Ocular Chemical Burns: Epidemiological Trends in a Colombian Medical Center.

Ocular chemical burns are a significant cause of visual impairment. This study aims to characterize ocular chemical burns in a southwestern Colombia referral center and identify associated factors with low vision. A cross-sectional study was carried out based on the review of medical records of patients diagnosed with chemical eye burns who consulted the emergency ophthalmology service between January 2016 and December 2019. Descriptive statistics were performed. Associations with low vision (Best Corrected Visual Acuity, BCVA, ≥20/70 in Snellen chart) in the last follow-up appointment were identified using a multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). 219 eyes affected by chemical burns were identified from 174 patients with a mean age of 39 years (SD±20), out of which 57.5% (n=100) were men. We ran a multivariate model adjusted by sex, eye wash, type of chemical, and Dua's classification. We found that the odds of low vision for patients without eyewash before the consult were three times the odds of those who had it (Adjusted OR [aOR]=3.5, 95%CI=1.3-9.4) and almost five times for those with Dua's classification greater than 1 (aOR=4.7, 95%CI=1.7-12.9). The ocular chemical burns reported in this study occurred more in young people of productive age. Acids were the principal causal agent. The association between lack of early management and the severity of the chemical burn with low vision has been highlighted. Ocular burns remain a relevant cause of consultation on the ophthalmology service in Cali, and prevention strategies are required.

Prevalence of Neuropathic Pain in Patients with Osteoarthritis.

Objective The aim of this study was to determine the prevalence of neuropathic pain and characterize the quality of life of patients with osteoarthritis who consulted a pain clinic in Southwestern Colombia. Methods A cross-sectional study was conducted via telephone survey. Participants ≥18 years of age with a diagnosis of osteoarthritis were included. The LANSS questionnaire was used to evaluate symptoms and signs of neuropathic pain, and the Short Form-8 was used to evaluate quality of life. Results Response rate was 54.1% (46/85). The male-to-female ratio was 5:1, with an average age of 72 ± 10 years. Most participants (91.3%) had severe pain. The prevalence of neuropathic pain was 28.3% (95%CI = 15.99-43.46), and the prevalence of neuropathic pain amongst women was 84.6% (95%CI = 54.55-98.01). Dysesthesias and paroxysmal pain were present in 92.3% of individuals with neuropathic pain. Regarding quality of life, limitations in physical activity were the most significant, as 63% of individuals reported such limitations. Conclusion Neuropathic pain was found to be prevalent and had a negative impact on physical function, highlighting the need for therapeutic strategies targeted to specific neuropathic pain pathways in patients with osteoarthritis.

The Association of Blood Banks per City with Mortality Due to Traumatic Hemorrhagic Shock in Colombia: A Population-Based Analysis.

Background: Hemorrhagic shock is the second leading cause of death for injured people and disproportionately affects low resource economies. The potential role of spatial allocation of blood banks and the unmet transfusion needs of patients are yet to be characterized. We aimed to estimate the effect of the number of blood banks in mortality due to traumatic hemorrhagic shock (THS) in Colombia. Methods: We performed a population-based cross-sectional study using secondary data from the Colombian Government: including annual reports from the Blood Bank Network, mortality, and population estimates for 2015-2016. International Classification of Disease 10th code T79.4 identified THS as the primary cause of death. A city-clustered multivariate negative binomial regression, weighted by violent deaths rate, was used to obtain incidence rate ratios (IRR) of death due to THS with 95% confidence intervals (95%CI). Results: Of the 59,030 violent deaths in Colombia in 2015-2016, 36.76% were due to THS. Only 3.13% of Colombian municipalities had a blood bank. THS incidence decreased as the number of blood banks in a city increased, and the lowest incidence was observed at ten banks (IRR:0.18, 95%CI:0.15-0.22). Receiving medical care in a city with blood banks had a more substantial impact on THS (IRR:0.85; 95%CI:0.76-0.96). Conclusion: The number of blood banks per city was associated with lower incidence of THS deaths. These findings may highlight the inequitable distribution of blood systems and their association with preventable deaths. Further studies with more focused clinical and geographical data might clarify the geographic determinants of blood products' availability.

Epidemiology of Eye Cancer in Cali, Colombia: A 55-Year Study.

PURPOSE: To describe the epidemiology, incidence, mortality and survival of ocular cancer in Cali between 1962 and 2019. METHODS: Ecological population-based study analyzing data of incidence, mortality, and 5-years survival of malignant ocular tumors from the Populational Cancer Registry of Cali between 1962 and 2019. RESULTS: Between 1962 and 2019, 586 ocular tumors were found, 50.5% occurred in females, the mean age at diagnosis was 45 years (standard deviation = 25), 70.3% of ocular malignancies occurred in >14 years. The average annual incidence rate was 7.8 per million for male and 6.9 per million for females. Retinoblastoma (21%), squamous cell carcinoma (20%), melanoma (16%) and lymphoma (8%) were the most common neoplasm. In those <15 years, the most frequent malignant tumors were retinoblastomas (85.7%), followed by non-specified malignant neoplasm (NOS, 7.9%), and rhabdomyosarcoma (3.6%). In those >14 years, there were NOS (30%), followed by squamous cell carcinomas (28%), melanomas (23%), and lymphomas (9.7%). Conjunctiva (38.2%), retina (21%) and orbit (10%) constituted the majority of anatomical sites of ocular tumors. The survival rate was about 83.2% and mortality did not show a decreasing trend over time (p > .05). CONCLUSIONS: The incidence of ocular cancer in Cali has a slightly increasing trend, with stable behavior in the last decades. Squamous cell carcinoma, retinoblastoma, melanoma and lymphoma are the most frequent ocular cancers, with being retinoblastoma more frequent than melanoma. In general, ocular cancer had good survival rates in Cali.

Mental health Narrative Community-Based Group Therapy in violence-displaced Afro-Colombians: a randomized controlled trial.

This study aims to evaluate the effect of a mental health Narrative Community-Based Group Therapy (NCGT) in Afro-Colombian violence survivors. A randomized controlled trial was conducted in Buenaventura and Quibdó, Colombia. Afro-Colombian adults (n=521) were randomly allocated to a NCGT (n1=175), a wait-control group (n2=171) or a Common Elements Treatment Approach (CETA, n3=175). The CETA was described separately given conceptual/methodological differences. Lay psychosocial community workers delivered the NCGT. Symptoms were assessed before and after intervention/wait with culturally adapted mental health symptoms and gender-specific functionality scales. Intent to treat analysis and mean difference of differences were used for comparisons. In Buenaventura, a significant reduction in functional impairment (mean difference: -0.30, 95% Confidence Interval [95% CI]: -0.55, -0.05) and depression (mean difference: -0.24, 95% CI: -0.42, -0.07) were found, with small and moderate effect size, respectively. In Quibdó, functionality improved significantly (mean difference: -0.29, 95% CI: -0.54, -0.04, small effect size). Even though differences in depression and anxiety were not significant, there were reductions in symptoms. The NCGT is effective in improving daily functioning among violence victims in the Colombian Pacific and has the potential to reduce symptoms of depression. Further exploration is required to understand the effects of a narrative group therapy for mental health in Afro-Colombian populations.Trial Registration: ClinicalTrials.gov number: NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

Prevalence of Neuropathic Pain in Patients with Osteoarthritis / Prevalência de dor neuropática em pacientes com osteoartrite

Abstract Objective The aim of this study was to determine the prevalence of neuropathic pain and characterize the quality of life of patients with osteoarthritis who consulted a pain clinic in Southwestern Colombia. Methods A cross-sectional study was conducted via telephone survey. Participants ≥18 years of age with a diagnosis of osteoarthritis were included. The LANSS questionnaire was used to evaluate symptoms and signs of neuropathic pain, and the Short Form-8 was used to evaluate quality of life. Results Response rate was 54.1% (46/85). The male-to-female ratio was 5:1, with an average age of 72 ±10 years. Most participants (91.3%) had severe pain. The prevalence of neuropathic pain was 28.3% (95%CI = 15.99-43.46), and the prevalence of neuropathic pain amongst women was 84.6% (95%CI = 54.55-98.01 ). Dysesthesias and paroxysmal pain were present in 92.3% of individuals with neuropathic pain. Regarding quality of life, limitations in physical activity were the most significant, as 63% of individuals reported such limitations. Conclusion Neuropathic pain was found to be prevalent and had a negative impact on physical function, highlighting the need for therapeutic strategies targeted to specific neuropathic pain pathways in patients with osteoarthritis.

Resumo Objetivo O objetivo deste estudo foi determinar a prevalência de dor neuropática e caracterizar a qualidade de vida de pacientes com osteoartrite que consultaram um ambulatório de dor no sudoeste da Colômbia. Métodos Este foi um estudo transversal realizado por meio de entrevista telefônica. Foram incluídos participantes ≥18 anos de idade com diagnóstico de osteoartrite. O questionário Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) foi utilizado para avaliação dos sintomas e sinais de dor neuropática e o Short Form-8 analisou a qualidade de vida. Resultados A taxa de resposta foi de 54,1% (46/85). A razão homem:mulher foi de 5:1, com média de idade de 72 ±10 anos. A maioria dos participantes (91,3%) apresentava dor intensa. A prevalência de dor neuropática foi de 28,3% (intervalo de confiança [IC] de 95% = 15,99-43,46) e a prevalência de dor neuropática entre mulheres foi de 84,6% (IC 95% = 54,55-98,01). Disestesias e dor paroxística foram relatadas por 92,3% dos indivíduos com dor neuropática. Em relação à qualidade de vida, as limitações na prática de atividade física foram as mais significativas e relatadas por 63% dos indivíduos. Conclusão A dor neuropática foi prevalente e tinha impacto negativo na função física. Isso destaca a necessidade de estratégias terapêuticas direcionadas a vias específicas da dor neuropática em pacientes com osteoartrite.

Factors associated with neuropathic pain in Colombian patients with spinal cord injury of traumatic origin: case-control study.

STUDY DESIGN: Case-control study. OBJECTIVES: To identify factors associated with neuropathic pain (NP) in patients with spinal cord injury of traumatic origin (TSCI). SETTING: University Hospital of Valle, Cali, Colombia. METHODS: Study participants were individuals with diagnosis of TSCI who visited a trauma referral center from January 1st, 2016, to December 31st, 2016. Information was retrospectively extracted from the Hospital's Spinal Cord Injury registry and patients' medical records. Cases were defined as patients with NP and controls were those without NP. The exposure of interest was intentional injuries. Individuals were matched by age and stratified into 11 groups of ±3 years each. RESULTS: We found 164 participants with an average age of 34 ± 13 years, of whom 95.1% were male, and 53.6% had NP. Neurogenic bladder and bowel occurred in 94.3% of NP patients. Cause of injury was not associated with NP. Older injuries were protective for NP (>10 years since injury OR = 0.10, 95% CI = 0.03-0.37, p < 0.0001) and neurogenic bladder and bowel were found as risk factors (OR = 5.89, 95% CI = 1.84-18.88; p = 0.003). CONCLUSIONS: Our study uniquely shows time since injury as a protective factor for NP and neurogenic bladder and bowel as a risk factor, while violence was not found associated. This could help guide the scope of future research about NP secondary to SCI.

Traumatic Brain Injury in Honduras: The Use of a Paper-based Surveillance System to Characterize Injuries Patterns.

Background: Traumatic brain injuries (TBI) are a leading cause of death and disability worldwide. Violence is the leading cause of mortality in Honduras. However, the incidence and impact of TBI in this low-middle income country (LMIC) is unknown. The aim of this study is to describe the epidemiology of TBI in Honduras, as captured by an injury surveillance tool in the country's major referral center. Methods: A cross sectional review of all TBI-related emergency department visits at the main referral hospital in Honduras from January to December 2013 was conducted. The calculation of descriptive statistics from Injury Surveillance System (InSS) data was performed. Results: Of 17,971 total injuries seen in 2013, 20% were traumatic brain injuries (n=3,588). The main mechanisms of injury were falls (41.11%), road traffic accidents (23.91%), blunt trauma (20.82%), penetrating knife injuries (5.85%), and firearm injuries (2.26%). Most TBI were classified as mild; 99.69% (Glasgow Coma Scale=15). Emergency room mortality was low (1.11%). The modified Kampala Trauma Score median was 8 (interquartile range 7-8). Conclusion: Mild TBI accounts for a significant percentage of all injuries presenting to a high-volume referral center in Honduras in 2013. Despite the high incidence of violence in this country, most TBI were accidental, secondary to road traffic accidents and falls. Further research is required with more recent data as well as with prospective data collection methods.

Impacts of violence on the mental health of Afro-descendant survivors in Colombia.

The Colombian armed conflict has disproportionately affected minorities, especially afro-Colombian communities. However, there is a lack of evidence about mental health of victims. This study aims to describe the prevalence of mental illness and its associated factors in Afro-descendant violence survivors in Buenaventura and Quibdó, Colombia. A cross-sectional study was carried out using data from a previous trial which aimed to reduce mental health symptoms (ClinicalTrials.gov: NCT01856673). Data of 710 adults identified through a snowball sampling technique was analysed. Diagnoses of depression, anxiety, post-traumatic stress disorder (PTSD), and dysfunction were established using adapted versions of the Hopkins Symptoms Checklist and the Harvard Trauma Questionnaire, plus variables identified in a qualitative study. Multivariate regressions were used to identify associated factors with these diagnoses. The prevalence of depression, anxiety and PTSD in both cities was 26.62% (95% confidence interval [95%CI]: 20.30;23.89), 36.53% (95%CI: 30.63;42.36), and 39.15% (95%CI: 33.36;44.83), respectively. Being married and having registered with the government as victim of the conflict were found to be protective factors for depression and PTSD, respectively. Psychological trauma, unemployment, and traumatic experiences, amongst others, were found as risk factors. The Colombian armed conflict, plus disparities and social exclusion, may be associated with mental health morbidity.

Epidemiology of traumatic spinal cord injuries in Colombia.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine the incidence and characteristics of newly injured individuals admitted to a traumatic spinal cord injury (TSCI) referral center during a 4-year period. SETTING: University Hospital of Valle, Cali, Colombia. METHODS: Individuals were identified, and their data was recorded based on the International Spinal Cord Injury Core Data Set. The outcome of interest was the American Spinal Injury Association Impairment Scale (AIS) grade at the last follow-up. RESULTS: There were 491 individuals admitted in the 4-year period. The mean annual incidence of TSCI was 56.27 per million inhabitants. Considering TSCI in individuals exclusively from Cali, the mean annual incidence was 27.78 per million. The leading cause of TSCI was interpersonal violence (47.25%) and falls (33.60%). There was a strong correlation between AIS grade at admission and last follow-up. The most common AIS grade at the last follow-up was E (34.01%) caused mostly by falls (57.48%), followed by A (31.16%) caused mostly by interpersonal violence (76.27%). The reported employment rate dropped from 75.56% to 18.94% before and after TSCI (p < 0.05). AIS grade A was associated with more post-injury complications (p < 0.05). CONCLUSIONS: This is the first cohort study in Colombia describing the incidence and AIS grades of individuals with TSCI from a trauma referral center. Interpersonal violence was overrepresented in this population. Future research should include the evaluation of prevention strategies, as well as research on interventions towards quality improvement in patient care and post-discharge services especially for individuals with AIS grade A.