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1.
Infectio ; 25(4): 207-211, oct.-dic. 2021. tab, graf
Artículo en Español | LILACS, COLNAL | ID: biblio-1286715

RESUMEN

Resumen Objetivo: Describir la proporción, características clínicas, demográficas y programáticas de casos fatales de coinfección TB/VIH de Cali-Colombia, en 2017. Material y Método: Estudio de corte transversal, con información de las bases de datos del programa de tuberculosis, las historias clínicas y unidades de análisis de mortalidad disponibles. Resultados: Se depuraron 257 casos fatales por TB, el 24,5% (63/257) falleció con coinfección TB/VIH. La mediana de edad fue 43 años (Rango Intercuartílico: 30-52), 73% (46/63) eran hombres, 76,2% (48/63) no pertenecían al régimen contributivo, 28,6% eran habitantes de calle. 81,2% (39/48) eran casos nuevos de TB, 76,6% (37/47), inició tratamiento; al 74,6% (47/63) se les realizó unidad de análisis de mortalidad. La presentación pulmonar fue frecuente (75,9%-44/58), en 60% de los registros se observó desnutrición (Índice de Masa Corporal <20), en 39,7% (25/63) dependencia al alcohol, tabaco o farmacodependencia. Conclusiones: La mortalidad asociada a TB/VIH es prevenible, pero en 2017 representó la cuarta parte de la mortalidad por TB en Cali. Hombres adultos con condiciones de vulnerabilidad social, diagnosticados en estados avanzados de enfermedad, fueron blanco de fatalidad. Mejorar los sistemas de información e integrar los programas de TB/VIH, deben ser estrategias prioritarias para la salud pública en Colombia.


Abstract Objective: To describe the proportion, clinical, demographic and programmatic characteristics of fatal cases of TB/HIV coinfection from Cali-Colombia, in 2017. Material and Method: Cross-sectional study, with information from the TB program databases, clinical records and mortality analysis units available. Results: 257 TB fatal cases were cleared in Cali in 2017, 24.5% (63/257) of these died with TB/HIV coinfection. The median age was 43 years (Interquartile Range: 30-52), 73% (46/63) were men, 76.2% (48/63) did not belong to the contributory health regimen, 28.6% were homeless. 81.2% (39/48) were new TB cases, 76.6% (37/47) started treatment; 74.6% (47/63) had mortality analysis register. Pulmonary presentation was frequent (75.9% -44 / 58), in 60% of the registries malnutrition was observed (Body Mass Index <20), in 39.7% (25/63), dependence on alcohol, tobacco or drug dependence was registered. Conclusions: Mortality associated with TB/HIV is preventable, but in 2017 it represented a quarter of the TB mortality in Cali. Adult men with conditions of social vulnerability, diagnosed in advanced stages of disease, were fatally targeted. Improving information systems and integrating TB/HIV programs should be priority strategies for public health in Colombia.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Tuberculosis , VIH , Índice de Masa Corporal , Infecciones por VIH , Salud Pública , Estudios Transversales , Mortalidad , Estrategias de Salud , Colombia , Vulnerabilidad Social , Desnutrición
2.
Rev. med. Risaralda ; 27(1): 92-95, ene.-jun. 2021. graf
Artículo en Español | LILACS, COLNAL | ID: biblio-1280498

RESUMEN

Resumen Las malformaciones venosas son lesiones vasculares benignas infrecuentes que se presentan en el útero. Están conformadas por venas anormales, de diferentes tamaños y proporciones, con configuración espongiforme y disposición al azar. En la literatura, han sido previamente reportados algunos casos, usando el término "hemangioma cavernoso", pero según los cambios recientes en la terminología, aprobados por Sociedad Internacional para el Estudio de las Anormalidades Vasculares (ISSVA), se desaconseja el uso de este término y se sugiere el de "Malformación venosa", si se cumplen los hallazgos histopatológicos al momento de hacer el diagnóstico. Presentamos el caso de una mujer de 44 años, con cuadro de hemorragia vaginal anormal y diagnóstico clínico de miomatosis y mioma abortado por el orificio cervical interno, el estudio histopatológico reveló la presencia de una malformación venosa que comprometía el miometrio y endometrio, con formación subsecuente de un pólipo.


Abstract Venous malformations are benign vascular lesions that rarely appear in the uterus. They are made up of abnormal veins, of different sizes and proportions, with spongiform configuration and random disposition. In the literature, some cases have been previously reported, using the term "cavernous hemangioma", but according to recent changes in terminology, approved by the International Society for the Study of Vascular Abnormalities (ISSVA), the use of this term is discouraged, and the diagnosis of Venous malformation is suggested, if the histopathological findings are met. We present the case of a 44-year-old woman, with abnormal vaginal bleeding and a clinical diagnosis of myomatosis and myoma aborted by the internal cervical orifice, in whom the histopathological study revealed the presence of a venous malformation that compromised the myometrium and endometrium, with subsequent formation of a polyp.


Asunto(s)
Humanos , Femenino , Adulto , Útero , Malformaciones Vasculares , Hemangioma Cavernoso , Útero/patología , Lesiones del Sistema Vascular , Hemangioma , Morfogénesis
3.
Am J Trop Med Hyg ; 104(4): 1309-1316, 2021 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-33617470

RESUMEN

Tuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4-0.9; P = 0.009) and patients living in Cali's western zone (aOR: 0.5; 95% CI: 0.3-0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1-66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2-15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years and none of the eight persons living with HIV, reported preventive therapy initiation. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.


Asunto(s)
Trazado de Contacto/estadística & datos numéricos , Composición Familiar , Tuberculosis/diagnóstico , Adolescente , Adulto , Colombia , Trazado de Contacto/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Tuberculosis/epidemiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Adulto Joven
4.
Colomb Med (Cali) ; 52(4): e2024875, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35571589

RESUMEN

Objective: To determine factors associated with mortality in tuberculosis/HIV co-infected patients in Cali, Colombia. Methods: This retrospective cohort design included tuberculosis/HIV co-infected persons. Kaplan-Meier and Cox regression were used to estimate survival and risk factors associated with mortality. Results: Of the 279 tuberculosis/HIV co-infected participants, 27.2% died during the study. Participants mainly were adults and males. CD4 count information was available for 41.6% (the median count was 83 cells/mm3), and half were subject to tuberculosis susceptibility testing. The median time between HIV diagnosis and antiretroviral therapy initiation was 372 days. HIV was identified prior to tuberculosis in 53% and concurrent HIV-tuberculosis were diagnosed in 37% of patients. 44.8% had tuberculosis treatment success. Body mass index above 18 kg/m2, initiation of tuberculosis treatment within two weeks, having any health insurance coverage and CD4 count information conferred a survival advantage. Conclusions: Delays in treatment initiation and factors associated with limited health care access or utilization were associated with mortality. As HIV and tuberculosis are both reportable conditions in Colombia, strategies should be focused on optimizing treatment outcomes within both tuberculosis and HIV programs, particularly improving early HIV diagnosis, early antiretroviral therapy treatment initiation, and adherence to tuberculosis treatment.


Objetivo: Determinar factores asociados con mortalidad en personas con co-infeccion Tuberculosis/VIH en Cali, Colombia. Métodos: Este diseño de cohorte retrospectiva incluyó personas co-infectadas con tuberculosis /VIH. Se utilizó Kaplan Meier y regresion de Cox para estimar supervivencia y factores de riesgo asociados con mortalidad. Resultados: De los 279 participantes coinfectados con tuberculosis/VIH, el 27.2% falleció durante el estudio. Los participantes fueron principalmente adultos y hombres. Se dispuso de información de recuento de CD4 en el 41.6% (la mediana del recuento fue 83 células/mm3), y en la mitad se realizaron pruebas de susceptibilidad para tuberculosis. La mediana de tiempo entre el diagnóstico de VIH e inicio de terapia antirretroviral fue 372 días. Se identificó VIH previo a tuberculosis en un 53%, e infección concurrente tuberculosis-VIH en el 37% de los pacientes. El 44.8% presentó éxito en el tratamiento para tuberculosis. Un índice de masa corporal superior a 18 kg/m2, inicio del tratamiento para TB dentro de las primeras dos semanas, contar con aseguramiento en salud y con recuento de CD4 se asociaron con mayor supervivencia. Conclusiones: Retraso en el inicio de tratamiento y factores relacionados con brechas en el acceso a atención en salud se asociaron con mortalidad. Dado que VIH y tuberculosis son enfermedades de notificación obligatoria en Colombia, las estrategias deben centrarse en optimizar los desenlaces del tratamiento dentro de ambos programas, en particular mejorar el diagnóstico temprano de VIH, el inicio temprano de la terapia antirretroviral y fomentar la adherencia al tratamiento para tuberculosis.

5.
Artículo en Inglés | MEDLINE | ID: mdl-33396399

RESUMEN

As communities worldwide shift from consuming traditional diets to more processed snacks and sugar-sweetened beverages (SSBs), increases in child obesity and tooth decay and persistence of undernutrition are particularly apparent in Latin American countries. Further evidence of shared risk factors between child undernutrition and poor oral health outcomes is needed to structure more effective health interventions for children's nutrition. This study aims to identify dietary, oral health, and sociodemographic risk factors for child undernutrition and severe early childhood caries (sECC) among a convenience sample of 797 caregiver-child pairs from rural Salvadoran communities. Caregiver interviews on child dietary and oral health practices were conducted, and their children's height, weight, and dental exam data were collected. Multivariable regression analyses were performed using RStudio (version 1.0.143). Caregiver use of SSBs in the baby bottle was identified as a common significant risk factor for child undernutrition (p = 0.011) and sECC (p = 0.047). Early childhood caries (p = 0.023) was also a risk factor for developing undernutrition. Future maternal-child health and nutrition programs should coordinate with oral health interventions to discourage feeding children SSBs in the baby bottle and to advocate for policies limiting SSB marketing to young children and their families.


Asunto(s)
Caries Dental , Desnutrición , Bebidas Azucaradas/efectos adversos , Niño , Preescolar , Caries Dental/epidemiología , Caries Dental/etiología , El Salvador/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Desnutrición/epidemiología , Desnutrición/etiología , Salud Bucal , Población Rural
6.
Neurochem Int ; 133: 104614, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31785349

RESUMEN

The therapeutic use of ketone bodies (KB) against acute brain injury and neurodegenerative disorders has lately been suggested by many studies. Several mechanisms responsible for the protective action of KB have been described, including metabolic, anti-inflammatory and epigenetic. However, it is still not clear whether a specific mechanism of action can be associated with a particular neurological disorder. Different strategies to induce ketosis including the ketogenic diet (KD), caloric restriction (CR), intermittent fasting (IF), as well as the administration of medium chain triglycerides (MCTs), exogenous ketones or KB derivatives, have been used in animal models of brain injury and in humans. They have shown different degrees of success to prevent neuronal damage, motor alterations and cognitive decline. However, more investigation is needed in order to establish safe protocols for clinical application. Throughout the present review, we describe the different approaches that have been used to elevate blood KB and discuss their effectiveness considering their advantages and limitations, as tested in models of brain injury, neurodegeneration and clinical research. We also describe the mechanisms of action of KB in non-pathologic conditions and in association with their protective effect against neuronal damage in acute neurological disorders and neurodegenerative diseases.


Asunto(s)
Lesiones Encefálicas/metabolismo , Cetonas/metabolismo , Enfermedades Neurodegenerativas/metabolismo , Neuronas/metabolismo , Animales , Encéfalo/metabolismo , Lesiones Encefálicas/tratamiento farmacológico , Restricción Calórica/métodos , Humanos , Enfermedades Neurodegenerativas/tratamiento farmacológico
7.
Rev Panam Salud Publica ; 43: e14, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31093238

RESUMEN

Objective: To determine factors associated with delays in pulmonary tuberculosis diagnosis and treatment initiation in the city of Cali, Colombia. Methods: This was a retrospective cohort study of cases of tuberculosis (TB) reported in the TB control program of Cali between January and December 2016. The information was collected from the databases of the TB control program, individual treatment cards, and clinical histories. The variables considered were sociodemographic factors, clinical factors, substance use, and performance of the health service. Results: A total of 623 cases were identified, of which 57.0% were male. The median age was 42 years (interquartile range (IQR): 27-60). The median time from onset of symptoms to TB diagnosis was 57 days (IQR: 21-117), and from onset of symptoms to TB treatment initiation was 72 days (IQR: 35-145). A factor associated with longer time from the onset of symptoms to TB treatment was being a previously treated TB patient (coefficient: 123.8 days, 95% confidence interval (CI): 48.3 to 199.3). In contrast, being incarcerated was a protective factor for earlier TB treatment initiation (coefficient: -57.3 days; 95% CI: -92.4 to -22.3). Conclusions: Our results provide important information concerning risk factors that are associated with delays in the diagnosis and treatment of tuberculosis, and that are subject to future interventions. Health insurance program managers must work together with health care providers on issues that include patient care, health promotion, and updating TB protocols and standards.

8.
Artículo en Inglés | PAHO-IRIS | ID: phr-50474

RESUMEN

[ABSTRACT]. Objective. To determine factors associated with delays in pulmonary tuberculosis diagnosis and treatment initiation in the city of Cali, Colombia. Methods. This was a retrospective cohort study of cases of tuberculosis (TB) reported in the TB control program of Cali between January and December 2016. The information was collected from the databases of the TB control program, individual treatment cards, and clinical histories. The variables considered were sociodemographic factors, clinical factors, substance use, and performance of the health service. Results. A total of 623 cases were identified, of which 57.0% were male. The median age was 42 years (interquartile range (IQR): 27–60). The median time from onset of symptoms to TB diagnosis was 57 days (IQR: 21–117), and from onset of symptoms to TB treatment initiation was 72 days (IQR: 35–145). A factor associated with longer time from the onset of symptoms to TB treatment was being a previously treated TB patient (coefficient: 123.8 days, 95% confidence interval (CI): 48.3 to 199.3). In contrast, being incarcerated was a protective factor for earlier TB treatment initiation (coefficient: -57.3 days; 95% CI: -92.4 to -22.3). Conclusions. Our results provide important information concerning risk factors that are associated with delays in the diagnosis and treatment of tuberculosis, and that are subject to future interventions. Health insurance program managers must work together with health care providers on issues that include patient care, health promotion, and updating TB protocols and standards.


[RESUMEN]. Objetivo. Determinar los factores relacionados con los retrasos en el diagnóstico e inicio del tratamiento de la tuberculosis pulmonar en la ciudad de Cali (Colombia). Métodos. Este fue un estudio de cohortes retrospectivo de los casos de tuberculosis notificados en el programa de control de la tuberculosis de Cali entre enero y diciembre del 2016. La información se recopiló a partir de las bases de datos del programa de control de la tuberculosis, las tarjetas de tratamiento individuales y las historias clínicas. Las variables consideradas fueron factores sociodemográficos, factores clínicos, consumo de tabaco y alcohol y funcionamiento del servicio de salud. Resultados. Se identificaron 623 casos, 57,0% de los cuales eran hombres. La mediana de la edad fue de 42 años (recorrido intercuartílico [RIC]: 20-60). La mediana del lapso entre el inicio de los síntomas de tuberculosis y el diagnóstico fue de 57 días (RIC: 21-117), y entre el inicio de los síntomas y el inicio del tratamiento antituberculoso, de 72 días (RIC: 35-145). Un factor relacionado con un lapso más largo entre el inicio de los síntomas y el inicio del tratamiento antituberculoso fue el ser un paciente con tuberculosis que ya había recibido tratamiento (coeficiente: 123,8 días; intervalo de confianza [IC] de 95%: 48.3 a 199,3). Por el contrario, estar en prisión fue un factor protector para un inicio más temprano del tratamiento antituberculoso (coeficiente: -57,3 días; IC de 95%: -92.4 a -22,3). Conclusiones. Nuestros resultados brindan información importante acerca de los factores de riesgo relacionados con los retrasos en el diagnóstico y el tratamiento de la tuberculosis, que son susceptibles de intervenciones futuras. Los directores de los programas de seguro de enfermedad deben colaborar con los prestadores de atención sanitaria en aspectos tales como la atención de los pacientes, la promoción de la salud y la actualización de los protocolos y normas relativos a la tuberculosis.


[RESUMO]. Objetivo. Determinar os fatores associados à demora no diagnóstico e no início do tratamento da tuberculose pulmonar na cidade de Cáli, Colômbia. Métodos. Estudo retrospectivo de coorte de casos de tuberculose notificados como parte do programa de controle de tuberculose de Cáli entre janeiro e dezembro de 2016. Os dados foram coletados das bases de dados do programa de controle de tuberculose, fichas individuais de tratamento e histórias clínicas. As variáveis consideradas foram fatores sociodemográficos, fatores clínicos, uso de substâncias químicas e desempenho do serviço de saúde. Resultados. Ao todo, foram identificados 623 casos, sendo 57,0% no sexo masculino. A média de idade foi 42 anos (intervalo interquartil [IIQ] 27-60). A mediana de tempo do início dos sintomas ao diagnóstico da tuberculose foi de 57 dias (IIQ 21-117) e do início dos sintomas ao início do tratamento da tuberculose foi de 72 dias (IIQ 35-145). Ter sido tratado anteriormente para tuberculose foi um fator associado a um intervalo maior entre o início dos sintomas e o tratamento da tuberculose (coeficiente 123,8 dias, intervalo de confiança de 95% [IC 95%] 48,3 a 199,3). Por outro lado, estar em detenção foi um fator de proteção para o início precoce do tratamento da tuberculose (coeficiente –57,3 dias; IC 95% –92,4 a –22,3). Conclusões. Os nossos resultados contribuem com aporte importante sobre os fatores de risco associados à demora no diagnóstico e no tratamento da tuberculose e são passíveis de intervenções futuras. Os responsáveis pelos programas dos planos de saúde devem colaborar com os profissionais da saúde na assistência ao paciente, promoção da saúde e atualização dos protocolos e padrões de atenção da tuberculose.


Asunto(s)
Tuberculosis Pulmonar , Diagnóstico , Terapéutica , Diagnóstico Tardío , Colombia , Tuberculosis Pulmonar , Diagnóstico , Terapéutica , Diagnóstico Tardío , Tuberculosis Pulmonar , Terapéutica , Diagnóstico Tardío , Colombia
9.
Neurochem Res ; 41(3): 600-9, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26303508

RESUMEN

Glucose is the major energy substrate in brain, however, during ketogenesis induced by starvation or prolonged hypoglycemia, the ketone bodies (KB), acetoacetate and ß-hydroxybutyrate (BHB) can substitute for glucose. KB improve neuronal survival in diverse injury models, but the mechanisms by which KB prevent neuronal damage are still not well understood. In the present study we have investigated whether protection by the D isomer of BHB (D-BHB) against neuronal death induced by glucose deprivation (GD), is related to autophagy. Autophagy is a lysosomal-dependent degradation process activated during nutritional stress, which leads to the digestion of damaged proteins and organelles providing energy for cell survival. Results show that autophagy is activated in cortical cultured neurons during GD, as indicated by the increase in the levels of the lipidated form of the microtubule associated protein light chain 3 (LC3-II), and the number of autophagic vesicles. At early phases of glucose reintroduction (GR), the levels of p62 declined suggesting that the degradation of the autophagolysosomal content takes place at this time. In cultures exposed to GD and GR in the presence of D-BHB, the levels of LC3-II and p62 rapidly declined and remained low during GR, suggesting that the KB stimulates the autophagic flux preventing autophagosome accumulation and improving neuronal survival.


Asunto(s)
Ácido 3-Hidroxibutírico/metabolismo , Autofagia , Corteza Cerebral/citología , Glucosa/metabolismo , Neuronas/citología , Ácido 3-Hidroxibutírico/química , Ácido 3-Hidroxibutírico/farmacología , Animales , Supervivencia Celular , Células Cultivadas , Corteza Cerebral/metabolismo , Proteínas de Choque Térmico/metabolismo , Proteínas Asociadas a Microtúbulos/metabolismo , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Ratas Wistar , Proteína Sequestosoma-1 , Estereoisomerismo
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