Changes in Televisit Modalities Due to the COVID Pandemic in Chile: A Comparison of Patient Satisfaction.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare guidelines and modalities of patient consultation worldwide. The frequent cycles of quarantine confinement in Chile have caused mobility restrictions for patients and physicians, forcing the Hospital Las Higueras de Talcahuano (HHT) to replace the assisted televisit modality with a more classic televisit program. Here we have described if this change in televisit modality and type of outpatient may have impacted patients' satisfaction. METHODS: The patient's perception of satisfaction was evaluated through self-administered survey questionnaires previously validated in Spanish. Cohorts were grouped according to the following two relational models: (i) assisted televisit, 503 neurology patients from 2018 to 2019, and (ii) televisit, 831 patients from different specialties treated during 2020. Perception of satisfaction was compared by gender, age, and type of televisit, and internal consistency (Cronbach alpha) and reliability (factorial analysis of principal components) were assessed. Finally, we compared the patient satisfaction of both modalities. RESULTS: Questionnaires showed excellent internal consistency; all items showed point biserial correlations greater than 0.30. Assisted televisit and televisit cohorts comprised 64.2% and 67.6% females, respectively, and patients under the age of 65 years were 62.2% and 75%, respectively. Assisted televisit patients showed very high 94.4% (n=475) and high 5.2% (n=26) satisfaction levels, while televisit patients showed very high 22.3% (n=185), high 63.9% (n=531), and moderate 13.1% (n=109) satisfaction levels; this difference was statistically significant at p<0.001. CONCLUSION: Lower perception of satisfaction due to the change in televisit relational modality underscores the importance of primary care professionals who support the specialist in the assisted televisit model. However, the televisit modality showed high patient satisfaction and suggested that this modality can be a plausible alternative according to each location's reality. The results of this study indicate that both assisted televisit and televisit contribute to delivering an integrative solution that helps to alleviate the system's fragmentation.

Next-Generation Multitarget Stool DNA Test for Colorectal Cancer Screening.

BACKGROUND: A next-generation multitarget stool DNA test, including assessments of DNA molecular markers and hemoglobin level, was developed to improve the performance of colorectal cancer screening, primarily with regard to specificity. METHODS: In a prospective study, we evaluated a next-generation multitarget stool DNA test in asymptomatic adults 40 years of age or older who were undergoing screening colonoscopy. The primary outcomes were sensitivity of the test for colorectal cancer and specificity for advanced neoplasia (colorectal cancer or advanced precancerous lesions). Advanced precancerous lesions included one or more adenomas or sessile serrated lesions measuring at least 1 cm in the longest dimension, lesions with villous histologic features, and high-grade dysplasia. Secondary objectives included the quantification of sensitivity for advanced precancerous lesions and specificity for nonneoplastic findings or negative colonoscopy and comparison of sensitivities for colorectal cancer and advanced precancerous lesions between the multitarget stool DNA test and a commercially available fecal immunochemical test (FIT). RESULTS: Of 20,176 participants, 98 had colorectal cancer, 2144 had advanced precancerous lesions, 6973 had nonadvanced adenomas, and 10,961 had nonneoplastic findings or negative colonoscopy. With the next-generation test, sensitivity for colorectal cancer was 93.9% (95% confidence interval [CI], 87.1 to 97.7), and specificity for advanced neoplasia was 90.6% (95% CI, 90.1 to 91.0). Sensitivity for advanced precancerous lesions was 43.4% (95% CI, 41.3 to 45.6), and specificity for nonneoplastic findings or negative colonoscopy was 92.7% (95% CI, 92.2 to 93.1). With the FIT, sensitivity was 67.3% (95% CI, 57.1 to 76.5) for colorectal cancer and 23.3% (95% CI, 21.5 to 25.2) for advanced precancerous lesions; specificity was 94.8% (95% CI, 94.4 to 95.1) for advanced neoplasia and 95.7% (95% CI, 95.3 to 96.1) for nonneoplastic findings or negative colonoscopy. As compared with FIT, the next-generation test had superior sensitivity for colorectal cancer (P<0.001) and for advanced precancerous lesions (P<0.001) but had lower specificity for advanced neoplasia (P<0.001). No adverse events occurred. CONCLUSIONS: The next-generation multitarget stool DNA test showed higher sensitivity for colorectal cancer and advanced precancerous lesions than FIT but also showed lower specificity. (Funded by Exact Sciences; BLUE-C ClinicalTrials.gov number, NCT04144738.).

The burden of intestinal parasitic infections in Antioquia, Colombia: Impact in childhood growth development and nutritional status.

Gastrointestinal protist (GP) and soil-transmitted helminth (STH) infections cause significant morbidity among children in poor-resource settings of tropical and sub-tropical countries including Colombia. Few prospective transversal studies investigating how GP and STH infections affect growth development and nutritional status during childhood have been conducted in this country, none of them in the Antioquia Department. This microscopy-based study estimated the prevalence of GP and helminth (including STH) infections in faecal samples from schoolchildren (n = 384) collected during April-May 2019 in three municipalities of the Antioquia Department. Demographic, epidemiological, and household data were elicited through face-to-face interviews. Parasite detection was carried out by direct microscopic examination of both fresh smears and concentrated faecal material. Children (aged 6-15 years) also had their haemoglobin (Hb) levels, height and weight data collected, and BMI estimated. Data were analysed using bivariate and multivariate logistic regression analysis. Overall, 60.7 % (233/384) of schoolchildren were infected by at least one intestinal parasitic species. Among GPs, Blastocystis sp. was the most common species found (47.7 %, 95 % CI: 42.6-52.8), followed by G. duodenalis (15.9 %, 95 % CI: 12.4-19.9). Cryptosporidium spp. and Cyclospora cayetanensis were sporadically identified (0.3 %, 95 % CI: 0.1-1.4 each). Among helminths, the most prevalent species found were Trichuris trichiura (6.0 %, 95 % CI: 3.8-8.9) and Enterobius vermicularis (1.0 %, 95 % CI: 0.3-2.6). Hookworms, Ascaris lumbricoides, and Strongyloides stercoralis were found at prevalence rates <1 %. Underweight, overweigh, or obese schoolchildren had 1.2 times greater chance of being infected with intestinal parasites than their counterparts with a healthy weight (P-value: 0.015). Variables significantly associated with an increased likelihood of being infected by intestinal parasites include living in a household with unfinished flouring, not wearing shoes, being in close proximity to rodents, and having improper waste disposal. Relatively simple interventional measures directed towards the improvement of household conditions, access to sanitary toilets, and promoting shoe wearing can significantly reduce childhood infections by GP and helminths in the Antioquia Department.

[Evaluation of a rapid weight estimation tool for pediatric emergencies]. / Evaluación de una herramienta de estimación rápida de peso para urgencias pediátricas.

Weight measurement is essential in the treatment of pediatric patients in emergencies, however, in cases of patient instability or limited resources, weight estimation becomes a plausible alternative. There are rapid estimation methods, although with performance discrepancies in different populations. OBJECTIVE: To compare the performance of the "Colombian Pediatric Tape" (CPT) and Broselow Tape (BT) in weight estimation in children. PATIENTS AND METHOD: Descriptive cross-sectional study and concordance analysis. Sample of 42,232 children from the 2010 National Survey of the Nu tritional Situation of Colombia. For the performance evaluation, the prediction of zones and weight of each tool and their concordance using the Kappa coefficient and the Bland-Altman index were considered. RESULTS: Cohen's Kappa index for the BT with respect to the color area agreement was 0.57 and for the CPT it was 0.65. The Bland-Altman index for CPT of the actual weight and the esti mated weight showed a mean difference of 0.005 Kg (CI95; -4.1 to +4.1), and for the BT was 0.13 Kg (CI95; -5.2 to 5.5). The percentage difference analysis of concordance between the two tools showed a statistically significant overall difference in favor of the CPT, 66% Vs 70% (p = 0.00001). CONCLUSIONS: In Colombian children, the BT overestimates or underestimates the weight by up to 21% with respect to the real value, while CPT can be used with better performance to estimate the weight.

Proposal of a guide for the interpretation, simplification of the regulatory process and good tax compliance, case of digital taxpayers, influencers.

Influencers generate opinions in individuals through multiple virtual platforms, this phenomenon implies social influence that induces consumers to buy and direct these activities to the sponsorship of brands, which means monetary income for the influencer. Many of these incomes are not reported to the tax system, which causes evasion due to misinformation or lack of knowledge. Therefore, the need for a correct adaptation and interpretation of the Peruvian tax regulations for the payment of taxes on income received by this segment of taxpayers was observed. The purpose of this research was a guide that interprets, simplifies the processes and provides a regulatory framework for tax compliance for domiciled and non-domiciled influencers. The tax guide was designed thanks to the adaptation of the Scribber methodology and consisted of 4 steps: Familiarization, coding, theme generation, defining themes. The guide was organized in level 01, describing how to achieve the tax obligation in the sector of digital taxpayers influencers, level 02, where the activities described by the regulations are mentioned and level 3, tax procedures carried out by the tax administration to influencers. This guide is an aid to define the category that attributes the taxpayer's tax payment method. By identifying the tax categorization code according to the type of activity. It identifies the key factors to be able to interpret and adapt the law to the influencer's activities.

Identification and validation of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening.

Blastocystis sp. is among the most frequent intestinal protists identified in humans globally. However, characterization of Blastocystis subtype diversity in humans is ongoing. We report here the identification of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening involving colonoscopy and fecal testing (microscopy, culture, PCR). The full-length ssu rRNA gene sequence of the protist was generated using MinION long-read sequencing technology. The validity of the novel subtype was confirmed via phylogenetic and pairwise distance analyses of the full-length ST41 sequence and all other valid subtypes. The study provides reference material essential for conducting subsequent experimental studies.

Discrimination of foreign bodies in quinoa (Chenopodium quinoa Willd.) grains using convolutional neural networks with a transfer learning approach.

The rising interest in quinoa (Chenopodium quinoa Willd.) is due to its high protein content and gluten-free condition; nonetheless, the presence of foreign bodies in quinoa processing facilities is an issue that must be addressed. As a result, convolutional neural networks have been adopted, mostly because of their data extraction capabilities, which had not been utilized before for this purpose. Consequently, the main objective of this work is to evaluate convolutional neural networks with a learning transfer for foreign bodies identification in quinoa samples. For experimentation, quinoa samples were collected and manually split into 17 classes: quinoa grains and 16 foreign bodies. Then, one thousand images were obtained from each class in RGB space and transformed into four different color spaces (L*a*b*, HSV, YCbCr, and Gray). Three convolutional neural networks (AlexNet, MobileNetv2, and DenseNet-201) were trained using the five color spaces, and the evaluation results were expressed in terms of accuracy and F-score. All the CNN approaches compared showed an F-score ranging from 98% to 99%; both color space and CNN structure were found to have significant effects on the F-score. Also, DenseNet-201 was the most robust architecture and, at the same time, the most time-consuming. These results evidence the capacity of CNN architectures to be used for the discrimination of foreign bodies in quinoa processing facilities.

Competency analysis based on accounting career anchors using clustering techniques.

This research work aims to identify the prevalent anchors in the professional accounting career using the Schein scale and to describe the prevalent anchors by defining the values, attitudes, aptitudes, skills, and interests. Career anchors are defined by the competence, motivation, and values a person has to perform a particular job in an organization and are present throughout their working life. When determining the soft and hard competencies of the professional profile, universities must consider the career anchors essential for graduates' work performance. To determine which anchors dominate the competencies of the graduate profile, two universities in Latin America with a degree in accounting were selected. The study was organized in two stages: first, the operationalization of the research was conducted, including the description of the instrument through the application of 40 questions divided into Schein's eight anchors. Samples were selected based on the convenience of the authors: one university in Peru and another in Colombia. The sample includes all students enrolled in the accounting major, and the data were coded and processed. In the second stage, data analysis was performed by grouping parameters, analysis of variance, explanatory analysis using a test for the best clustering algorithm, statistical testing, and discussion of the findings. The predominant anchors in the two universities are creativity, entrepreneurship, and lifestyle. The selected universities placed considerable emphasis on training future accountants with an innovative spirit, integrity, and social commitment without neglecting the professional requirements. This approach allows students to undertake challenges and new businesses in their field of work.

Evaluation design of the patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard (InAdvance): a randomised controlled trial.

BACKGROUND: Palliative care aims to contribute to pain relief, improvement with regard to symptoms and enhancement of health-related quality of life (HRQoL) of patients with chronic conditions. Most of the palliative care protocols, programmes and units are predominantly focused on patients with cancer and their specific needs. Patients with non-cancer chronic conditions may also have significantly impaired HRQoL and poor survival, but do not yet receive appropriate and holistic care. The traditional focus of palliative care has been at the end-of-life stages instead of the relatively early phases of serious chronic conditions. The 'Patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard' (InAdvance) project implements and evaluates early palliative care in the daily clinical routine addressing patients with complex chronic conditions in the evolution towards advanced stages. The objective of the current study is to evaluate the acceptability, feasibility, effectiveness and cost-effectiveness of this novel model of palliative care in the relatively early phases in patients with chronic conditions. METHODS: In this study, a single blind randomised controlled trial design will be employed. A total of 320 participants (80 in each study site and 4 sites in total) will be randomised on a 1:1 basis to the Palliative Care Needs Assessment (PCNA) arm or the Care-as-Usual arm. This study includes a formative evaluation approach as well as a cost-effectiveness analysis with a within-trial horizon. Study outcomes will be assessed at baseline, 6 weeks, 6 months, 12 months and 18 months after the implementation of the interventions. Study outcomes include HRQoL, intensity of symptoms, functional status, emotional distress, caregiving burden, perceived quality of care, adherence to treatment, feasibility, acceptability, and appropriateness of the intervention, intervention costs, other healthcare costs and informal care costs. DISCUSSION: The InAdvance project will evaluate the effect of the implementation of the PCNA intervention on the target population in terms of effectiveness and cost-effectiveness in four European settings. The evidence of the project will provide step-wise guidance to contribute an increased evidence base for policy recommendations and clinical guidelines, in an effort to augment the supportive ecosystem for palliative care. TRIAL REGISTRATION: ISRCTN, ISRCTN24825698 . Registered 17/12/2020.

Prevalence of intestinal parasites in a cohort of HIVinfected patients from Antioquia, Colombia. / Prevalencia de parásitos intestinales en una cohorte de pacientes positivos para HIV en Antioquia, Colombia

INTRODUCTION: HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia. OBJECTIVE: To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country. MATERIAL AND METHODS: We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data. RESULTS: The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% - 16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/µL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort. CONCLUSIONS: Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.

Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/µl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Prevalence of intestinal parasites in a cohort of HIV- infected patients from Antioquia, Colombia / Prevalencia de parásitos intestinales en una cohorte de pacientes positivos para HIV en Antioquia, Colombia

Abstract | Introduction: HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia. Objective: To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country. Material and methods: We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data. Results: The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% -16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/µL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort. Conclusions: Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.

Resumen | Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. Y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/μl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Plasma cell free DNA methylation markers for hepatocellular carcinoma surveillance in patients with cirrhosis: a case control study.

BACKGROUND: Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis, primarily due to failed early detection. HCC screening is recommended among individuals with cirrhosis using biannual abdominal ultrasound, for earlier tumor detection, administration of curative treatment, and improved survival. Surveillance by imaging with or without biomarkers such as alpha-fetoprotein (AFP) remains suboptimal for early stage HCC detection. Here we report on the development and assessment of methylation biomarkers from liquid biopsies for HCC surveillance in cirrhotic patients. METHODS: DNA methylation markers including the HCCBloodTest (Epigenomics AG) and a DNA-methylation panel established by next generation sequencing (NGS) were assessed using a training/testing design. The NGS panel algorithm was established in a training study (41 HCC patients; 46 cirrhotic non-HCC controls). For testing, plasma samples were obtained from cirrhotic patients (Child class A or B) with (60) or without (103) early stage HCC (BCLC stage 0, A, B). The assays were then tested using blinded sample sets and analyzed by preset algorithms. RESULTS: The HCCBloodTest and the NGS panel exhibited 76.7% and 57% sensitivities at 64.1% and 97% specificity, respectively. In a post-hoc analysis, a combination of the NGS panel with AFP (20 ng/mL) achieved 68% sensitivity at 97% specificity (AUC = 0.9). CONCLUSIONS: Methylation biomarkers in cell free plasma DNA provide a new alternative for HCC surveillance. Multiomic panels comprising DNA methylation markers with other biological markers, such as AFP, provide an option to further increase the overall clinical performance of surveillance via minimally invasive blood samples. TRIAL REGISTRATION: Test set study-ClinicalTrials.gov (NCT03804593) January 11, 2019, retrospectively registered.

Observational Study of the Clinical Characteristics and Short-Term Outcomes of Kidney Transplant Recipients Diagnosed With COVID-19 Infection (SARS-CoV-2) Requiring Hospitalization in New Orleans.

Background: Kidney transplant recipients are at increased risk of severe disease and death caused by coronavirus disease 2019 (COVID-19) infection. The role of immunosuppressive medications in the clinical presentation, disease course, and outcomes is not well understood. Methods: We analyzed kidney transplant recipients diagnosed with COVID-19 and requiring hospitalization during the initial infection surge at 2 large transplant centers in New Orleans, Louisiana, between February 1, 2020 and April 30, 2020. Patient presentation, clinical course, kidney transplant function, and postdischarge details are included in this analysis. Results: Twenty-three kidney transplant recipients hospitalized with COVID-19 were included in the study. The majority of patients were Black (95.7%). Diabetes, hypertension, and obesity were present in more than 50% of the patients. The most common presenting symptom was fever, present in 52.2% of patients. All patients were managed with reduction in immunosuppression. Patients received azithromycin (60.9%), hydroxychloroquine (47.8%), remdesivir (8.7%), and intravenous methylprednisolone pulse (8.7%). The average length of stay was 4.5 days (range, 2-18 days). In this study population, 73.9% of the patients sustained acute kidney injury, with an average peak serum creatinine of 3.81 mg/dL. Twenty-six percent of the patients required renal replacement therapy. Seventy-seven percent of patients developed proteinuria (at least 1+ proteinuria on urinalysis). Of the patients in this population who required mechanical ventilation (39.1%), 77.8% died. Overall, 30.4% of patients died of COVID-19-related complications during admission. Of the 16 patients discharged, the average serum creatinine at discharge was 2.09 mg/dL compared with an average preadmission serum creatinine of 1.8 mg/dL. Conclusion: During the initial COVID-19 infection surge in New Orleans, we noted that kidney transplant recipients had initial symptoms similar to the general population. However, we recorded a higher incidence of acute kidney injury and death compared to nontransplant patients. Patients who required mechanical ventilation had a high mortality rate. Black patients are overrepresented in our study.

Características sociodemográficas y clínicas, según el índice CD4: CD8, de una población de personas infectadas con el VIH que consultó en la Corporación para Investigaciones Biológicas de Medellín, Colombia / Sociodemographic and clinical characteristics based on their cd4: cd8 ratio. of HIV infected persons who consulted at Corporación para Investigaciones Biológicas of Medellín, Colombia

RESUMEN Objetivo: las personas infectadas con el virus de la inmunodeficiencia humana tipo 1 (VIH-1+) con un índice CD4:CD8 menor a 1, presentan un mayor riesgo de morbilidad y mor-talidad por eventos no asociados con el SIDA. El objetivo de este trabajo fue explorar‚ en la población seleccionada‚ variables sociodemográficas y clínicas de acuerdo con dicho índice, debido a que este es más informativo que LT CD4+ y LT CD8+ por sí solos. Materiales y métodos: estudio observacional en pacientes con VIH-1+ atendidos en la Corporación para Investigaciones Biológicas (CIB). En 227 pacientes se evaluaron diferencias en edad‚ recuento de LT CD4+‚ carga viral‚ número y tipo de esquemas. Se dividieron los pacientes en dos grupos: (A con índice CD4:CD8 ≥ 1 y, B < 1). Resultados: el estudio se compuso de la siguiente forma, 71 % hombres y 29 % mujeres. El 22,5 % pertenecía al grupo A y el 77,5 % al B. La media de la edad fue 42‚8 años en el grupo A y 45 en el B (p = 0‚176). El 100 % de los individuos en el grupo A recibían tratamiento y, 97‚7 % en el B. La media de LT CD4+ fue de 772‚4 para el grupo A y, 448‚1 en el B (p = 0‚00001). En el grupo A el 90‚2 % tenían carga viral indetectable‚ en contraste con el 68‚8 % del B (p = 0‚002). El 41‚2 % en el grupo A tuvieron un solo esquema‚ en relación con el 43,8 % del B (p = 0‚744). Conclusiones: la mayoría de los pacientes presentaron un índice CD4:CD8 < 1 a pesar de haber presentado LT CD4+ aceptables. Fue más frecuente encontrar un índice < 1 en los pacientes sin un adecuado control virológico. Se requieren más estudios para determinar las variables asociadas con su normalización.

SUMMARY Introduction: Human Immunodeficiency Virus type 1 (HIV-1+) patients with a CD4:CD8 ratio < 1 presents a higher risk of morbidity and mortality due to not-associated AIDS events. The aim was to explore, in the selected population, sociodemographic and clinical variables, based on that ratio, because it is more informative than LT CD4+ and LT CD8+ by themselves. Materials and Methods: Observational, in HIV-1 infected patients attended at Biological Research Corporation. In 227 patients, age differences, LT CD4+ count, viral load, number and type of treatments were evaluated. The patients were divided in group A with a CD4:CD8 ratio equal or above to 1, and B bellow 1. Results: The study includes 71% of male and 29% of female. 22,5% were from group A and 77,5% from B. The mean of age was 42,8 years old in A and 45,3 years old in B (p=0,176). 100% of individuals from group A receive treatment, meanwhile 97,7% in B. Mean of LT CD4+ count was 772,4 cell/μL in A and 448,1 cell/μL in B (p=0,00001). In A, 90,2% had undetectable viral load vs 68,8% in B (p=0,002). 41,2% in A had only one type of treatment, vs 43,8% in B (p=0,744). Conclusion: Most of the patients had a CD4:CD8 ratio bellow to 1, despite an acceptable count of LTCD4++. To find a ratio bellow 1 in patients without an adequate virological control was more frequent. More studies to determinate variables associated with its normalization are required.

Mortalidad por Cáncer de Mama. Policlínico 13 de Marzo. 2017-2018 / Breast Cancer Mortality. Polyclinic March 13. 2017-2018 / Mortalidade por câncer de mama. Policlínica 13 de Março. 2017-2018

RESUMEN El cáncer de mama es la neoplasia más frecuente en el sexo femenino y una de las principales causas de muerte en este grupo. Se realizó un estudio descriptivo retrospectivo, de mujeres fallecidas por cáncer de mama en el período 2017 al 2018, con el objetivo de describir la mortalidad de esta enfermedad, teniendo en cuenta la zona de residencia, promedio de edad de las fallecidas y años de vida potencialmente perdidos según Consejos Populares. Las medidas estadísticas utilizadas fueron, tasa de mortalidad, valores absolutos, valores promedios, números absolutos y años de vidas potencialmente perdidos, observándose un incremento de la tasa de mortalidad, con un predominio en la zona urbana, el promedio de edad de los fallecidos se encuentra por encima de los 50 años y son los Consejos Populares de San Juan-El Cristo los que aportaron, las mayores tasa de años de vida potencialmente perdidos.

ABSTRACT Breast cancer is the most common neoplasm in the female sex and one of the leading causes of death in this group. A retrospective descriptive study was conducted of women who died of breast cancer in the period 2017 to 2018, with the aim of describing the mortality of this disease, taking into account the area of residence, average age of the deceased and years of life potentially lost according to Popular Councils. The statistical measures used were, mortality rate, absolute values, average values, absolute numbers and years of lives potentially lost, with an increase in the mortality rate, with a predominance in the urban area, the average age of the deceased is above 50 years and it is the People's Councils of St. John-The Christ who contributed, the highest rate of potentially lost life years.

RESUMO O câncer de mama é a neoplasia maiscomum no sexo feminino e uma das principais causas de mortenesse grupo. Foi realizado umestudo retrospectivo descritivo de mulheres que morreram de câncer de mama no período de 2017 a 2018, como objetivo de descrever a mortalidade da doença, levando emconsideração a área de residência, idademédia do falecido e anos de vida potencialmente perdidos segundo Conselhos Populares. As medidas estatísticas utilizadas foram, taxa de mortalidade, valores absolutos, valores médios, números absolutos e anos de vidas potencialmente perdidos, com aumento da taxa de mortalidade, compredomíniona área urbana, a idademédia do falecido é superior a 50 anos e são os Conselhos Do Povo de São João-O Cristo que contribuíram, a maiortaxa de anos de vida potencialmente perdidos.

Mortalidad por Cáncer de Mama. Policlínico 13 de Marzo. 2017-2018 / Breast Cancer Mortality. Polyclinic March 13. 2017-2018

El cáncer de mama es la neoplasia más frecuente en el sexo femenino y una de las principales causas de muerte en este grupo. Se realizó un estudio descriptivo retrospectivo, de mujeres fallecidas por cáncer de mama en el período 2017 al 2018, con el objetivo de describir la mortalidad de esta enfermedad, teniendo en cuenta la zona de residencia, promedio de edad de las fallecidas y años de vida potencialmente perdidos según Consejos Populares. Las medidas estadísticas utilizadas fueron, tasa de mortalidad, valores absolutos, valores promedios, números absolutos y años de vidas potencialmente perdidos, observándose un incremento de la tasa de mortalidad, con un predominio en la zona urbana, el promedio de edad de los fallecidos se encuentra por encima de los 50 años y son los Consejos Populares de San Juan El Cristo los que aportaron, las mayores tasa de años de vida potencialmente perdidos(AU)

Breast cancer is the most common neoplasm in the female sex and one of the leading causes of death in this group. A retrospective descriptive study was conducted of women who died of breast cancer in the period 2017 to 2018, with the aim of describing the mortality of this disease, taking into account the area of residence, average age of the deceased and years of life potentially lost according to Popular Councils. The statistical measures used were, mortality rate, absolute values, average values, absolute numbers and years of lives potentially lost, with an increase in the mortality rate, with a predominance in the urban area, the average age of the deceased is above 50 years and it is the People's Councils of St. John The Christ who contributed, the highest rate of potentially lost life years(EU)

Efecto del cambio de la terapia antirretroviral en la falla virológica en una cohorte de pacientes que conviven con el VIH en Medellín, Antioquia, Colombia / Effect of the change in antirretroviral therapy on virological failure in a cohort of patients living with HIV in Medellín, Antioquia, Colombia

Objetivo: determinar el efecto del cambio en la terapia antirretroviral sobre el control virológico en una cohorte de pacientes VIH positivos de una institución prestadora de servicios de salud en Medellín, Antioquia (Colombia) en el año 2017. Materiales y métodos: estudio observacional analítico transversal, comparativo entre pacientes que cambiaron y no cambiaron el esquema inicial de terapia antirretroviral. Se realizó en una cohorte de 1245 pacientes que conviven con el VIH. Resultados: un total de 322 pacientes fueron evaluados. El principal motivo de cambio fue la presencia de efectos adversos a la terapia antirretroviral, seguido de la falla virológica sin genotipo e intolerancia a la terapia antirretroviral. La falla virológica, RP 1,4 IC95% (1,2-1,6, p0,00), el tener genotipo, RP 1,2 IC95% (1,1-1,3, p 0,00) y el padecer una infección oportunista, RP 1,3 IC95% (1,0-1,6, p 0,03), se asociaron a mayor número de cambios a la TAR. La adherencia a la terapia antirretroviral, RP 0,18 IC95% (0,1-0,3, p 0,00) y la toma de otros medicamentos no relacionados al VIH (RP 0,6, IC95% 0,4-0,8, p 0,005) se asociaron a menor frecuencia de cambio de la terapia antirretroviral. El cambio de la terapia antirretroviral (OR ajustado 3,4, IC 95% (2,0-5,8), continúa siendo el factor pronóstico más importante para falla virológica. Conclusión: el cambio de la terapia antirretroviral, definida en este estudio como la principal variable de exposición, representa el principal factor de riesgo para falla virológica, incluso cuando fue ajustado por otras variables..Au

Objective: to determine the effect of the change in antiretroviral therapy on virological control in a cohort of HIV positive patients corresponding to a healthcare institution in Medellín, Antioquia (Colombia) in 2017. Materials and methods: cross-sectional,comparative analytical observational study. It was performed in a cohort of 1245 patients living with HIV. Results: a total of 322 patients were evaluated. The main reason for change was the presence of adverse effects to antiretroviral therapy, followed by virological failure without genotype and antiretroviral therapy intolerance. Virological failure, PR 1.4 95% CI (1.2-1.6, p 0,00), having genotype, PR 1.2 95% CI (1.1-1.3, p0,00 ) and suffering from an opportunistic infection, PR 1.3 95% CI (1.0-1.6, p 0,03),were associated with a greater number of changes to antiretroviral therapy. Adherence to antiretroviral therapy, PR 0.18 95% CI (0.1-0.3, p 0,00) and taking other non-HIVrelated medications (PR 0.6, 95% CI 0.4-0 , 8, p 0,005) were associated with a lower frequency of change of antiretroviral therapy. The change in antiretroviral therapy (adjusted OR 3.4, 95% CI (2.0-5.8)) remains the most important prognostic factor for virological failure. Conclusion: the change in antirretroviral therapy, defined in this study as the main exposure variable, represents the main risk factor for virological failure, even when was adjusted for other variables..Au

An interferon gamma release assay specific for Histoplasma capsulatum to detect asymptomatic infected individuals: A proof of concept study.

Histoplasmosis is the most common endemic mycosis in the Americas. Currently, there is no laboratory test capable to detect subclinical or latent infections by Histoplasma capsulatum (Hc), which might develop as severe infections in immunocompromised individuals. For the first time to our knowledge, we explore the suitability of an interferon gamma release assay (IGRA) to detect latent Hc infection in asymptomatic individuals. A cohort of 126 volunteers was enrolled in the study, 13 of which underwent a Hc infection in the past, and 93 of them showing risk factors for this infection. The remaining 20 participants did not refer any risk factors of Hc infection, but eight of them showed evidences of infection with Mycobacterium tuberculosis. All participants were recruited in Medellin, Colombia, between January 2014 and December 2017. Whole blood samples were cultured with four different Hc crude antigens and phytohemaglutinin as positive control. The interferon (IFN)-γ released by T lymphocytes upon antigen stimulation was quantified by ELISA. A defined cutoff value of 20 pg/ml for the IFN-γ concentration allowed us to distinguish between the group with documented past infections and the group of noninfected individuals with high sensitivity (70-92%) and specificity (85-95%), for the four tested antigens. Positive 82-95% and negative 77-92% predictive values were also very high, comparable to those reported for commercially available IGRAs. The new test constitutes a promising screening method to detect individuals with latent Hc infection, even decades after the primary infection, as evidenced in this study.