follow-up year occurred in the subgroup of patients with the frequent exacerbator phenotype and eosinophils ≥300 cells/µL. Discussion: In this cohort, the frequency of biomass exposure as a risk factor is considerable. High blood eosinophil count was related to smoking, and to the frequent exacerbator phenotype.

Patterns and Trends in the Use of Medications for COPD Control in a Cohort of 9476 Colombian Patients, 2017-2019.

Purpose: Chronic obstructive pulmonary disease (COPD) affects approximately 174 million people worldwide. The objective was to determine the trends of COPD medication use in a group of Colombian patients. Patients and Methods: This was a retrospective study on prescription patterns of bronchodilators and other medications used in COPD from a population database with follow-up at 12 and 24 months. Patients older than 18 years of age of any sex with a COPD diagnostic code between 2017 and 2019 were included. Sociodemographic variables, medications, treatment schedules for COPD, comorbidities, comedications, and the specialty of the prescriber were considered. Results: Data from 9476 people with COPD was evaluated. The mean age was 75.9 ± 10.7 years, 50.1% were male, and 86.8% were prescribed by a general practitioner. A total of 57.9% had comorbidities, most often hypertension (44.4%). At the baseline measurement, on average, they received 1.6 medications/patient, mainly short-acting antimuscarinics (3784; 39.9%), followed by short-acting ß-agonists (2997, 31.6%) and inhaled corticosteroids (ICS) (2239, 23.6%); more than half (5083, 53.6%) received a long-acting bronchodilator. Prescription of triple therapy (antimuscarinic, ß-agonist, and ICS) went from 645 (6.8%) at baseline to 1388 (20.6%) at the 12-month mark. Conclusion: This group of patients with COPD treated in Colombia frequently received short-acting bronchodilators and ICS, but a growing proportion are undergoing controlled therapy with long-acting bronchodilators, a situation that can improve the indicators of morbidity, exacerbations, and hospitalization.

Clinical characterization of a cohort of patients treated for systemic lupus erythematosus in Colombia: A retrospective study.

INTRODUCTION: Systemic lupus erythematosus is an autoimmune disease associated with serious complications and high costs. The aim was to describe the clinical characteristics and health care resource utilization of a Colombian systemic lupus erythematosus outpatient cohort. METHODS: This was a retrospective descriptive study. Clinical records and claims data for systemic lupus erythematosus patients from ten specialized care centers in Colombia were reviewed for up to 12 months. Baseline clinical variables, Systemic Lupus Erythematosus Disease Activity Index, drug use, and direct costs were measured. Descriptive statistics were analyzed using SPSS. RESULTS: A total of 413 patients were included; 361 (87.4%) were female, and the mean age was 42 ± 14 years. The mean disease evolution was 8.9 ± 6.0 years; 174 patients (42.1%) had a systemic manifestation at baseline, mostly lupus nephritis (105; 25.4%). A total of 334 patients (80.9%) had at least one comorbidity, mainly antiphospholipid syndrome (90; 21.8%) and hypertension (76; 18.4%). The baseline Systemic Lupus Erythematosus Disease Activity Index score was 0 in 215 patients (52.0%), 1-5 in 154 (37.3%), 6-10 in 41 (9.9%) and 11+ in 3 (0.7%). All patients received pharmacological therapy, and the most common treatment was corticosteroids (293; 70.9%), followed by antimalarials (chloroquine 52.5%, hydroxychloroquine 31.0%), immunosuppressants (azathioprine 45.3%, methotrexate 21.5%, mycophenolate mofetil 20.1%, cyclosporine 8.0%, cyclophosphamide 6.8%, leflunomide 4.8%) and biologicals (10.9%). The mean annual costs were USD1954 per patient/year, USD1555 for antirheumatic drugs (USD10,487 for those with biologicals), USD86 for medical visits, USD235 for drug infusions and USD199 for laboratory tests. CONCLUSIONS: Systemic lupus erythematosus generates an important economic and morbidity burden for the Colombian health system. Systemic lupus erythematosus outpatient attention costs in the observation year were mainly determined by drug therapy (especially biologics), medical visits and laboratory tests. New studies addressing the rate of exacerbations, long-term follow-up or costs related to hospital care are recommended.

[Quality of clinical practice guidelines published in nutrition in hospitalized oncological adult patients]. / Calidad de las guías de práctica clínica publicadas en nutrición de pacientes hospitalizados adultos oncológicos.

BACKGROUND: There is a high variability in clinical practice regarding nutritional care which could affect nutritional status of oncological patients. This variability can be diminished following evidence based recommendations from clinical practice guidelines (CPG) with good methodological quality in its development. OBJECTIVE: To review and evaluate the quality of published guidelines in nutrition in hospitalized oncological adult patients. METHODS: A search of CPGs was conducted in MEDLINE, EMBASE, GIN, TripDatabase and pages of recognized guidelines developers. CPGs published between 2003 and 2012 were included. Four independent reviewers assessed the quality of CPGs using the AGREE II instrument. Characteristics of assessed guidelines were extracted and analyzed. RESULTS: 22 CPGs met selection criteria. 90% of guidelines are written in English. There was great variability in quality scores for each domain. Highest rated domain was "clarity of presentation" (median 65.95, range 19.40 to 93.10) while the lowest was "Applicability" (median 21.20, range 0 to 77.10). Sixteen guidelines scored low on "rigour of development" and six had an acceptable or good quality. Only five documents can be considered as "good quality guidelines" because they showed high performance in all domains. CONCLUSION: It was found a wide range of methodological quality scores of evaluated CPGs. Highest rated guidelines are made by agencies that develop guidelines but these are little known in our country. Most of the assessed guidelines have methodological weaknesses, which can affect the quality of the recommendations they make and its validity.

Calidad de las guías de práctica clínica publicadas en nutrición de pacientes hospitalizados adultos oncológicos / Quality of clinical practice guidelines published in nutrition in hospitalized oncological adult patients

Introducción: Existe alta variabilidad en la práctica clínica en nutrición que podría afectar el estado nutricional del paciente oncológico. Esta variabilidad disminuye con el uso de recomendaciones válidas basadas en la evidencia proveniente de guías de práctica clínica (GPC) con adecuada calidad metodológica en su elaboración. Objetivo: Revisar y evaluar la calidad de las guías publicadas en nutrición de pacientes adultos oncológicos hospitalizados. Métodos: Una búsqueda de GPC fue realizada en MEDLINE, EMBASE GIN, TripDatabase y páginas de elaboradores reconocidos de guías. Se incluyeron guías basadas en la evidencia publicadas entre 2003 y 2012. Cuatro revisores independientes evaluaron la calidad de las GPC usando el instrumento AGREE II. Las características de las guías evaluadas fueron extraídas y analizadas. Resultados: Fueron seleccionadas 22 GPC. Un 90% de las guías están escritas en inglés. Hubo gran variabilidad en los puntajes de calidad de cada dominio. El dominio mejor puntuado fue "Claridad de la presentación" (mediana 65,95, rango 19,40-93,10) mientras que el más bajo fue "Aplicabilidad" (mediana 21,20, rango 0,077,10). Dieciséis guías puntuaron bajo en "Rigor metodológico" y seis presentaron una calidad aceptable o buena. Cinco GPC presentaron un alto desempeño en todos los dominios y fueron consideradas de alta calidad. Conclusión: Hubo un amplio rango de puntajes de calidad metodológica de las GPC. Las guías mejor puntuadas son elaboradas por entidades desarrolladores de guías, pero poco conocidas en nuestro medio. Muchas GPC presentan debilidades metodológicas que pueden afectar la calidad de las recomendaciones que emiten y por lo tanto su validez (AU)

Background: There is a high variability in clinical practice regarding nutritional care which could affect nutritional status of oncological patients. This variability can be diminished following evidence based recommendations from clinical practice guidelines (CPG) with good methodological quality in its development. Objective: To review and evaluate the quality of published guidelines in nutrition in hospitalized oncological adult patients. Methods: A search of CPGs was conducted in MEDLINE, EMBASE, GIN, TripDatabase and pages of recognized guidelines developers. CPGs published between 2003 and 2012 were included. Four independent reviewers assessed the quality of CPGs using the AGREE II instrument. Characteristics of assessed guidelines were extracted and analyzed. Results: 22 CPGs met selection criteria. 90% of guidelines are written in English. There was great variability in quality scores for each domain. Highest rated domain was "clarity of presentation" (median 65.95, range 19.40 to 93.10) while the lowest was "Applicability" (median 21.20, range 0 to 77.10). Sixteen guidelines scored low on "rigour of development" and six had an acceptable or good quality. Only five documents can be considered as "good quality guidelines" because they showed high performance in all domains. Conclusion: It was found a wide range of methodological quality scores of evaluated CPGs. Highest rated guidelines are made by agencies that develop guidelines but these are little known in our country. Most of the assessed guidelines have methodological weaknesses, which can affect the quality of the recommendations they make and its validity (AU)

Efficacy of robotic-assisted prostatectomy in localized prostate cancer: a systematic review of clinical trials.

Background. Radical prostatectomy is an effective treatment for clinically localized prostate cancer. The three approaches in current use have been extensively compared in observational studies, which have methodological limitations. Objective. To compare the efficacy and safety of three radical prostatectomy approaches in patients with localized prostate cancer: open, laparoscopic, and robotic-assisted laparoscopic surgery. Materials and Methods. A systematic review of the literature was carried out. Databases MEDLINE, EMBASE, LILACS, and CENTRAL were searched for randomized clinical trials that directly compared two or more radical prostatectomy approaches. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent researchers using Cochrane Collaboration's tools. Results. Three trials were included. In one study, laparoscopic surgery was associated with fewer blood loss and transfusion rates than the open procedure, in spite of longer operating time. The other two trials compared laparoscopic and robotic-assisted surgery in which no differences in perioperative outcomes were detected. Nevertheless, robotic-assisted prostatectomy showed more favorable erectile function and urinary continence recovery. Conclusion. At the present time, no clear advantage can be attributed to any of the existing prostatectomy approaches in terms of oncologic outcomes. However, some differences in patient-related outcomes favor the newer methods. Larger trials are required.

Use of black vulture (Coragyps atratus) in complementary and alternative therapies for cancer in Colombia: a qualitative study.

BACKGROUND: Although Coragyps atratus has been used as a traditional therapy for patients with cancer, the scientific literature does not contain enough information on how this therapy is used or the mechanisms that explain this therapeutic practice. OBJECTIVES: To understand the methods of use and the reasons given by patients and caregivers for the use of Coragyps atratus in cancer treatment. METHODS: This study used a qualitative design based on twenty in-depth interviews of patients with cancer or caregivers of patients with the disease. The analysis of the text was based on an inductive thematic approach. RESULTS: Resistance to disease and immune enhancement are properties attributed to Coragyps atratus when used for cancer treatment. The most recommended method of use is fresh blood ingestion, and the associated mechanism of action is transfer of immune factors to the individual who consumes it. CONCLUSIONS: Use of Coragyps atratus as a treatment for cancer is a popular alternative therapy in Colombia. More studies are needed to understand the clinical effects of this intervention in cancer patients.

[Rainfall and acute febrile syndrome in a dengue-endemic area]. / Pluviosidad como Predictor de Consulta por Síndrome Febril Agudo en un Area Endémica de Dengue.

OBJECTIVE: Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. METHODS: 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 % of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. RESULTS: June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 %CI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 %CI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 %CI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). CONCLUSIONS: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.

Pluviosidad como predictor de consulta por síndrome febril agudo en un área endémica de dengue / Rainfall and acute febrile syndrome in a dengue-endemic area

Objetivo Describir los patrones de consulta por SFA asociado al dengue y evaluar su asociación con la pluviosidad. Métodos En dos clínicas, durante un periodo de 7 meses (de marzo a septiembre) se identificaron 318 casos de SFA indiferenciado que se incluyeron en un seguimiento clínico sistemático. El 31 por ciento (81/281) fueron IgM positivos para dengue. Se evaluó la pluviosidad (litros/metro cuadrado por día) previa como variable explicatoria del patrón de consultas. Resultados Los meses con más casos de SFA fueron junio, julio y septiembre. Los casos de dengue sólo fueron significativamente más frecuentes en julio. Al evaluar los patrones de pluviosidad de las semanas anteriores, la consulta por SFA estuvo asociada con la pluviosidad promedio registrada 5 semanas antes y esta asociación fue independiente de la institución y del mes (Razón de tasas de incidencia ajustada: RTI=1,04; IC95 por ciento 1-1,08; p=0,045). Por otra parte, un promedio de la pluviosidad de 5 semanas consecutivas fue un predictor independiente de consulta por dengue, 4 semanas después (RTI=1,6; IC95 por ciento 1,15-2,22; p=0.006). Se evidenció una relación lineal entre la pluviosidad y las consultas por dengue: pluviosidad (promedio de 5 semanas) x 0,72 (IC95 por ciento 0,60-0,84; p<0,001)=casos por cada 100 000 habitantes en una semana (4 semanas después). Conclusiones La pluviosidad podría predecir el patrón de consulta por dengue en una región endémica.

Objective Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. Methods 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 percent of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. Results June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 percentCI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 percentCI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 percentCI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). Conclusions: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.