SARS-CoV-2 infection in newborn infants: descriptive epidemiological analysis of cases reported to the Colombian national surveillance system during the first pandemic year, March 2020-February 2021.

OBJECTIVE: To describe the clinical and epidemiological characteristics of newborn infants with SARS-CoV-2 infection notified in the Colombian Public Health Surveillance System. DESIGN: This epidemiological descriptive analysis was conducted using the data of all cases of newborn infants with confirmed SARS-CoV-2 infection notified in the surveillance system. Absolute frequencies and central tendency measures were calculated and a bivariate analysis comparing variables of interest with symptomatic and asymptomatic disease was performed. SETTING: Population-based descriptive analysis. PATIENTS: Laboratory-confirmed COVID-19 cases in newborn infants (aged ≤28 days of life) reported to the surveillance system from 1 March 2020 to 28 February 2021. RESULTS: 879 newborns were identified, corresponding to 0.04% of all reported cases in the country. The mean age at diagnosis was 13 days (range 0-28 days), 55.1% were male and most (57.6%) were classified as symptomatic. Preterm birth and low birth weight were identified in 24.0% and 24.4% of the cases, respectively. Common symptoms were fever (58.3%), cough (48.3%) and respiratory distress (34.9%). A higher prevalence of symptomatic newborns was seen in individuals with low birth weight for gestational age (prevalence ratio (PR): 1.51, 95% CI: 1.44 to 1.59) and newborns with underlying conditions (PR: 1.33, 95% CI: 1.13 to 1.55). CONCLUSIONS: There were a low proportion of confirmed COVID-19 cases in the newborn population. A substantial number of newborns were classified as symptomatic, having low birth weight and being preterm. Clinicians caring for COVID-19-infected newborns should be aware of population characteristics that potentially contribute to disease manifestations and severity.

Estimating Zika virus attack rates and risk of Zika virus-associated neurological complications in Colombian capital cities with a Bayesian model.

Zika virus (ZIKV) is a mosquito-borne pathogen that caused a major epidemic in the Americas in 2015-2017. Although the majority of ZIKV infections are asymptomatic, the virus has been associated with congenital birth defects and neurological complications (NC) in adults. We combined multiple data sources to improve estimates of ZIKV infection attack rates (IARs), reporting rates of Zika virus disease (ZVD) and the risk of ZIKV-associated NC for 28 capital cities in Colombia. ZVD surveillance data were combined with post-epidemic seroprevalence data and a dataset on ZIKV-associated NC in a Bayesian hierarchical model. We found substantial heterogeneity in ZIKV IARs across cities. The overall estimated ZIKV IAR across the 28 cities was 0.38 (95% CrI: 0.17-0.92). The estimated ZVD reporting rate was 0.013 (95% CrI: 0.004-0.024), and 0.51 (95% CrI: 0.17-0.92) cases of ZIKV-associated NC were estimated to be reported per 10 000 ZIKV infections. When we assumed the same ZIKV IAR across sex or age group, we found important spatial heterogeneities in ZVD reporting rates and the risk of being reported as a ZVD case with NC. Our results highlight how additional data sources can be used to overcome biases in surveillance data and estimate key epidemiological parameters.

Severity of illness by pregnancy status among laboratory-confirmed SARS-CoV-2 infections occurring in reproductive-aged women in Colombia.

BACKGROUND: Multiple studies have described increased risk of severe coronavirus disease (COVID-19) among pregnant women compared to nonpregnant women. The risk in middle-income countries where the distributions of age groups and preexisting conditions may differ is less known. OBJECTIVES: To determine whether pregnant women with SARS-CoV-2 infection are at increased risk for severe COVID-19 compared to nonpregnant women in Colombia. METHODS: We analysed national surveillance data from Colombia, of women aged 15-44 years with laboratory-confirmed infection with SARS-CoV-2 by molecular or antigen testing, from 6 March 2020 to 12 December 2020. An enhanced follow-up of pregnant women with COVID-19 was established to monitor pregnancy and birth outcomes. RESULTS: Of 371,363 women aged 15-44 years with laboratory-confirmed SARS-CoV-2 infection, 1.5% (n = 5614) were reported as pregnant; among those, 2610 (46.5%) were considered a complete pregnancy for reporting purposes at the time of analysis. Hospitalisation (23.9%) and death (1.3%) occurred more frequently among pregnant symptomatic women compared to nonpregnant symptomatic women (2.9% and 0.3%, respectively). Compared to nonpregnant symptomatic women, pregnant symptomatic women were at increased risk of hospitalisation (adjusted risk ratio [RR] 2.19, 95% confidence interval [CI] 2.07, 2.32) and death (RR 1.82, 95% CI 1.60, 2.07), after adjusting for age, type of health insurance and presence of certain underlying medical conditions. Among complete pregnancies, 55 (2.1%) were pregnancy losses, 72 (2.8%) resulted in term low birthweight infants and 375 (14.4%) were preterm deliveries. CONCLUSIONS: Although pregnant women were infrequently reported with laboratory-confirmed SARS-CoV-2 infection, pregnant symptomatic women with COVID-19 were at increased risk for hospitalisation and death compared to nonpregnant symptomatic women. Almost all infections we reported on were third-trimester infections; ongoing follow-up is needed to determine pregnancy outcomes among women infected earlier in pregnancy. Healthcare providers should counsel pregnant women about preventive measures to protect from SARS-CoV-2 infection and when to seek care.

Spatial and temporal invasion dynamics of the 2014-2017 Zika and chikungunya epidemics in Colombia.

Zika virus (ZIKV) and chikungunya virus (CHIKV) were recently introduced into the Americas resulting in significant disease burdens. Understanding their spatial and temporal dynamics at the subnational level is key to informing surveillance and preparedness for future epidemics. We analyzed anonymized line list data on approximately 105,000 Zika virus disease and 412,000 chikungunya fever suspected and laboratory-confirmed cases during the 2014-2017 epidemics. We first determined the week of invasion in each city. Out of 1,122, 288 cities met criteria for epidemic invasion by ZIKV and 338 cities by CHIKV. We analyzed risk factors for invasion using linear and logistic regression models. We also estimated that the geographic origin of both epidemics was located in Barranquilla, north Colombia. We assessed the spatial and temporal invasion dynamics of both viruses to analyze transmission between cities using a suite of (i) gravity models, (ii) Stouffer's rank models, and (iii) radiation models with two types of distance metrics, geographic distance and travel time between cities. Invasion risk was best captured by a gravity model when accounting for geographic distance and intermediate levels of density dependence; Stouffer's rank model with geographic distance performed similarly well. Although a few long-distance invasion events occurred at the beginning of the epidemics, an estimated distance power of 1.7 (95% CrI: 1.5-2.0) from the gravity models suggests that spatial spread was primarily driven by short-distance transmission. Similarities between the epidemics were highlighted by jointly fitted models, which were preferred over individual models when the transmission intensity was allowed to vary across arboviruses. However, ZIKV spread considerably faster than CHIKV.

Descriptive analysis of surveillance data for Zika virus disease and Zika virus-associated neurological complications in Colombia, 2015-2017.

Zika virus (ZIKV) is a mosquito-borne pathogen that recently caused a major epidemic in the Americas. Although the majority of ZIKV infections are asymptomatic, the virus has been associated with birth defects in fetuses and newborns of infected mothers as well as neurological complications in adults. We performed a descriptive analysis on approximately 106,000 suspected and laboratory-confirmed cases of Zika virus disease (ZVD) that were reported during the 2015-2017 epidemic in Colombia. We also analyzed a dataset containing patients with neurological complications and recent febrile illness compatible with ZVD. Females had higher cumulative incidence of ZVD than males. Compared to the general population, cases were more likely to be reported in young adults (20 to 39 years of age). We estimated the cumulative incidence of ZVD in pregnant females at 3,120 reported cases per 100,000 population (95% CI: 3,077-3,164), which was considerably higher than the incidence in both males and non-pregnant females. ZVD cases were reported in all 32 departments. Four-hundred and eighteen patients suffered from ZIKV-associated neurological complications, of which 85% were diagnosed with Guillain-Barré syndrome. The median age of ZIKV cases with neurological complications was 12 years older than that of ZVD cases. ZIKV-associated neurological complications increased with age, and the highest incidence was reported among individuals aged 75 and older. Even though neurological complications and deaths due to ZIKV were rare in this epidemic, better risk communication is needed for people living in or traveling to ZIKV-affected areas.

Zika Virus Disease and Pregnancy Outcomes in Colombia.

BACKGROUND: In 2015 and 2016, Colombia had a widespread outbreak of Zika virus. Data from two national population-based surveillance systems for symptomatic Zika virus disease (ZVD) and birth defects provided complementary information on the effect of the Zika virus outbreak on pregnancies and infant outcomes. METHODS: We collected national surveillance data regarding cases of pregnant women with ZVD that were reported during the period from June 2015 through July 2016. The presence of Zika virus RNA was identified in a subgroup of these women on real-time reverse-transcriptase-polymerase-chain-reaction (rRT-PCR) assay. Brain or eye defects in infants and fetuses and other adverse pregnancy outcomes were identified among the women who had laboratory-confirmed ZVD and for whom data were available regarding pregnancy outcomes. We compared the nationwide prevalence of brain and eye defects during the outbreak with the prevalence both before and after the outbreak period. RESULTS: Of 18,117 pregnant women with ZVD, the presence of Zika virus was confirmed in 5926 (33%) on rRT-PCR. Of the 5673 pregnancies with laboratory-confirmed ZVD for which outcomes had been reported, 93 infants or fetuses (2%) had brain or eye defects. The incidence of brain or eye defects was higher among pregnancies in which the mother had an onset of ZVD symptoms in the first trimester than in those with an onset during the second or third trimester (3% vs. 1%). A total of 172 of 5673 pregnancies (3%) resulted in pregnancy loss; after the exclusion of pregnancies affected by birth defects, 409 of 5426 (8%) resulted in preterm birth and 333 of 5426 (6%) in low birth weight. The prevalence of brain or eye defects during the outbreak was 13 per 10,000 live births, as compared with a prevalence of 8 per 10,000 live births before the outbreak and 11 per 10,000 live births after the outbreak. CONCLUSIONS: In pregnant women with laboratory-confirmed ZVD, brain or eye defects in infants or fetuses were more common during the Zika virus outbreak than during the periods immediately before and after the outbreak. The frequency of such defects was increased among women with a symptom onset early in pregnancy. (Funded by the Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).

Etiology of Microcephaly and Central Nervous System Defects during the Zika Epidemic in Colombia.

OBJECTIVE: To estimate the prevalence of microcephaly and central nervous system (CNS) defects during the Zika virus (ZIKV) epidemic in Colombia and proportion attributable to congenital ZIKV infection. STUDY DESIGN: Clinical and laboratory data for cases of microcephaly and/or CNS defects reported to national surveillance between 2015 and 2017 were reviewed and classified by a panel of clinical subject matter experts. Maternal and fetal/infant biologic specimens were tested for congenital infection and chromosomal abnormalities. Infants/fetuses with microcephaly and/or CNS defects (cases) were classified into broad etiologic categories (teratogenic, genetic, multifactorial, and unknown). Cases classified as potentially attributable to congenital ZIKV infection were stratified by strength of evidence for ZIKV etiology (strong, moderate, or limited) using a novel strategy considering birth defects unique or specific to ZIKV or other infections and laboratory evidence. RESULTS: Among 858 reported cases with sufficient information supporting a diagnosis of microcephaly or CNS defects, 503 were classified as potentially attributable to congenital ZIKV infection. Of these, the strength of evidence was considered strong in 124 (24.7%) cases; moderate in 232 (46.1%) cases; and limited in 147 (29.2%). Of the remaining, 355 (41.4%) were attributed to etiologies other than ZIKV infection (syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes 1 and herpes 2 viruses only, n = 32 [3.7%]; genetic, n = 16 [1.9%]; multifactorial, n = 42 [4.9%]; unknown, n = 265 [30.9%]). CONCLUSIONS: Fifty-eight percent of cases of microcephaly and/or CNS defects were potentially attributable to congenital ZIKV infection; however, the strength of evidence varied considerably. This surveillance protocol might serve as a model approach for investigation and etiologic classification of complex congenital conditions.

Long-term outcomes of Guillain-Barré syndrome possibly associated with Zika virus infection.

BACKGROUND: This prospective cohort investigation analyzed the long-term functional and neurologic outcomes of patients with Zika virus-associated Guillain-Barré syndrome (GBS) in Barranquilla, Colombia. METHODS: Thirty-four Zika virus-associated GBS cases were assessed a median of 17 months following acute GBS illness. We assessed demographics, results of Overall Disability Sum Scores (ODSS), Hughes Disability Score (HDS), Zung Depression Scale (ZDS), and Health Related Quality of Life (HRQL) questionnaires; and compared outcomes indices with a normative sample of neighborhood-selected control subjects in Barranquilla without GBS. RESULTS: Median age at time of acute neurologic onset was 49 years (range, 10-80); 17 (50%) were male. No deaths occurred. At long-term follow-up, 25 (73%) patients had a HDS 0-1, indicating complete / near complete recovery. Among the group, HDS (mean 1.4, range 0-4), ODSS (mean 1.9, range 0-9) and ZDS score (mean 34.4, range 20-56) indicated mild / moderate ongoing disability. Adjusting for age and sex, Zika virus-associated GBS cases were similar to a population comparison group (n = 368) in Barranquilla without GBS in terms of prevalence of physical or mental health complaints, though GBS patients were more likely to have an ODSS of ≥ 1 (OR 8.8, 95% CI 3.2-24.5) and to suffer from moderate / moderate-severe depression (OR 3.89, 95% CI 1.23-11.17) than the comparison group. CONCLUSIONS: Long-term outcomes of Zika virus-associated GBS are consistent with those associated with other antecedent antigenic stimuli in terms of mortality and ongoing long-term morbidity, as published in the literature. Persons with Zika virus-associated GBS more frequently reported disability and depression after approximately one year compared with those without GBS.

Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999-2008.

OBJECTIVE: To describe fetal and neonatal mortality due to congenital anomalies in Colombia. METHODS: We analyzed all fetal and neonatal deaths due to a congenital anomaly registered with the Colombian vital statistics system during 1999-2008. RESULTS: The registry included 213,293 fetal deaths and 7,216,727 live births. Of the live births, 77,738 (1.08%) resulted in neonatal deaths. Congenital anomalies were responsible for 7321 fetal deaths (3.4% of all fetal deaths) and 15,040 neonatal deaths (19.3% of all neonatal deaths). The fetal mortality rate due to congenital anomalies was 9.9 per 10,000 live births and fetal deaths; the neonatal mortality rate due to congenital anomalies was 20.8 per 10,000 live births. Mortality rates due to congenital anomalies remained relatively stable during the study period. The most frequent fatal congenital anomalies were congenital heart defects (32.0%), central nervous system anomalies (15.8%), and chromosomal anomalies (8.0%). Risk factors for fetal and neonatal death included: male or undetermined sex, living in villages or rural areas, mother's age >35 years, low and very low birthweight, and <28 weeks gestation at birth. CONCLUSIONS: Congenital anomalies are an important cause of fetal and neonatal deaths in Colombia, but many of the anomalies may be preventable or treatable.

Supervivencia de receptores de trasplante renal en Colombia, 2008-2012 / Survival in renal transplant recipients in Colombia, 2008-2012

Resumen Introducción. La Red Nacional de Donación y Trasplantes del Instituto Nacional de Salud reportó que durante 2014 se realizaron en Colombia 1.059 trasplantes de órganos, de los cuales 761 fueron de riñón y, de estos, 643 (84,5 %) correspondieron a órganos provenientes de cadáveres. Objetivo. Describir las características sociodemográficas de los pacientes con trasplante renal y los resultados en términos de supervivencia. Materiales y métodos. Se hizo un estudio observacional y retrospectivo de cohorte mediante el análisis de la base nacional de datos de receptores de trasplante renal. Se estimó la supervivencia global con el método de Kaplan-Meier, se compararon las curvas según sexo, edad, tipo de donante, tipo de régimen de afiliación al sistema de salud y tiempo en lista de espera mediante la prueba de hipótesis de Mantel-Cox (log rank) y una regresión de Cox. Resultados. De los 3.980 pacientes incluidos en el estudio, 338 fallecieron según el Registro Único de Afiliados. Con una mediana de seguimiento de 49 meses, la supervivencia global fue de 6,35 años (IC95% 6,30-6,40), la supervivencia al año del trasplante fue de 97,2 %, a los tres años, de 93,2 %, y a los cinco años, de 90,8 %. La supervivencia fue mayor en los pacientes menores de 50 años receptores de trasplante con donante vivo y con menos de seis meses en lista de espera. Conclusiones. Los resultados reflejaron el panorama de los pacientes con trasplante renal en el país en términos de supervivencia, lo cual sirve de base para estudios prospectivos con seguimiento estricto.

Abstract Introduction: The Red Nacional de Donación y Trasplantes of the Colombian Instituto Nacional de Salud reported that in 2014, 1,059 organ transplants were performed, of which 761 were kidney transplants, and 643 (84.5%) of these were from cadaveric organ donors. Objective: To describe the socio-demographic characteristics of patients who received renal transplants, as well as their outcomes in terms of survival. Materials and methods: National kidney transplants were analyzed through an observational retrospective cohort study. Overall survival was estimated using the Kaplan-Meier method. The survival curves by sex, age, type of donor, type of insurance, and time on the waiting list were compared utilizing the log rank hypothesis and a Cox regression. Results: A total of 3,980 patients were included, of whom 338 died according to the Registry of Affiliates. The median follow-up time was 49 months, overall survival was 6.35 years (95% CI: 6.30 to 6.40), the one-year survival following transplantation was 97.2%, the three-year survival, 93.2%, and the five-year survival, 90.8%. The survival rate was higher in patients under 50 years of age, receptors of living donor transplants, and with less than six months on the waiting list. Conclusions: The results obtained serve as the basis for future studies with strict monitoring of survival among kidney transplant recipients in Colombia.

[Survival in renal transplant recipients in Colombia, 2008-2012].

INTRODUCTION: The Red Nacional de Donación y Trasplantes of the Colombian Instituto Nacional de Salud reported that in 2014, 1,059 organ transplants were performed, of which 761 were kidney transplants, and 643 (84.5%) of these were from cadaveric organ donors. OBJECTIVE: To describe the socio-demographic characteristics of patients who received renal transplants, as well as their outcomes in terms of survival. MATERIALS AND METHODS: National kidney transplants were analyzed through an observational retrospective cohort study. Overall survival was estimated using the Kaplan-Meier method. The survival curves by sex, age, type of donor, type of insurance, and time on the waiting list were compared utilizing the log rank hypothesis and a Cox regression. RESULTS: A total of 3,980 patients were included, of whom 338 died according to the Registry of Affiliates. The median follow-up time was 49 months, overall survival was 6.35 years (95% CI: 6.30 to 6.40), the one-year survival following transplantation was 97.2%, the three-year survival, 93.2%, and the five-year survival, 90.8%. The survival rate was higher in patients under 50 years of age, receptors of living donor transplants, and with less than six months on the waiting list. CONCLUSIONS: The results obtained serve as the basis for future studies with strict monitoring of survival among kidney transplant recipients in Colombia.

Mortalidad en menores de cinco años debida a lesiones causadas por el tránsito, Colombia, 2005-2009 / Road traffic deaths in children under the age of five in Colombia, 2005-2009

Introducción. En los últimos años las muertes relacionadas con accidentes de tránsito han aumentado a nivel mundial; durante 2007, la tasa de mortalidad en Colombia fue de 11,7 por 100.000. Objetivo. Describir la tendencia de las muertes causadas por tránsito en niños menores de cinco años para brindar información de soporte a las acciones de prevención, control e intervención. Materiales y métodos. Se hizo un estudio transversal descriptivo de las muertes en niños menores de cinco años registradas en las estadísticas vitales del 2005 al 2009 bajo las causas correspondientes a los códigos V000 al V999 de la Clasificación Internacional de Enfermedades, décima versión. Se hizo un análisis descriptivo, se calcularon las tasas con proyecciones del Departamento Administrativo Nacional de Estadística (DANE), y se establecieron los niveles de riesgo por departamentos y municipios (percentiles) y por conglomerados. Se utilizaron los programas Excel ® , PASW statistics18 ® y EpiInfo ® , para levantar los mapas. Resultados. Se presentaron 713 muertes por lesiones debidas a accidentes de tránsito (0,8 % de ellas en el grupo de edad del estudio); el promedio anual fue de 142,6 (pasó de 159 en 2005 a 136 en 2009). La tasa nacional fue de 3,3 por 100.000, siendo mayor en niños entre uno y cuatro años de edad (3,5 por 100.000) que en el grupo de menores de un año (2,6). La mayor proporción de eventos ocurrió en enero (9,7 %) y julio (10,6 %) y durante los fines de semana (16 %), y fue más elevada en niños. Los departamentos de Meta, Boyacá, Arauca, Norte de Santander y Cundinamarca superaron la tasa nacional. De los 292 conglomerados establecidos (26 % de los municipios), se mantuvieron estables Armenia, Bogotá, Buenaventura, Cúcuta, Medellín, Pereira, San Andrés de Tumaco, Tunja y Villavicencio. Conclusiones. Los niños fueron el grupo más afectado, y los casos aumentaron en épocas en que no estaban en la escuela, tendencia que se acentuó en zonas turísticas y comerciales.

Introduction : Road traffic deaths have increased during the past years worldwide. During 2007, the mortality due to road traffic accidents in children under the age of five was 11.7 per 100,000 in Colombia. Objective: To describe the trend of road traffic deaths in children under the age of five in Colombia from 2005 to 2009. Materials and methods: We conducted a cross - sectional study of death certificates in children under the age of five as registered in the official vital statistics records from 2005 to 2009 (ICD-10, codes V000-V999). We made a descriptive analysis, calculated mortality rates based on projections by the National Administrative Statistics Department and we established risk levels by provinces and municipalities (percentiles), as well as by conglomerates using Excel ® , PASW statistics18 ® and EpiInfo ® for the maps. Results: All in all, 713 road traffic deaths occurred from 2005 to 2009 in children under the age of five corresponding to 0.8% of total deaths in that age group. The total number of road traffic deaths decreased from 2005 (159 deaths) to 2009 (136 deaths). The mean national death rate due to road traffic accidents was 3.3 per 100,000 with a higher rate among one to four year-old children (3.5/100,000) compared to children under the age of one (2.6/100,000). The highest prevalence of road traffic deaths was observed in January (9.7%) and July (10.6%). The provinces with the highest road traffic death rate were Meta, Boyacá, Arauca, Norte de Santander and Cundinamarca. Conclusions: Children were the group mostly affected by the event, which increased during school holidays and was more pronounced in tourist and commercial areas.

[Road traffic deaths in children under the age of five in Colombia, 2005-2009]. / Mortalidad en menores de cinco años debida a lesiones causadas por el tránsito, Colombia, 2005-2009.

INTRODUCTION: Road traffic deaths have increased during the past years worldwide. During 2007, the mortality due to road traffic accidents in children under the age of five was 11.7 per 100,000 in Colombia. OBJECTIVE: To describe the trend of road traffic deaths in children under the age of five in Colombia from 2005 to 2009. MATERIALS AND METHODS: We conducted a cross - sectional study of death certificates in children under the age of five as registered in the official vital statistics records from 2005 to 2009 (ICD-10, codes V000-V999). We made a descriptive analysis, calculated mortality rates based on projections by the National Administrative Statistics Department and we established risk levels by provinces and municipalities (percentiles), as well as by conglomerates using Excel ® , PASW statistics18 ® and EpiInfo ® for the maps. RESULTS: All in all, 713 road traffic deaths occurred from 2005 to 2009 in children under the age of five corresponding to 0.8% of total deaths in that age group. The total number of road traffic deaths decreased from 2005 (159 deaths) to 2009 (136 deaths). The mean national death rate due to road traffic accidents was 3.3 per 100,000 with a higher rate among one to four year-old children (3.5/100,000) compared to children under the age of one (2.6/100,000). The highest prevalence of road traffic deaths was observed in January (9.7%) and July (10.6%). The provinces with the highest road traffic death rate were Meta, Boyacá, Arauca, Norte de Santander and Cundinamarca. CONCLUSIONS: Children were the group mostly affected by the event, which increased during school holidays and was more pronounced in tourist and commercial areas.

Factores relacionados con neumonía asociada a ventilación mecánica en una unidad de cuidados intensivos de la Orinoquia colombiana / Factors related with ventilator-associated pneumonia in an intensive care unit of the colombian Orinoco river region

La neumonía asociada a ventilación mecánica es la infección nosocomial que se desarrolla después de 48 horas de estar intubado y sometido a ventilación mecánica. Se identificaron los factores asociados con neumonía asociada a ventilación mecánica en el ingreso a la unidad de cuidado intensivo, en el periodo de junio de 2007 a junio de 2008. Se diseñó un estudio de casos y controles a partir de la revisión de historias clínicas, del registro diario de vía aérea artificial y ventilación mecánica. Se creó una base de datos en Excel, seleccionando 32 casos y 64 controles mediante apareamiento por fecha de intubación orotraqueal.Las variables con valores de p entre 0,001 y 0,200 fueron seleccionadas para el análisis de regresión logística, encontrando relación con el ingreso en la noche AOR= 6,02 por ciento 1,76-20,57), intubación en urgencias AOR= 3,79 (IC95 por ciento 1,11-12,99), más de una intubación AOR= 5,81 (IC95 por ciento 1,36-24,91) y transporte fuera de la UCI AOR= 5,13 (IC95 por ciento 1,72-15,26). Los resultados permitirán desarrollar medidas para la prevención del evento, el uso adecuado de los recursos asistenciales, el seguimiento y la evaluación en el cumplimiento de las guías de manejo en la unidad, así como la reducción de los costos y la estancia hospitalaria.

Syphilis infection among female sex workers in Colombia.

OBJECTIVE: To study the epidemiology of Treponema pallidum (syphilis) among female sex workers (FSW) in Santa Fe de Bogotá, Colombia. DESIGN: A cross-sectional study was conducted. Participants were interviewed using a standardized questionnaire, which collected socio-demographic characteristics and risk behavior information. Blood samples were screened for syphilis using the VDRL test and the MHATP assay. RESULTS: The prevalence of syphilis was 10.3% (53/514). Adjusted risk factors significantly associated with syphilis were: age (linear increase), education (primary or no education), monthly income (or=4 years), number of clients per week (>or=22), main workplace (street), inconsistent (never) condom use in sex work, previous STI history, and use of illegal drugs. CONCLUSIONS: Effective health education programs for improving the level of knowledge of STI and the promotion of consistent condom use activities along with other appropriate harm reduction activities are urgently required among FSW in Colombia.

Reducción de la transmisión madre hijo del VIH en Colombia: dos años de experiencia nacional, 2003-2005 / Reduction of VIH mother-to-child transmission in Colombia, two years of experience, 2003-2005

Introducción. Desde el 2003, en Colombia se desarrolla el Proyecto Nacional de Reducción de la Transmisión Madre Hijo de VIH, cuyo objetivo es prevenir la transmisión vertical de VIH mediante la incorporación de la prueba voluntaria de VIH durante el control prenatal, el tratamiento y la profilaxis antirretroviral en la gestante infectada y el niño expuesto, el parto por cesárea y la sustitución de la leche materna. Objetivo. Describir los resultados de la implementación de la estrategia de prevención de la transmisión madre hijo 2003-2005. Materiales y métodos. Se hizo el estudio descriptivo de la cobertura alcanzada, la probabilidad de transmisión vertical y los factores asociados y prevalencias registradas en cada departamento. Se exploró la probabilidad de transmisión según tratamiento y se identificaron las diferencias por regiones. Resultados. El proyecto se implementó en 757 municipios (68 por ciento), en los cuales se realizó la prueba de VIH a 200.853 gestantes, y se detectaron 377 infectadas (0,19 por ciento en la región Caribe, en Quindío y en Santander. Se completó el seguimiento a 285 mujeres y sus hijos, y se registraron 12 casos en niños. La probabilidad de transmisión con el suministro oportuno del protocolo (n=170) fue de 1,78 por ciento(IC95 por ciento: 0,37 a 5,13 por ciento). Los factores relacionados con la transmisión fueron: carga viral inicial mayor de 10.000/mm3, ausencia de control prenatal y captación tardía en el embarazo. No se encontraron diferencias estadísticas entre los esquemas antirretrovirales utilizados. La región Caribe tuvo menor cobertura del control prenatal py mayor captación tardía. Conclusiones. La reducción de la transmisión madre hijo de VIH es una intervención preventiva eficaz que favorece el fortalecimiento de los servicios de control prenatal. El sostenimiento de la estrategia con cobertura nacional debe ser una meta de los gobiernos nacional y regionales y de las entidades aseguradoras

Una respuesta de la Facultad de Medicina ante la problemática infantil / A Response from a Medical School to the Children's Problematic

El quehacer del profesional de la medicina ha evolucionado de tal manera que progresiva-mente se ha ido incorporando a otros campos del conocimiento y a otros desempeños, entre ellos la investigación comunitaria, el desarrollo de programas para la promoción de la salud y prevención de la enfermedad, la administración pública, el desarrollo sostenible y la construcción de políticas públicas. Ese desempeño, sumado a su labor como clínico, se enmarca en la situación actual del país con crisis gubernamental, institucional y social; con descenso ostensible de la calidad de vida, a pesar del aumento en su cantidad (esperanza de vida), y ensanchamiento de la brecha de pobreza y de las iniquidades; con debilitamiento de la familia; con generalización del conflicto arma-do; con persistencia de otras formas de violencia; con dificultades en el acceso a los servicios, y con enfermedades endémicas y emergentes.

The work of the medical professional has evolved in such a way that he/she has been progressively incorporated into other fields of knowledge and other activities, including community research, development of programs for health promotion and disease prevention, public administration, sustainable development and the construction of public policies. This performance, added to his work as a clinician, is framed in the current situation of the country with governmental, institutional and social crisis; with ostensible decrease in the quality of life, despite the increase in its quantity (life expectancy), and widening of the poverty gap and iniquities; with weakening of the family; with generalization of armed conflict; with persistence of other forms of violence; with difficulties in access to services, and with endemic and emerging diseases

Manejo de la infección materna con VIH y del recién nacido expuesto / Managing HIV during pregnancy and in exposed newborn children

El VIH/SIDA afecta cada vez más a las mujeres, lo que aumenta la posiblidad de transmisión perinatal. La detección temprana del VIH mediante el acceso a la consejería y prueba voluntaria durante el control prenatal facilitan el tratamiento anti-retroviral oportuno que disminuye la transmisión durante el embarazo y el parto, y en el puerperio, asociado a la lactancia materna. En la presente revisión se condensan los principales aspectos del manejo de la infección materna con VIH y del recién nacido expuesto. La aplicación de un protocolo integral de atención facilita la disminución de la transmisión a niveles menores de 2 por ciento.

[Reduction of HIV mother-to-child transmission in Colombia, two years of experience, 2003-2005]. / Reducción de la transmisión madre hijo del VIH en Colombia: dos años de experiencia nacional, 2003-2005.

INTRODUCTION: A national initiative on reduction of HIV mother-to-child-transmission is being implemented since 2003 in Colombia, including HIV counseled and voluntary testing as part of the routine antenatal care, comprehensive care with ARV treatment to HIV-positive pregnant women and their infected children, caesarian delivery, and replacement of breast milk. OBJECTIVE: To describe the achievements in the implementation of the prevention strategy of mother-to-child HIV transmission, 2003-2005. MATERIALS AND METHODS: The implementation procedures of the Project are described, as well as the coverage percentages achieved, the prevention of vertical transmission and its associated factors, and the six-month prevalence by geographical departments. The probability of transmission adjusted to the ARV treatment offered and the differences by regions are also analyzed. RESULTS: The Project was implemented in 757 municipalities (68%); diagnostic tests were performed to 200,853 pregnant women, 377 of whom were diagnosed as HIV positive (0.19%), with higher prevalences in the Caribbean region, and in the Departments of Quindio and Santander. Complete six-month follow-up after delivery was provided to 285 women and their neonates (12 of whom were HIV-positive). The probability of transmission with the use of ARV schemes during pregnancy (n=170) was 1.78% (IC 95%: 0.37-5.13%). Factors related to probability of transmission were: initial viral load > 10,000/mm3, absence of antenatal care, and late recruitment of pregnant women. No statistical differences were found between the ARV schemes used. In the Caribbean region, antenatal care was lower, and late recruitment of pregnant women was higher. CONCLUSIONS: Reduction of HIV mother-to-child-transmission is an effective preventive intervention, which also strengthens the quality of antenatal care services. Sustainability of this initiative, with nationwide coverage, must be a target for national and regional public health authorities, and for health care providers.

Caracterización de los trastornos hipertensivos del embarazo / Characterising hypertensive disorders during pregnancy in Villavicencio, Colombia

Objetivo: describir la incidencia de los trastornos hipertensivos del embarazo en Villavicencio (Colombia) y las características que pueden relacionarse con la hospitalización materna y las complicaciones. Materiales y métodos: registro prospectivo de embarazadas hipertensas, mediante búsqueda activa. se registraron las características sociodemográficas, clínicas y de tratamiento; los datos son comparados con información institucional de la población de embarazadas atendidas en el periodo de estudio. Las participantes del grupo de hipertensas fueron clasificadas con base en la ausencia o presencia de complicaciones y hospitalización materna. Se hizo comparación de los grupos mediante análisis univariado y regresión logística múltiple. Resultados: la incidencia de trastornos hipertensivos del embarazo fue de 5,2 (IC95 por ciento: 4,2 - 6,3 por ciento). La edad y el número de gestaciones entre las hipertensas y la población total de embarazadas, no mostraron diferencias. Se encontraron mayores porcentajes de parto pretérmino, parto intervenido y peso inferior a 2.500 gr en el grupo de hipertensas. El 53,2 por ciento de los casos se clasificaron como complicados, el 15,4 por ciento de ellos no recibió un tratamiento específico. Se encontró asociación entre más de 4 días de hospitalización materna con proteinuria grave y epigastralgia. El parto pretérmino y la proteinuria leve fueron predictores de complicaciones. La epigastralgia fue pronóstico para complicación con una razón de probabilidades positiva de 2,29 y negativa de 0,51, índice de Youden de 0,53. Conclusiones: la hipertensión en el embarazo posee alto impacto en la salud materna y perinatal. Se sugiere fortalecer las medidas de prevención, diagnóstico y los recursos para tratamiento.