Autosomal dominant polycystic kidney disease in Colombia.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of chronic kidney disease (CKD) that requires dialysis. Knowing geographical clusters can be critical for early diagnosis, progression control, and genetic counseling. The objective was to establish the prevalence, geographic location, and ethnic groups of patients with ADPKD who underwent dialysis or kidney transplant in Colombia between 2015 and 2019. METHODS: We did a cross-sectional study with data from the National Registry of Chronic Kidney Disease (NRCKD) managed by the High-Cost Diseases Fund (Cuenta de Alto Costo [CAC] in Spanish) between July 1, 2015, and June 30, 2019. We included Colombian population with CKD with or without renal replacement therapy (RRT) due to ADPKD. Crude and adjusted prevalence rates were estimated by state and city. RESULTS: 3,339 patients with ADPKD were included, period prevalence was 9.81 per 100,000 population; there were 4.35 cases of RRT per 100,000 population, mean age of 52.58 years (± 13.21), and 52.78% women. Seventy-six patients were Afro-Colombians, six were indigenous, and one Roma people. A total of 46.07% began scheduled dialysis. The highest adjusted prevalence rate was in Valle del Cauca (6.55 cases per 100,000 population), followed by Risaralda, and La Guajira. Regarding cities, Cali had the highest prevalence rate (9.38 cases per 100,000 population), followed by Pasto, Medellin, and Bucaramanga. CONCLUSIONS: ADPKD prevalence is lower compared to Europe and US; some states with higher prevalence could be objective to genetic prevalence study.

Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy.

BACKGROUND: We performed a retrospective trial to determine asymptomatic CMV reactivation and CMV disease in kidney allograft recipients with positive CMV serostatus. METHODS: Preemptive modified strategy under low dose thymoglobulin versus basiliximab induction was evaluated. Patients were monitored by CMV-polymerase chain reaction (PCR); if the viral load was >4000copies/µl, they received valganciclovir adjusted for their renal function. RESULTS: 132 recipients were included in the study, 84 and 48 receiving basiliximab and thymoglobulin induction respectively, and followed up for 12 months. Asymptomatic CMV reactivation was significantly higher for thymoglobulin (77.1% vs. 16.7%, p<0.001). Treatment groups had similar rates of CMV disease (3.6% vs. 2.1%, p 0.538). The significant difference in asymptomatic CMV reactivation between two treatment groups did not have any impact on 1 year graft function (71±26ml/min vs. 74±19ml/min; p=0.475) and no histological differences in protocol biopsies were observed among patients with asymptomatic CMV reactivation vs those without CMV reactivation. CONCLUSIONS: Due to the high asymptomatic CMV reactivation incidence in patients who received thymoglobulin induction, our results suggest that valganciclovir prophylaxis may be advantageous in CMV seropositive renal transplant recipients after low dose thymoglobulin induction. A preemptive strategy appeared to significantly reduce the likelihood of CMV disease in both groups. Rejection risk and negative impact in renal function associated with asymptomatic CMV reactivation was not found in our series.

Prevalence of skin diseases in children 1 to 6 years old in the city of Bogota, Colombia.

BACKGROUND: Skin diseases represent an important part of the morbidity among children and are possibly influenced by geographic, racial, social, cultural, and economic factors. Despite being so frequent around the world, skin diseases have not been important in developing strategies in public health. AIM: The purpose of this study was to evaluate the prevalence of skin diseases among the student population between 1 and 6 years of age in Bogotá, Colombia between March 2009 and June 2011. MATERIALS AND METHODS: This cross-sectional study was performed across a probabilistic, stratified, randomized sampling by proportional assignment (based on locality and type of institution) and was developed in schools in Bogotá, Colombia. RESULTS: A total of 2437 children between 1 and 6 years of age were examined, and 42.8% (1035) presented a dermatologic disease. Papular urticaria was the most frequent (62.9%) (IC: 58.4%; 67.1%), followed by dermatitis/eczema (13.0%) (IC: 10.8%; 15.4%), and infectious diseases (12.3%) (IC: 9.7%; 15.3%). CONCLUSION: The research demonstrates a high prevalence of papular urticaria as a result of flea and mosquito bites and infectious diseases of the skin in the studied population. The dermatologic diseases found are easy to diagnose, respond to the proper treatment, and are preventable. However, the fact that many of the examined children likely had not visited the doctor for the detected pathology could indicate the lack of access to health services affecting this population.

Hallazgos histológicos en biopsia por protocolo asociados con reducción en función renal 12 meses postrasplante, en receptores de trasplante renal con bajo riesgo inmunológico, recibiendo inducción con basiliximab / Histological findings in protocol biopsy associated with reduction in renal function 12 months post transplant in renal transplant recipients with low immunological risk

Resumen Introducción: identificar los factores asociados con pérdida de la función del injerto puede ser un paso importante hacia la prolongación de la sobrevida del injerto renal. Objetivo: determinar la asociación entre los cambios histológicos presentes en las biopsias por protocolo, en el primer año postrasplante en receptores de bajo riesgo inmunológico, recibiendo inducción con basiliximab y pérdida en la función del injerto 12 meses postrasplante. Métodos: se incluyeron pacientes receptores de riñones de donante cadavérico (95 %) o donante vivo (5 %) trasplantados entre agosto de 2007 y julio de 2012. El desenlace primario fue pérdida en la tasa de filtración glomerular calculada (Cockroft & Gault) mayor a 5ml/min 12 meses postrasplante, en comparación con la función renal previa a la biopsia por protocolo. Resultados: la cohorte de estudio estuvo conformada por 114 pacientes, de los cuales 25 presentaron el desenlace principal. Los hallazgos asociados con pérdida de función fueron glomerulitis (p=0,024), inflamación intersticial (p=0,001), tubulitis (p=0,001), capilaritis (p=0,001), glomerulitis + capilaritis (p=0,001), nefropatía por polioma virus (p=0,04) y la presencia de rechazo subclínico (p=0,015). Por análisis de regresión logística la presencia de inflamación intersticial (OR = 2,11; IC 95 %: 1,13-3,95) y capilaritis (0R=7,12; IC 95 %:1,57-32,27) fueron las variables asociadas con pérdida de función del injerto renal 12 meses postrasplante renal. Conclusión: la inflamación intersticial y capilaritis son variables histológicas asociadas con pérdida de función del injerto renal, 12 meses postrasplante, independiente de otras variables.

Abstract Introduction: Identifying factors that are associated of allograft function loss might be an important step toward prolonging kidney allograft survival. Purpose: In this study we found to determine the association between histologic changes on 1-year surveillance biopsies and changes in graft function. Methods: Recipients of kidneys from deceased donors (95%) or living donors (5%) trasplanted between 2007 and 2012. The primary end point was reduction in calculated glomerular filtration rate (Cockroft anf Gault) higher 5ml/min 12 months post transplant vs calculated glomerular filtration rate previous surveillance biopsie. Results: This analysis included 114 adults, recipients of kidneys with low immunological risk receiving basiliximab induction from deceased donors (95%) or living donors (5%), transplanted between august 2007 and july 2012. The primary end point was reduction in calculated glomerular filtration rate (Cockroft & Gault) higher 5ml/min 12 months post trasplant. 25 of 114 patientes showing reduction; The histologic changes associated with renal function reduction were glomerulitis (p=0,024), interstitial inflamation (p=0,001), tubulitis (p=0,001), capilaritis (p=0,001), glomerulitis + capilaritis (p=0,001), polyoma virus nephropathy (p=0,04) and subclinical rejection (p=0,015). By regression analyses, interstitial inflamation (OR = 2,11; IC 95%: 1,13-3,95) and capilaritis (0R=7,12; IC 95%: 1,57-32,27) were associated with renal function reduction 12 month post-transplant. Conclusion: inflammation and capilaritis in protocol biopsies in first year post-transplant predict loss of graft function and independently of other variables.

Institutionalized physical activity curriculum benefits of medical students in Colombia.

BACKGROUND: Health authorities internationally have recommended implementing physical activity and exercise for health training programs within the curriculum of medical schools. The purpose of this evaluation was to determine the changes in physical fitness and health (Fitnessgram criteria) of a sports medicine and physical activity course implemented for 3rd year students in a private medical school in Bogotá, Colombia. METHODS: Intervention was targeted to 13 medical student cohorts. Cardiovascular endurance (20 m shuttle run test), speed (20 m sprint), strength (push-ups and curl-ups in 30 s), and flexibility (sit and reach) were evaluated at the beginning and end of the school semester. It was a 54 semester-hour intervention (3 h/week), with 37 h (69%) of directed group-based physical exercise. RESULTS: Five hundred and twenty-four students were evaluated with an average age of 20 ± 1.4 years; 341 (65.1%) were women. In all the fitness tests for men and women, a significant increase was found. The prevalence of a healthy cardiorespiratory capacity went from 47.8% to 89.1% in women (P < 0.001) and from 54.6% to 83.1% in men (P < 0.001). Body mass index and weight increased in both sexes. DISCUSSION: The results of the current study showed that a 54 h physical activity course within the medicine curriculum had a positive impact on health-related fitness indicators in Colombian medical students.

New echinocandin susceptibility patterns for nosocomial Candida albicans in Bogotá, Colombia, in ten tertiary care centres: an observational study.

BACKGROUND: Candida albicans remains as the first cause of nosocomial fungal infections in hospitals worldwide and its susceptibility pattern should be better described in our tertiary care hospitals. METHODS: This study aimed at identifying the caspofungin susceptibility pattern regarding nosocomial Candida albicans infection in ten tertiary care hospitals using the methodology proposed by CLSI M27-A3 and CLSI M27-S4, and its association with risk factors and clinical outcome. The approach involved descriptive research concerning the diagnosis of nosocomial infection during a 7-month period in 10 hospitals in Bogotá, Colombia. Associations were established using exact non-parametric statistical tests having a high statistical power (>95%), suitable for small samples. The exact Mann Whitney test or Kruskall-Wallis non-parametric ANOVA tests were used for distributions which were different to normal or ordinal variables when comparing three or more groups. Multivariate analysis involved using binomial, multinomial and ordinal exact logistical regression models (hierarchical) and discrimination power was evaluated using area under the ROC curve. RESULTS: 101 nosocomial infections were found in 82,967 discharges, for a Candida spp. infection rate of 12.2 per 10,000 discharges, 30.7% caused by C. albicans, 22.8% by C. tropicalis, 20.8% by C. parapsilosis, 19.8% by other Candida, 3% by C. krusei and 3% by C. glabrata. Statistically significant associations between mortality rate and the absence of parenteral nutrition were found in multivariate analysis (OR = 39.746: 1.794-880.593 95% CI: p = 0.020). The model's predictive power was 83.9%, having an 85.9% significant prediction area (69.5%-100 95% CI; p = 0.001). CONCLUSIONS: Significant differences were found regarding susceptibility results when comparing CLSI M27-A3 to CLSI M27-S4 when shifting clinical break-point values. However, one nosocomial strain was consistent in having reduced susceptibility when using both guidelines without having been directly exposed to echinocandins beforehand and no mutations were found in the FKS1 gene for hot spot 1 and/or hot spot 2 regions, thereby highlighting selective pressure regarding widespread antifungal use in tertiary healthcare centres. Nutritional conditions and low family income were seen to have a negative effect on survival rates.

Molecular epidemiology and characterization of virulence genes of community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus isolates in Colombia.

OBJECTIVE: To determine the molecular epidemiology and presence of virulence genes in community-acquired (CA) and hospital-acquired (HA) methicillin-resistant Staphylococcus aureus (MRSA) isolates and their relationship to clinical outcomes. METHODS: An observational and prospective study of infections caused by MRSA was conducted between June 2006 and December 2007 across seven hospitals in three Colombian cities. MRSA isolates were analyzed for SCCmec. Also, pulsed-field gel electrophoresis and multilocus sequence typing were performed and 25 virulence genes were identified. RESULTS: Two hundred and seventy isolates were collected from 262 adult hospital patients with MRSA infections. Overall, 68% of the isolates were classified as HA-MRSA and 32% as CA-MRSA. We identified differences in the patterns of virulence genes: 85% of HA-MRSA isolates possessed the enterotoxin gene cluster (egc), whereas 92% of CA-MRSA isolates possessed the lukF-PV/lukS-PV genes. Multivariate analysis showed an increased risk of mortality for seg (p=0.001, odds ratio 4.73) and a protective effect for eta (p=0.018, odds ratio 0.33). CONCLUSIONS: Our study confirms that three clones of MRSA predominantly circulate in Colombia: a Chilean clone, a pediatric clone that causes HA-MRSA infections, and a USA300-related clone (SCCmec IVc) in CA-MRSA infections, which differ in the content of clinically important virulence genes. This study confirms that PVL is not a determinant of severity or mortality in CA-MRSA infections.

Epidemiology of prelingual sensorineural hearing impairment at a children’s center in Bogotá, Colombia between 1997 and 2008 / Epidemiología de la pérdida auditiva neurosensorial pre-lingual en un centro de atención a niños de Bogotá, Colombia entre 1997 y 2008

Introduction: Hearing loss is a frequent problem in childhood with an incidence of about one case per 1000 births. Control of deafness should be aimed at prevention and early diagnosis in efforts to provide appropriate treatment and stimulate adequate communication in children affected. The objective of this study was to determine the prevalence of different etiologies among deaf children with a diagnosis of prelingual sensorineural hearing loss referred to the Fundación CINDA in Bogotá, Colombia, between 1997 and 2008. Materials and methods: The medical records were selected from those with prelingual hearing loss. Information was gathered in a format containing variables related to the risk factors suggested by the Joint Committee of Infant Hearing. Results: We studied 254 children; boys and girls were equally distributed. The most common etiological diagnosis was ®unknown cause¼, followed by genetic causes (31 cases), and 38 cases from TORCH infections (toxoplasmosis, others – syphilis, rubella, cytomegalovirus, herpes), with rubella as the most common cause. Conclusions: Review of prenatal, perinatal, and postnatal history often reveals the cause of the deafness in children; therefore, appropriate evaluation of pregnant mothers could result in decreased frequency of deafness in children in our country.

Introducción: La deficiencia en la capacidad auditiva es la alteración sensorial que con más frecuencia se encuentra en la literatura científica. La incidencia en la infancia es de un niño con pérdida auditiva profunda por cada mil recién nacidos. Los esfuerzos en el manejo de la pérdida auditiva deben estar orientados a la prevención primaria y a la detección temprana para estimular el desarrollo de la comunicación en los niños. El objetivo del presente trabajo fue establecer la prevalencia de los diferentes factores etiológicos en una población de niños sordos que asistieron a la Fundación CINDA, entre 1997 y 2008. Material y métodos: Se seleccionaron las historias clínicas de aquellos con pérdida auditiva pre-lingual y se recolectó la información en un formato que contenía las variables relacionadas con los factores de riesgo planteados por el Joint Committee of Infant Hearing. Resultados: Cumplieron el criterio de selección 254 niños (56.7% niños y 43.3% niñas). El diagnóstico etiológico más frecuente (47.2%) fue desconocido, 31 casos se identificaron como genéticos y 38 tuvieron diagnóstico de STORCH (sífilis, toxoplasmosis, rubeola, citomegalovirus, herpes), entre los que se encontró con mayor frecuencia la rubeola. Conclusiones: Los antecedentes positivos de tipo pre (63.4%), peri (37.8%) y post-natal (75.2%) permiten afirmar que un control adecuado del embarazo probablemente lograría disminuir en forma importante la incidencia de sordera en Colombia.

Validation study of human figure drawing test in a Colombian school children population.

The aim of this article was to assess the validity of the emotional and developmental components of the Koppitz human figure drawing test. 2420 children's drawings available in a database resulting from a previous cross sectional study designed to determine the prevalence of neurological diseases in children between 0 and 12 years old in Bogota schools were evaluated. They were scored using the criteria proposed by Koppitz, and classified into 16 groups according to age, gender, and presence/absence of learning or attention problems. The overall results were then compared with the normative study to assess whether descriptive parameters of the two populations were significantly different. There were no significant differences associated with presence/absence of learning and attention disorders or school attended within the overall sample. An Interrater reliability test has been made to assure the homogeneity of scoring by the evaluator team. There were significant differences between this population and that of the original study. New scoring tables contextualized for our population based on the frequency of appearance in this sample are presented. We can conclude that various ethnic, social, and cultural factors can influence the way children draw the human figure. It is thus important to establish local reference values to adequately distinguish between normality and abnormality. The new scoring tables proposed here should be followed up with a clinical study to corroborate their validity.

Validation study of human figure drawing test in a Colombian school children population

The aim of this article was to assess the validity of the emotional and developmental components of the Koppitz human figure drawing test. 2420 children’s drawings available in a database resulting from a previous cross sectional study designed to determine the prevalence of neurological diseases in children between 0 and 12 years old in Bogota schools were evaluated. They were scored using the criteria proposed by Koppitz, and classified into 16 groups according to age, gender, and presence/absence of learning or attention problems. The overall results were then compared with the normative study to assess whether descriptive parameters of the two populations were significantly different. There were no significant differences associated with presence/absence of learning and attention disorders or school attended within the overall sample. An Interrater reliability test has been made to assure the homogeneity of scoring by the evaluator team. There were significant differences between this population and that of the original study. New scoring tables contextualized for our population based on the frequency of appearance in this sample are presented. We can conclude that various ethnic, social, and cultural factors can influence the way children draw the human figure. It is thus important to establish local reference values to adequately distinguish between normality and abnormality. The new scoring tables proposed here should be followed up with a clinical study to corroborate their validity (AU)

El trabajo tiene como objetivo fue validar los componentes evolutivos y emocionales del test de Koppitz del dibujo de la figura humana. Se revisaron 2420 dibujos de niños de la base de datos de un estudio de corte transversal realizado previamente para evaluar la prevalencia de enfermedades neuropediátricas en niños de 0 a 12 años de colegios de Bogotá y fueron divididos en 16 grupos organizados de acuerdo a edad, género y de presentación o no de problemas del aprendizaje o de la atención y evaluados bajo los parámetros propuestos por Koppitz. No se encontraron diferencias entre los grupos por la presencia o no de trastornos, ni entre el tipo de establecimiento educativo. Se realizó una prueba de concordancia interevaluador para homogenizar la calificación. Se encontraron diferencias con la clasificación propuesta por Koppitz por lo que se construyeron nuevas tablas de calificación, teniendo en cuenta los porcentajes de presentación en el presente estudio. A manera de conclusiones se puede decir que diferentes factores socioculturales y étnicos influyen en ítems específicos del dibujo de la figura humana en el niño. Es de gran importancia tener valores referenciales locales para poder establecer diferencias reales entre lo normal y lo anormal. Se debe realizar un estudio para validar clínicamente las tablas propuestas (AU)

Prevalencia de sintomáticos respiratorios en instituciones prestadoras de servicios de salud de Bogotá, D.C., junio de 2005 a marzo de 2006 / Prevalence of respiratory symptomatic in health institutions of Bogotá, Colombia

Introducción. Una de las mayores dificultades en el control de la tuberculosis es la detección tardía de casos, lo que obedece, entre otros motivos, a la poca búsqueda activa de casos sintomáticos respiratorios entre los consultantes y al reducido número de baciloscopias ordenados por el personal de salud. Objetivo. Estimar la prevalencia de casos sintomáticos respiratorios entre usuarios de la red de prestadores de servicios de salud de Bogotá mayores de 15 años, y la proporción a quienes se les solicita baciloscopia de manera oportuna.Materiales y métodos. Se trató de una encuesta transversal en una muestra probabilística, estratificada, multietápica, de conglomerados sin reemplazo, de 113 instituciones de salud y 3.710 usuarios. Se hizo seguimiento telefónico y revisión de registros de laboratorio para saber a quiénes se les solicitó baciloscopia en la consulta médica. Resultados. La prevalencia de casos sintomáticos respiratorios en instituciones de salud de Bogotá entre junio de 2 005 y marzo de 2006 fue de 7,49% (IC95% 6,40-8,59), y fue mayor en instituciones públicas (9,48%) (IC95% 8,04-10,92), en instituciones de primer nivel (8,61%) (IC95% 7,40-9,82), en mayores de 60 años (15,79%) (IC95% 12,36-19,23) y en personas afiliadas al Sistema General de Seguridad Social en Salud (7,57%) (IC95% 6,42-8,72). No se solicitó baciloscopia al 47% de los casos sintomáticos respiratorios.Conclusiones. La proporción de casos sintomáticos respiratorios estimada en este estudio con alta precisión (menos de 2% de error estándar relativo), es la cifra más actualizada en Colombia y permite hacer inferencias para las instituciones prestadoras de salud de Bogotá, dada la expansión de la muestra. Se podrán ajustar las metas del programa de control de la tuberculosis en Bogotá, cuya base hasta ahora es un estudio de 1977 (prevalencia de 10%). Es importante sensibilizar al personal médico para la búsqueda de casos de tuberculosis mediante baciloscopias.

Introduction. One of the greatest challenges in tuberculosis control is the early detection of cases. Detection is hindered by low level of active search for respiratory symptoms by health consultants and the small number of tubercular smear tests ordered by health personnel. Objective. The prevalence of individuals with respiratory symptoms was estimated in Bogotá Health Service Institutions, along with the proportion of those receiving diagnostic baciloscopies (smear or culture tests). Materials and methods. A cross sectional survey was carried out in 113 health service institutions located in the city of Bogotá, involved 3,170 users and covered a 10-month period between June 2005 and March 2006. Sampling design was based on a probabilistic, stratified, multistage, cluster–without-replacement strategy. A telephone follow-up and review of laboratory registers was done to identify symptomatic individuals for whom baciloscopy was requested.Results. The prevalence of symptomatic individuals was 7.5% (95%CI 6.4-8.6%). A higher prevalence occurred in public institutions, 9.5% (95%CI 8.0-10.9%), in institutions of first level, 8.6% (95%CI 7.4-9.8), in persons ≥60 years of age 15.8% (95%CI 12.4-19.2%) and in health users with social security, 7.6% (95% CI 6.4-8.7%). In 47% of symptomatic cases, a baciloscopic procedures were not ordered. Conclusions. The study updated the prevalence of respiratory symptomatic individuals in Colombia and due to the large sample size (and small confidence interval), inferences can be generalized to the entire health service system in Bogotá. The current tuberculosis program goals in Bogotá require adjustment based on the current prevalence of 7.5% compared with a 1977 estimate of 10%.. The study recommends an awareness program for physicians to use TB diagnostic tests in suspect cases.

Nosocomial infections caused by community-associated methicillin-resistant Staphylococcus aureus in Colombia.

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus strains (CA-MRSA) have emerged as the causative agent of health care-associated infections. METHODS: An observational and prospective study was carried out in 5 hospitals in Bogotá, Colombia; severe MRSA infections were identified, and their origin led to classification as health care-associated (HA-MRSA), community-associated, or nosocomial infections. MRSA isolates were analyzed by SCCmec, pulsed-field gel electrophoresis, multilocus sequence typing, and virulence factors. RESULTS: Twenty-six (10.4%) CA-MRSA nosocomial infection-causing strains (eg, USA300) were detected in 250 MRSA infection isolates in mainly primary bacteremia and surgical site infections. The mortality related to nosocomial infection by CA-MRSA was 27%. CONCLUSION: The presence of nosocomial infection by CA-MRSA in Colombia was confirmed.

[Prevalence of respiratory symptomatic in health institutions of Bogotá, Colombia]. / Prevalencia de sintomáticos respiratorios en instituciones prestadoras de servicios de salud de Bogotá, D.C., junio de 2005 a marzo de 2006.

INTRODUCTION: One of the greatest challenges in tuberculosis control is the early detection of cases. Detection is hindered by low level of active search for respiratory symptoms by health consultants and the small number of tubercular smear tests ordered by health personnel. OBJECTIVE: The prevalence of individuals with respiratory symptoms was estimated in Bogotá Health Service Institutions, along with the proportion of those receiving diagnostic baciloscopies (smear or culture tests). MATERIALS AND METHODS: A cross sectional survey was carried out in 113 health service institutions located in the city of Bogotá, involved 3,170 users and covered a 10-month period between June 2005 and March 2006. Sampling design was based on a probabilistic, stratified, multistage, cluster-without-replacement strategy. A telephone follow-up and review of laboratory registers was done to identify symptomatic individuals for whom baciloscopy was requested. RESULTS: The prevalence of symptomatic individuals was 7.5% (95%CI 6.4-8.6%). A higher prevalence occurred in public institutions, 9.5% (95%CI 8.0-10.9%), in institutions of first level, 8.6% (95%CI 7.4-9.8), in persons ≥ 60 years of age 15.8% (95%CI 12.4-19.2%) and in health users with social security, 7.6% (95% CI 6.4-8.7%). In 47% of symptomatic cases, a baciloscopic procedures were not ordered. CONCLUSIONS: The study updated the prevalence ofrespiratory symptomatic individuals in Colombia and due to the large sample size (and small confidence interval), inferences can be generalized to the entire health service system in Bogotá. The current tuberculosis program goals in Bogotá require adjustment based on the current prevalence of 7.5% compared with a 1977 estimate of 10%.. The study recommends an awareness program for physicians to use TB diagnostic tests in suspect cases.

Validación de índices pronósticos e infección del sitio quirúrgico en hospitales de Colombia / Validating prognostic surgical site infection indices from hospitals in Colombia

Objetivo Establecer la capacidad predictiva para infección del sitio quirúrgico (ISQ) de los índices de riesgo del National Nosocomial Infections Surveillance System (NNIS) y Study on the Efficacy of Nosocomial Infection Control (SENIC) en cinco hospitales y, evaluar la capacidad predictiva de otros factores de riesgo. Métodos Cohorte prospectiva de pacientes sometidos a cirugía entre julio de 2006 a febrero de 2007 en cinco hospitales de Colombia. Se definió ISQ según los criterios del CDC. Se evaluaron variables como: edad, género, coomorbilidad, tipo de cirugía, herida, especialidad, tiempo quirúrgico y desenlace. Se evaluó el desempeño operativo de los índices usando el área bajo la curva operador receptor; se construyó un modelo predictivo usando un modelo de regresión logística incondicional con las variables asociadas a infección en el análisis bivariado y/o aquellas conocidas por estudios previos. Resultados Fueron evaluados 7 022 procedimientos quirúrgicos con una tasa de ISQ de 2,9 por ciento. El rendimiento de los índices de riesgo NNIS y SENIC fue muy similar para predecir ISQ (área bajo la curva de 0,682 IC95 por ciento 0,641-0,710 y 0,668 IC95 por ciento 0.641-0.722, respectivamente). Se construyó un modelo predictivo que incluía variables del NNIS y SENIC, además de edad, antecedente de diabetes, transfusiones y especialidad quirúrgica el cual mostró un desempeño de 0,746 (IC95 por ciento 0,709-0,783), en ISQ superficial de 0,70 (IC95 por ciento 0,659-0,741), en ISQ profunda de 0,712 (IC95 por ciento 0,673-0,751) y en ISQ órgano espacio de 0,719 (IC95 por ciento 0,683-0,755). Conclusiones Los modelos de predicción existentes para ISQ tienen una moderada capacidad discriminativa pero pueden ser mejorados con algunos factores locales.

Objective Establishing the effectiveness of the National Nosocomial Infection Surveillance System (NNIS) and Study of the Efficacy of Nosocomial Infection Control's (SENIC) prognostic surgical site infection (SSI) indices in Colombian hospitals and assessing the influence of other risk factors. Methods A prospective, multicentre cohort study was conducted in five Colombian hospitals. All patients undergoing surgery requiring hospitalisation or ambulatory surgeries having a greater risk of infection were enrolled. A case was defined as being those subjects who presented the CDC diagnostic criteria of incisional superficial, deep incisional or organ-space SSI. Age, gender, co-morbidities, type of surgery, procedures, medical specialty, type of wound, surgical time, antibiotic prophylaxis and patient outcome were used for developing a predictive model of SSI using logistical regression analysis. The indexes' predictive ability was assessed by using the area under the receiver operating curve (ROC). Results 7,022 surgical procedures were evaluated and SSI rate was 2.9 percent. NNIS and SENIC risk index performance was similar to that for predicting SSI (0.68 cf 0.66 area under ROC, respectively). The new predictive model involved other factors such as age, diabetes mellitus, transfusions and surgical specialty showing 0.74 operating performance. Conclusions Existing SSI predictive models have a moderate ability for predicting SSI but this can be improved with some local factors.

Comportamiento epidemiológico de la sepsis nosocomial en la Unidad de Recién Nacidos de la Fundación Cardioinfantil / Nosocomial Infections at the Neonatal Intensive Care Unit of Fundación Cardioinfantil in Bogotá

Objetivo. Se realizó un estudio retrospectivo que describe las características demográficas, la etiología, los factores asociados, la mortalidad, la sensibilidad y la resistencia de los microorganismos a los antibióticos usados en sepsis nosocomial. Diseño del estudio. Se realizó la recolección de datos desde el 2004 hasta el primer trimestre del 2006. Se definió infección nosocomial probada como la infección diagnosticada después de 72 horas de hospitalización y que recibe manejo antibiótico mayor a 3 días. Resultados. Se revisaron 60 historias clínicas, en las cuales los gérmenes Gram negativos fueron los principales causantes de sepsis nosocomial, tanto intra como extrainstitucional; de ellos la k. pneumoniae fue el germen más frecuentemente encontrado. Conclusiones. Los gérmenes Gram negativos son los microorganismos predominantemente causantes de sepsis nosocomial en la Unidad de Recién Nacidos (URN) de la Fundación Cardioinfantil (FCI).

Objective. To describe the demographic characteristics, etiologic agents, some associated factors and, the resistance pattern of the microorganisms in neonates identified with nosocomial infections at the Neonatal Intensive Care Unit of Fundación Cardioinfantil in Bogotá. Study design. This retrospective study was developed from 2004 to the first trimester of 2006. Nosocomial infection was defined as the infection diagnosed after 72 hours of hospital admission in a neonate who received antimicrobial therapy during more than three days. Results. Sixty clinical medical charts were reviewed. Gram-negative organisms were the most frequent agents (71.2%) causing nosocomial infections acquired within or outside of the institution. Klebsiella pneumoniae was the agent most frequently identified with 65% of resistance to third generation cephalosporin. Conclusion. Gram-negative are the predominant etiologic agents responsible of nosocomial infections in neonates admitted to the Fundación Cardioinfantil.

Caracterización epidemiológica de una población de pacientes del programa ®manejo integral de la enfermedad pulmonar obstructiva crónica¼ de la EPS Sanitas en Bogotá / Patient characteristics and diagnostic evaluation in a management programme of Chronic Obstructive Pulmonary Disease (COPD) in Bogota (2640m), Colombia

Objetivo: describir las características epidemiológicas de los pacientes al ingreso a un programa de manejo integral de la EPOC en Bogotá. Material y método: estudio de corte transversal. Evaluamos 756 pacientes con diagnóstico presuntivo de EPOC. Se confirmaron 408 por espirometría (54 por ciento), de los cuales se excluyeron 57. Se describen las características demográficas, clínicas, paraclínicas de 351 pacientes y su asociación con el grado de severidad de la obstrucción. Análisis estadístico: Se presentan las frecuencias y medidas de tendencia central y dispersión. Se utilizó el coeficiente paramétrico de Pearson o el coeficiente no-paramétrico de Spearman según normalidad, a un nivel de significancia del 1 por ciento (p<0.01). Resultados: La EPOC, definida por una relación VEF1/CVF < 70 por ciento, post-broncodilatador, se confirmó en el 54 por ciento de los pacientes. La edad promedio fue 72,8±9 años, 61 por ciento hombres, fumadores activos 9,1 por ciento, expuestos a humo de leña 33,3 por ciento. El 68,6 por ciento no utiliza correctamente los inhaladores. El VEF1 promedio fue 1.285±517 litros. El 68,1 por ciento y 46,4 por ciento no se habían vacunado contra neumococo e influenza respectivamente. Se encontró correlación directa y significativa entre VEF1 (por ciento) con saturación, PaO2 e índice de masa corporal; e inversa con PCO2, hematocrito e índice de disnea; no se encontró correlación con la escala de calidad de vida (S. George) y test de marcha en 6 minutos. Conclusiones: El 54 por ciento de los pacientes remitidos están adecuadamente diagnosticados. Hay baja cobertura en vacunación contra neumococo e influenza, la mayoría utilizan en forma incorrecta los inhaladores. Resaltamos la importancia de utilizar la espirometría como herramienta básica en el diagnóstico de EPOC, al igual que programas educativos que impacten en el manejo de la EPOC. (Nota el enlace a Internet opera para todo el fasciculo 1/2008).

Caracterización de un brote de infección por Acinetobacter baumannii en una unidad de cuidado crítico en Bogotá, Colombia / Characterization of an outbreak infection caused by Acinetobacter baumanni in an intensive care unit, in Bogotá, Colombia

Objetivo: caracterización de un brote de infección por Acinetobacter baumannii y determinación de los factores asociados. Diseño: estudio de casos y controles anidado en una cohorte de pacientes críticos entre octubre de 2003 y marzo de 2004. Criterios de inclusión: haber estado hospitalizado en la unidad de cuidados intensivos en el mismo periodo y ser sometidos a procedimientos invasivos. Se excluyeron los pacientes que fallecieron en las primeras 24 horas de haber ingresado a la unidad de cuidados intensivos o que habían sido remitidos de otras instituciones. Se evaluó edad, sexo, antecedentes de enfermedad crónica, índice de intervención terapéutica (therapeutic index score system, TISS), tiempo de uso de dispositivos invasivos, tipo de nutrición, exposición previa a antibióticos, procedimiento quirúrgico, tiempo de uso de exposición y estancia. La investigación epidemiológica de los aislamientos incluyó la tipificación molecular mediante electroforesis en gel de campo pulsado. Resultados: los aislamientos de A baumannii provenientes de los pacientes infectados y de los cultivos de vigilancia fueron resistentes a múltiples antibióticos. Los aislamientos se encontraron relacionados genéticamente con un porcentaje de similitud mayor del 97 por ciento. Se encontró asociación estadísticamente significativa entre la infección de A. baumannii y un mayor puntaje de intervención terapéutica durante la hospitalización (p=0,030), uso de nutrición parenteral (0=0,030) y tiempo de exposición (p=0,02 super índice 2). Conclusiones: la infección por A baumannii, Se asoció a un mayor índice de intervención terapeútica, al uso de nutrición parenteral y al tiempo de exposición. Los aislamientos se encontraron relacionados genéticamente.

[Validating prognostic surgical site infection indices from hospitals in Colombia]. / Validación de indices pronósticos e infección del sitio quirúrgico en hospitales de Colombia.

OBJECTIVE: Establishing the effectiveness of the National Nosocomial Infection Surveillance System (NNIS) and Study of the Efficacy of Nosocomial Infection Control's (SENIC) prognostic surgical site infection (SSI) indices in Colombian hospitals and assessing the influence of other risk factors. METHODS: A prospective, multicentre cohort study was conducted in five Colombian hospitals. All patients undergoing surgery requiring hospitalisation or ambulatory surgeries having a greater risk of infection were enrolled. A case was defined as being those subjects who presented the CDC diagnostic criteria of incisional superficial, deep incisional or organ-space SSI. Age, gender, co-morbidities, type of surgery, procedures, medical specialty, type of wound, surgical time, antibiotic prophylaxis and patient outcome were used for developing a predictive model of SSI using logistical regression analysis. The indexes' predictive ability was assessed by using the area under the receiver operating curve (ROC). RESULTS: 7,022 surgical procedures were evaluated and SSI rate was 2.9%. NNIS and SENIC risk index performance was similar to that for predicting SSI (0.68 cf 0.66 area under ROC, respectively). The new predictive model involved other factors such as age, diabetes mellitus, transfusions and surgical specialty showing 0.74 operating performance. CONCLUSIONS: Existing SSI predictive models have a moderate ability for predicting SSI but this can be improved with some local factors.

Inmunogenicidad de una vacuna recombinante anti-HBs en trabajadores de la salud, del Instituto de Medicina Legal de Colombia / Immunogenicity of Hepavax-Gene recombinant hepatitis B vaccine in INML workers, Colombia

Objetivo: Evaluar la inmunogenicidad de la vacuna recombinante Hepavax-Gene para hepatitis B desde la última dosis administrada en trabajadores del INML. Materiales y métodos: Estudio de corte transversal en 603 trabajadores de la salud con mínimo 3 dosis de vacuna recombinante (0, 1, 6 meses) donde se midieron los niveles de anticuerpos anti-HBs con la técnica de ELISA entre diciembre de 2000 y enero de 2001 desde la aplicación de la última dosis de la vacuna, que varió entre 1 y 6 años. Resultados: El grupo de estudio lo conformaron 344 hombres y 259 mujeres, con un promedio de edad de 38.8±7.3 años. El nivel de protección fue 90.7% (>10 U/l) que disminuyó significativamente con el tiempo de aplicación de la última dosis de la vacuna (p<0.01) y con la edad del trabajador (p<0.001), presentó mayor protección en 4.7% de los trabajadores que se habían aplicado 4 dosis si se comparan con los de 3 dosis y en sus medianas (209.8 vs. 130.07) (p<0.001), los otros factores no se encontraron asociados, género (p=0.463), consumo de cigarrillo (p=0.331) y exposición a sangre y/o hemoderivados (p=0.433). En el análisis multivariante la no protección acumulativamente se encontró asociada sólo con la edad, 40-44 (RRI=2.37, IC 95%:1.18, 4.78), >45 (RRI=3.58, IC 95%:1.83, 6.99) con respecto a <40 años. Conclusión: La vacuna recombinante Hepavax-Gene anti-HBs tiene alta efectividad en los trabajadores de la salud (90.7%) aunque presenta disminución de protección a mayor tiempo de aplicación de la última dosis y al aumentar la edad del trabajador.

Objective: To evaluate the immunogenicity of Hepavax-Gene recombinant hepatitis B vaccine in INML workers since the last administered doses. Methods: Cross-sectional study on 603 health workers with at least three administered recombinant vaccine doses. Antibody levels (anti-HBs) were measured using the ELISA technique during December 2000 and January 2001, taking into account that the last dose in the vaccination varied between 1 and 6 years. Results: A total of 344 men and 259 women with an age mean of 38.8±7.3 years were studied. Protection levels were found in 90.7% (>10 U/l), decreasing significantly with the worker’s age (p<0.001) and with the vaccine last dose administration time (p<0.01). Health workers with four doses compared to those with three doses had a 4.7% higher protection (antibody median 209.8 vs. 130.07, p<0.001). No association was found with gender (p=0.463), smoking (p=0.331) and blood exposure (p=0.433). Multivariate analyses found that no protection associated only with age (40-44 years HR=2.37, CI 95%:1.18,4.78 and >45 years HR=3.58, CI 95%: 1.83,6.99). Conclusions: Although Hepavax-Gene recombinant hepatitis B vaccine (anti-HBs) has a high effectiveness in the health workers (90.7%) it presents a decrease in protection levels related to a higher worker’s age and a long vaccine last dose administration time.

Escala UNAL de predicción para identificar pacientes con hemorragia digestiva alta que necesitan endoscopia urgente / UNAL of prediction climbs to identify patient with digestive high hemorrhage that urgent endoscopia needs

La determinación de variables clínicas que permitan predecir qué pacientes con hemorragia digestiva alta (HVDA) tienen sangrado activo es muy importante ya que identificarían a los que necesitan endoscopia digestiva urgente (dentro de las primeras 12 horas de ingreso) o si el procedimiento se puede diferir para hacerlo dentro de las primeras 24 horas. Además de lo anterior, una escala predictiva sería muy útil para los servicios de urgencias de hospitales y centros de salud ya que facilita optimizar los recursos y más aún en Colombia donde éstos son insuficientes y muy pocos hospitales prestan un servicio de endoscopia las 24 horas del día. El propósito de este trabajo fue evaluar, en nuestro medio, la utilidad de los hallazgos clínicos y de laboratorio para identificar aquellos pacientes con HVDA que al momento del ingreso están presentando sangrado activo, para construir con ellos una escala original, la cual posteriormente fue validada de manera prospectiva en un grupo diferente de pacientes.