[Trends in motorcycle road deaths in Colombia, 2008-2021Tendências de mortalidade por acidentes de motocicleta na Colômbia, 2008-2021]. / Tendencias en la mortalidad por accidentes de tránsito en motocicleta en Colombia, 2008-2021.

Objective: To identify trends in motorcycle road deaths in Colombia between 2008 and 2021. Methods: An observational and descriptive study of trends in motorcycle road deaths was conducted using official death records from 2008 to 2021. Jointpoint Poisson regression analysis was performed to detect inflection points in mortality rates specific to age, sex, and area of residence. Results: A total of 28 200 motorcycle road deaths were identified during the period; 24 271 men and 3 929 women died. Of the deaths, 74.1% occurred in urban areas and 25.9% in rural areas. In rural areas, there was an increasing trend in fatalities in young adults of both sexes during the period. The same occurred in men over 65 years of age. In urban areas, there was an upward trend in fatalities in the age group from 45-64 for both sexes during the period. Only one inflection point was detected, in 2015, showing a downward trend in adolescent females. Conclusion: The trend in motorcycle road deaths in Colombia continued to rise during the 2008-2021 period, both in rural areas for young adults and in urban areas for middle-aged adults.

Objetivo: Identificar tendências de mortalidade por acidentes de motocicleta na Colômbia entre 2008 e 2021. Métodos: Realizou-se um estudo observacional e descritivo das tendências de mortalidade por acidentes de motocicleta com base em registros oficiais de óbitos entre 2008 e 2021. Conduziu-se uma análise baseada na regressão de Poisson (Joinpoint) para detectar pontos de inflexão em taxas de mortalidade específicas por idade, sexo e área de residência. Resultados: Foram identificadas 28 200 mortes por acidentes de motocicleta durante todo o período, correspondendo a 24 271 homens e 3 929 mulheres. As mortes ocorreram tanto na área urbana (74,1%) quanto rural (25,9%). Na área rural, observou-se uma tendência crescente na mortalidade de adultos jovens de ambos os sexos ao longo de todo o período. O mesmo ocorreu em relação a homens com mais de 65 anos. Na área urbana, identificou-se uma tendência de aumento da mortalidade na faixa etária de 45 a 64 anos, em ambos os sexos, durante todo o período. Apenas um ponto de inflexão foi detectado em 2015, mostrando uma redução na tendência em adolescentes do sexo feminino. Conclusão: A tendência de mortalidade por acidentes de motocicleta na Colômbia continuou a aumentar durante todo o período (2008 a 2021), tanto na área rural, para jovens adultos, quanto na área urbana, para pessoas de meia-idade.

Tendencias en la mortalidad por accidentes de tránsito en motocicleta en Colombia, 2008-2021 / Trends in motorcycle road deaths in Colombia, 2008-2021 / Tendências de mortalidade por acidentes de motocicleta na Colômbia, 2008–2021

[RESUMEN]. Objetivo. Identificar las tendencias de mortalidad por accidentes de tránsito en motocicleta en Colombia entre los años 2008 y 2021. Métodos. Se realizó un estudio observacional y descriptivo de tendencias de la mortalidad por accidentes de tránsito en motocicleta a partir de los registros oficiales de defunciones entre 2008 y 2021. Se efectuó un análisis de regresión Jointpoint Poisson para detectar los puntos de inflexión en las tasas de mortalidad espe- cíficas por edad, sexo y área de residencia. Resultados. Se identificaron 28 200 muertes por accidentes de tránsito en motocicleta en todo el período; fallecieron 24 271 hombres y 3 929 mujeres. El 74,1% de las defunciones ocurrió en el área urbana y el 25,9% en el área rural. En esta área se observó una tendencia creciente en la mortalidad en adultos jóvenes de ambos sexos a lo largo de todo el período. Lo mismo ocurrió en hombres de más de 65 años. En el área urbana, se identificó una tendencia al aumento de la mortalidad en las edades entre 45 a 64 años para ambos sexos durante todo el período. Solo se detectó un punto de inflexión en el año 2015, que mostró una disminución en la tendencia, en mujeres adolescentes. Conclusión. La tendencia en la mortalidad por accidentes de tránsito en motocicleta en Colombia se mantuvo en aumento durante todo el período (2008-2021) tanto en áreas rurales para adultos jóvenes como en áreas urbanas para personas de mediana edad.

[ABSTRACT]. Objective. To identify trends in motorcycle road deaths in Colombia between 2008 and 2021. Methods. An observational and descriptive study of trends in motorcycle road deaths was conducted using official death records from 2008 to 2021. Jointpoint Poisson regression analysis was performed to detect inflection points in mortality rates specific to age, sex, and area of residence. Results. A total of 28 200 motorcycle road deaths were identified during the period; 24 271 men and 3 929 women died. Of the deaths, 74.1% occurred in urban areas and 25.9% in rural areas. In rural areas, there was an increasing trend in fatalities in young adults of both sexes during the period. The same occurred in men over 65 years of age. In urban areas, there was an upward trend in fatalities in the age group from 45-64 for both sexes during the period. Only one inflection point was detected, in 2015, showing a downward trend in adolescent females. Conclusion. The trend in motorcycle road deaths in Colombia continued to rise during the 2008-2021 period, both in rural areas for young adults and in urban areas for middle-aged adults.

[RESUMO]. Objetivo. Identificar tendências de mortalidade por acidentes de motocicleta na Colômbia entre 2008 e 2021. Métodos. Realizou-se um estudo observacional e descritivo das tendências de mortalidade por acidentes de motocicleta com base em registros oficiais de óbitos entre 2008 e 2021. Conduziu-se uma análise baseada na regressão de Poisson (Joinpoint) para detectar pontos de inflexão em taxas de mortalidade específicas por idade, sexo e área de residência. Resultados. Foram identificadas 28 200 mortes por acidentes de motocicleta durante todo o período, corres- pondendo a 24 271 homens e 3 929 mulheres. As mortes ocorreram tanto na área urbana (74,1%) quanto rural (25,9%). Na área rural, observou-se uma tendência crescente na mortalidade de adultos jovens de ambos os sexos ao longo de todo o período. O mesmo ocorreu em relação a homens com mais de 65 anos. Na área urbana, identificou-se uma tendência de aumento da mortalidade na faixa etária de 45 a 64 anos, em ambos os sexos, durante todo o período. Apenas um ponto de inflexão foi detectado em 2015, mostrando uma redução na tendência em adolescentes do sexo feminino. Conclusão. A tendência de mortalidade por acidentes de motocicleta na Colômbia continuou a aumentar durante todo o período (2008 a 2021), tanto na área rural, para jovens adultos, quanto na área urbana, para pessoas de meia-idade.

Association of Healthcare Fragmentation and the Survival of Patients with Colorectal Cancer in Colombia.

OBJECTIVES: The objective of this study was to identify the association between healthcare fragmentation and survival for patients with colorectal cancer in Colombia. METHODS: A retrospective cohort study was performed using administrative databases, with an electronic algorithm to identify patients with colorectal cancer based on codes. The patients were enrolled between January 1, 2013, and December 31, 2016. The exposure variable was fragmentation, which was measured based on the number of different healthcare institutions that treated a patient during the first year after diagnosis. Matching was performed using propensity scores to control for confounding, and the hazard ratio for exposure to higher fragmentation was calculated for the matched sample. RESULTS: A total of 5036 patients with colorectal cancer were identified, 2525 (49.88%) of whom were women. The mean number of network healthcare institutions for the total sample was 5.71 (SD 1.98). The patients in the quartile with higher fragmentation had the highest mortality rate, 35.67 (95% CI 33.63-38.06) per 100 patients. The comparison of higher and lower quartiles of fragmentation resulted in an incidence rate ratio of 1.23 (95% CI 1.04-1.45; P = .02). Of the 5036 patients, 422 (8.38%) were classified as the exposed cohort (higher fragmentation). The total matched sample consisted of 844 subjects, and an HR of 1.26 (95%CI; 1.05-1.51) was estimated. CONCLUSIONS: Exposure to more highly fragmented healthcare networks decreases overall 4-year survival for patients with colorectal cancer in Colombia.

Tackling potentially inappropriate prescriptions in older adults: development of deprescribing criteria by consensus from experts in Colombia, Argentina, and Spain.

BACKGROUND: Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop and validate a tool for identifying PIMs in older adults within the primary care setting. The tool is composed of a list of criteria and was created based on consensus among experts from three Spanish-speaking countries, including two from Latin America. METHODS: A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability. RESULTS: Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial). CONCLUSIONS: The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.

Fragmentation of Care and Its Association With Survival and Costs for Patients With Breast Cancer in Colombia.

PURPOSE: Breast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system. MATERIALS AND METHODS: A retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model. RESULTS: A total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26). CONCLUSION: Fragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.

A longitudinal study of free leptin index in pre-eclamptic pregnancies.

The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the aim of our study was to investigate the FLI in mild pre-eclamptic pregnancies in a nested case-control study within a prospective observational study. Circulating levels of leptin and sOB-R levels rise significantly during pregnancy in healthy (p < 0.05) (n = 46) and pre-eclamptic pregnancies (p < 0.05) (n = 20). Serum levels of leptin were significantly higher in pre-eclamptic compared to healthy pregnancies at second and third trimesters of pregnancy (p < 0.05). Additionally, serum levels of sOB-R were significantly lower in pre-eclamptic pregnancies during the second and third trimesters of pregnancy compared to healthy pregnancies (p < 0.05). Moreover, we found that FLI did not vary significantly during pregnancy in healthy women (p > 0.05), while it increases in pre-eclamptic pregnancies (p < 0.05). Indeed, FLI was significantly higher at second and third trimesters of pregnancy in pre-eclamptic compared to healthy pregnancies (p < 0.05). In addition, FLI was significantly higher in the luteal phase compared with the follicular phase of the menstrual cycle in eumenorrheic women (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed the ability of leptin (AUC = 0.72) and FLI (AUC = 0.67) as a reliable predictor for mild pre-eclampsia during the second trimester of pregnancy. In conclusion, our findings show that FLI were significantly increased in mild pre-eclamptic pregnancies and allowed us to hypothesize that this rise might alter leptin bioavailability and bioactivity which might lead to the sympathetic hyperactivity and the hypertensive disorders during pregnancy.

Failure to Rescue and Mortality Differences After Appendectomy in a Low-Middle-Income Country and the United States.

BACKGROUND: Major disparities in complications and mortality after appendectomy between countries with different income levels have not been well characterized, as comparative studies at patient level between countries are scant. This study aimed to investigate variations in postoperative complications, mortality, and failure to rescue after appendectomy between a high-income country and a low-to-middle-income country. METHODS: Hospital discharges on adult patients who underwent appendectomy were extracted from administrative databases from Colombia and 2 states of the United States (Florida and New York). Outcomes included major postoperative complications, in-hospital mortality, and failure to rescue. Univariate analyses were conducted to compare outcomes between the 2 countries. Multivariable logistic regression analyses were conducted to examine the independent effect of country on outcomes after adjustment for patient age, sex, comorbidity index, severity of appendicitis, and appendectomy route (laparoscopic/open). RESULTS: A total of 62,338 cases from Colombia and 57,987 from the United States were included in the analysis. Patients in Colombia were significantly younger and healthier but had a higher incidence of peritonitis. Use of laparoscopy was significantly lower in Colombia (5.9% vs 89.4%; P < .0001). After adjustment for covariates, multivariable logistic regression analyses revealed that compared to the United States, Colombia had lower complication rates (2.8% vs 6.6%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.39-0.44; P < .0001) but higher mortality (0.44% vs 0.08%; OR, 8.92; 95% CI, 5.69-13.98; P < .0001) and failure to rescue (13.6% vs 1.0%; OR, 17.01; 95% CI, 10.66-27.16; P < .0001). CONCLUSIONS: Despite lower rates of postoperative complications, in-hospital mortality after appendectomy was higher in Colombia than in the United States. This difference may be explained by higher rates of failure to rescue in the low-to-middle-income country (ie, decreased ability of Colombian hospitals to rescue patients from complications).

Health Insurance Scheme: Main Contributor to Inequalities in COVID-19 Mortality in Colombia.

Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies. (Am J Public Health. 2022;112(S6):S586-S590. https://doi.org/10.2105/AJPH.2021.306637).

[Health insurance scheme: main contributor to inequalities in COVID-19 mortality in ColombiaTipo de cobertura de assistência à saúde: o principal fator contribuinte para as desigualdades em mortalidade por COVID-19 na Colômbia]. / Plan de seguro de salud: factor que más contribuye a las desigualdades en la mortalidad por COVID-19 en Colombia.

Objectives: To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods: We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results: We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions: Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies.

Objetivos: Quantificar as desigualdades socioeconômicas na mortalidade por COVID-19 na Colômbia e avaliar até que ponto o tipo de cobertura de assistência à saúde, a carga de comorbidades, o local de residência e a etnia contribuíram para tais desigualdades. Métodos: Analisamos dados de uma coorte retrospectiva de casos de COVID-19. Calculamos os índices relativo e angular de desigualdade (RII e SII, respectivamente) utilizando modelos de sobrevivência em todos os participantes, estratificando-os por idade e gênero. Calculamos o percentual de redução no RII e no SII após ajuste para fatores possivelmente relevantes. Resultados: Identificamos desigualdades significativas na coorte como um todo e por subgrupos (idade e gênero). As desigualdades foram maiores para adultos mais jovens e decaíram gradualmente com a idade, indo de um RII de 5,65 (intervalo de confiança [IC] de 95% = 3,25; 9,82] nos participantes com idade inferior a 25 anos a um RII de 1,49 [IC 95% = 1,41; 1,58] nas pessoas com 65 anos ou mais. O tipo de cobertura de assistência à saúde foi o fator mais importante, representando 20% e 59% das desigualdades relativa e absoluta, respectivamente. Conclusões: Desigualdades socioeconômicas significativas afetaram a mortalidade por COVID-19 na Colômbia. O tipo de cobertura de saúde parece ser o principal fator contribuinte para essas desigualdades, impondo desafios à elaboração de estratégias de saúde pública.

Plan de seguro de salud: factor que más contribuye a las desigualdades en la mortalidad por COVID-19 en Colombia

[RESUMEN]. Objetivo. Cuantificar las desigualdades socioeconómicas en la mortalidad por COVID-19 en Colombia y evaluar en qué medida el tipo de seguro de salud, la carga de enfermedades concomitantes, la zona de residencia y el origen étnico explican estas desigualdades. Métodos. Se analizaron los datos de una cohorte retrospectiva de casos de COVID-19. Se estimó el índice relativo de desigualdad (IRD) y el índice de desigualdad basado en la pendiente (IDP) utilizando modelos de supervivencia con todos los participantes, y estratificándolos por edad y sexo. El porcentaje de reducción del IRD y el IDP se calculó después de ajustar con respecto a factores que podrían ser relevantes. Resultados. Se pusieron en evidencia desigualdades notables en toda la cohorte y en los subgrupos (edad y sexo). Las desigualdades fueron mayores en los adultos más jóvenes y disminuyeron de manera gradual con la edad, pasando de un IRD de 5,65 (intervalo de confianza de 95% [IC 95%] = 3,25-9,82) en los participan- tes menores de 25 años a un IRD de 1,49 (IC 95% = 1,41-1,58) en los mayores de 65 años. El tipo de seguro de salud fue el factor más importante, al cual se atribuyó 20% de las desigualdades relativas y 59% de las absolutas. Conclusiones. La mortalidad por COVID-19 en Colombia presenta importantes desigualdades socioeconó- micas. El seguro de salud aparece como el factor que más contribuye a estas desigualdades, lo cual plantea retos al diseño de las estrategias de salud pública.

[ABSTRACT]. Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insu- rance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies.

[RESUMO]. Objetivos. Quantificar as desigualdades socioeconômicas na mortalidade por COVID-19 na Colômbia e ava- liar até que ponto o tipo de cobertura de assistência à saúde, a carga de comorbidades, o local de residência e a etnia contribuíram para tais desigualdades. Métodos. Analisamos dados de uma coorte retrospectiva de casos de COVID-19. Calculamos os índices relativo e angular de desigualdade (RII e SII, respectivamente) utilizando modelos de sobrevivência em todos os participantes, estratificando-os por idade e gênero. Calculamos o percentual de redução no RII e no SII após ajuste para fatores possivelmente relevantes. Resultados. Identificamos desigualdades significativas na coorte como um todo e por subgrupos (idade e gênero). As desigualdades foram maiores para adultos mais jovens e decaíram gradualmente com a idade, indo de um RII de 5,65 (intervalo de confiança [IC] de 95% = 3,25; 9,82] nos participantes com idade inferior a 25 anos a um RII de 1,49 [IC 95% = 1,41; 1,58] nas pessoas com 65 anos ou mais. O tipo de cobertura de assistência à saúde foi o fator mais importante, representando 20% e 59% das desigualdades relativa e absoluta, respectivamente. Conclusões. Desigualdades socioeconômicas significativas afetaram a mortalidade por COVID-19 na Colômbia. O tipo de cobertura de saúde parece ser o principal fator contribuinte para essas desigualdades, impondo desafios à elaboração de estratégias de saúde pública.

Maternal Fibroblast Growth Factor 21 Levels Decrease during Early Pregnancy in Normotensive Pregnant Women but Are Higher in Preeclamptic Women-A Longitudinal Study.

(1) Background: Fibroblast growth factor 21 (FGF-21) is an endocrine factor involved in glucose and lipid metabolism that exerts pleiotropic effects. The aim of this study was to investigate the serum FGF-21 profile in healthy and mild preeclamptic pregnant women at each trimester of pregnancy; (2) Methods: Serum FGF-21 levels were determined by ELISA in a nested case-control study within a longitudinal cohort study that included healthy (n = 54) and mild preeclamptic (n = 20) pregnant women, women at three months after delivery (n = 20) and eumenorrheic women during the menstrual cycle (n = 20); (3) Results: FGF-21 levels were significantly lower in the mid-luteal phase compared to the early follicular phase of the menstrual cycle in eumenorrheic women (p < 0.01). Maternal levels of FGF-21 were significantly lower in the first and second trimesters and peaked during the third trimester in healthy pregnant women (p < 0.01). Serum levels of FGF-21 in healthy pregnant were significantly lower in the first and second trimester of pregnancy compared with the follicular phase of the menstrual cycle and postpartum (p < 0.01). Serum FGF-21 levels were significantly higher in preeclamptic compared to healthy pregnant women during pregnancy (p < 0.01); (4) Conclusions: These results suggest that a peak of FGF-21 towards the end of pregnancy in healthy pregnancy and higher levels in preeclamptic women might play a critical role that contributes to protecting against the negatives effects of high concentrations of non-esterified fatty acids (NEFA) and hypertensive disorder. Furthermore, FGF-21 might play an important role in reproductive function in healthy eumenorrheic women during the menstrual cycle.

Hepatocellular carcinoma: A real-life experience in a specialized center in Bogotá, Colombia / Hepatocarcinoma: experiencia de la vida real en un centro especializado de Bogotá, Colombia

Abstract Introduction: Hepatocellular carcinoma (HCC) is the most frequent malignant primary liver tumor globally. In 2018, it ranked sixth and represented the fourth cause of death from cancer; the five-year overall survival is 18 %. Most cases of HCC develop in patients with cirrhosis of any etiology, especially because of hepatitis B and C viruses, alcohol, and recently nonalcoholic steatohepatitis (NASH). Aim: To analyze the clinical characteristics, diagnostic methods, treatments, prognostic variables, and survival. Materials and methods: This retrospective descriptive study was conducted on a cohort of patients diagnosed with cirrhosis and treated between January 2011 and December 2020 at a health care center in Bogotá. The diagnosis of HCC was confirmed radiologically or by biopsy. We analyzed the information descriptively with absolute frequency measures in the case of categorical variables. For continuous variables, the information was summarized with measures of central tendency (mean or median) and their relevant measures of dispersion. Results: We included 152 patients diagnosed with HCC, with a mean age of 69.4 years; 51.3 % were men. The leading cause of HCC was nonalcoholic fatty liver disease (NAFLD), which accounted for almost a third of cases (32 %); other causes were alcohol (15 %) and hepatitis C virus (14 %). The median manifestation of the tumor was two nodules with a size close to 4 cm. Besides, 35 % of patients had a BCLC (Barcelona Clinic Liver Cancer) stage with curative options, and 25 % received curative treatment options. The first-line systemic therapy used in this cohort was sorafenib®, used in 35 patients (33.7 %). Survival curves showed that women, Child-Pugh class A, and BCLC stage 0 had higher median survival. Multivariate analysis showed a higher risk of death for males (hazard ratio [HR]: 2.16; confidence interval [CI]: 1.24-3.76), Child-Pugh class B (HR: 2.14; CI 1.16-3.95), and Child-Pugh class C (HR: 7.52; CI 2.88-19.57). Conclusions: NAFLD is the leading cause of HCC in this cohort. A third of patients are diagnosed in early BCLC stages with a curative treatment option, and 25 % are treated with curative therapies. Sorafenib was the first-line therapy in advanced HCC. Overall survival after diagnosis of HCC remains low, being necessary to join forces in the follow-up of patients with cirrhosis to improve these outcomes.

Resumen Introducción: el hepatocarcinoma (HCC) es el tumor hepático primario maligno más frecuente en el mundo: en 2018 ocupó la sexta posición y representó la cuarta causa de muerte por cáncer; la supervivencia global a 5 años es del 18 %. La mayoría de los casos de HCC se desarrolla en pacientes con cirrosis de cualquier etiología, especialmente por virus de la hepatitis B y C, alcohol y, recientemente, por la esteatohepatitis no alcohólica (NASH). Objetivo: analizar las características clínicas, métodos de diagnóstico, tratamientos, variables pronósticas y supervivencia. Metodología: estudio descriptivo retrospectivo de una cohorte de pacientes con diagnóstico de cirrosis atendidos entre enero de 2011 y diciembre de 2020 en un centro de atención médica de Bogotá, con diagnóstico de HCC confirmado radiológicamente o por biopsia. La información se analizó de forma descriptiva con medidas de frecuencia absoluta en el caso de las variables categóricas; para las variables continuas se resumió la información con medidas de tendencia central (media o medianas) y su respectiva medida de dispersión. Resultados: se incluyeron 152 pacientes diagnosticados con HCC, con edad promedio de 69,4 años, 51,3 % eran hombres. La principal causa de HCC fue el hígado graso no alcohólico (NAFLD), que representó casi una tercera parte de los casos (32 %); otras causas fueron el alcohol (15 %) y el virus de la hepatitis C (14 %). La mediana de presentación del tumor fue de 2 nódulos con un tamaño cercano a 4 cm. El 35 % de los pacientes tenía un estadio BCLC (Barcelona Clinic Liver Cancer) con opciones curativas y el 25 % de los pacientes recibió opciones curativas de tratamiento. La terapia sistémica de primera línea utilizada en esta cohorte fue el sorafenib®, que se utilizó en 35 pacientes (33,7 %). Las curvas de supervivencia mostraron que las mujeres, el estadio Child-Pugh A y el estadio BCLC 0 presentaron mayores medianas de supervivencia. El análisis multivariado evidenció un mayor riesgo de muerte al ser hombre (Hazard ratio [HR]: 2,16; intervalo de confianza [IC]: 1,24 a 3,76), estar en los estadios Child-Pugh B (HR: 2,14; IC: 1,16 a 3,95) y Child-Pugh C (HR: 7,52; IC: 2,88 a 19,57). Conclusiones: el NAFLD es la principal causa de HCC en la presente cohorte, una tercera parte de los pacientes se diagnostica en estadios BCLC tempranos con opción curativa de tratamiento, y un 25 % se trata con terapias curativas. El sorafenib fue la terapia de primera línea en HCC avanzado. La supervivencia global luego del diagnóstico de HCC sigue siendo baja, y es necesario aunar esfuerzos en el seguimiento de los pacientes con cirrosis para mejorar estos resultados.

The behavior of liver diseases in a cohort of Colombian patients with COVID-19 / Comportamiento de las enfermedades hepáticas en una cohorte de pacientes colombianos con COVID-19

Abstract Introduction: Severe acute respiratory syndrome type 2 coronavirus infection (SARS-CoV-2) is receiving the most attention now. The asymptomatic elevation of transaminases is typical in the liver, and liver involvement varies from 14 % to 78 %. The assessment of liver comorbidities is scarce, with prevalence ranging between 2 % and 11 %. Aim: To describe the behavior of a cohort of patients with liver diseases who fell ill with coronavirus disease 2019 (COVID-19). Materials and methods: This retrospective observational study analyzed the behavior of a cohort of patients with liver diseases who fell ill with COVID-19. Results: 543 patients became ill with COVID-19, of which 300 were women (55.3 %). The median age at diagnosis of liver disease was 52 years. The leading causes of liver disease were nonalcoholic steatohepatitis (49.5 %), cholestatic disease (7.7 %), and hepatitis C and B viruses (6.3 %). Alanine aminotransferase (ALT) had a median of 52 U/L (interquartile range [IQR]: 30-98) and aspartate aminotransferase (AST) 32 U/L (IQR: 23-62). Mortality due to viral infection was 5.7 %, with an incidence rate of 2.9 (95 % confidence interval [CI]: 2-4.2). Conclusions: It is a retrospective study but, until the preparation of the manuscript, it had been the first cohort in Colombia to describe the behavior of liver diseases in patients who become ill with COVID-19. No statistically significant differences were found between the causes of liver disease that confer a higher risk of mortality; however, having decompensated cirrhosis is the only condition related to mortality.

Resumen Introducción: la infección por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) concentra la mayor atención en el momento. En el hígado es frecuente la elevación asintomática de transaminasas y la afectación hepática varía del 14 % al 78 %. La evaluación de las comorbilidades hepáticas es escasa, con prevalencias que oscilan entre el 2 % y el 11 %. Objetivo: describir el comportamiento de una cohorte de pacientes con enfermedades hepáticas que presentaron el coronavirus de 2019 (COVID-19). Materiales y métodos: estudio observacional retrospectivo que analizó el comportamiento de una cohorte de pacientes con hepatopatías que enfermaron por COVID-19. Resultados: 543 pacientes padecieron por COVID-19, de los cuales 300 fueron mujeres (55,3 %). La mediana de edad al diagnóstico de la enfermedad hepática fue de 52 años. Las principales causas de las hepatopatías fueron esteatohepatitis no alcohólica (49,5 %), enfermedad colestásica (7,7 %), virus de la hepatitis C y B (6,3 %). La alanina-aminotransferasa (ALT) presentó una mediana de 52 U/L (rango intercuartílico [RIC]: 30-98) y aspartato-aminotransferasa (AST) 32 U/L (RIC: 23-62). La mortalidad por la infección viral fue del 5,7 % con una tasa de incidencia de 2,9 (intervalo de confianza [IC] 95 %: 2-4,2). Conclusiones: es un estudio de carácter retrospectivo; sin embargo, hasta la elaboración del manuscrito es la primera cohorte en Colombia en describir el comportamiento de las enfermedades hepáticas en pacientes que enferman de COVID-19. No se encontraron diferencias estadísticamente significativas entre las causas de hepatopatía que confieran un mayor riesgo de mortalidad; sin embargo, tener una descompensación de cirrosis es la única condición que tiene una relación con la mortalidad.

Do alcohol and cannabis substitute or complement each other? Analysis from behavioral economics for formulating public policy on substance use in Colombia.

After alcohol and tobacco, cannabis is the third most used substance among young Colombian adults, and many consume alcohol and cannabis concomitantly. However, academics have debated whether these substances substitute or complement each other among consumers. Understanding the relationship between the price and demand for psychoactive substances can clarify consumption patterns and help to develop strategies to reduce harmful consumption. This paper summarizes worldwide evidence of both complementary and substitution relationships and discusses the most probable relationship types in Colombia based on its substance use patterns and current regulations. Like other countries, Colombia is considering legalizing recreational cannabis use. However, there is a growing concern that legalization would increase the negative impacts of cannabis and increase alcohol use among the young adult population. The lack of Colombian empirical studies about the impacts of legal changes on the cannabis market makes it difficult to predict how such changes would affect demand and price elasticities.

Mental health consequences of armed conflicts in adults: an overview.

Armed conflicts (AC) in the world are still active and lead to the growth of violence, with a possible impact on mental health (MH).

Validation of the Colombian version of the Karolinska sleepiness scale.

Introduction: Currently, daytime sleepiness is a prevalent condition worldwide. Locally validated instruments for measuring sleepiness are required. The objective of this study was to validate a version of the Karolinska sleepiness scale that was translated into the Spanish spoken in Colombia. Methods: Individuals who attended a sleep laboratory for a polysomnography study and people in the general population were included. The validation process was performed in 6 phases: translation and back translation of the original version of the scale (English), face validity (n=13), pilot test (n=20), criteria validity (n=139) by means of polysomnography and the Epworth sleepiness scale, reproducibility (n=34), and sensitivity to change (n=40). Results: Regarding its discriminant validity, the Colombian version of the Karolinska sleepiness scale is correlated with the Epworth sleepiness scale, provided that a Mann-Whitney z=2661 (p=0.0078) was obtained. The scale has an acceptable reproducibility, Spearman Rho=0.55 (p=0.0002), and sensitivity to change, as shown through a two-tailed t test (p=0.0000). Conclusions: The Karolinska Sleepiness Scale was successfully adapted to the Spanish variation spoken in Colombian and to the conditions of adult Colombians; thus, it constitutes a valid, reliable, and easy to use instrument for the assessment of patients with hypersomnia.

Consecuencias de los conflictosarmados sobre la salud mentalen adultos: revisión de revisiones dela literatura / Mental health consequences of armed conflicts in adults: an overview

Introducción. Los conflictos armados (CA) en el mundo siguen activos y conllevan a un continuo crecimiento de violencia, con una posible afectación de la salud mental (SM). Objetivo: identificar y sintetizar las diferentes consecuencias de los CA sobre la SM de la población adulta en una revisión de revisiones de la literatura. Métodos. Búsqueda sistemática de revisiones hasta mayo de 2020 en las siguientes bases de datos: MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, LILACS y recursos adicionales. Los resultados fueron analizados de forma narrativa, describiendo las características de los estudios, participantes y consecuencias en la SM. Igualmente, se realizó un análisis por rango de años de publicación de las revisiones incluidas. Resultados. Cincuenta y nueve estudios fueron incluidos. Las poblaciones más representativas fueron sobrevivientes, víctimas y refugiados. Se evidenció a nivel general, un predominio de los síntomas relacionados con estrés traumático, ansiedad y depresión, entre ellos miedo, inseguridad, pánico, reexperimentación, tristeza, ira, e incluso comportamiento violento. Adicionalmente, se identificaron resultados en relación con grupos vulnerables como mujeres, refugiados y combatientes. Finalmente, se detallan otras consecuencias referentes a dimensiones físicas, sociales, culturales, ocupacionales y económicas. Conclusión. Existen múltiples consecuencias de los CA en la SM de adultos predominantemente trastornos depresivos y del estrés traumático, con algunas manifestaciones de tipo disociativo, desregulación afectiva, hostilidad, y deterioro cognitivo.(AU)

Introduction. Armed conflicts (AC) in the world are still active and lead to the growth of violence, with a possible impact on mental health (MH). Objective. to identify and synthesize the different consequences of AC on MH in the adult population in an overview of the literature. Methods. Systematic search for reviews until May 2020 in MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The results were analyzing narratively, describing the characteristics of the studies, participants, and consequences in the MH. An analysis was made based on the year range of reviews’ publication identified. Results. Fifty-nine studies were included. The most representative populations were survivors, victims, and refugees. In general, among the symptoms predominant in relation to traumatic stress, anxiety, and depression were found fear, insecurity, panic, re-experimentation, sadness, anger, and violent behavior. Additionally, results were identified regarding vulnerable groups such as women, refugees, and combatants. Finally, other consequences linked with physical, social, cultural, occupational, and economic dimensions were detailed. Conclusions: There are multiple consequences of AC in adult MH referent to depression and traumatic stress, with some kind clinical manifestations like dissociative, emotional instability, hostility, and cognitive impairment.(AU)

Survival in Patients with Cirrhosis According to Etiology. Retrospective Cohort / Sobrevida en pacientes con cirrosis de acuerdo con su etiología. Cohorte retrospectiva

Abstract Introduction: Cirrhosis is the final stage of chronically progressive liver diseases of various etiologies. It is a common disease, with a variable prevalence in each country. Its peak incidence occurs between 40 and 50 years of age, predominantly in men. Aims: To compare a cohort of patients diagnosed with cirrhosis, evaluate their complications and survival according to etiology, describe clinical and laboratory aspects, and determine the role of a fatty liver. Materials and methods: A retrospective cohort study was carried out with patients who held a specialized hepatology consultation in the center of liver and digestive diseases (CEHYD) in Bogotá, Colombia, between January 2010 and June 2019. Results: We reviewed a total of 1,200 medical records (56.8 % women). There were no statistically significant differences in median survival between groups by etiology, sex, presence or absence of complications, or Child. We noted that the older the age at the diagnosis of cirrhosis, the higher the risk of death; HR 1.04 (95 % CI 1.02-1.075). For each month that follow-up increases, the risk of death decreases by 90 %; HR 0.1 (95 % CI 0.03-0.29). For each month that the follow-up of complications increases, the risk of death is reduced by 2 %; HR 0.98 (95 % CI 0.97-0.99). Conclusions: Survival by etiology was similar in the different groups. Nonalcoholic steatohepatitis (NASH) was the leading cause of cirrhosis in this cohort. Efforts should focus on its diagnosis and management in the early stages.

Resumen Introducción: la cirrosis es el estadio final de enfermedades hepáticas crónicamente progresivas de diferentes etiologías. Es una enfermedad frecuente, con una prevalencia variable en cada país. Su pico de incidencia se presenta entre los 40 y 50 años, predominantemente en hombres. Objetivos: comparar una cohorte de pacientes con diagnóstico de cirrosis, evaluar sus complicaciones y sobrevida de acuerdo con su etiología, describir los aspectos clínicos y de laboratorio, y determinar el papel del hígado graso. Materiales y métodos: se realizó un estudio de cohorte retrospectiva, en donde se incluyeron pacientes que asistieron a consulta especializada de hepatología en el centro de enfermedades hepáticas y digestivas (CEHYD), en la ciudad de Bogotá, durante enero de 2010 y junio de 2019. Resultados: se revisaron un total de 1200 historias clínicas (56,8 % mujeres). No se evidenció diferencias estadísticamente significativas en las medianas de sobrevida entre los grupos por etiologías, sexo, presencia o no de complicaciones, o Child. Se evidenció que entre mayor edad en el diagnóstico de cirrosis, el riesgo de muerte es mayor; HR 1,04 (IC 95 % 1,02-1,075). Por cada mes que aumenta el seguimiento se reduce el riesgo de muerte en 90 %; HR 0,1 (IC 95 % 0,03-0,29). Por cada mes que aumenta el seguimiento de las complicaciones se reduce el riesgo de muerte en 2 %; HR 0,98 (IC 95 % 0,97-0,99). Conclusiones: La sobrevida por etiología fue similar en los diferentes grupos. La esteatohepatitis no alcohólica (NASH) fue la principal causa de cirrosis en esta cohorte. Se deben orientar esfuerzos a su diagnóstico y manejo en fases tempranas.