Molecular characterization and descriptive analysis of carbapenemase-producing Gram-negative rod infections in Bogota, Colombia.

In this study, the genetic differences and clinical impact of the carbapenemase-encoding genes among the community and healthcare-acquired infections were assessed. This retrospective, multicenter cohort study was conducted in Colombia and included patients infected with carbapenem-resistant Gram-negative rods between 2017 and 2021. Carbapenem resistance was identified by Vitek, and carbapenemase-encoding genes were identified by whole-genome sequencing (WGS) to classify the alleles and sequence types (STs). Descriptive statistics were used to determine the association of any pathogen or gene with clinical outcomes. A total of 248 patients were included, of which only 0.8% (2/248) had community-acquired infections. Regarding the identified bacteria, the most prevalent pathogens were Pseudomonas aeruginosa and Klebsiella pneumoniae. In the WGS analysis, 228 isolates passed all the quality criteria and were analyzed. The principal carbapenemase-encoding gene was blaKPC, specifically blaKPC-2 [38.6% (88/228)] and blaKPC-3 [36.4% (83/228)]. These were frequently detected in co-concurrence with blaVIM-2 and blaNDM-1 in healthcare-acquired infections. Notably, the only identified allele among community-acquired infections was blaKPC-3 [50.0% (1/2)]. In reference to the STs, 78 were identified, of which Pseudomonas aeruginosa ST111 was mainly related to blaKPC-3. Klebsiella pneumoniae ST512, ST258, ST14, and ST1082 were exclusively associated with blaKPC-3. Finally, no particular carbapenemase-encoding gene was associated with worse clinical outcomes. The most identified genes in carbapenemase-producing Gram-negative rods were blaKPC-2 and blaKPC-3, both related to gene co-occurrence and diverse STs in the healthcare environment. Patients had several systemic complications and poor clinical outcomes that were not associated with a particular gene.IMPORTANCEAntimicrobial resistance is a pandemic and a worldwide public health problem, especially carbapenem resistance in low- and middle-income countries. Limited data regarding the molecular characteristics and clinical outcomes of patients infected with these bacteria are available. Thus, our study described the carbapenemase-encoding genes among community- and healthcare-acquired infections. Notably, the co-occurrence of carbapenemase-encoding genes was frequently identified. We also found 78 distinct sequence types, of which two were novel Pseudomonas aeruginosa, which could represent challenges in treating these infections. Our study shows that in low and middle-income countries, such as Colombia, the burden of carbapenem resistance in Gram-negative rods is a concern for public health, and regardless of the allele, these infections are associated with poor clinical outcomes. Thus, studies assessing local epidemiology, prevention strategies (including trials), and underpinning genetic mechanisms are urgently needed, especially in low and middle-income countries.

Prevalencia de tuberculosis latente determinada mediante la prueba de derivado proteico purificado (PPD) en una población de pacientes adultos con artritis reumatoide llevados a terapia biotecnológica / Prevalence of latent tuberculosis determined using the Purified Protein Derivative (PPD) test in adult patients with rheumatoid arthritis receiving biotechnological therapy

RESUMEN Introducción: Colombia es un país endémico para tuberculosis (TB), con una prevalencia de 26 casos por millón. Sin embargo, no se cuenta con datos recientes y claros respecto a la prevalencia de tuberculosis latente (TBL) en la población con artritis reumatoide (AR) candidata a terapia biotecnológica. Metodología: Estudio de corte transversal con componente analítico para determinar la pre-valencia de TBL en pacientes con AR candidatos a terapia biotecnológica. Resultados: La prevalencia de TBL en pacientes con AR candidatos a terapia biotecnológica es alta, del 18,3% (IC 95% 14,7-21,9), y en los cruces exploratorios se encontró una relación entre TBL y la variable género masculino (p ≤ 0,001), hallazgos anormales en la radiografía de tórax (p = 0,039) y el tabaquismo (p = 0,028). Conclusión: La prevalencia de TBL en pacientes con AR candidatos a terapia biotecnológica es alta. Se requieren estudios prospectivos para evaluar la incidencia de TB en este grupo de pacientes y así corroborar su asociación.

ABSTRACT Introduction: Although tuberculosis (TB) is endemic in Columbia, with a prevalence of 26 cases per million, there are no recent and clear data regarding the prevalence of latent tuberculosis (LBT) in the population with rheumatoid arthritis (RA), candidates for biotechnological therapy. Methodology: A cross-sectional study with an analytical component to determine the prevalence of LBT in patients with RA who are candidates for biotechnological therapy. Results: The prevalence of LTB in RA patients who are candidates for biotechnological therapy is high, 18.3% (95% CI: 14.7-21.9). In the exploratory analysis, a relationship between LBT and male gender was found (P ≤ .001), as well as abnormal findings on chest radiography (P = .039), and smoking (P = .028). Conclusion: The prevalence of LTB in patients with RA who are candidates for biotechnological therapy is high. Prospective studies are needed to evaluate the incidence of TB in this group of patients and corroborate this association.

Indigenous Territoriality: External Discourses and Native Perspectives on the Space Inhabited by Tegria's U'wa Community / Territorialidad Indígena: Discursos externos y perspectivas propias del espacio habitado por la comunidad U'wa de Tegría

ABSTRACT Tegria's community is part of the U'wa indigenous people, who have inhabited the eastern slope of the Sierra Nevada del Cocuy since the pre-Hispanic period, in the jurisdiction of the current municipality of Cubara in Boyaca (Colombia). However, this region known as Sarare has been described from anthropological, ethnohistorical, linguistical, and to a lesser extent, geographical approaches, which have generated representations of territory that ignore the historical process of indigenous people. To account for the present territoriality, it was proposed to contrast these external discourses with the community's visions on its history of occupation and the transformations of the inhabited space, compiled through participatory methodologies that sought the collaborative construction of knowledge based on joint recognition of the place, the participant observation and the constant dialogue between indigenous and researchers. In this way, it was established that the external discourses show a territory that does not correspond to the processes of appropriation, adaptation, and reconfiguration of the space that the U'wa indigenous community has lived through and are evident in everyday settings such as the cultivation plot and the school. Therefore, it is only possible to recognize indigenous territoriality by exploring other alternatives, expressions, and perspectives that involve directly the communities and are not external to the context of the inquiry itself.

RESUMEN La comunidad de Tegría hace parte del pueblo indígena U'wa, que ha habitado desde el periodo prehispánico la ladera este de la Sierra Nevada del Cocuy, en jurisdicción del actual municipio de Cubará en el departamento de Boyacá. Colombia. Esta región, conocida como el Sarare, ha sido descrita desde enfoques antropológicos, etnohistóricos, lingüísticos y, en menor medida, geográficos, que han generado representaciones del territorio que desconocen el proceso histórico del habitar indígena. Para dar cuenta de la territorialidad presente, se contrastaron estos discursos externos con las perspectivas propias de la comunidad sobre su historia de ocupación y las transformaciones del espacio habitado, recopiladas a través de metodologías participativas que buscaron la construcción colaborativa de conocimiento a partir de la observación participante y un constante diálogo de saberes. De esta forma, se estableció que los discursos externos muestran un territorio que no se corresponde con los procesos de apropiación, adaptación y reconfiguración del espacio que la comunidad indígena U'wa ha vivido y son evidentes en escenarios cotidianos como la chagra -área destinada para cultivos rotativos- y la escuela, por lo que solo es posible reconocer la territorialidad indígena mediante la exploración de otras alternativas, lenguajes y perspectivas que involucren directamente a las comunidades y no resulten ajenas ni extrañas al propio contexto de indagación.

Cost-utility analysis of an integrated care program for children with asthma in a medium-income country.

OBJECTIVE: To evaluate the cost-utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care. METHODS: A decision-analytic model was used to compare an integrated care program compared to the standard of care in children with asthma in Bogota, Colombia. Baseline characteristics of the patients were established according to the distribution of patients in the PAI database. Other inputs were obtained from published meta-analysis, local registries, medical bills, general mortality data, and expert opinion. Costs were presented in 2017 Colombian pesos. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 5% per year. Incremental cost-utility ratios were presented for PAI compared with standard of care. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty. RESULTS: The model predicted that patients that are part of the PAI would accrue more QALYs than patients on standard of care. The incremental results suggest that the PAI is a cost-effective treatment (incremental cost-utility ratio of Colombian pesos $33 753 817/QALY) compared with standard of care. Sensitivity analyses suggest that results are most sensitive to cost of care (with and without PAI) and costs of severe exacerbation. However, the PAI is cost-effective irrespective of variation in any of the input parameters. CONCLUSION: Our model predicted that an integrated intervention for the management of asthma in pediatric patients improves QALYs, reduces number of disease related exacerbations compared to standard therapy and is cost-effective for the long-term control of the disease in Colombia.

Pressures on La Lindosa, Guaviare: Land-Cover Change and Incidence of Fires Between 2012 and 2018 / Presiones ejercidas sobre la serranía de la lindosa, guaviare: cambios de cobertura e incidencia de fuegos entre 2012 y 2018

RESUMEN El cambio en el uso del suelo y el fuego como mecanismo utilizado para el mismo han creado perturbaciones ecológicas a grandes escalas, como lo son la fragmentación y aislamiento de ecosistemas importantes en paisajes tropicales. En el presente estudio, analizamos los cambios de uso del suelo entre los años 2012-2016 y los eventos de fuego entre los años 2016-2018, para identificar la dinámica de cambio espaciotemporal en la Serranía de la Lindosa, Guaviare, a partir de información oficial y sensores remotos. Para 2016 la cobertura boscosa se redujo en un 17 % correspondiendo con el aumento de vegetación secundaria y pastizales en el área. Los focos de fuego detectados estuvieron concentrados en el noroeste y sureste de la serranía, puntos coincidentes en zonas de bosque primario y zonas de pastizal consolidadas. Estos resultados indican que existe un proceso activo de deforestación en la serranía, que fragmenta la matriz boscosa dejando parches de bosque aislados, lo cual tendría repercusiones sobre la biodiversidad allí presente. Asimismo, la sinergia entre dicho proceso y el uso de fuego se muestra como amenaza constante, a diferentes escalas, sobre los diferentes ecosistemas. Esta información se presenta como herramienta para elaborar estrategias puntuales para evitar mayores repercusiones negativas sobre la serranía, que actualmente se encuentra en estado vulnerable.

ABSTRACT The change in land use and fire as a mechanism used for this change, have created ecological disturbances at large scales, such as the fragmentation and isolation of essential ecosystems within tropical landscapes. In the present study, we analyze the land-use changes along 2012-2016 and fire events between 2016-2018, to identify the dynamics of spatial-temporal change in the Serranía La Lindosa, Guaviare using official information and remote sensors. Forest cover was reduced by 17 %, during 2012-2016, corresponding to an increase in secondary vegetation and pastures in the area. The fire-hotspots detected were concentrated on the northwest and southeast of the mountain range, coinciding with areas of primary forest and consolidated pasture areas. These results show that there is an active process of deforestation in La Lindosa, leaving a fragmented matrix and isolated forest patches, which would have repercussions on the local biodiversity. Besides, the synergy between this process and the use of fire, represent a constant threat, at different scales, on the different ecosystems. This information is presented as a resource to elaborate punctual strategies in order to avoid greater negative repercussions on the mountain range area, which is currently in a vulnerable state.

Keystone Flap: Overcoming Paradigms.

BACKGROUND: The physiology and geometry of the keystone flap (KF) are the main factors that support its development. This study reports our experience using the KF and proposes the concept of pedicular area. METHODS: A prospective cohort study was conducted from October 2014 to December 2016, in which 112 KF procedures were performed with an average follow-up time of 10 months. The conclusions drawn from clinical observations were compared with the findings of a literature review. RESULTS: One hundred twelve flaps were performed in 89 patients (45 men and 44 women) with an average age of 64 years (range, 3-89 years). The flap survival rate was 100%. The term pedicular area (PA) was coined to describe a flap segment that remains attached to its bed without vascular detriment and whose location can be randomly selected. In this study, the PA could be reduced up to a 10%, which means that over 90% of each flap was dissected without any harm. CONCLUSIONS: The KF is a safe, cost-effective technique with better results when compared with other reconstructive procedures. Although research is still needed to better understand the physiological adaptations of KF, the clinical evidence supports its use in many reconstructive scenarios.

High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country.

BACKGROUND: Some studies, mainly in Europe, have shown a low level of sensitization to house dust mite (HDM) allergens at high altitude (HA). Differently, some others in tropical countries have shown a higher level. The aim of this study was to evaluate allergens sensitization, including HDM, in children with severe asthma (SA), residents at HA in a tropical middle-income developing country. METHODS: Observational, analytical, cross-sectional study in children aged 6-15 years old with SA at HA (2640 m). Skin prick tests (SPT), serum IgE, exhaled fraction of nitric oxide (FENO ), spirometry, and asthma questionnaire (ACT) were performed. Associations were explored by Pearson or Spearman coefficients. RESULTS: We included 61 children. Most patients were male (61.3%), median age: 10 years (Interquartile range [IQR]: 8-12), median BMI: 17 kg/m2 (IQR: 16-20); Median of positive SPT: 2 (IQR: 2-3). At least one SPT was positive in 88.7% of patients and 87.9% were positive for at least one HDM. Serum IgE: 348 UI/mL (IQR: 154-760) and FENO : 22 ppb (IQR: 9-41). Prebronchodilator values were (% predicted): FVC: 109.7% (±15.5%), FEV1 : 98.4% (±16.3); FEV1 /FVC: 82% (±8%). SPT were inversely correlated with the FEV1 /FVC (Rho: -0.34; 95% CI: -0.55 a -0.09; P = 0.008). CONCLUSIONS: These children with SA living at HA in a tropical middle-income developing country have a high prevalence of HDM sensitization. One explanation for this might be that tropical conditions, such as temperature and humidity, could modify the effect of the altitude on asthma.

Pierre Robin Sequence: An Evidence-Based Treatment Proposal.

BACKGROUND: The Pierre Robin sequence (PRS) has been defined as the presence of micrognathia, glossoptosis, and respiratory obstruction in the neonatal period. Since its original description, different therapeutic approaches have been proposed obtaining different success rates, but there is no consensus about its management. METHODS: A literature review was conducted in PubMed, Embase, and Cochrane databases, for the period of January,1985 to November, 2016. A number of 23 articles resulting from clinical studies, discussing diagnostic tests or therapeutic approaches, and directly or indirectly comparing diagnostic or treatment modalities were selected and assessed using the GRADE methodology. RESULTS: After reviewing and analyzing the selected articles, an evidence-based algorithm for diagnosis and integral management of PRS patients was designed. CONCLUSION: Based on the anatomical principles and natural evolution of PRS, the clinical scenario must be evaluated thoroughly as a dynamic event to develop a management sequence that minimizes morbidity and mortality and accelerates patients' reinsertion to normal life.

Caminata de seis minutos: propuesta de estandarización del protocolo y aplicación práctica para la evaluación de la hipertensión pulmonar con especial referencia a la de los niños / Six-minute walk test: protocol and practical application for the evaluation of pulmonary hypertension, with special reference to children

Objetivo: La práctica clínica diaria exige una valoración objetiva, confiable y sencilla del paciente. En particular, en las patologías que afectan el rendimiento y la actividad física, como es el caso de la hipertensión pulmonar, es necesario conocer la repercusión que estas enfermedades tienen sobre este aspecto, básico de la vida del paciente, es decir cómo se afecta su tolerancia al ejercicio, y conocer cuál es la respuesta funcional del individuo frente a las intervenciones médicas. Metodología: La caminata de seis minutos fue concebida como una prueba que, aunque no conlleva un esfuerzo grande para el paciente, puede cuantificar de manera bastante precisa la capacidad de tolerancia a la actividad física y sus variaciones en relación con las intervenciones terapéuticas realizadas y respecto a la propia evolución de la enfermedad. Resultados: Una ventaja logística de la prueba es que no requiere equipos costosos, el espacio físico que se necesita es fácil de adecuar, el personal que la lleva a cabo precisa entrenamiento básico, y su interpretación es sencilla y se obtienen resultados muy confiables. Todo lo anterior, sumado a que puede repetirse con facilidad y es económica, la convierten en una prueba altamente recomendable para la evaluación y el seguimiento de pacientes pediátricos con patología cardiovascular, ya que es posible practicarla desde edades tempranas, con colaboración mínima por parte del niño evaluado. Conclusión: En cuanto a la hipertensión pulmonar en la edad pediátrica, es imprescindible medir de manera objetiva, sencilla y confiable la evolución del paciente, dadas las pocas opciones posibles en lo que concierne a las peculiaridades fisiológicas de los niños. De ahí que esta prueba puede constituir un punto de apoyo importante para la toma de decisiones y la evaluación del impacto de las intervenciones terapéuticas, tanto en el estado general como en la salud cardiovascular del paciente.

Objective: Clinical practice demands an objective, reliable and simple evaluation of our patients. Particularly in diseases that affect performance and physical activities, such as pulmonary hypertension, it is necessary to know the repercussions on a basic aspect in the life of the patient, that is, the tolerance to physical activity, and to know the functional response of patients to medical interventions. Methodology: Although it does not involve great effort for the patient, the Six-Minute Walk test can provide a quantification of the capacity of the tolerance to physical activity, the response to therapeutic interventions, and patient progress. Results: This test has logistical advantages, namely it does not require expensive devices, the physical area used is easy to prepare, the patients performing the test only need basic training and results are objective and of simple interpretation. The previous aspects and the fact that this test is easy to repeat, is inexpensive, and has no risk for the patient, makes it a highly recommended test for the evaluation and monitoring of paediatric patients with cardiovascular diseases, since it can be performed with young children because it requires minimal cooperation from them. Conclusion: In pulmonary hypertension in children it is important to evaluate in an objective, simple and reliable way how our patients evolve, taking into account that there are few possibilities to study the physiological peculiarities of children. This test is important for decision-making and for evaluating the impact of therapeutic interventions, both from the general condition as well as from the cardiovascular health of the patient.

Estudios moleculares en pacientes colombianos con Fibrosis quística

La fibrosis quística (FQ), la enfermedad autosómica recesiva más frecuente en poblaciones caucásicas, tiene una incidencia promedio de 1/2.500 recién nacidos