Comparative outcomes of direct-acting antiviral treatment in patients with HIV-Hepatitis C co-infection: insights from a single center experience in Colombia.

Background: Direct-acting antivirals (DAA) were introduced to Latin America with the aim of eliminating hepatitis C (HCV) in the region. There are scarce data on the outcomes of people living with HIV and HCV treated with these medications in Colombia. This study compares the outcomes of patients with HIV-HCV co-infection and HCV mono-infection treated with DAAs. Methods: Retrospective observational study including patients ≥18 years old with HCV infection treated with DAAs from August 2017 to December 2019 in a comprehensive center in Colombia. The main outcome was sustained virologic response (SVR). Secondary outcomes included reinfection, relapse and adverse events. Results: We included 223 individuals with HCV treated with DAAs; 142 (63.6%) individuals were mono-infected and 81 (36.3%) co-infected. Genotypes 1b (49.7%) and 4 (33.9%) were the most common. Overall SVR after DAA treatment was 96.8%. Relapse rate was 2.24%, reinfection rate was 6.28% and adverse events occurred in 27.8% of cases. SVR was comparable in patients with co- and mono-infection (95% vs 97.8%, p=0.245). Conclusion: DAA were effective in mono-infected (HCV) and co-infected (HCV/HIV) patients and reinfection was high in this last group.

The Promotion of Healthy Hydration Habits through Educational Robotics in University Students.

In recent years, there has been a lack of healthy lifestyle habits in the population, including hydration, with negative consequences for health. At the same time, advances in technology have changed the process of teaching and learning since elementary school, highlighting the incorporation of educational robots as innovative resources in recent years. This study analyzes the state of the scientific knowledge presented by university students doing a university degree in Primary Education after a robotics-based educational intervention. The study adopted a quasi-experimental design with a qualitative approach, using category systems and a quantitative approach with descriptive and inferential (Chi-square and Contingency Coefficient) statistics. The results of the study show that the level of scientific knowledge has improved in the different scientific contents involved, highlighting the excellent level presented for the recommended daily volume of hydration. Innovative interventions, through digital resources such as Educational Robotics, are presented as possible alternatives to promoting the healthy habit of hydration, due the effective learning of biosanitary knowledge in the young population.

Clinical Epidemiology and Antimicrobial Resistance Patterns of Infections Due to Salmonella Species in Children, Houston, TX. 2016-2021: A Retrospective Study.

BACKGROUND: Salmonellosis continues to be a major public health issue and high rates of infection are reported among young children. The contemporary clinical epidemiology of pediatric Salmonella spp. infections in the US is not well characterized. METHODS: We performed a retrospective observational study in a large hospital network in Houston, TX. We included all patients 18 years or younger identified as having a positive culture for Salmonella spp. from any body site during the years 2016-2021. The patient's medical record was accessed and detailed demographic, clinical and microbiologic information were collected. RESULTS: We identified a total of 110 pediatric patients with Salmonella spp. infections between 2016 and 2021. The highest frequency (69%) of infections was observed among children 0-5 years old. Bloody diarrhea was most frequently reported for children 0-1 years old. Although the highest number of salmonellosis was among infants smaller than 1 year, the percentage of bacteremia in this age group was the lowest (15%). Serotype Infantis was the most common (21%) and was less likely to cause Salmonella bacteremia. Among the Salmonella spp. isolates that had antimicrobial susceptibility performed 5 showed resistance to one or more antibiotics including 1 extensively drug-resistant S . ser. Typhi originating from Pakistan. CONCLUSION: Our findings suggest distinct clinical characteristics of Salmonella infections in the pediatric population. Consistent identification of isolates to the sub-species level along with serotyping seems critical to identify emerging lineages with increased virulence. Special consideration should be given to empiric treatment for patients who have recently returned from the Indian subcontinent.

Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population.

INTRODUCTION: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

Real World Long-term Assessment of The Efficacy of Tocilizumab in Patients with COVID-19: Results From A Large De-identified Multicenter Electronic Health Record Dataset in the United States.

BACKGROUND: Studies have shown conflicting results on the efficacy of tocilizumab (TCZ) for patients with COVID-19, with many confounders of clinical status and limited duration of the observation. Here, we evaluate the real-world long-term efficacy of TCZ in COVID-19 patients. METHODS: We conducted a retrospective study of hospitalized adult patients with COVID-19 using a large US-based multicenter COVID-19 database (Cerner Real-World Data; updated in September, 2020). The TCZ group was defined as patients who received at least one dose of the drug. Matching weight (MW) and a propensity score weighting method were used to balance confounding factors. RESULTS: A total of 20,399 patients were identified. 1,510 and 18,899 were in the TCZ and control groups, respectively. After MW adjustment, no statistically significant differences in all-cause mortality were found for the TCZ vs. control group (Hazard Ratio [HR]:0.76, p=0.06). Survival curves suggested a better trend in short-term observation, driven from a subgroup of patients requiring oxygen masks, BIPAP or CPAP. CONCLUSION: We observed a temporal (early) benefit of TCZ, especially in patients on non-invasive high-flow supplemental oxygen. However, the benefit effects faded with longer observation. The long-term benefits and risks of TCZ should be carefully evaluated with follow-up studies.

Analysis of Digital Literacy in Health through Active University Teaching.

As we have seen as a consequence of the COVID-19 global pandemic, our scientific-technological society requires a transformation of knowledge in a global, digital and virtual manner. In light of this, and to improve the public health skills of professionals working to promote health education, one of the current priorities is to train pre-service teachers on how to search for health-related scientific knowledge relating to bio-health through digital literacy in health. The objectives of this study were to determine the level of eHealth literacy, scientific knowledge in health and confidence on the part of students, analyzing the degree of improvement following a teaching intervention with students of the Bachelor's Degree of Education of the University of Extremadura. A quasi-experimental longitudinal study was carried out with pre-test and post-test groups and a mixed data analysis. It involved the application of an active cooperative methodology with tutoring using the jigsaw technique, with the use of four quality digital browsers to enhance scientific rigor. The results show that the initial level of eHealth literacy and confidence was problematic. Following the intervention with the cooperative methodology, both these levels and the level of scientific knowledge in health reached an excellent level. In conclusion, this suggests that university training programs need to be implemented to improve digital and scientific skills in health education as they are currently insufficient. It has been demonstrated that a cooperative active methodology improved these levels and accordingly its use in active and digital higher education should be promoted.

Infections and systemic sclerosis: an emerging challenge / Infecciones y esclerosis sistémica: un desafío emergente

ABSTRACT Mounting evidence has shown non-systemic sclerosis (SSc) related complications as a rising cause of hospital admission and mortality, out of which infections are among the top-five causes. Patients with SSc are at an increased risk of infection due to several features of the treatment options and to the disease itself. For instance, lung involvement is associated with a higher frequency of respiratory infections, whereas the presence of digital ulcers or calcinosis may result in skin and soft tissue infections, and even osteomyelitis. On the other hand, the growing trend towards immunomodulation and immunosuppression in patients with autoimmune diseases will place SSc patients at a higher risk of infectious complications, including opportunistic infections. A low suspicion threshold and an increasing awareness among treating specialists, particularly rheumatologists, are warranted for prevention, early diagnosis and management of infectious complications. Nonetheless, data on risk management strategies in SSc, such as vaccination and antimicrobial prophylaxis, are scarce. A narrative non-systematic review was performed to provide an update of infectious complications in patients with SSc.

RESUMEN La evidencia creciente muestra que las complicaciones no asociadas a la esclerosis sistémica (ES) son una causa cada vez más frecuente de hospitalización y mortalidad, dentro de las cuales las infecciones se encuentran entre las primeras cinco causas. Los pacientes con ES presentan un riesgo elevado de infección asociado con las opciones terapéuticas y con la enfermedad misma. Por ejemplo, el compromiso pulmonar se asocia con una mayor frecuencia de infecciones respiratorias, mientras que la presencia de úlceras digitales o calcinosis pueden resultar en infecciones de piel y tejidos blandos, incluso en osteomielitis. Por otro lado, la tendencia creciente hacia la inmunomodulación y la inmunosupresión, como tratamiento de las enfermedades autoinmunes, pondrá a estos pacientes en un mayor riesgo de infecciones, incluidas las infecciones oportunistas. Son necesarios un umbral bajo de sospecha y un alto nivel de alerta entre las especialidades tratantes, particularmente los reumatólogos, para la prevención, el diagnóstico temprano y el manejo de las complicaciones infecciosas. Sin embargo, la información respecto a estrategias de gestión de riesgo en ES, como la vacunación o la profilaxis antibiótica, es escasa. Se realizó una revisión narrativa no sistemática que presenta una actualización sobre las complicaciones infecciosas en pacientes con ES.

Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020.

BACKGROUND: Colombia detected its first coronavirus disease 2019 (COVID-19) case on March 2, 2020. From March 22 to April 25, it implemented a national lockdown that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses, the government then opened many commercial activities, which was followed by an increase in cases and deaths. This paper presents a critical analysis of the Colombian surveillance data in order to identify strengths and pitfalls of the control measures. METHODS: A descriptive analysis of PCR-confirmed cases between March and July 25 was performed. Data were described according to the level of measurement. Incidence and mortality rates of COVID-19 were estimated by age, sex, and geographical area. Sampling rates for suspected cases were estimated by geographical area, and the potential for case underestimation was assessed using sampling differences. RESULTS: By July 25, Colombia (population 50 372 424) had reported 240 745 cases and 8269 deaths (case fatality rate of 3.4%). A total of 1 370 271 samples had been analyzed (27 405 samples per million people), with a positivity rate of 17%. Sampling rates per million varied by region from 2664 to 158 681 per million, and consequently the incidence and mortality rates also varied. Due to geographical variations in surveillance capacity, Colombia may have overlooked up to 82% of the actual cases. CONCLUSION: Colombia has a lower case and mortality incidence compared to other South American countries. This may be an effect of the lockdown, but may also be attributed, to some extent, to geographical differences in surveillance capacity. Indigenous populations with little health infrastructure have been hit the hardest.

Interferon-γ and voriconazole combined therapy for refractory meningeal coccidioidomycosis in a patient with interferon-γ deficiency.

Coccidioides meningitis (CM) is a challenging infection, given the limited penetration to the cerebrospinal fluid of conventional antifungals, resulting in a high risk of recurrence. We present the first case of a successfully treated persistent CM with voriconazole and adjuvant INF-γ 1b.

Persistence of Clonal Azole-Resistant Isolates of Candida albicans from a Patient with Chronic Mucocutaneous Candidiasis in Colombia.

PURPOSE: The present article describes retrospectively a case of a patient with chronic mucocutaneous candidiasis (CMC) who presented recurrent Candida albicans infection since he was 6 months old. We obtained 16 isolates recovered during a 4-year period. Our purpose was to determinate the susceptibility, genotyping, and the pathogenicity profile in all the isolates. METHODS: Sixteen C. albicans were isolated from a 25-year-old male with several recurrent fungal infections admitted to Hospital. The isolates were recovered during 4 years from a different anatomical origin. We typified them by multilocus sequence typing, also we evaluated susceptibility to fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole, caspofungin, and amphotericin B by microdilution method and we also test the pathogenic capacity in the Galleria mellonella model. RESULTS: Genotyping of all clinical isolates showed the persistence of the same diploid sequence type (DST). Isolates changed their susceptibility profile over time, but there were no significant statistical differences in pathogenicity. CONCLUSION: Herein, a persistent clonal isolates of C. albicans (DST 918) in a patient with CMC, showed changes in its susceptibility profile after several antifungal treatments acquiring gradual resistance to the azole drugs, which did not affect their pathogenicity.

Risk factors associated with methicillin-resistant Staphylococcus aureus skin and soft tissue infections in hospitalized patients in Colombia.

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) represent a major clinical problem in Colombia. The aim of this study was to evaluate the risk factors associated with MRSA SSTI in Colombia. METHODS: A multicenter cohort study with nested case-control design was performed. Patients with an SSTI with at least 48h of inpatient care were included. Patients with an MRSA SSTI were considered the case group and patients with either a non-MRSA SSTI or with an Methicillin-susceptible S. aureus (MSSA) SSTI were the control groups. A multivariate logistic regression approach was used to evaluate risk factors associated with MRSA SSTI with two different statistical models. RESULTS: A total 1134 patients were included. Cultures were positive for 498 patients, of which 52% (n=259) were Staphylococcus aureus. MRSA was confirmed in 68.3% of the S. aureus cultures. In the first model, independent risk factors for MRSA SSTI were identified as the presence of abscess (P<0.0001), cellulitis (P=0.0007), age 18-44 years (P=0.001), and previous outpatient treatment in the previous index visit (P=0.003); surgical site infection was a protective factor (P=0.008). In the second model, the main risk factor found was previous outpatient treatment in the previous index visit (P=0.013). CONCLUSIONS: Community-acquired SSTIs in Colombia are commonly caused by MRSA. Therefore, clinicians should consider MRSA when designing the initial empirical treatment for purulent SSTI in Colombia, although there seems to be low awareness of this fact.

Disseminated tuberculosis and gastric mucormycosis coinfection.

Tuberculosis and mucormycosis coinfection has rarely been reported in the medical literature. We present a case of gastrointestinal (GI) mucormycosis in a diabetic patient with disseminated tuberculosis. Early diagnosis, addressing the risk factors for mucormycosis, surgical debridement, and timely antifungal treatment are the mainstay of care.

Progressive and disseminated histoplasma infection and hemophagocytic lymphohistiocytosis in an immunocompetent adult.

Hemophagocytic lymphohistiocytosis (HLH) in adults is a life-threatening underdiagnosed disorder that complicates different infectious syndromes and overlaps with sepsis. No guidelines are available for the management of HLH in adults. A high index of suspicion is required in patients with disseminated histoplasmosis.

Lactococcus garvieae, an unusual pathogen in infective endocarditis: case report and review of the literature.

BACKGROUND: Lactococcus garvieae is an unusual cause of infective endocarditis (IE). No current diagnostic and therapeutic guidelines are available to treat IE caused by these organisms. Based on a case report, we provide a review of the literature of IE caused by L. garvieae and highlight diagnostic and treatment challenges of these infections and implications for management. CASE PRESENTATION: A 50-year-old Asian male with mitral prosthetic valve presented to the hospital with intracranial haemorrhage, which was successfully treated. Three weeks later, he complained of generalized malaise. Further work up revealed blood cultures positive for Gram-positive cocci identified as L. garvieae by MALDI-TOF. An echocardiogram confirmed the diagnosis of IE. Susceptibility testing showed resistance only to clindamycin. Vancomycin plus gentamicin were started as empirical therapy and, subsequently, the combination of ceftriaxone plus gentamicin was used after susceptibility studies were available. After two weeks of combination therapy, ceftriaxone was continued as monotherapy for six additional weeks with good outcome. CONCLUSIONS: Twenty-five cases of IE by Lactococcus garvieae have been reported in the literature. Compared to other Gram-positive cocci, L. garvieae affects more frequently patients with prosthetic valves. IE presents in a subacute manner and the case fatality rate can be as high as 16%, comparable to that of streptococcal IE (15.7%). Reliable methods for identification of L. garvieae include MALDI-TOF, 16S RNA PCR, API 32 strep kit and BD Automated Phoenix System. Recommended antimicrobials for L. garvieae IE are ampicillin, amoxicillin, ceftriaxone or vancomycin in monotherapy or in combination with gentamicin.

A 19-year old man with IgA vasculitis after vaccination.

A 19-year-old patient who mistakenly received two doses of influenza vaccine 10 days before presentation, was admitted with malaise, weakness, and a purpuric non-blanching rash most prominent on the ankles followed by abdominal pain and hematochezia 72h later. The diagnosis of influenza vaccine-related Henoch-Schonlein vasculitis was made. This complication, although rare, is the most common vasculitis related to immunization.

A 19-year old man with IgA vasculitis after vaccination

ABSTRACT A 19-year-old patient who mistakenly received two doses of influenza vaccine 10 days before presentation, was admitted with malaise, weakness, and a purpuric non-blanching rash most prominent on the ankles followed by abdominal pain and hematochezia 72 h later. The diagnosis of influenza vaccine-related Henoch-Schonlein vasculitis was made. This complication, although rare, is the most common vasculitis related to immunization.

First report of sporadic cases of Candida auris in Colombia.

BACKGROUND: Candida auris is a recently reported Candida species that is phenotypically similar to Candida haemulonii and related to hospital outbreaks. This organism can be misidentified as Candida haemulonii, Candida famata, Candida catenulata, or Rhodotorula glutinis by phenotypic approaches. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis using internal transcribed spacer rDNA bar-coding provide an accurate identification. CASE REPORTS: Three cases of C. auris infection in patients with risk factors for fungal infection (one admitted to the intensive care unit, one with lymphoma, and one with HIV; all three with previous antibiotic use) are reported; these infections were not epidemiologically related. Yeast isolates were recovered from blood, ocular secretion, and bronchoalveolar lavage and were misidentified as C. catenulata and Candida albicans by the phenotypic MicroScan method. The isolates were confirmed to be C. auris by means of MALDI-TOF MS and DNA sequence analysis. Antifungal susceptibility testing was performed on these C. auris isolates, which exhibited high minimum inhibitory concentrations to triazoles and amphotericin B. One patient survived and the other two died. Only one of these deaths was related to fungemia. CONCLUSIONS: C. auris is an emerging and opportunistic multidrug-resistant human pathogen. It is necessary to strengthen measures to achieve an accurate and quick identification and also to avoid its dissemination. This will require improvements in health and infection control measures, as well as the promotion of antifungal stewardship in healthcare facilities.

Foreign Relations.

In a large Colombian teaching hospital, a fifty-five-year-old woman complaining of stomach pain is examined by a foreign-exchange medical student from the United States. Speaking in Spanish, the student elicits a medical history that suggests a possible recurrence of gallstones, but nothing further. Upon discussing the patient's case in private with the attending physician, the student is shocked to learn that the patient is suffering from terminal, metastatic gastric cancer but is unaware of her diagnosis. The attending physician explains that the patient's husband instructed the health care providers not to tell the patient what her diagnosis is. The medical student feels uncomfortable withholding the diagnosis from the patient. The thought of disclosure feels equally uncomfortable, however, as it would mean contradicting the instructions of the attending physician at the host hospital as well as violating what the student suspects, but is not sure, may be acceptable medical practice in Colombia. How should the medical student proceed?

Trastornos neuropsiquiátricos en la población con VIH: una revisión narrativa / Neuropsychiatric Disorders in the People Living with HIV: A Narrative Review

Introducción: el sistema nervioso central es uno de los órganos afectados, de manera directa e indirecta, por el VIH; adicionalmente, los trastornos psiquiátricos son más frecuentes en esta población. Objetivo: comprender la patogénesis, las manifestaciones clínicas y el manejo de las enfermedades neuropsiquiátricas en la población con VIH. Métodos: se realizó una búsqueda en las bases de datos Medline, Embase, SciELO, LILACS y Psychlnfo utilizando término libres y MeSH. Resultados: los trastornos neuropsiquiátricos generan un impacto negativo en el tratamiento y seguimiento de los pacientes con VIH, lo cual disminuye su adherencia al tratamiento y aumenta las dificultades en su manejo integral. Llamativamente, existe una falta de estudios latinoamericanos en esta área.

Introduction: HIV is the infectious disease with the biggest worldwide impact in the last decades. For this reason, the control of this disease was induded in the millennium objectives of the UN. There has been a long time interest for studying the psychiatric comorbidities in these patients due to its impact in survival. Níethods: A research in the data bases Medline, Embase, SciELO, LILACS, and Psychlnfo was made using free terms and MeSH terms. Results: The neuropsychiatric disorders have a negative impact in the treatment and control of HIV positive patients, reducing their adherence and increasing the difficulties in the comprehensive treatment. There is a déficit in studies that could clear up this relationship in Colombian population.