Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America.

This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government's decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

Prospective, comparative, pilot study of maintenance treatment in comorbid bipolar disorders with post-traumatic stress disorder.

There is limited real-world evidence that evaluates the impact of monotherapy vs. combination therapy as a maintenance treatment in comorbid post-traumatic stress disorder (PTSD) in bipolar disorder (BD). Our aim was to compare lithium vs. lithium plus quetiapine in maintenance treatment in a sample of comorbid BD with PTSD. An exploratory, comparative pilot study over a 28-week period in 34 comorbid BD with PTSD patients was performed to compare monotherapy (n = 18) vs. combination therapy (n = 16) during maintenance treatment. The primary outcome was the time to event of recurrence of any mood episode. The secondary outcomes were regarding change from the baseline to endpoint in the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). A Cox regression, Kaplan-Meir survival, and mixed-effects model for repeated measures analyses were performed. Lithium plus quetiapine reduces the risk of recurrence of any mood episode. There are significant differences between baseline and endpoint for YMRS, MADRS, and CGI-BP scales in the sample. In this pilot, exploratory analysis, combination therapy during maintenance treatment for comorbid BD with PTSD may be effective in preventing recurrences of any type of mood episode.

Dizziness in adults with chronic otitis media at two otology referral centres in Colombia: a cross-sectional study in a middle-income country.

OBJECTIVE: This study aimed to determine the prevalence of dizziness and its associated factors in patients with COM at two otologic referral centres in a middle-income country. DESIGN: Cross-sectional study. Adults with and without COM diagnosis from two otology-referral centres in Bogotá (Colombia) were included. Dizziness and quality of life were assessed using the "Chronic Suppurative Otitis Media Questionnaire-12" (COMQ-12), and sociodemographic questionnaires were applied. Otoscopic evaluation and audiometric data were collected. STUDY SAMPLE: A total of 231 adults. RESULTS: Of the 231 participants, up to 64.5% (n = 149) reported at least mild inconvenience due to dizziness. Factors associated with dizziness included female sex (aPR: 1.23; 95% CI: 1.04-1.46), chronic suppurative otitis media (aPR: 3.02; 95% CI: 1.21-7.52), and severe tinnitus (aPR: 1.75; 95% CI: 1.24-2.48). An interaction was found between socioeconomic status and educational level, with more frequent reports of dizziness in the middle/high economic status and secondary education (aPR: 3.09; 95% CI: 0.52-18.55; p < 0.001). Differences of 14 points in symptom severity and 18.5 points in the total score of the COMQ-12 were found between the groups with dizziness and without dizziness. CONCLUSIONS: Dizziness was frequent in patients with COM and was associated with severe tinnitus and quality of life deterioration.

Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America / Autopercepción de la salud mental, COVID-19 y factores sociodemográficos y contextuales asociados en Latinoamérica / Autopercepção da saúde mental, COVID-19 e fatores sociodemográficos e contextuais associados na América Latina

Abstract This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government's decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

Resumen Este estudio tuvo como objetivo estimar la prevalencia de alteraciones en la autopercepción de la salud mental durante la pandemia de COVID-19 y sus factores asociados en cuatro países de América Latina. Este es un estudio transversal de datos recopilados de adultos en el 2021 por medio de la investigación Respuesta Colaborativa a COVID-19 de la Academia McDonnell en la Universidad Washington en St. Louis (Estados Unidos). La muestra estuvo compuesta por 8.125 personas de Brasil, Colombia, México y Chile. El estudio utilizó un modelo lineal generalizado para una variable de desenlace binario con un enlace logístico y efectos fijos por país. En total, 2.336 (28,75%) personas consideraron que habían sufrido alteraciones en la autopercepción de la salud mental. Los desempleados (OR = 1,40; IC95%: 1,24-1,58), aquellos con calidad de vida mala/regular (OR = 5,03; IC95%: 4,01-6,31) y aquellos con alto nivel socioeconómico (OR = 1,66; IC95%: 1,41-1,96) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental que aquellos con empleo a tiempo completo, excelente calidad y bajo nivel socioeconómico. Según el modelo de efectos fijos, los brasileños que vivían en el país durante la pandemia y que no estuvieron de acuerdo con las decisiones del gobierno (OR = 2,05; IC95%: 1,74-2,42) y no confiaban en su gobierno (OR = 2,10; IC95%: 1,74-2,42) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental. Casi el 30% de los encuestados indicaron que la pandemia de COVID-19 alteró su autopercepción de la salud mental. Este desenlace se asoció con factores políticos, sociodemográficos y de riesgo a la salud. Estos hallazgos deben ayudar a los formuladores de políticas a desarrollar intervenciones comunitarias pospandémicas.

Resumo Este estudo teve como objetivo estimar a prevalência de alterações na autopercepção de saúde mental durante a pandemia de COVID-19 e seus fatores associados em quatro países da América Latina. Este é um estudo transversal de dados coletados de adultos em 2021 por meio da pesquisa Resposta Colaborativa à COVID-19 da Academia McDonnell na Universidade Washington em St. Louis (Estados Unidos). A amostra foi composta por 8.125 pessoas do Brasil, Colômbia, México e Chile. O estudo utilizou um modelo linear generalizado para uma variável de desfecho binário com uma conexão logística e efeitos fixos do país. No total, 2.336 (28,75%) pessoas consideraram ter sofrido alterações na autopercepção de saúde mental. Os desempregados (OR = 1,40; IC95%: 1,24-1,58), aqueles com qualidade de vida ruim/regular (OR = 5,03; IC95%: 4,01-6,31) e aqueles com alto nível socioeconômico (OR = 1,66; IC95%: 1,41-1,96) apresentaram maior risco de alterações na autopercepção de saúde mental do que aqueles com emprego em tempo integral, excelente qualidade e baixo nível socioeconômico. De acordo com o modelo de efeitos fixos, os brasileiros que viviam no país durante a pandemia, que discordavam das decisões do governo (OR = 2,05; IC95%: 1,74-2,42) e não confiavam em seu governo (OR = 2,10; IC95%: 1,74-2,42) apresentaram maior risco de alterações na autopercepção de saúde mental. Quase 30% dos entrevistados indicaram que a pandemia da COVID-19 alterou sua autopercepção de saúde mental. Esse desfecho estava associado a fatores políticos, sociodemográficos e de risco à saúde. Estes achados devem ajudar os formuladores de políticas a desenvolver intervenções comunitárias pós-pandemia.

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia.

Background and Aims: The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. Methods: This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. Results: Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. Conclusion: ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Factors associated with mental health outcomes after COVID-19: A 24-month follow-up longitudinal study.

OBJECTIVE: Investigate the proportion of mental health outcomes (MHOs) and associated factors in COVID-19 survivors during a 24-month follow-up period. METHOD: An observational, prospective study was performed in a teaching hospital in Barranquilla, Colombia, from April 1, 2020, to August 30, 2022. A cohort of 1565 COVID-19 survivors was recruited after discharge from the emergency room (ER), inpatient floor (IF), and intensive care unit (ICU) services and followed for 24 -months. The clinical assessment included screening scales for symptoms of anxiety, depressive, post-traumatic stress disorder (PTSD), and insomnia. Sociodemographic and clinical factors were also collected to identify possible associated factors. Descriptive, bivariate and mixed random-effect linear models were performed. RESULTS: A total of 1565 patients were included, of whom 785 (50.35%) were men. A large proportion of patients with mental symptoms were identified. After 24-months, the proportions of anxiety, depression, PTSD, and insomnia symptoms remained high at 16.55%, 21.79%, 35.27%, and 23.86%, respectively. Social factors, location of hospital stays, physical comorbidities, and the severity of COVID-19 were significantly associated with anxiety, depression, PTSD, and insomnia symptoms. CONCLUSIONS: COVID-19's 2-year deleterious impacts on mental health, as well as the variables influencing these findings, have been documented. These results should aid in the development of public health initiatives to reduce morbidity rates in post-COVID-19 patients.

Factors associated with allergic rhinitis and combined allergic rhinitis and asthma syndrome (CARAS) in adults undergoing immunotherapy in a tropical country: Is ISAAC-III questionnaire useful in adult populations?

BACKGROUND: Allergic diseases affect about 10-30% of the population in low- or middle-income tropical countries. Few studies describe the factors associated with allergic diseases in adult patients undergoing immunotherapy in Latin American countries. OBJECTIVE: This study aimed to determine the factors associated with allergic rhinitis (AR) and AR in comorbidity with asthma (CARAS) in adults treated with immunotherapy in two allergy referral centers in Bogotá (Colombia). MATERIAL AND METHODS: Observational, cross-sectional study conducted between January 2018 and January 2019. ISAAC-III and sociodemographic questionnaires were applied to determine the factors associated with AR and CARAS in adults treated with immunotherapy who attended the allergy consult at the Fundación Santa Fe de Bogotá and Unimeq-Orl. RESULTS: Among 416 adults aged 18-68 years, 71.4% (n = 297) were women. Regarding the sensitization results obtained by skin prick test, the most frequent allergens were house dust mites (64.18%): 49.03% were positive for both Dermatophagoides pteronyssinus and Dermatophagoides farinae, while 28.61% were positive for Blomia tropicalis. Excluding house dust mites, the most frequent allergens were dog hair (31.01%), cat hair (15.1%), grasses (15.9%), and food (15.9%). The main factor associated with exclusive AR was regular acetaminophen use more than four times a year: Prevalence ratio (PR) = 1.77 (95% CI: 1.12-2.25). The main factor associated with CARAS was cesarean delivery PR: 1.44 (95% CI: 1.09-1.78). CONCLUSION: The main factor associated with AR was regular acetaminophen use, while that associated with CARAS was cesarean delivery. The ISAAC-III questionnaire can be a useful low-cost tool to assess the factors associated with allergic diseases in adults in tropical countries.

Audiological benefit, quality of life, and factors associated with functional gain in elderly hearing aid users in a developing country between 2017 and 2020: a pre-post-study.

BACKGROUND: Sensorineural hearing loss (SNHL) is the most common auditory deficit in older adults and may lead to quality-of-life deterioration. However, few studies have been performed in low/middle-income countries, particularly in Latin America. This study aimed to assess the audiological benefit, quality of life, and factors associated with functional gain in elderly hearing aid users in the Fundación Santa Fe de Bogotá and UNIMEQ-ORL, two otology referral centers in Colombia. DESIGN: Pre-post study that included hearing aid users at the otology consult of the Fundación Santa Fe de Bogotá and UNIMEQ-ORL between June 2017 and December 2020. Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaires were applied. Audiometric (0,5 kHz to 4 kHz) and speech audiometry results were collected. RESULTS: A total of 75 participants (132 ears) were included. The mean age was 70.73 years (SD: 12.66). The median hearing aid use in years was 0.71 (IQR: 0.64-0.90). Mean change in speech audiometry was - 26.53dB (95%CI: -28.09, -24.97; p < 0.001), in functional gain was - 21.75dB (-23.81, -19.68; p < 0.001). The mean changes in the APHAB domains were Ease of Communication: -37.85 (95%CI: -43.01; -32.7), Background Noise: -3.51 (-6.06; -0.95), and Aversiveness of Sounds: -6.9 (-2.04; 11.77). The GBI assessment of quality of life showed improvement in 100% of the population after the use of hearing aids. The number of years of hearing aids use was associated with functional gain. CONCLUSION: The number of years of hearing aids use may impact on the functional gain in these populations. A significant clinical benefit was found in terms of quality of life, communication, and reverberation related to the use of hearing aids. Access to hearing aids should be granted, and public health strategies are needed to grant the access to hearing rehabilitation in these populations. TRIAL REGISTRATION: Fundación Santa Fe de Bogotá (Protocol Number: CCEI-12666-2020).

Auditory function in symptomatic patients recovered from SARS-CoV-2 and unexposed patients: An analytical cross-sectional study.

Objective: To describe audiological symptoms, audiometric profile, and distortion product otoacoustic emission in symptomatic patients recovering from SARS-CoV-2 infection (positive RT-PCR test) and asymptomatic patients (negative RT-PCR test). Methods: An analytical cross-sectional study was conducted using data obtained from clinical charts, physical examination, audiometry, and distortion product otoacoustic emission on 40 patients [case patients (CP)] recovering from SARS-CoV-2 infection diagnosed by a positive RT-PCR test and 22 asymptomatic participants with a negative RT-PCR test [non-case (NC)]. Results: Sixty-two patients (mean age: 31.1 and 28.2 years in the CP and NC groups, respectively) were included. All participants were young without significant comorbidities, risk factors for hearing loss or otological history. Vertigo (5%), tinnitus (17.5%) and aural fullness/hearing loss (35%) were found in the CP group. A statistically significant difference was found in specific frequencies (1000, 4000, and 8000 Hz) and pure tone average (low and high conversational frequencies with increased threshold in the PC group compared with the NC group), which was not found in distortion product otoacoustic emission. Conclusion: Audiovestibular symptoms are frequent in symptomatic patients recovering from SARS-CoV-2 infection. SARS-CoV-2 infection was consistently associated with an increased audiometric hearing threshold at specific frequencies and low tone average.

External validation of the ACC/AHA ASCVD risk score in a Colombian population cohort.

No cardiovascular risk score has included Latin American patients in its development. The ACC/AHA ASCVD risk score has not been validated in Latin America; consequently, its predictive capacity in the population of the region is unknown. The aim of this study is to evaluate the discrimination capacity and calibration of the ACC/AHA ASCVD score to predict the 10-year risk of a cardiovascular event in a primary prevention cohort followed in a Colombian hospital. A retrospective cohort study was conducted in primary prevention patients belonging to an intermediate/high-risk and low-risk cohort without established atherosclerotic disease. Cardiovascular risk was calculated at inclusion. The calibration was analyzed by comparing observed and expected events in the different risk categories. A discrimination analysis was made using the area under the ROC curve and C statistic. A total of 918 patients were included-202 from the intermediate/high-risk and 716 from the low-risk cohort. The median cardiovascular risk was 3.6% (IQR 1.7-8.5%). At the 10-year follow-up, 40 events (4,4%) occurred. The area under the ROC curve was 0.782 (95% CI 0.71-0.85). The Hosmer-Lemeshow test did not show differences between expected and observed events. The ACC/AHA ASCVD score is calibrated and has good discrimination capacity in predicting 10-year risk of cardiovascular events in a Colombian population.

Use of high-flow cannula in pediatric patients with respiratory failure: A prospective cohort study in three high-altitude hospitals.

Background and Aims: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. Methods: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. Results: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies.

Risk of childhood trauma exposure and severity of bipolar disorder in Colombia.

BACKGROUND: Bipolar disorder (BD) is higher in developing countries. Childhood trauma exposure is a common environmental risk factor in Colombia and might be associated with a more severe course of bipolar disorder in Low-Middle Income-Countries. We carried out the first case-control study in Colombia using a structural clinical interview and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to describe the prevalence and association between trauma exposure during childhood with a severe course of illness (early age onset, rapid cycling, ideation or suicide attempt, or ≥ 3 hospitalization) in a sample of BD patients. RESULTS: A total of 114 cases and 191 controls evaluated showed the following results. Cases included 61.4% BD type I and 38.6% BD type II. The median age was 31.5 years (IQR, 75-24) for BD patients and 31 years old (IQR, 38-24) for healthy controls. A higher prevalence of childhood trauma was evidenced in cases compared to controls. Emotional abuse, physical abuse, sexual abuse, physical neglect and emotional neglect evidenced a strong association with severe bipolar disorder (OR = 3.42, p < .001; OR = 4.68, p < .001; OR = 4.30, p = .003; OR = 5.10, p < .001; OR = 5.64, p < .001, respectively). CONCLUSIONS: This is the first association study between childhood trauma exposure as a higher risk for a severe course of illness in BD patients in Colombian. Our findings highlight the higher prevalence of childhood trauma in bipolar patients and the strong association of childhood trauma with severe bipolar disorder. These findings are relevant for screening and evaluating childhood trauma exposure during the course of BD patients.

Factors associated with allergic rhinitis and combined allergic rhinitis and asthma syndrome (CARAS) in children aged 5-18 years undergoing immunotherapy in a tropical low- or middle-income country.

BACKGROUND: Tropics have some particularities that can impact the natural history and factors associated with allergic diseases. However, few studies described the characteristics of patients with allergic rhinitis (AR) and combined AR and asthma syndrome (CARAS) in Latin American tropical countries. OBJECTIVE: This study aimed to determine the medical, social, and environmental factors associated with AR and CARAS in children aged 5-18 years treated with immunotherapy in two allergy referral centers in Bogotá (Colombia). MATERIAL: and methods: An observational, cross-sectional study was conducted between January 2018 and January 2019. International Study Asthma Allergies Childhood-III and sociodemographic questionnaires were applied to adolescents and parents of children undergoing immunotherapy at the allergy consult in the Hospital Universitario Fundación Santa Fe de Bogotá and UNIMEQ-ORL. RESULTS: Among 830 children aged 5-18 years, 38.1% (n = 316) were women. Up to 63.25% of the population had a positive skin prick test for house dust mites: 63.25% for Dermatophagoides pteronyssinus, 61.81% for Dermatophagoides farinae, and 31.57% for Blomia tropicalis. The factors associated with AR were male sex (PR: 1.31, 95% CI: 1.08-1.57), antibiotic consumption during the first year of life (PR: 0.80; 95% CI: 0.63-0.99), and exposure to dogs (PR: 1.32; 95% CI: 1.06-2.66). The factors associated with CARAS were older age (PR=0.95; 95% CI: 0.95-0.99), acetaminophen consumption over four times a year (PR: 1.31; 95% CI: 1.03-1.55), and antibiotic consumption during the first year of life (PR: 1.21; 95% CI: 1.06-1.34). CONCLUSION: A high prevalence of B. tropicalis was found in this study. The factors associated with AR and CARAS are like those described in high-income tropical countries. Further studies are needed in low- or middle-income tropical countries to identify modifiable factors associated with allergic diseases.

Analysis of tinnitus severity and associated factors in patients with chronic otitis media in a low- to middle-income country.

OBJECTIVE: This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. DESIGN: Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. STUDY SAMPLE: About 231 adults with COM. RESULTS: Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01-1.05), higher education (aOR: 2.24; 95% CI: 1.03-4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02-3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05-4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28-3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the "Chronic Suppurative Otitis Media Questionnaire-12" were found between the tinnitus severity groups. CONCLUSIONS: Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes.

Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms.

BACKGROUND: Atopic dermatitis (AD, eczema) is driven by a combination of skin barrier defects, immune dysregulation, and extrinsic stimuli such as allergens, irritants, and microbes. The role of environmental allergens (aeroallergens) in triggering AD remains unclear. OBJECTIVE: We systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD. METHODS: As part of the 2022 American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters AD Guideline update, we searched the MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Global Resource for Eczema Trials, and Web of Science databases from inception to December 2021 for randomized controlled trials comparing subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT), and/or no AIT (placebo or standard care) for guideline panel-defined patient-important outcomes: AD severity, itch, AD-related quality of life (QoL), flares, and adverse events. Raters independently screened, extracted data, and assessed risk of bias in duplicate. We synthesized intervention effects using frequentist and Bayesian random-effects models. The GRADE approach determined the quality of evidence. RESULTS: Twenty-three randomized controlled trials including 1957 adult and pediatric patients sensitized primarily to house dust mite showed that add-on SCIT and SLIT have similar relative and absolute effects and likely result in important improvements in AD severity, defined as a 50% reduction in SCORing Atopic Dermatitis (risk ratio [95% confidence interval] 1.53 [1.31-1.78]; 26% vs 40%, absolute difference 14%) and QoL, defined as an improvement in Dermatology Life Quality Index by 4 points or more (risk ratio [95% confidence interval] 1.44 [1.03-2.01]; 39% vs 56%, absolute difference 17%; both outcomes moderate certainty). Both routes of AIT increased adverse events (risk ratio [95% confidence interval] 1.61 [1.44-1.79]; 66% with SCIT vs 41% with placebo; 13% with SLIT vs 8% with placebo; high certainty). AIT's effect on sleep disturbance and eczema flares was very uncertain. Subgroup and sensitivity analyses were consistent with the main findings. CONCLUSIONS: SCIT and SLIT to aeroallergens, particularly house dust mite, can similarly and importantly improve AD severity and QoL. SCIT increases adverse effects more than SLIT. These findings support a multidisciplinary and shared decision-making approach to optimally managing AD.

Factors associated with allergic rhinitis and combined allergic rhinitis and asthma syndrome (CARAS) in adults undergoing immunotherapy in a tropical country: Is ISAAC-III questionnaire useful in adult populations?

Background: Allergic diseases affect about 10–30% of the population in low- or middle-income tropical countries. Few studies describe the factors associated with allergic diseases in adult patients undergoing immunotherapy in Latin American countries. Objective: This study aimed to determine the factors associated with allergic rhinitis (AR) and AR in comorbidity with asthma (CARAS) in adults treated with immunotherapy in two allergy referral centers in Bogotá (Colombia). Material and Methods: Observational, cross-sectional study conducted between January 2018 and January 2019. ISAAC-III and sociodemographic questionnaires were applied to determine the factors associated with AR and CARAS in adults treated with immunotherapy who attended the allergy consult at the Fundación Santa Fe de Bogotá and Unimeq-Orl. Results: Among 416 adults aged 18–68 years, 71.4% (n = 297) were women. Regarding the sensitization results obtained by skin prick test, the most frequent allergens were house dust mites (64.18%): 49.03% were positive for both Dermatophagoides pteronyssinus and Dermatophagoides farinae, while 28.61% were positive for Blomia tropicalis. Excluding house dust mites, the most frequent allergens were dog hair (31.01%), cat hair (15.1%), grasses (15.9%), and food (15.9%). The main factor associated with exclusive AR was regular acetaminophen use more than four times a year: Prevalence ratio (PR) = 1.77 (95% CI: 1.12–2.25). The main factor associated with CARAS was cesarean delivery PR: 1.44 (95% CI: 1.09–1.78). Conclusion: The main factor associated with AR was regular acetaminophen use, while that associated with CARAS was cesarean delivery. The ISAAC-III questionnaire can be a useful low-cost tool to assess the factors associated with allergic diseases in adults in tropical countries (AU)

Effect of the COVID-19 pandemic on the mental health, daily and occupational activities among health professionals in Colombia: a national study.

BACKGROUND: The COVID-19 pandemic has placed an unprecedented physical and mental burden on healthcare workers who are frequently at high risk of infection, particularly in low-income countries. This study aimed to assess the prevalence and associated factors of anxiety, depression, and stress, as well as changes in daily and occupational activities among healthcare professionals due to the COVID-19 pandemic in Colombia. METHODS: An observational, cross-sectional study was conducted between February and June 2021. The survey incorporated validated mental health tools such as the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10. Multivariable ordinal logistic regression analysis was performed to determine the factors associated with severe mental health outcomes. RESULTS: Among 1345 healthcare workers the prevalence of anxiety, depression, and stress were 75.61, 59.18, and 53.09%, respectively. Anxiety (OR:1.44; 95%CI:1.16-1.8), depression (OR:1.74; 95%CI:1.27-2.37), and stress (OR:1.51; 95%CI:1.18-1.94) were more frequent in women, and individuals who expressed fear of a negative outcome (death, sequelae) (OR:2.25; 95%CI:1.60-3.25), (OR:1.49; 95%CI:1.03-2.16) and (OR:2.36; 95%CI:1.69-3.29) respectively. Age was negatively associated with anxiety (OR:0.98; 95%CI:0.98-0.99), stress (OR:0.98; 95%CI:0.97-0.99), and depression (OR:0.97; 95% CI:0.96-0.98). Reduction in consultations and surgeries (OR:1.01; 95%CI:1.0-1.01) was positively associated with anxiety. Due to the pandemic, most specialists expected to incorporate drastic long-term (> 1 year) changes in their clinical setting and daily activities. CONCLUSIONS: The prevalence of anxiety, depression, and stress is higher among Colombian healthcare workers compared to previous reports. Further research regarding these psychological outcomes is needed to achieve early mental health intervention strategies. TRIAL REGISTRATION: Hospital Universitario Fundación Santa Fe, Ethical Committee Registration ID: CCEI-12992-2021.

Effect of the COVID-19 pandemic on the mental health, daily and occupational activities of pediatric otolaryngologists in Latin America.

Background: Otolaryngologists have a higher risk of physical/psychological problems due to their frequent exposure to SARS-CoV-2. There is no information about the impact of COVID-19 on the mental health of these specialists in low/middle-income countries from Latin America. This study aimed to assess the frequency of anxiety, depression, and stress, as well as the changes in occupational and daily activities due to the COVID-19 pandemic in a group of pediatric otolaryngologists in Latin America. Methods: Observational, cross-sectional study conducted between October and December 2020. Mental health tools such as the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10 were applied. Fear to COVID-19 scale and questionnaires about occupational and daily activities were also applied. Results: Among 55 pediatric otolaryngologists, the frequency of anxiety, depression, and stress were 67.3%, 45.5, and 40%, respectively. Up to 27.3% of the specialists reported moderate to severe symptoms of anxiety, while 7.3 and 40% presented moderate depression and stress symptoms. The specialists reported a reduction of 58.3% of their consultations, as well as a 51.7% reduction in their monthly income compared to the same period before the pandemic. Up to 14.6% of the specialists expect to incorporate long-term (>1 year) drastic changes in their daily activities due to the pandemic. Conclusions: The frequency of anxiety, depression, and stress was high among pediatric otolaryngologists in Latin America compared to previous studies performed in high-income countries. Further research on these psychological outcomes is needed to achieve early mental health strategies.

Impact of the COVID-19 national lockdown in the allergic rhinitis symptoms in patients treated with immunotherapy at two allergy referral centers in Bogotá, Colombia.

Background: Coronavirus disease-19 (COVID-19) "lockdowns" caused an abruptly restricted access to health care services such as immunotherapy for allergic rhinitis (AR) and led to higher exposure to indoor allergens. This study aimed to assess the impact of COVID-19 lockdowns on AR symptoms reported by the patients treated with immunotherapy who attended the Hospital Fundación Santa Fe de Bogotá and Unidad Médico Quirúrgica de Otorrinolaringología, Colombia. Methods: Pre-post study that included patients with AR confirmed diagnosis (prick test), treated with immunotherapy before and after COVID-19 lockdowns on March-June 2020. Visual analog scales (VAS) and sociodemographic questionnaires were applied to assess AR symptoms (nasal obstruction, pruritus, rhinorrhea, and ocular symptoms) and their associated factors. Results: A total of 318 participants were included, and their mean age was 18.9 years (SD: 12.8). The median number of immunotherapy doses applied before isolation was 11 (interquartile range [IQR]: 6-19), and the median number of immunotherapy doses missed during isolation was three doses (IQR: 2-3). Up to 38.4% of the AR patients reported that their symptoms got worse during lockdowns. A pre-post mean difference in the VAS score of 0.5 was found for nasal obstruction (p = .01), 0.7 for pruritus (p < .001), 0.7 points for rhinorrhea (p < .001), and 0.8 for ocular symptoms (p < .001). Factors associated with worsening of AR symptom scores were pet ownership, atopic dermatitis, lower educational level, and a low number of immunotherapy doses applied before lockdowns. Conclusion: A large proportion of patients reported worsening of their AR symptoms, probably due to higher exposure to indoor AR allergens and interruption of immunotherapy during COVID-19 lockdowns.

Prediction of SARS-CoV-2 infection with a Symptoms-Based model to aid public health decision making in Latin America and other low and middle income settings.

Symptoms-based models for predicting SARS-CoV-2 infection may improve clinical decision-making and be an alternative to resource allocation in under-resourced settings. In this study we aimed to test a model based on symptoms to predict a positive test result for SARS-CoV-2 infection during the COVID-19 pandemic using logistic regression and a machine-learning approach, in Bogotá, Colombia. Participants from the CoVIDA project were included. A logistic regression using the model was chosen based on biological plausibility and the Akaike Information criterion. Also, we performed an analysis using machine learning with random forest, support vector machine, and extreme gradient boosting. The study included 58,577 participants with a positivity rate of 5.7%. The logistic regression showed that anosmia (aOR = 7.76, 95% CI [6.19, 9.73]), fever (aOR = 4.29, 95% CI [3.07, 6.02]), headache (aOR = 3.29, 95% CI [1.78, 6.07]), dry cough (aOR = 2.96, 95% CI [2.44, 3.58]), and fatigue (aOR = 1.93, 95% CI [1.57, 2.93]) were independently associated with SARS-CoV-2 infection. Our final model had an area under the curve of 0.73. The symptoms-based model correctly identified over 85% of participants. This model can be used to prioritize resource allocation related to COVID-19 diagnosis, to decide on early isolation, and contact-tracing strategies in individuals with a high probability of infection before receiving a confirmatory test result. This strategy has public health and clinical decision-making significance in low- and middle-income settings like Latin America.