Endoscopic Endonasal Transcavernous Hemipituitary Transposition for Resection of Invasive Prolactinoma: 2-Dimensional Operative Video.

Invasive prolactinomas often require multimodal management including medical and surgical interventions. Here, we present the case of a 34-year-old man with a history of progressive visual disturbances. MRI unveiled a sella lesion with suprasellar and retrosellar extensions. Elevated prolactin levels (6125 ng/mL) confirmed the diagnosis of prolactinoma, leading to initiation of medical treatment, with gradual escalation to maximum dosing. The patient achieved only partial hormonal response and incomplete improvement of symptoms, and therefore, surgical intervention was pursued with objective of maximum safe resection. The patient consented to the procedure. An endonasal endoscopic approach was selected. Surgical procedures encompassed transsellar, transtuberculum, and transplanum approaches, extended laterally to expose the right parasellar carotid and the anterior wall of the cavernous sinus. Subsequent steps involved opening the sellar and suprasellar dura mater, anterior wall of the cavernous sinus, and transcavernous hemipituitary transposition for access to the retrosellar region.1-5 Debulking of the lesion was performed, followed by dissection of the retrosellar space and resection of tumor component within the interpeduncular cistern. Reconstruction employed dura substitute and vascularized nasoseptal flap. Histopathology confirmed diagnosis of prolactinoma. Postoperative MRI findings and significantly improved prolactin levels (50 ng/mL) were compatible with near total resection. The patient's postoperative course was uneventful, resulting in discharge on the second postoperative day. The patient was additionally started on cabergoline 0.5 mg 2x/week to achieve hormonal control. This case demonstrates the application of surgical anatomy and its translation in modern surgical techniques that allow improved resection of such complex tumors while ensuring optimal clinical outcomes.

Indication-prescription study for the management of conjunctivitis in a Colombian population.

PURPOSE: Conjunctivitis is one of the most common ocular pathologies. Its treatment depends on its etiology, but an excessive use of antibiotics and corticosteroids, which in many cases are contraindicated, has been described. The objective was to describe the prescription patterns of medications used to treat conjunctivitis in a Colombian population. METHODS: This was a cross-sectional study on the pharmacological treatment of patients diagnosed with conjunctivitis between April 1, 2020, and March 31, 2021; based on a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian Health System. Some sociodemographic and pharmacological variables and comorbidities were considered. A descriptive analysis was performed. RESULTS: A total of 8708 patients were identified; they had a median age of 44.7 years, and 59.3% were women. The most common causes of conjunctivitis were unspecified (53.1%) and allergic (37.4%). The most commonly used drug was olopatadine (26.1%), followed by dexamethasone with neomycin and polymyxin B (25.0%). A total of 97.0% of the patients received ophthalmic prescriptions, while 12.8% received systemic medications. Glucocorticoids (40.3%), antibiotics (37.7%) and antihistamines (31.7%) were the most commonly used groups of ophthalmic drugs. Glucocorticoids and ophthalmic antibiotics were the medications most frequently prescribed by general practitioners for the treatment of viral or bacterial conjunctivitis. CONCLUSIONS: Many patients with conjunctivitis are not being managed according to the recommendations of clinical practice guidelines, which highlights that the widespread use of antibiotics with ophthalmic glucocorticoids could be considered potentially inappropriate prescriptions in many cases.

Study of Prescription-Indication of Outpatient Systemic Anti-Fungals in a Colombian Population. A Cross-Sectional Study.

The inappropriate use of antifungals is associated with greater antimicrobial resistance, costs, adverse events, and worse clinical outcomes. The aim of this study was to determine prescription patterns and approved and unapproved indications for systemic antifungals in a group of patients in Colombia. This was a cross-sectional study on indications for the use of systemic antifungals in outpatients from a drug dispensing database of approximately 9.2 million people affiliated with the Colombian Health System. Sociodemographic, pharmacological, and clinical variables were considered. Descriptive, bivariate, and multivariate analyses were performed. A total of 74,603 patients with antifungal prescriptions were identified; they had a median age of 36.0 years (interquartile range: 22.0−53.0 years), and 67.3% of patients were women. Fluconazole (66.5%) was the most prescribed antifungal for indications such as vaginitis, vulvitis, and vulvovaginitis (35.0%). A total of 29.3% of the prescriptions were used in unapproved indications. A total of 96.3% of ketoconazole users used the medication in unapproved indications. Men (OR: 1.91; CI95%: 1.79−2.04), <18 years of age (OR: 1.20; CI95%: 1.11−1.31), from the Caribbean region (OR: 1.26; CI95%: 1.18−1.34), with chronic obstructive pulmonary disease (OR: 1.80; CI95%: 1.27−2.54), prescriptions made by a general practitioner (OR: 1.17; CI95%: 1.04−1.31), receiving comedications (OR: 1.58; CI95%: 1.48−1.69), and the concomitant use of other antimicrobials (OR: 1.77; CI95%: 1.66−1.88) were associated with a higher probability that the antifungal was used for unapproved indications; deep mycosis (OR: 0.49; CI95%: 0.41−0.58), prescribing fluconazole (OR: 0.06; CI95%: 0.06−0.06), and having diabetes mellitus (OR: 0.33; CI95%: 0.29−0.37), cancer (OR: 0.13; CI95%: 0.11−0.16), or HIV (OR: 0.07; CI95%: 0.04−0.09) reduced this risk. Systemic antifungals were mostly used for the management of superficial mycoses, especially at the gynecological level. In addition, more than a quarter of patients received these medications in unapproved indications, and there was broad inappropriate use of ketoconazole.

Factores asociados a esteatosis hepática no alcohólica en pacientes del área rural del cantón Chambo / Factors Associated with Nonalcoholic Hepatic Steatosis in Patients from the Rural Area of Chambo town

La hepatopatía crónica más prevalente en el mundo es la esteatosis hepática no alcohólica. Así, se realizó una investigación con el objetivo de determinar los factores asociados a esa patología en pacientes atendidos en el Centro de salud tipo B Chambo, Ecuador, durante 2020. Se realizó un estudio con enfoque cuantitativo, de tipo no experimental, correlacional y retrospectivo. Las historias clínicas seleccionadas aportaron los datos de las variables de interés. La media de la edad de los involucrados fue de 54,43 ± 8,10 años. El 60,38% tenía hipertensión arterial, el 52,83% diabetes mellitus, el 62,26% sobrepeso u obesidad y el 49,06% dislipidemia, determi-nando que estas comorbilidades tuvieron una relación significativa con la enfermedad objeto de estudio, la que resultó más incidente en edades mayores de 50 años. Las personas sedentarias o con bajos niveles de actividad física mostraron de ALT y AST.

The most prevalent chronic liver disease in the world is nonalcoholic fatty liver disease. Thus, research aimed to determine the factors associated with this pathology in patients treated at the Type B Chambo Health Center, Ecuador, during 2020. A study was carried out with a quantitati-ve, non-experimental, correlational, and retrospective approach. The selected medical records provided the information for the variables of interest. The mean age of the population was 54.43 ± 8.10 years of age. 60.38% had arterial hypertension, 52.83% diabetes mellitus, 62.26% overweight or obesity and 49.06% dyslipidemia. It was determined that these comorbidities had a significant relationship with the disease under study, which was more incident in ages older than 50. Sedentary people or those ones with low levels of physical activity showed ALT and AST.

"Este caso me desorientó" / "This case confused me "

Paciente femenina de 2 años, sin antecedentes de relevancia, quien consultó en otro centro por cuadro de diarrea, vómitos y fiebre de 5 días de evolución, asociado a bradipsiquia y tendencia al sueño. A su ingreso se solicitó tomo-grafía computada de cerebro (TC), evidenciando ventrículomegalia asociada a edema periependimario y múltiples imágenes isodensas (frontal basal derecha, frontal izquierda y parietal homolateral) con marcado edema perilesional. Se decidió realizar resonancia magnética (RMN) para caracterizar mejor las lesiones

Multivariate time-series analysis of biomarkers from a dengue cohort offers new approaches for diagnosis and prognosis.

Dengue is a major public health problem worldwide with distinct clinical manifestations: an acute presentation (dengue fever, DF) similar to other febrile illnesses (OFI) and a more severe, life-threatening form (severe dengue, SD). Due to nonspecific clinical presentation during the early phase of dengue infection, differentiating DF from OFI has remained a challenge, and current methods to determine severity of dengue remain poor early predictors. We present a prospective clinical cohort study conducted in Caracas, Venezuela from 2001-2005, designed to determine whether clinical and hematological parameters could distinguish DF from OFI, and identify early prognostic biomarkers of SD. From 204 enrolled suspected dengue patients, there were 111 confirmed dengue cases. Piecewise mixed effects regression and nonparametric statistics were used to analyze longitudinal records. Decreased serum albumin and fibrinogen along with increased D-dimer, thrombin-antithrombin complex, activated partial thromboplastin time and thrombin time were prognostic of SD on the day of defervescence. In the febrile phase, the day-to-day rates of change in serum albumin and fibrinogen concentration, along with platelet counts, were significantly decreased in dengue patients compared to OFI, while the day-to-day rates of change of lymphocytes (%) and thrombin time were increased. In dengue patients, the absolute lymphocytes to neutrophils ratio showed specific temporal increase, enabling classification of dengue patients entering the critical phase with an area under the ROC curve of 0.79. Secondary dengue patients had elongation of Thrombin time compared to primary cases while the D-dimer formation (fibrinolysis marker) remained always lower for secondary compared to primary cases. Based on partial analysis of 31 viral complete genomes, a high frequency of C-to-T transitions located at the third codon position was observed, suggesting deamination events with five major hot spots of amino acid polymorphic sites outside in non-structural proteins. No association of severe outcome was statistically significant for any of the five major polymorphic sites found. This study offers an improved understanding of dengue hemostasis and a novel way of approaching dengue diagnosis and disease prognosis using piecewise mixed effect regression modeling. It also suggests that a better discrimination of the day of disease can improve the diagnostic and prognostic classification power of clinical variables using ROC curve analysis. The piecewise mixed effect regression model corroborated key early clinical determinants of disease, and offers a time-series approach for future vaccine and pathogenesis clinical studies.

Predicciones de un modelo SEIR para casos de COVID-19 en Cali, Colombia / Predictions of a SEIR model for COVID-19 cases in Cali-Colombia

RESUMEN Objetivo Predecir el número de casos de COVID-19 en la ciudad de Cali-Colombia mediante el desarrollo de un modelo SEIR. Métodos Se utilizó un modelo determinista compartimental SEIR considerando los estados: susceptibles (S), expuestos (E), infectados (I) y recuperados (R). Los parámetros del modelo fueron seleccionados de acuerdo a la revisión de literatura. En el caso de la tasa de letalidad, se usaron los datos de la Secretaría de Salud Municipal de Cali. Se plantearon varios escenarios teniendo en cuenta variaciones en el número básico de reproducción (R0) y en la tasa de letalidad; además, se comparó la predicción hasta el 9 de abril con los datos observados. Resultados A través del modelo SEIR se encontró que, con el número básico de reproducción más alto (2,6) y utilizando la letalidad calculada para la ciudad de 2,0%, el número máximo de casos se alcanzaría el primero de junio con 195 666 (prevalencia); sin embargo, al comparar los casos observados con los esperados, al inicio la ocurrencia observada estaba por encima de la proyectada; pero luego cambia la tendencia con una disminución marcada de la pendiente. Conclusiones Los modelos epidemiológicos SEIR son métodos muy utilizados para la proyección de casos en enfermedades infecciosas; sin embargo, se debe tener en cuenta que son modelos deterministas que pueden utilizar parámetros supuestos y podrían generar resultados imprecisos.(AU)

ABSTRACT Objective To predict the number of cases of COVID-19 in the city of Cali-Colombia through the development of a SEIR model. Methods A SEIR compartmental deterministic model was used considering the states: susceptible (S), exposed (E), infected (I) and recovered (R). The model parameters were selected according to the literature review, in the case of the case fatality rate data from the Municipal Secretary of Health were used. Several scenarios were considered taking into account variations in the basic number of reproduction (R0), and the prediction until april 9 was compared with the observed data. Results Through the SEIR model it was found that with the highest basic number of reproduction [2,6] and using the case fatality rate for the city of 2,0%, the maximum number of cases would be reached on June 1 with 195 666 (prevalence). However, when comparing the observed with the expected cases, at the beginning the observed occurrence was above the projected, but then the trend changes decreasing the slope. Conclusions SEIR epidemiological models are widely used methods for projecting cases in infectious diseases, however it must be taken into account that they are deterministic models that can use assumed parameters and could generate imprecise results.(AU)

Análisis espacio-temporal del SARS-COV-2 en Cali, Colombia / SARS-coV-2 spatio - temporal analysis in Cali, Colombia

RESUMEN Objetivo Describir la distribución espacio-temporal del COVID-19 en la ciudad de Cali durante el primer mes de epidemia. Métodos Se realizó un análisis exploratorio de datos espaciales, compuesto por un análisis de densidad de Kernel y se verificó la presencia de patrones espaciales por medio de la función K de Ripley. Resultados La distribución espacial de los casos tiende a concentrarse inicialmente en el norte y sur de la ciudad, con una dinámica cambiante hacia el oriente y occidente. Conclusiones El patrón espacial identificado puede estar influenciado por las medidas de aislamiento tomadas a nivel local y nivel nacional, además no se puede descartar el efecto del poco acceso que tiene la población general a las pruebas diagnósticas, los retrasos y represamientos para conocer los resultados de las mismas y aun los posibles sesgos por dificultades en la técnica de toma de la muestra o su conservación.(AU)

ABSTRACT Objective To describe the spatio-temporal distribution of the COVID-19 in the city of Cali during the first month of the epidemic. Methods An exploratory analysis of spatial data was carried out, consisting of a kernel density analysis and the presence of spatial patterns was verified by the K-Ripley function. Results The spatial distribution of the cases tends to initially concentrate in the north and south of the city, with a changing dynamic towards the east and west. Conclusions The identified spatial pattern may be influenced by the isolation measures taken at the local and national level, but the effect of the low access of the general population to diagnostic tests, delays and restraints to know the results cannot be ruled out and even possible biases due to difficulties in the technique of taking the sample or its conservation.(AU)

Objetivo: Descrever a distribuição espaço-temporal do COVID-19 na cidade de Cali durante o primeiro mês da epidemia. Métodos: Foi realizada uma análise exploratória de dados espaciais, consistindo em uma análise de densidade de kernel e a presença de padrões espaciais foi verificada pela função K-Ripley. Resultados: A distribuição espacial dos casos tende a se concentrar inicialmente no norte e no sul da cidade, com uma dinâmica mutante para o leste e oeste. Conclusões: O padrão espacial identificado pode ser influenciado pelas medidas de isolamento tomadas a nível local e nacional, mas não se pode descartar o efeito do baixo acesso da população em geral aos exames diagnósticos, atrasos e limitações para conhecer os resultados e mesmo possíveis vieses devido às dificuldades na técnica de coleta da amostra ou na sua conservação.(AU)

[Predictions of a SEIR model for COVID-19 cases in Cali-Colombia]. / Predicciones de un modelo SEIR para casos de COVID-19 en Cali, Colombia.

OBJECTIVE: To predict the number of cases of COVID-19 in the city of Cali-Colombia through the development of a SEIR model. METHODS: A SEIR compartmental deterministic model was used considering the states: susceptible (S), exposed (E), infected (I) and recovered (R). The model parameters were selected according to the literature review, in the case of the case fatality rate data from the Municipal Secretary of Health were used. Several scenarios were considered taking into account variations in the basic number of reproduction (R0), and the prediction until april 9 was compared with the observed data. RESULTS: Through the SEIR model it was found that with the highest basic number of reproduction [2,6] and using the case fatality rate for the city of 2,0%, the maximum number of cases would be reached on June 1 with 195 666 (prevalence). However, when comparing the observed with the expected cases, at the beginning the observed occurrence was above the projected, but then the trend changes decreasing the slope. CONCLUSIONS: SEIR epidemiological models are widely used methods for projecting cases in infectious diseases, however it must be taken into account that they are deterministic models that can use assumed parameters and could generate imprecise results.

[SARS-coV-2 spatio - temporal analysis in Cali, Colombia]. / Análisis espacio-temporal del SARS-COV-2 en Cali, Colombia.

OBJECTIVE: To describe the spatio-temporal distribution of the COVID-19 in the city of Cali during the first month of the epidemic. METHODS: An exploratory analysis of spatial data was carried out, consisting of a kernel density analysis and the presence of spatial patterns was verified by the K-Ripley function. RESULTS: The spatial distribution of the cases tends to initially concentrate in the north and south of the city, with a changing dynamic towards the east and west. CONCLUSIONS: The identified spatial pattern may be influenced by the isolation measures taken at the local and national level, but the effect of the low access of the general population to diagnostic tests, delays and restraints to know the results cannot be ruled out and even possible biases due to difficulties in the technique of taking the sample or its conservation.

Does Resolution 8430 of 1993 respond to the current needs of ethics in health research with human beings in Colombia? / ¿Responde la Resolución 8430 de 1993 a las necesidades actuales de la ética de la investigación en salud con seres humanos en Colombia?

Verifying the compliance with the ethical principles of health research legitimizes its exercise in the eyes of the society and allows for the resolution of ethical dilemmas that emerge from new research interests and methods. Resolution 8430 of 1993 is one of the main ethical guidelines governing health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation it becomes necessary to evaluate its current validity and adequacy to address the potential ethical dilemmas in the existing country's health research. Some gaps, contradictions, and aspects that require a deep review are detailed in this paper from a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternatives are proposed to adjust the resolution to the present needs in health research with human beings.

La verificación del cumplimiento de los principios éticos en la investigación en salud legitima su ejercicio ante la sociedad y posibilita la resolución de dilemas éticos frente a nuevos intereses y métodos de investigación. En Colombia, la Resolución 8430 de 1993 es una de las principales pautas éticas que regulan la investigación en salud. Dado que no ha sido revisada ni actualizada desde su adopción, se hace necesario valorar su vigencia y suficiencia para abordar los potenciales dilemas éticos que se plantean actualmente en la investigación en salud en el país. En este contexto, se detallan algunos vacíos y contradicciones, así como aspectos que requieren de una revisión profunda, a partir de una concepción amplia de las áreas y los métodos de investigación en salud. Tras discutir las principales falencias e imprecisiones, se proponen alternativas para que la Resolución responda a las necesidades actuales del país frente a la ética en investigación en salud con seres humanos.

Fracturas en niños: experiencia en un centro de alta complejidad del suroccidente Colombiano / Fractures in children: experience in a tertiary referral hospital in South west Colombia

Resumen Introducción: Es importante conocer las características demográficas y clínicas de las fracturas en niños para mejorar las estrategias de prevención y tratamiento en estos pacientes. Objetivos: Describir las fracturas en niños y sus características epidemiológicas. Metodología: Estudio tipo corte transversal desde enero 2014 hasta diciembre 2017. Pacientes menores de 18 años que consultaron por fracturas a una clínica en Colombia fueron incluidos. Se incluyeron datos demográficos, lugar donde ocurrió el trauma, huesos fracturados y tipo de tratamiento. Se evaluó la distribución por género y grupo etario. La fuente de información fue la historia clínica. Se utilizaron medidas de tendencia central y dispersión para agrupar los datos. Se calculó la incidencia de fracturas por cada 1000 niños/ año. Este estudio recibió aval del comité de ética de la institución. Resultados: Hubo 2436 niños fracturados, 65.6% (n=1597) ocurrieron en hombres. La mayoría fueron entre 6-11 años (40.7%, n=991), luego entre 12-17 años (36.4%, n=887) y finalmente, menores de 6 años (22.9%, n=558). La localización de la fractura más frecuente entre 0-5 años fue el húmero (30.6%, n=171), seguido por el radio (29%, n=162) y la clavícula (15.9%, n=89); entre 6-11 años fue el radio (45.2%, n=448), seguido por el húmero (18%, n=178) y el cúbito (16.6%, n=165); y entre 12-17 años fue el radio (34.6%, n=307), seguido por los huesos de la mano (22.7%, n=201) y los huesos del pie (10.8%, n=96). Requirieron manejo quirúrgico 30.9% de los niños fracturados (n=752). La incidencia de fracturas fue de 29.7/1000 niños por año. Conclusión: Las fracturas en niños se presentan con mayor frecuencia en el género masculino. Los huesos fracturados varían dependiendo del grupo etario, con un porcentaje importante del radio en todos los grupos. La mayoría se manejan de forma conservadora.

Abstract Introduction: It is important to know the demographic and clinical characteristics of fractures in children to improve prevention and treatment strategies in these patients. Objectives: To describe fractures in children and their epidemiological characteristics. Methodology: Cross-sectional study performed between January 2014 and December 2017. Patients under 18 years old with fractures who consulted to a hospital in Colombia were included. Demographic data, the location where the trauma occurred, fractured bones and type of treatment were included. Age and gender distribution were analyzed. Medical records were the source of information. Central tendency and dispersion measures were used to group the data. Incidence of fractures per 1000 children / year was calculated. This study received approval from the institution's ethics committee. Results: There were 2436 children with fractures, 65.6% (n=1597) occurred in males. Most fractures were in children between 6-11 years old (40.7%, n=991), followed by 12-17 years old (36.4%, n=887) and finally by children under 6 years old (22.9%, n=558). For the group under 6 years, most fractures occurred in humerus (30.6%, n=171), followed by radius (29%, n=162) and clavicle (15.9%, n=89); between 6-11 years old it was in radius (45.2%, n=448), followed by humerus (18%, n=178) and ulna (16.6%, n=165); and between 12-17 years it was in radio (34.6%, n=307), followed by bones of the hand (22.7%, n=201) and bones of the foot (10.8%, n=96). Surgical treatment was required in 30.9% (n=752) of the patients. The incidence of fractures was 29.7/1000 children per year. Conclusions: Fractures in children occur more frequently in males. The fractured bones differ depending on the age group; however, radius fractures represent an important proportion in all groups. Most fractures in children are treated in a conservative manner.

¿Responde la Resolución 8430 de 1993 a las necesidades actuales de la ética de la investigación en salud con seres humanos en Colombia? / Does Resolution 8430 of 1993 respond to the current needs of ethics in health research with human beings in Colombia?

Resumen La verificación del cumplimiento de los principios éticos en la investigación en salud legitima su ejercicio ante la sociedad y posibilita la resolución de dilemas éticos frente a nuevos intereses y métodos de investigación. En Colombia, la Resolución 8430 de 1993 es una de las principales pautas éticas que regulan la investigación en salud. Dado que no ha sido revisada ni actualizada desde su adopción, se hace necesario valorar su vigencia y suficiencia para abordar los potenciales dilemas éticos que se plantean actualmente en la investigación en salud en el país. En este contexto, se detallan algunos vacíos y contradicciones, así como aspectos que requieren de una revisión profunda, a partir de una concepción amplia de las áreas y los métodos de investigación en salud. Tras discutir las principales falencias e imprecisiones, se proponen alternativas para que la Resolución responda a las necesidades actuales del país frente a la ética en investigación en salud con seres humanos.

Abstract Verifying the compliance with the ethical principles of health research legitimizes its exercise in the eyes of the society and allows for the resolution of ethical dilemmas that emerge from new research interests and methods. Resolution 8430 of 1993 is one of the main ethical guidelines governing health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation it becomes necessary to evaluate its current validity and adequacy to address the potential ethical dilemmas in the existing country's health research. Some gaps, contradictions, and aspects that require a deep review are detailed in this paper from a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternatives are proposed to adjust the resolution to the present needs in health research with human beings.

Development of clinical algorithms for the diagnosis of dengue in Colombia / Desarrollo de algoritmos clínicos para el diagnóstico del dengue en Colombia

Introduction: Due to the increase in dengue incidence and mortality, its diagnosis is relevant for endemic countries. Clinical classifications and laboratory tests have a variable performance in clinical practice with a sensitivity level between 45% and 98%, and a specificity level between 4% and 98% partly due to the variety of contexts where they are applied. Objective: To develop clinical algorithms for the diagnosis of dengue in the Colombian context. Materials and methods: A cross-sectional study was conducted based on secondary sources. We constructed clinical diagnostic algorithms of dengue based on Bayesian methods combining symptoms, signs, and blood count parameters, and then we compared them in terms of diagnostic accuracy with gold standard tests. In addition, an external validation of the algorithm with greater accuracy and sensibility was performed comparing it with the WHO-1997 and the WHO-2009 clinical classifications, the Colombian guide for 2010, and the diagnostic scale recommended by the Ministerio de Salud y Protección Social of Colombia for 2013. Results: Four algorithms were generated, two for signs and symptoms, and two that included leukocytes (≤4,500/mm3) and/or platelets (≤160,000/mm3) counts. The most accurate algorithm included blood count parameters with a sensitivity of 76.5% (95%CI: 71.9-80.5) and a specificity of 46.0% (95%CI: 37.6-54.7). In the external validation we found a sensitivity of 11.1% (95%CI: 4.9-20.7) and a specificity of 91.9% (95%CI: 87.5-93.9). The scale of the Ministerio de Salud had a sensitivity of 76.4% (95%CI: 64.9-85.6) and a specificity of 38.0% (95%CI: 32.8-43.4). Conclusion: The inclusion of blood count parameters improved the sensitivity of diagnostics algorithms based on signs and symptoms. Clinical diagnosis of dengue remains a challenge for health research.

Introducción. Dado el aumento de la incidencia y la mortalidad por dengue, su diagnóstico es relevante para los países endémicos. Las clasificaciones clínicas y las pruebas de laboratorio existentes tienen un desempeño variable en la práctica clínica, pues su sensibilidad fluctúa entre 45 y 98 %, y su especificidad, entre 4 y 98 %, lo cual se debe, en parte, a la diversidad de contextos en los que se utilizan. Objetivo. Desarrollar algoritmos clínicos para el diagnóstico del dengue en el contexto colombiano. Materiales y métodos. Se hizo un estudio transversal a partir de fuentes secundarias. Se construyeron algoritmos clínicos de diagnóstico del dengue con base en métodos bayesianos que combinaron síntomas, signos y parámetros del hemograma, y se comparó su exactitud diagnóstica con la de las pruebas de referencia. Se hizo una validación externa del algoritmo de mayor exactitud y sensibilidad, comparándolo con la clasificación clínica de la Organización Mundial de la Salud de 1997 y la del 2009, con la guía colombiana del 2010 y con la escala diagnóstica propuesta por el Ministerio de Salud y Protección Social de Colombia en el 2013. Resultados. Se generaron cuatro algoritmos, dos de signos y síntomas y dos que incluyeron el conteo de leucocitos (≤4.500/mm3) o de plaquetas (≤60.000/mm3). El algoritmo de mayor exactitud incluyó los parámetros del hemograma, con una sensibilidad de 76,5 % (IC95% 71,9-80,5) y una especificidad de 46,0 % (IC95% 37,6-54,7). En la validación externa, la sensibilidad fue de 11,1 % (IC95% 4,9-20,7) y la especificidad fue de 91,9 % (IC95% 87,5-93,9). La escala del Ministerio tuvo una sensibilidad de 76,4 % (IC95% 64,9-85,6) y una especificidad de 38,0 % (IC95% 32,8-43,4). Conclusión. La inclusión de los parámetros del hemograma mejoró la sensibilidad de los algoritmos de diagnóstico basados en los signos y los síntomas. Sin embargo, el diagnóstico clínico del dengue sigue siendo un reto para la investigación en salud.

Desarrollo de algoritmos clínicos para el diagnóstico del dengue en Colombia / Development of clinical algorithms for the diagnosis of dengue in Colombia

Resumen Introducción. Dado el aumento de la incidencia y la mortalidad por dengue, su diagnóstico es relevante para los países endémicos. Las clasificaciones clínicas y las pruebas de laboratorio existentes tienen un desempeño variable en la práctica clínica, pues su sensibilidad fluctúa entre 45 y 98 %, y su especificidad, entre 4 y 98 %, lo cual se debe, en parte, a la diversidad de contextos en los que se utilizan. Objetivo. Desarrollar algoritmos clínicos para el diagnóstico del dengue en el contexto colombiano. Materiales y métodos. Se hizo un estudio transversal a partir de fuentes secundarias. Se construyeron algoritmos clínicos de diagnóstico del dengue con base en métodos bayesianos que combinaron síntomas, signos y parámetros del hemograma, y se comparó su exactitud diagnóstica con la de las pruebas de referencia. Se hizo una validación externa del algoritmo de mayor exactitud y sensibilidad, comparándolo con la clasificación clínica de la Organización Mundial de la Salud de 1997 y la del 2009, con la guía colombiana del 2010 y con la escala diagnóstica propuesta por el Ministerio de Salud y Protección Social de Colombia en el 2013. Resultados. Se generaron cuatro algoritmos, dos de signos y síntomas y dos que incluyeron el conteo de leucocitos (≤4.500/mm3) o de plaquetas (≤60.000/mm3). El algoritmo de mayor exactitud incluyó los parámetros del hemograma, con una sensibilidad de 76,5 % (IC95% 71,9-80,5) y una especificidad de 46,0 % (IC95% 37,6-54,7). En la validación externa, la sensibilidad fue de 11,1 % (IC95% 4,9-20,7) y la especificidad fue de 91,9 % (IC95% 87,5-93,9). La escala del Ministerio tuvo una sensibilidad de 76,4 % (IC95% 64,9-85,6) y una especificidad de 38,0 % (IC95% 32,8-43,4). Conclusión. La inclusión de los parámetros del hemograma mejoró la sensibilidad de los algoritmos de diagnóstico basados en los signos y los síntomas. Sin embargo, el diagnóstico clínico del dengue sigue siendo un reto para la investigación en salud.

Abstract Introduction: Due to the increase in dengue incidence and mortality, its diagnosis is relevant for endemic countries. Clinical classifications and laboratory tests have a variable performance in clinical practice with a sensitivity level between 45% and 98%, and a specificity level between 4% and 98% partly due to the variety of contexts where they are applied. Objective: To develop clinical algorithms for the diagnosis of dengue in the Colombian context. Materials and methods: A cross-sectional study was conducted based on secondary sources. We constructed clinical diagnostic algorithms of dengue based on Bayesian methods combining symptoms, signs, and blood count parameters, and then we compared them in terms of diagnostic accuracy with gold standard tests. In addition, an external validation of the algorithm with greater accuracy and sensibility was performed comparing it with the WHO-1997 and the WHO-2009 clinical classifications, the Colombian guide for 2010, and the diagnostic scale recommended by the Ministerio de Salud y Protección Social of Colombia for 2013. Results: Four algorithms were generated, two for signs and symptoms, and two that included leukocytes (≤4,500/mm3) and/or platelets (≤160,000/mm3) counts. The most accurate algorithm included blood count parameters with a sensitivity of 76.5% (95%CI: 71.9-80.5) and a specificity of 46.0% (95%CI: 37.6-54.7). In the external validation we found a sensitivity of 11.1% (95%CI: 4.9-20.7) and a specificity of 91.9% (95%CI: 87.5- 93.9). The scale of the Ministerio de Salud had a sensitivity of 76.4% (95%CI: 64.9-85.6) and a specificity of 38.0% (95%CI: 32.8-43.4). Conclusion: The inclusion of blood count parameters improved the sensitivity of diagnostics algorithms based on signs and symptoms. Clinical diagnosis of dengue remains a challenge for health research.

Tendencia espacial y temporal de eventos climáticos extremos en el valle geográfico del río cauca / Spatial and temporal trends of extreme climate events in geographical valley of cauca river

Los eventos climáticos extremos pueden incrementar la ocurrencia del dengue y de enfermedades diarreicas agudas, en áreas altamente sensibles, con poco nivel de adaptación a condiciones cambiantes, bajo el escenario del cambio climático. El objetivo de este estudio fue describir la tendencia espacial y temporal de los eventos extremos de temperatura y de precipitación en el valle geográfico del río Cauca. Se controló la calidad y la homogenización de los datos climáticos. Se desarrolló un análisis robusto no paramétrico de tendencia de eventos climáticos extremos para precipitación y temperatura. Se analizaron 24 estaciones climatológicas en el Valle geográfico del río Cauca. El análisis regional para precipitación y temperatura mostró una tendencia al incremento de los índices de eventos extremos y el análisis local identificó una distribución no homogénea, en el área de estudio. Los resultados se discutieron en virtud de los posibles impactos en salud, específicamente, para dengue y enfermedad diarreica aguda. El aumento de los días lluviosos y de la cantidad de precipitación podrían generar un aumento en la densidad vectorial y la longevidad larval de Aedes aegypti, además causar el desbordamiento de ríos y canales, con combinación de aguas servidas y resuspensión de sólidos, produciendo el aumento de microorganismos patógenos en el agua de consumo. Adicionalmente, la tendencia al incremento de la temperatura podría acortar el ciclo de vida del Aedes y la replicación interna del virus con mayor probabilidad de transmisión del dengue, al mismo tiempo, que aumentaría la sobrevida de bacterias y de protozoos en aguas negras, superficiales y suelo, aumentando la ocurrencia de las EDA.

Extreme climate events can impact the occurrence of dengue and diarrheal diseases. The objective of this paper was to describe the spatial and temporal trend of extreme temperature and precipitation events in the geographical Valley of Cauca River. Quality and homogenization of climate data was monitored. Robust nonparametric trend analysis of extreme weather events for precipitation and temperature was developed. 24 weather stations were analyzed in the geographical Valle del Cauca River. The regional trend analysis showed a trend of increasing rates of extreme events for precipitation and temperature. Meanwhile, local analysis identified that this trend is not homogeneous in the study area. The rise in volume of precipitation and in the number of rainy days can increase Aedes aegypti, density and larval longevity and also cause overflowing of rivers and canals, with combination of sewage and resuspension of solids and pathogenic microorganisms in water. In addition, the rise in temperature shortens Aedes life cycle and viral replication in mosquitoes with higher probability of dengue transmission and meanwhile increases the survival of bacteria and protozoa in surface sewage and soil causing more occurrence of EDA.

[Spatial distribution of potential and positive Aedes aegypti breeding sites].

INTRODUCTION: The spatial distribution of Aedes aegypti is heterogeneous, and the interaction between positive and potential breeding sites located both inside and outside homes is one of the most difficult aspects to characterize in vector control programs. OBJECTIVE: To describe the spatial relationship between potential and positive breeding sites of A. aegypti inside and outside homes in Cali, Colombia. MATERIALS AND METHODS: We conducted an entomological survey to collect data from both indoor and outdoor breeding sites. The exploratory analysis of spatial data included location, spatial trends, local spatial autocorrelation, spatial continuity and spatial correlation of positive and potential breeding sites according to habitat. RESULTS: Spatial trends were identified, as well as clusters of potential and positive breeding sites outdoors using local spatial autocorrelation analysis. A positive correlation was found between potential and positive breeding sites, and a negative correlation existed between indoor and outdoor sites. CONCLUSIONS: The spatial relationship between positive and potential A. aegypti breeding sites both indoors and outdoors is dynamic and highly sensitive to the characteristics of each territory. Knowing how positive and potential breeding sites are distributed contributes to the prioritization of resources and actions in vector control programs.

[Socioeconomic status, eating patterns, and heavy metals exposure in women of childbearing age in Cali, Colombia].

INTRODUCTION: Global increase in food and water pollution is associated with health risk, which depends on the concentration, the dose, and the exposure time. This has raised concerns about the possible long-term effects of chronic exposure to low concentrations of heavy metals, such as lead, cadmium and mercury. OBJECTIVE: To explore the relationship among socioeconomic status, eating patterns, and exposure to heavy metals among a population of women in Cali, Colombia. MATERIALS AND METHODS: A total of 233 non-pregnant women of childbearing age living in the Aguablanca district of Cali, Colombia, were enrolled in the study. We gathered sociodemographic data, as well as information on housing conditions, exposure to heavy metals, frequency of food intake, and anthropometric measurements. Samples of lettuce, cabbage and fish (tilapia and butterfish) were collected to determine lead, cadmium, and mercury concentrations. Descriptive and multiple correspondence analyses were performed to establish eating patterns. RESULTS: Fish was served in each of the three main meals of the day, with a bigger serving at lunch time. Cadmium was found in three samples of butterfish at levels below the acceptable. Of those who ate fish more than once a week, 11.1% bought the product at a cadmium-positive store. The multiple correspondence analysis showed a positive relationship between being black and consuming butterfish and tilapia more than once per week. CONCLUSIONS: The findings showed that the studied population had access to heavy metal-contaminated food, which combined with the women's cultural eating patterns, socioeconomic status, and metabolic characteristics led to a greater vulnerability to the effects of heavy metals exposure.

Condición socioeconómica, patrones de alimentación y exposición a metales pesados en mujeres en edad fértil de Cali, Colombia / Socioeconomic status, eating patterns, and heavy metals exposure in women of childbearing age in Cali, Colombia

Resumen Introducción. La contaminación del agua y de los alimentos constituye un riesgo creciente para la salud a nivel mundial. Dicho riesgo varía según las concentraciones y las dosis de los contaminantes y el tiempo de exposición, especialmente por los posibles efectos a largo plazo debidos a la exposición crónica a bajas concentraciones de metales pesados como el plomo, el cadmio y el mercurio. Objetivo. Explorar la relación entre la condición socioeconómica, los patrones de alimentación y la exposición a metales pesados en una población de mujeres de Cali. Materiales y métodos. Participaron 233 mujeres en edad fértil, no embarazadas, residentes en el distrito de Aguablanca, Cali, Colombia. Se recolectó información sociodemográfica, así como sobre las condiciones de la vivienda, la exposición a metales pesados, la frecuencia de consumo de alimentos y las mediciones antropométricas. Para determinar las concentraciones de plomo, cadmio y mercurio, se tomaron muestras de lechuga, repollo y peces (tilapia y 'manteco'). Se hicieron análisis descriptivos y de correspondencias múltiples para establecer los patrones de consumo. Resultados. El pescado se incluía en las tres comidas del día, especialmente en el almuerzo; se encontró cadmio por debajo de los niveles permitidos en tres muestras de 'manteco'. El 11,1 % de quienes consumían pescado una vez o más por semana lo había comprado en un expendio en el cual las muestras fueron positivas para cadmio. Mediante el análisis de correspondencias múltiples, se determinó la presencia de una relación entre el ser de raza negra y el consumo de 'manteco' y tilapia una vez o más por semana. Conclusiones. La población de estudio tuvo acceso a alimentos contaminados con metales pesados. Esto, sumado a las características metabólicas de las mujeres y a sus condiciones socioeconómicas, incrementó su exposición y vulnerabilidad frente a los efectos de la contaminación.

Abstract Introduction: Global increase in food and water pollution is associated with health risk, which depends on the concentration, the dose, and the exposure time. This has raised concerns about the possible long-term effects of chronic exposure to low concentrations of heavy metals, such as lead, cadmium and mercury. Objective: Toexplore the relationship among socioeconomic status, eating patterns, and exposure to heavy metals among a population of women in Cali, Colombia. Materials and methods: A total of 233 non-pregnant women of childbearing age living in the Aguablanca district of Cali, Colombia, were enrolled in the study. We gathered sociodemographic data, as well as information on housing conditions, exposure to heavy metals, frequency of food intake, and anthropometric measurements. Samples of lettuce, cabbage and fish (tilapia and butterfish) were collected to determine lead, cadmium, and mercury concentrations. Descriptive and multiple correspondence analyses were performed to establish eating patterns. Results: Fish was served in each of the three main meals of the day, with a bigger serving at lunch time. Cadmium was found in three samples of butterfish at levels below the acceptable. Of those who ate fish more than once a week, 11.1% bought the product at a cadmium-positive store. The multiple correspondence analysis showed a positive relationship between being black and consuming butterfish and tilapia more than once per week. Conclusions: The findings showed that the studied population had access to heavy metal-contaminated food, which combined with the women's cultural eating patterns, socioeconomic status, and metabolic characteristics led to a greater vulnerability to the effects of heavy metals exposure.

Distribución espacial de criaderos positivos y potenciales de Aedes aegypti / Spatial distribution of potential and positive Aedes aegypti breeding sites

Resumen Introducción. La distribución espacial de Aedes aegypti es heterogénea, y la interacción entre criaderos positivos y potenciales en el intradomicilio y el extradomicilio es uno de los aspectos más difíciles de caracterizar en los programas de control vectorial. Objetivo. Describir la relación espacial entre los criaderos potenciales y positivos de A. aegypti en el intradomicilio y en el extradomicilio en un sector de Cali, Colombia. Materiales y métodos. Se hizo una encuesta entomológica con el objetivo de recolectar datos de los criaderos en el intradomicilio y el extradomicilio. El análisis exploratorio de los datos espaciales incluyó la localización, la tendencia espacial, la autocorrelación espacial local, la continuidad espacial y la correlación espacial de los criaderos positivos y potenciales según el hábitat. Resultados. Se determinaron las tendencias espaciales. Mediante el análisis de autocorrelación espacial local se ubicaron los conglomerados de criaderos potenciales y positivos del extradomicilio. Se encontró una correlación positiva entre los criaderos potenciales y los positivos y una correlación negativa entre el intradomicilio y el extradomicilio. Conclusiones. La relación espacial entre criaderos positivos y potenciales de A. aegypti en el intradomicilio y el extradomicilio es dinámica y muy sensible a las características de cada territorio, por lo que establecer su distribución en el espacio contribuye a la priorización de recursos y acciones en los programas de control vectorial.

Abstract Introduction: The spatial distribution of Aedes aegypti is heterogeneous, and the interaction between positive and potential breeding sites located both inside and outside homes is one of the most difficult aspects to characterize in vector control programs. Objective: To describe the spatial relationship between potential and positive breeding sites of A. aegypti inside and outside homes in Cali, Colombia. Materials and methods: We conducted an entomological survey to collect data from both indoor and outdoor breeding sites. The exploratory analysis of spatial data included location, spatial trends, local spatial autocorrelation, spatial continuity and spatial correlation of positive and potential breeding sites according to habitat. Results: Spatial trends were identified, as well as clusters of potential and positive breeding sites outdoors using local spatial autocorrelation analysis. A positive correlation was found between potential and positive breeding sites, and a negative correlation existed between indoor and outdoor sites. Conclusions: The spatial relationship between positive and potential A. aegypti breeding sites both indoors and outdoors is dynamic and highly sensitive to the characteristics of each territory. Knowing how positive and potential breeding sites are distributed contributes to the prioritization of resources and actions in vector control programs.