Concordance between nice classification and histopathology in colonic polyps: a tertiary center experience.

Background: Narrow-Band imaging International Colorectal Endoscopic (NICE) could reduce histopathology study requirements in colorectal polyp evaluation. Local and regional studies are required to validate its utility. Objectives: To evaluate concordance between NICE classification and histopathology. Design: Prospective analytic study performed in the Hospital Universitario San Ignacio, Bogotá (Colombia) between 2021 and 2022. Methods: Concordance between NICE I, II and III classification and histopathology [Hyperplastic Polyp (HP), adenoma and deep submucosal invasive cancer (DSIC)] was evaluated using weighted kappa. Diagnostic performance was evaluated for NICE I-II versus NICE III for DSIC versus adenoma/HP. A subgroup analysis was performed for polyps ⩾10 mm and those located in the rectum, sigmoid, and left colon. Results: A total of 238 polyps from 135 patients were evaluated. Median age 67 years (IQR 58.5-74.5), 54.4% males. 23 (17.1%) had ⩾3 polyps. Of polyps, 52.1% were located on rectum, sigmoid and left colon. A total of 182 (76.5%) were <10 mm. NICE and histopathology evidenced a fair-moderate concordance (quadratic weighted kappa 0.36, linear weighted kappa 0.43). NICE classification (NICE I-II versus III) compared to histopathology (DSIC versus adenoma/HP) evidenced a sensitivity of 90.9% and specificity of 99.1%. For DSIC diagnosis specificity was ⩾95% on polyps ⩾10 mm and those left sided located. Conclusion: NICE and histopathology concordance is suboptimal. However, NICE III for DSIC diagnosis evidence good specificity. Therefore, NICE III polyps require a prompt histopathological evaluation and follow-up. Good operative characteristics stand in polyps ⩾10 mm and left sided located. NBI formal training is recommended in gastroenterology units in Latin America.

Concordance between colonoscopy polyp evaluation with NBI optical technology and histopathology evaluation Most colorectal cancer are developed from polyps. A proper polyp evaluation is required to orientate which polyp could be a potential neoplasia. However, a definitive diagnosis is made according to histopathology evaluation. On the other hand, Narrow-Band imaging International Colorectal Endoscopic (NICE) classification based on colonoscopy could predict neoplastic polyps and drive therapeutic decisions. Our tertiary center study in Colombia evidence that NICE classification predicts adequately neoplastic polyps but is suboptimal to categorize low risk polyps. Therefore, histopathology polyp evaluation should be still recommended and NBI formal training is recommended in gastroenterology units in Latin -America.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis.

Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.

Prevalencia de fibrilación auricular en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of atrial fibrillation in Colombia according to information from the Comprehensive Information System of the Social Protection (SISPRO)

Resumen Introducción: La fibrilación auricular es la arritmia cardíaca más frecuente, es una de las causas más importantes de eventos cerebrovasculares de origen embólico y se asocia con el desarrollo de insuficiencia cardíaca y muerte súbita. En Colombia, constituye una enfermedad con altos costos para el sistema de salud; sin embargo, su prevalencia es desconocida. Objetivo: Describir la prevalencia de fibrilación auricular reportada a los sistemas oficiales de información en Colombia. Método: Mediante la extracción, el tabulado y el análisis de datos de la herramienta SISPRO, del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de fibrilación auricular estandarizada por edad, global y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Se identificaron 143,656 casos reportados con el código I48X, que corresponde a fibrilación auricular en la CIE-10. La prevalencia de fibrilación auricular se incrementó desde 41 hasta 87 por cada 100,000 habitantes entre 2013 y 2017 (p < 0.001). En Colombia, la fibrilación auricular es más frecuente en las mujeres, con mayor prevalencia en mayores de 60 años (606/100,000 en 2017); hay zonas con prevalencia superior a 150/100,000 en los departamentos de Antioquia, Caldas, Santander y Bogotá D.C. Conclusiones: Este estudio sugiere que la fibrilación auricular tiene una tendencia ascendente en Colombia, es más frecuente en las mujeres y más prevalente en los centros urbanos, posiblemente debido a una mayor proporción de pacientes mayores y al mejor acceso a los sistemas de salud.

Abstract Introduction: Atrial fibrillation is the most frequent cardiac arrhythmia. It is responsible for an important proportion of embolic strokes and is associated with the development of congestive heart failure and sudden cardiac death. In Colombia, atrial fibrillation is highly costly for the healthcare system; however, its true prevalence is unknown. Objective: To describe the prevalence of atrial fibrillation reported to the official information systems in Colombia. Method: We calculated the prevalence of atrial fibrillation through the extraction, tabulation and analysis of data contained in the Integral Information System for Social Protection tool, which was created by the Ministry of Health and Social Protection in Colombia. Global and age-standardized prevalence rates were obtained for the period between years 2013 and 2017. Results: A total of 143,656 cases were identified. These were reported through the ICD-10 code I48X, corresponding to atrial fibrillation. The prevalence of atrial fibrillation increased from 41 to 87 cases per 100,000 inhabitants between years 2013 and 2017 (p < 0.001). In Colombia, atrial fibrillation is more frequent among women, and individuals over the age of 60 (606/100,000 in 2017). The departments of Antioquia, Caldas, Santander and Bogotá D.C had zones with prevalence greater than 150/100,000. Conclusions: This study suggests that atrial fibrillation displays an upward trend in Colombia. Its prevalence is higher in women and urban centers. The latter may be due to the higher proportion of older patients and better access to healthcare in these subgroups.

Evaluation of Long-Term Kidney Function Following Orthotopic Heart Transplantation.

INTRODUCTION: Acute impairment of kidney function in patients with heart failure and heart transplantation is a frequent condition. However, the impact of the transplant on long-term kidney function remains controversial. METHODS: This study describes a cohort of patients who received a heart transplant in a reference hospital between 2005 and 2019. Glomerular filtration rate during follow-up was calculated at 0, 6,12, 24, and 60 months using the Cockcroft-Gault and MDRD (modification of diet in renal disease study) equations. To identify changes we compared glomerular filtration rate (GFR) at baseline with measurements over time after heart transplantation, using a paired t test and a longitudinal model of Generalized Estimating Equations (GEE). RESULTS: Forty-four patients were included. The mean of baseline GFR was 67.9 ± 1.3 mL/min. A triple immunosuppressive therapy scheme was used with cyclosporine/tacrolimus, mycophenolate mofetil, and steroid, with progressive dose reduction. After adjusting for multiple variables, we found no reduction of GFR over time with the GEE model. There was no significant difference in GFR using Cockcroft-Gault equation at 6 (mean difference [MD] 4.46; confidence interval [CI] -2.1 to 11.09; P = 0.18), 12 (MD 1.65, CI -4.5 to 7.82; P = 0.59), 36 (MD 0.69; CI -6.04 to 7.43; P = 0.83), and 60 months (MD 0.62; CI -5.5 to 6.79; P = 0.83). Similar findings were found using MDRD equation. CONCLUSIONS: There is no significant GFR decline between the time of heart transplantation and a follow-up at 60 months. New studies are needed to evaluate changes in renal function beyond this timeframe.

Comparison of Performance of the Pediatric Index of Mortality (PIM)-2 and PIM-3 Scores in the Pediatric Intensive Care Unit of a High Complexity Institution.

OBJECTIVE: To determine the performance of each of the available pediatric index of mortality (PIM) scores, by assessing the capability for discrimination and calibration in patients admitted to a pediatric intensive care unit in Bogotá. DESIGN AND SETTING: We designed a retrospective, observational cohort study, which included all patients aged between a month and 17 years and 364 days, admitted to the pediatric intensive care unit of a high complexity university hospital between April 1, 2016 and December 31, 2018. We analyzed the standardized mortality ratio, discrimination, calibration, and net reclassification index (NRI) for each model. RESULTS: A total of 722 patients were included, the mortality rate was 3.74%, and for PIM-3, the ratio between expected and observed mortality was 0.66 [confidence interval (CI) 0.40-1.05] for PIM-2 and 1.00 (CI 0.59-1.68) for PIM-3. The Hosmer-Lemeshow (HL) test suggests inadequate calibration for PIM-2 (HL = 13.18, p = 0.11) and adequate calibration for PIM-3 (HL = 28.08, p < 0.01). The area under the diagnostic performance curves for PIM-2 and PIM-3 were 0.87 (95% CI 0.80-0.94) and 0.89 (95% CI 0.82-0.95), respectively. The NRI was -27.1%. PIM-3 classified survivors better than PIM-2, but inadequately classified nonsurvivors. CONCLUSION: Although both models show adequate discrimination ability, PIM-3 shows a better correlation between predicted risk score and observed mortality. Thus, it may be a useful tool for measuring the internal processes of intensive care units in Colombia and for making comparisons between groups of similar characteristics. HOW TO CITE THIS ARTICLE: Quiñónez-López D, Patino-Hernandez D, Zuluaga CA, García ÁA, Muñoz-Velandia OM. Comparison of Performance of the Pediatric Index of Mortality (PIM)-2 and PIM-3 Scores in the Pediatric Intensive Care Unit of a High Complexity Institution. Indian J Crit Care Med 2020;24(11):1095-1102.

Impacto terapéutico de las estatinas en el perfil lipídico y el riesgo cardiovascular en pacientes con lupus eritematoso sistémico: revisión sistemática de la literatura y metaanálisis / Therapeutic impact of statins on the lipid profile and cardiovascular risk in patients with systemic lupus erythematosus: systematic review of the literature and a meta-analysis

ANTECEDENTES: Existe evidencia que muestra un aumento del riesgo cardiovascular en pacientes que padecen de enfermedades autoinmunes, en particular, de lupus eritematoso sistémico. Hasta el momento existen pocos estudios que evalúen el potencial beneficio de las estatinas en la incidencia de eventos cardiovasculares y en el perfil lipídico de pacientes con, y esta evidencia no ha sido sintetizada y evaluada en conjunto. MÉTODOS: Se realizó una búsqueda de la literatura hasta agosto de 2016 (Embase, MEDLINE, Cochrane Library, SciELO, Clinical Evidence, DynaMed, registro de experimentos clínicos de Cochrane, LILACS), identificando ensayos clínicos controlados que evaluaran el impacto de las estatinas en mortalidad, eventos cardiovasculares, proteína C reactiva y perfil lipídico en pacientes con lupus eritematoso sistémico. Se evaluó la calidad de la información disponible y se metaanalizó utilizando un modelo de efectos aleatorios, utilizando el programa RevMan 5.3. RESULTADOS: Un total de 6 estudios y 412 pacientes fueron incluidos para el análisis. Se encontró que el uso de las estatinas en paciente con LES reduce significativamente los niveles de colesterol total (diferencia de medias [DM] -31,2mg/dL; IC 95% -41,9; -20,5), colesterol de baja densidad (DM -31,4mg/dL; IC 95% -43,0; -19,9), sin impacto en los niveles de triglicéridos (DM 4mg/dL; IC 95% 2,49; 6,21) y proteína C reactiva (DM -0,78; IC 95% -1,43; -0,13). No se encontró ninguna evidencia sobre impacto en el riesgo de mortalidad o eventos cardiovasculares. CONCLUSIÓN: Las estatinas tienen un impacto significativo en los niveles de colesterol total, colesterol unido a lipoproteínas de baja densidad y proteína C reactiva, sin embargo, son necesarios nuevos estudios aleatorizados controlados con seguimiento a largo plazo para evaluar el impacto en la mortalidad y el riesgo cardiovascular

BACKGROUND: There is strong evidence of a rise in cardiovascular risk in patients suffering from autoimmune diseases, especially in those with Sistemic Lupus Erythematosus. Until now, there are a few trials that assess the potencial benefit of statins on the incidence of cardiovascular events and on lipid profile of patients with SLE. This evidence has not been synthesized and assessed altogether. METHODS: We performed a search in databases of literature published until August of 2016 (Embase, MEDLINE, Cochrane Library, SciELO, Clinical Evidence, DynaMed, Cochrane Central Register of Controlled Trials, LILACS), identifying controlled clinical trials that could estimate the impact of statins on mortality, cardiovascular events, C-reactive protein and lipid profile in patients with Systemic Lupus Erythematosus. The quality of the information available was assessed with a meta-analysis, using a random effects model, employing the RevMan 5.3 software. RESULTS: 6 trials and 412 patients were included in the analysis. The use of statins in patients with SLE was found to significantly reduce the levels of serum total cholesterol (mean difference [MD] -31,4 mg/dL; CI 95% -43,0; -19,9), and serum low density cholesterol (MD -31,4 mg/dL; IC 95% -43,0; -19,9), but had no impact on levels of serum triglycerides (MD 4 mg/dL; IC 95% 2,49; 6,21) and C-reactive protein (MD -0,78; IC 95% -1,43; -0,13). No evidence was found about the impact on the risk of mortality or cardiovascular events. CONCLUSION: Statins have a significant effect on the levels of serum total cholesterol, LDL cholesterol and C-reactive protein, however, more randomized controlled trials with long-term follow-up are necessary to assess the impact on mortality and cardiovascular risk

Therapeutic Impact of Statins on the Lipid Profile and Cardiovascular Risk in Patients With Systemic Lupus Erythematosus: Systematic Review of the Literature and a Meta-analysis. / Impacto terapéutico de las estatinas en el perfil lipídico y el riesgo cardiovascular en pacientes con lupus eritematoso sistémico: revisión sistemática de la literatura y metaanálisis.

BACKGROUND: There is strong evidence of a rise in cardiovascular risk in patients suffering from autoimmune diseases, especially in those with Sistemic Lupus Erythematosus. Until now, there are a few trials that assess the potencial benefit of statins on the incidence of cardiovascular events and on lipid profile of patients with SLE. This evidence has not been synthesized and assessed altogether. METHODS: We performed a search in databases of literature published until August of 2016 (Embase, MEDLINE, Cochrane Library, SciELO, Clinical Evidence, DynaMed, Cochrane Central Register of Controlled Trials, LILACS), identifying controlled clinical trials that could estimate the impact of statins on mortality, cardiovascular events, C-reactive protein and lipid profile in patients with Systemic Lupus Erythematosus. The quality of the information available was assessed with a meta-analysis, using a random effects model, employing the RevMan 5.3 software. RESULTS: 6 trials and 412 patients were included in the analysis. The use of statins in patients with SLE was found to significantly reduce the levels of serum total cholesterol (mean difference [MD] -31,4 mg/dL; CI 95% -43,0; -19,9), and serum low density cholesterol (MD -31,4 mg/dL; IC 95% -43,0; -19,9), but had no impact on levels of serum triglycerides (MD 4 mg/dL; IC 95% 2,49; 6,21) and C-reactive protein (MD -0,78; IC 95% -1,43; -0,13). No evidence was found about the impact on the risk of mortality or cardiovascular events. CONCLUSION: Statins have a significant effect on the levels of serum total cholesterol, LDL cholesterol and C-reactive protein, however, more randomized controlled trials with long-term follow-up are necessary to assess the impact on mortality and cardiovascular risk.