Impact of access to treatment on patient-reported outcomes among rheumatoid arthritis patients with tDMARDs and bDMARDS in two Latin-American countries: A prospective observational study.

Background and Aims: A noninterventional prospective study was performed in Colombia and Peru. The aim was to describe the impact of access to treatment on Patient-reported outcomes (PRO) in patients with Rheumatoid arthritis (RA) after failure to conventional disease-modifying antirheumatic drugs (DMARDs) in real-life conditions. Methods: The impact of access to treatment was measured by access barriers, time to supply (TtS) and interruption evaluating their effect in changes of PROs between baseline and 6-month follow-up between February 2017 and November 2019. The association of access to care with disease activity, functional status, health-related quality of life was assessed using bivariate and multivariable analysis. Results are expressed in least mean difference; TtS in mean number of days for delivery of treatment at baseline. Variability measures were standard deviation and standard error. Results: One hundred seventy patients were recruited, 70 treated with tofacitinib and 100 with biological DMARDs. Thirty-nine patients reported access barriers. The mean of TtS was 23 ± 38.83 days. The difference from baseline to 6-month visit in PROs were affected by access barriers and interruptions. There was not statistically significant difference in the of PRO's score among visits in patients that reported delay of supply of more than 23 days compared to patients with less days of delay. Conclusion: This study suggested the access to treatment can affect the response to the treatment at 6 months of follow-up. There seems to be no effect in the PROs for delay of TtS during the studied period.

Development of a Psychosocial Intervention to Promote Treatment Adherence in Patients with Bipolar Disorder at Risk of Cardiovascular Disease.

Nonadherence to treatment is a serious concern that affects the successful management of bipolar disorder (BD) patients. The aim of this study was to pilot test a psychosocial intervention (previously developed by this team) intended to increase adherence to medication and health behaviors targeting cardiovascular disease (CVD) risk factors in BD patients. An open, single-group design was used to assess the feasibility and acceptability of the intervention. The participants had BD, type I/II or unspecified, and CVD risk factors. Baseline demographic measures were taken. We also obtained preliminary effect sizes related to pre-post changes on measures of self-reported adherence to psychiatric medication, depressive and manic symptoms, and pharmacy records. At baseline, 29% of the participants reported recent adherence to psychiatric medications. A total of 71% of the participants completed the intervention. Pre-post improvements by medium and large effect sizes (Cohen's d = 0.52-0.92) were seen in medication adherence, attitudes toward medication, and mania symptoms. The participants reported high levels of satisfaction with the intervention. A culturally sensitive psychosocial intervention for Puerto Rican BD patients who are at risk of CVD was found to be feasible and acceptable. Improvements in the key outcomes were seen in this small, preliminary study. Further research is needed with a larger sample size.

Prevalencia comparativa de pólipos adenomatosos en personas de 45 a 49 años y en mayores de 50 años en una población colombiana: estudio de casos y controles / Comparative prevalence of adenomatous polyps in people aged 45 to 49 years and in people over 50 years of age in a Colombian population: a case-control study

RESUMEN Introducción: El cáncer de colon y recto (CCR) es el tercer cáncer más frecuente y la cuarta causa de muerte por cáncer en el mundo. En Colombia, es la tercera causa de muerte por cáncer. La recomendación más aceptada es hacer tamización con colonoscopia en personas de 50 a 75 años. Sin embargo, recientemente la Asociación Americana de Cáncer (ACS) ha recomendado iniciar la tamización a partir de los 45 años. En nuestro medio no hay estudios sobre prevalencia de pólipos adenomatosos en menores de 50 años. Objetivo: Comparar la prevalencia de pólipos adenomatosos durante colonoscopia de tamización en personas de 45-49 años (casos) y compararla con la de personas de 50 a 75 años (control). Materiales y métodos: Estudios de casos y controles. Los datos se recolectaron de forma prospectiva durante el periodo de enero 2018 hasta noviembre de 2019 en el centro de gastroenterología y endoscopia digestiva de Bogotá Colombia. Resultados: Se incluyeron 490 pacientes, 119 casos y 371 controles, relación casos:control fue 1:3. La prevalencia de pólipos en los casos 36,7% y en los controles (42,5%) p=0,279. Los pólipos adenomatosos se detectaron en 18,5% (IC 95% 12,4-26,6) de los casos y 32,4% (IC 95% 27,7-37,2) de los controles (p=0,004). Conclusión: La prevalencia de pólipos durante la colonoscopia de tamización en personas de 45-49 años es similar a la esperada en colonoscopias de tamización de personas entre los 50-75 años. Este hallazgo favorecería colonoscopia de tamización a partir de los 45 años.

ABSTRACT Introduction: Colon and rectal cancer (CRC) is the third most frequent cancer and the fourth cause of cancer death in the world. In Colombia, it is the third leading cause of death from cancer. The most accepted recommendation is to do colonoscopy screening in people 50 to 75 years old. However, recently the American Cancer Association (ACS) has recommended starting screening from the age of 45. In our environment there are no studies on the prevalence of adenomatous polyps in children under 50 years of age. Objective: To compare the prevalence of adenomatous polyps during screening colonoscopy in people aged 45-49 years (cases) and compare it with that of people aged 50 to 75 years (control). Materials and methods: Case-control studies. The data were collected prospectively during the period from January 2018 to November 2019 at the gastroenterology and digestive endoscopy center of Bogotá Colombia. Results: 490 patients were included, 119 cases and 371 controls, case: control ratio was 1: 3. The prevalence of polyps in cases 36.7% and in controls (42.5%) p=0.279. Adenomatous polyps were detected in 18.5% (95% CI 12.4-26.6) of the cases and 32.4% (95% CI 27.7-37.2) of the controls (p=0.004). Conclusion: The prevalence of polyps during screening colonoscopy in people aged 45-49 years is similar to that expected in screening colonoscopies of people between 50-75 years. This finding would favor screening colonoscopy from 45 years of age.

[Comparative prevalence of adenomatous polyps in people aged 45 to 49 years and in people over 50 years of age in a Colombian population: a case-control study]. / Prevalencia comparativa de pólipos adenomatosos en personas de 45 a 49años y en mayores de 50 años en una población colombiana: estudio de casos y controles.

INTRODUCTION: Colon and rectal cancer (CRC) is the third most frequent cancer and the fourth cause of cancer death in the world. In Colombia, it is the third leading cause of death from cancer. The most accepted recommendation is to do colonoscopy screening in people 50 to 75 years old. However, recently the American Cancer Association (ACS) has recommended starting screening from the age of 45. In our environment there are no studies on the prevalence of adenomatous polyps in children under 50 years of age. OBJECTIVE: To compare the prevalence of adenomatous polyps during screening colonoscopy in people aged 45-49 years (cases) and compare it with that of people aged 50 to 75 years (control). MATERIALS AND METHODS: Case-control studies. The data were collected prospectively during the period from January 2018 to November 2019 at the gastroenterology and digestive endoscopy center of Bogotá Colombia. RESULTS: 490 patients were included, 119 cases and 371 controls, case: control ratio was 1: 3. The prevalence of polyps in cases 36.7% and in controls (42.5%) p=0.279. Adenomatous polyps were detected in 18.5% (95% CI 12.4-26.6) of the cases and 32.4% (95% CI 27.7-37.2) of the controls (p=0.004). CONCLUSION: The prevalence of polyps during screening colonoscopy in people aged 45-49 years is similar to that expected in screening colonoscopies of people between 50-75 years. This finding would favor screening colonoscopy from 45 years of age.

Procedimientos endoscópicos y pandemia COVID-19: consideraciones básicas / Basic considerations regarding endoscopic procedures during the COVID-19 pandemic

El SARS-Cov-2 es un coronavirus productor de la enfermedad COVID-19. Esta inició en Wuhan, capital de la provincia Hubei, China. En menos de cuatro meses la enfermedad se dispersó por el mundo, lo que dio origen a miles de muertes. La Organización Mundial de la Salud (OMS) la ha declarado pandemia. La humanidad está consternada, múltiples gobiernos han obligado al aislamiento total, con éxito variable debido a la negligencia de parte de la comunidad. En muchas ciudades las instituciones y el personal sanitario no son suficientes para atender la catástrofe. El aislamiento es la única estrategia eficaz para detener el crecimiento logarítmico de COVID-19. El motivo científico del aislamiento es que más del 60 % de los contagios surgen de personas asintomáticas. La enfermedad no solo produce síntomas respiratorios. El SARS-Cov-2, además, puede producir náuseas, dolor abdominal, vómito, diarrea, anosmia y ageusia. El 50% de los infectados pueden tener síntomas digestivos, que incluso preceden a los respiratorios. La ruta fecal-oral trasmite el virus, aún sin diarrea. En las unidades de endoscopia están todas las formas de contagio: aerosoles (vómitos, arcadas, eructos, flatos), materia fecal, contacto estrecho, contaminación del ambiente. Se deben suspender todas las endoscopias programadas para diagnóstico. Solo deben realizarse las urgentes y terapéuticas. Todo el personal de endoscopia debe tener medidas de protección estrictas. El paciente debe saber que en la sala de endoscopia puede contagiarse, con constancia en el consentimiento informado. Debe contactarse al paciente posendoscopia vía telefónica a los días 7 y 14 para indagar sobre todos los síntomas mencionados.(AU)

SARS-CoV-2 is the coronavirus which produces the dreaded COVID-19. Starting in Wuhan, the capital of China's Hubei province, it has spread it spread throughout the world in less than four months and has caused thousands of deaths. The WHO has declared it to be a pandemic. Humanity is shocked, and many governments have imposed total isolation. It has had varying success due to community negligence. In many cities, institutions and health personnel have not successfully managed this catastrophe. Isolation is the only effective strategy to stop the logarithmic growth of COVID 19. The scientific reason for isolation is that more than 60 % of infections arise from asymptomatic people. SARS-CoV-2 not only produces respiratory symptoms but can also cause nausea, abdominal pain, vomiting, diarrhea, anosmia and ageusia. Fifty percent of those infected may have digestive symptoms which may even precede respiratory symptoms. The fecal-oral route can transmit the virus even when there is no diarrhea. All forms of contagion are found in endoscopy units: aerosols from vomiting, retching, bel-ching, and flatus; fecal matter, close contact, and contamination of the environment. All diagnostic endoscopies should be discontinued. Only urgent and therapeutic endoscopy should be performed. All endoscopy personnel must have strict protection measures. Each patient should be informed, and sign an informed consent form, that the virus can be spread within the endoscopy room. After performance of endoscopy, the patient should be contacted by phone on days 7 and 14 to inquire about all symptoms mentioned.(AU)

Prevalencia y características histológicas de los pólipos diminutos del recto y del sigmoides en una población colombiana / Prevalence and histological characteristics of tiny rectal and sigmoid polyps in a Colombian population

Resumen Introducción: el cáncer de colon y recto (CCR) se origina a partir de pólipos adenomatosos y serrados. Por tanto, se recomienda que todos los pólipos colónicos sean resecados y enviados a patología. Sin embargo, en los pólipos diminutos (<5 mm) del recto y del sigmoides existe controversia sobre esta conducta, razón por la cual se ha planteado la estrategia de resecar y descartar o dejar in situ, a partir de la utilización de endoscopios avanzados (con una imagen de banda angosta [Narrow Band Imaging, NBI] u otras), y se logre concordancia con la histopatología, superior al 90 %. En nuestro medio, no hay estudios prospectivos con luz blanca sobre la prevalencia y las características histológicas de estos pólipos en el recto y el sigmoides. Por esta razón, se desarrolló este trabajo. Materiales y métodos: estudio de prevalencia analítica, prospectivo. Se incluyeron las colonoscopias de tamización realizadas en la Unidad de Gastroenterología de la Clínica Fundadores de Bogotá, entre enero y julio de 2018. Resultados: se incluyeron 719 pacientes. La prevalencia de pólipos diminutos en el recto y el sigmoides fue del 27 % (intervalo de confianza [IC], 95 %: 23,7-30,2 %). El 50 % eran pólipos adenomatosos, mientras que en 8 casos se presentó una displasia de alto grado (DAG). Entre los pólipos diminutos, 3 fueron tumores neuroendocrinos. No hubo cáncer en ninguna de las lesiones. Conclusiones: la mitad de los pólipos diminutos encontrados fueron adenomatosos y 8 (0,83 %) tuvieron DAG. Recomendamos resecar todos los pólipos diminutos hasta que los estudios locales realizados con NBI u otra tecnología demostrasen la capacidad para discriminar en más del 90 % los pólipos hiperplásicos (dejarlos in situ) o adenomatosos (resecarlos).

Abstract Introduction: Because colorectal cancer (CRC) originates from adenomatous and serrated polyps, it is recommended that all colonic polyps be resected and sent to pathology. However, there is controversy over this recommendation in the case of rectal and sigmoid polyps measuring less than 5 mm. Strategies using advanced NBI endoscopes to either "resect and discard" or leave "in situ" have been proposed. Concordance with histopathology of over 90% has been achieved. No prospective studies of the prevalence and histological characteristics of these rectal and sigmoid polyps had been done with white light in this country, so we undertook this study. Materials and methods: This is an analytical and prospective prevalence study. Screening colonoscopies performed in the gastroenterology unit of Clínica Fundadores in Bogotá between January and July 2018 were included. Results: Seven hundred nineteen patients were included. The prevalence of tiny polyps in the rectum and sigmoid colon was 27% (95% CI: 23.7 to 30.2%). Fifty percent were adenomatous, but eight cases had high grade dysplasia. Among the tiny polyps, three were neuroendocrine tumors. There was no cancer in any of the lesions. Conclusions: Half of the tiny polyps found were adenomatous, and eight (0.83%) had high grade dysplasia. We recommend resecting all tiny polyps until local studies conducted with NBI or other technology demonstrate the ability to discriminate between the more than 90% hyperplastic polyps (leaving them in situ) and adenomatous polyps (resect them).

Helicobacter pylori: Multiple resistance in patients from Bogotá, Colombia / Helicobacter pylori: resistencia múltiple en pacientes de Bogotá, Colombia

Introduction: The main cause for Helicobacter pylori infection treatment failure is antibiotic resistance, where clarithromycin and metronidazole play the main role. In Colombia, primary resistance as a consequence of the use of these two antibiotics and excessive levofloxacin use is above the accepted limit (13.6%, 83%, and 16%, respectively). Despite this fact, empirical therapies that include the combination of these antibiotics are used in patients with previous therapeutic failure. Objective: To determine antibiotic resistance in patients previously treated for H. pylori in Bogotá, Colombia. Materials and methods: We conducted a descriptive study that included ten isolates obtained from five patients with three or four previous failed treatments for H. pylori. Antibiotic resistance to amoxicillin, clarithromycin, levofloxacin, and metronidazole was investigated by agar dilution and confirmed by DNA sequencing (Magrogen, Korea). Results: Eight isolates were resistant to two or more antibiotics. All isolates were resistant to levofloxacin. Susceptibility patterns in isolates from the gastric antrum and the body of the stomach were different in three patients. Conclusion: As far as we know, this is the first evidence of multiple H. pylori resistance in Colombia in previously treated patients. Results demonstrated the consequences of using an ineffective antibiotic scheme and the need to assess antibiotic susceptibility in different anatomical sites of the stomach. The consequences of multiple resistance decrease possible antibiotic effectiveness to eradicate H. pylori in the future.

Introducción. La resistencia a los antibióticos es la principal causa del fracaso del tratamiento contra Helicobacter pylori; la claritromicina y el metronidazol son los antibióticos que generan mayor resistencia. En Colombia, la resistencia primaria a estos dos antibióticos y el uso excesivo de levofloxacina han alcanzado los límites aceptados (13,6, 83 y 16 %, respectivamente). A pesar de ello, se usa el tratamiento empírico combinando estos antibióticos en pacientes en los que ha fallado anteriormente. Objetivo. Determinar la resistencia a los antibióticos en pacientes previamente tratados para H. pylori en Bogotá, Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo en el que se evaluó mediante dilución en agar la resistencia a la amoxicilina, la claritromicina, la levofloxacina y el metronidazol en 10 aislamientos provenientes de 5 pacientes con tres o cuatro tratamientos fallidos para H. pylori. La resistencia a los antibióticos se confirmó mediante secuenciación de ADN (Magrogen, Korea). Resultados. Ocho de los aislamientos presentaron resistencia a dos o más antibióticos y todos fueron resistentes a la levofloxacina. Los patrones de sensibilidad de los aislamientos provenientes del antro pilórico y del cuerpo del estómago, fueron diferentes en tres de los pacientes. Conclusión. Hasta donde se sabe, esta es la primera evidencia de resistencia múltiple de H. pylori en Colombia en pacientes previamente tratados. Los resultados evidenciaron las consecuencias del uso de un esquema ineficaz de tratamiento antibiótico y la necesidad de evaluar la sensibilidad a los antibióticos en diferentes sitios anatómicos del estómago. La resistencia múltiple limita el número de antibióticos útiles para erradicar H. pylori.

Helicobacter pylori: resistencia múltiple en pacientes de Bogotá, Colombia / Helicobacter pylori: Multiple resistance in patients from Bogotá, Colombia

Resumen Introducción. La resistencia a los antibióticos es la principal causa del fracaso del tratamiento contra Helicobacter pylori; la claritromicina y el metronidazol son los antibióticos que generan mayor resistencia. En Colombia, la resistencia primaria a estos dos antibióticos y el uso excesivo de levofloxacina han alcanzado los límites aceptados (13,6, 83 y 16 %, respectivamente). A pesar de ello, se usa el tratamiento empírico combinando estos antibióticos en pacientes en los que ha fallado anteriormente. Objetivo. Determinar la resistencia a los antibióticos en pacientes previamente tratados para H. pylori en Bogotá, Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo en el que se evaluó mediante dilución en agar la resistencia a la amoxicilina, la claritromicina, la levofloxacina y el metronidazol en 10 aislamientos provenientes de 5 pacientes con tres o cuatro tratamientos fallidos para H. pylori. La resistencia a los antibióticos se confirmó mediante secuenciación de ADN (Magrogen, Korea). Resultados. Ocho de los aislamientos presentaron resistencia a dos o más antibióticos y todos fueron resistentes a la levofloxacina. Los patrones de sensibilidad de los aislamientos provenientes del antro pilórico y del cuerpo del estómago, fueron diferentes en tres de los pacientes. Conclusión. Hasta donde se sabe, esta es la primera evidencia de resistencia múltiple de H. pylori en Colombia en pacientes previamente tratados. Los resultados evidenciaron las consecuencias del uso de un esquema ineficaz de tratamiento antibiótico y la necesidad de evaluar la sensibilidad a los antibióticos en diferentes sitios anatómicos del estómago. La resistencia múltiple limita el número de antibióticos útiles para erradicar H. pylori.

Abstract Introduction: The main cause for Helicobacter pylori infection treatment failure is antibiotic resistance, where clarithromycin and metronidazole play the main role. In Colombia, primary resistance as a consequence of the use of these two antibiotics and excessive levofloxacin use is above the accepted limit (13.6%, 83%, and 16%, respectively). Despite this fact, empirical therapies that include the combination of these antibiotics are used in patients with previous therapeutic failure. Objective: To determine antibiotic resistance in patients previously treated for H. pylori in Bogotá, Colombia. Materials and methods: We conducted a descriptive study that included ten isolates obtained from five patients with three or four previous failed treatments for H. pylori. Antibiotic resistance to amoxicillin, clarithromycin, levofloxacin, and metronidazole was investigated by agar dilution and confirmed by DNA sequencing (Magrogen, Korea). Results: Eight isolates were resistant to two or more antibiotics. All isolates were resistant to levofloxacin. Susceptibility patterns in isolates from the gastric antrum and the body of the stomach were different in three patients. Conclusion: As far as we know, this is the first evidence of multiple H. pylori resistance in Colombia in previously treated patients. Results demonstrated the consequences of using an ineffective antibiotic scheme and the need to assess antibiotic susceptibility in different anatomical sites of the stomach. The consequences of multiple resistance decrease possible antibiotic effectiveness to eradicate H. pylori in the future.

Serología del virus de la hepatitis B: para múltiples escenarios, múltiples exámenes / Serology of hepatitis B virus: multiple scenarios and multiple exams

Resumen El virus de la hepatitis B (VHB) tiene un gran impacto mundial. No obstante la disponibilidad de la vacuna, 2000 millones de personas se han infectado agudamente y, de ellos, 240 millones persisten crónicamente infectados. La infección tiene diferentes formas de presentación tales como infección aguda, infección crónica, infección oculta y reactivación cuando hay inmunosupresión. Así mismo, hay marcadores muy sensibles como el anticore, cuya positividad puede tener diversos significados. El recientemente descrito antígeno relacionado con el antígeno core es un marcador emergente que podría reemplazar al ácido desoxirribonucleico (ADN) viral. En la presente revisión se discuten los exámenes de laboratorio necesarios para el diagnóstico de los diferentes escenarios de la infección.

Abstract Hepatitis B virus (HBV) has an enormous global impact. Despite the availability of a vaccine, two billion people have been acutely infected. Of these, 240 million remain chronically infected. The infection has different forms of presentation including acute infections, chronic infections, hidden infections, and reactivation when there is immunosuppression. Similarly, there are very sensitive markers such as anti-core, but a positive test can have different meanings. This recently described antigen which is related to the core antigen is an emerging marker that could replace viral DNA. In this review we discuss the laboratory tests necessary for diagnosing the various scenarios of the infection.

Helicobacter pylori, gastritis nodular y lesiones premalignas de estómago: un estudio de casos y controles / Helicobacter pylori, nodular gastritis and premalignant stomach lesions: a case-control study

Introducción: La gastritis nodular (GN) es un tipo de gastritis fuertemente relacionada con Helicobacter pylori y puede ser un factor de riesgo para cáncer gástrico. Es una patología altamente prevalente en niños infectados por H. pylori. En Colombia no hay estudios sobre esta entidad y por eso decidimos realizar la presente investigación. Materiales y métodos: Estudio de casos y controles. Caso; gastritis nodular endoscópica e histológica, controles, gastritis crónica sin folículos linfoides a la histología. Población: adultos mayores de 18 años, a quienes se les realizó una endoscopia digestiva alta y que firmaron el consentimiento informado. A todos los pacientes se les tomaron biopsias con el sistema OLGA. Resultados: Se incluyeron 344 pacientes, 172 en cada grupo. Los casos tuvieron 10 años menos que los controles (40,9 vs 50,9, p=0,045). En los casos se encontró H. pylori en el 91,9% vs 47,8% (p < 0,001). Los folículos linfoides fueron más frecuentes en el antro que en el cuerpo (60,5 vs 4,7% p < 0,00001). OLGA II en los casos 6,4% versus 1,2% (p=0,01), OLGA III fue similar. No hubo OLGA IV en ningún paciente En los casos se encontró un cáncer gástrico. Conclusiones: Los pacientes con gastritis nodular son más jóvenes que los controles. El 92% de los casos tenía H. pylori. Recomendaciones. Se recomienda que se investigue y se erradique esa infección en los pacientes con ese tipo de gastritis.

Introduction: Nodular gastritis (GN) is a type of gastritis strongly related to Helicobacter pylori and may be a risk factor for gastric cancer. It is a highly prevalent pathology in children infected with H. pylori. In Colombia there are no studies on this entity and for this reason we decided to carry out the present investigation. Materials and methods: Case studies and controls. Case; endoscopic and histological nodular gastritis, controls, chronic gastritis without lymphoid follicles to histology. Population: adults older than 18 years, who underwent a high digestive endoscopy and signed informed consent. All patients were biopsied with the OLGA system. Results: We included 344 patients, 172 in each group. The cases had 10 years less than the controls (40.9 vs 50.9, p = 0.045). In the cases H. pylori was found in 91.9% vs 47.8% (p <0.001). Lymphoid follicles were more frequent in the antrum than in the body (60.5 vs 4.7% p < 0.00001). OLGA II in cases 6.4% versus 1.2% (p = 0.01), OLGA III was similar. There was no OLGA IV in any patient. In the cases a gastric cancer was found. Conclusions: Patients with nodular gastritis are younger than controls. 92% of the cases had H. pylori. Recommendations: It is recommended that this infection be investigated and eradicated in patients with this type of gastritis.

Tuberculosis (TB) outbreak in a closed Aotus monkey breeding colony: Epidemiology, diagnosis and TB screening using antibody and interferon-gamma release testing.

Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) is a devastating and terminal disease in non-human primates (NHPs). Regular TB screenings using the intradermal tuberculin test (TST) have been the mainstay of TB surveillance and control in NHPs. Historically, Aotus monkeys have been considered less susceptible to TB than other NHPs. Here we present the diagnosis and epidemiology of a TB outbreak at The Gorgas Memorial Institute Aotus colony in Panama, and the results of two cross-sectional randomized TB screening studies, using antibody (Ab) and IFN-gamma release assay testing. RESULTS: Epidemiological and spatial analysis confirmed that the outbreak was the result of a continuing intermittent exposure, with human to monkey transmission as the most likely source. During the outbreak that lasted five months (January-June 2015), Mycobacterium kansassi and MTB were isolated from lung caseous granulomas in 1/7 and 3/7 TB suspicious animals respectively. Furthermore, MTB was detected by qRT-PCR in formalin fixed lung and liver granulomas in 2/7 and 1/6 monkeys respectively, suggesting an aerosol route of infection. Likewise, a random sample that included 63 / 313 adult (>2 year-old) monkeys, screened for latent TB with the Primagam® IFN-gamma release assay, between March-May, 2016, were all non-reactors; indicating that the outbreak was self-limiting and the colony was likely free or latent TB infection. Control measures included, quarantine, disinfection and TST screening of all personnel. In conclusion, this study demonstrates that Aotus are highly susceptible to TB, therefore, TB prevention measures should be strictly enforced in Aotus monkey colonies.

Cáncer metastásico con primario desconocido. Una revisión / A review of metastatic cancer with unknown primary cancer

Resumen El tumor metastásico no siempre tiene un origen evidente, hasta en un tercio de los casos nunca se encuentra el tumor primario. Este artículo es una guía de los avances más recientes para mejorar el enfoque diagnóstico y el manejo del paciente con este tumor fatal y frecuente. El objetivo de este artículo, además de ser una guía, es ayudar a evitar errores comunes y graves. Uno de los errores más importantes es no tener en cuenta el papel fundamental de la confirmación histológica, pues esta puede evitar investigaciones innecesarias. En el artículo también se detallan los componentes de la evaluación estándar, la clasificación según su pronóstico y las indicaciones de la evaluación secundaria, que incluye las indicaciones de la endoscopia alta y baja, los marcadores tumorales, la tomografía por emisión de positrones (TEP), el papel que ocupa el perfil genético, la epigenética y el ácido desoxirribonucleico (ADN) viral. Adicionalmente, se indica el momento en que se debe detener la investigación. Recientemente, el tratamiento se ha modificado, lo que parece cambiar la historia de estos pacientes y de sus contrapartes con primario conocido.

Abstract Metastatic tumors do not always have obvious origins: in one third of these cases, the primary tumor is never found. This article is a guide to the most recent advances in diagnostic approaches and patient management of these fatal and frequent tumors. An additional objective of this article is to help avoid common and serious errors. One of the most important errors is not taking the fundamental role of histological confirmation into account since it can avoid unnecessary investigations. The article also details the components of a standard evaluation, classification according to prognosis and indications for a secondary evaluation. These include indications for upper and lower endoscopy, tumor markers, positron emission tomography, and the roles of genetic profiling, epigenetics and viral DNA. It also indicates the moment at which an investigation should be stopped. Recently, treatment has changed, and these changes seems to have changed the history of these patients and their counterparts with known primary tumors.

Bone Marrow Is a Major Parasite Reservoir in Plasmodium vivax Infection.

Plasmodium vivax causes heavy burdens of disease across malarious regions worldwide. Mature P. vivax asexual and transmissive gametocyte stages occur in the blood circulation, and it is often assumed that accumulation/sequestration in tissues is not an important phase in their development. Here, we present a systematic study of P. vivax stage distributions in infected tissues of nonhuman primate (NHP) malaria models as well as in blood from human infections. In a comparative analysis of the transcriptomes of P. vivax and Plasmodium falciparum blood-stage parasites, we found a conserved cascade of stage-specific gene expression despite the greatly different gametocyte maturity times of these two species. Using this knowledge, we validated a set of conserved asexual- and gametocyte-stage markers both by quantitative real-time PCR and by antibody assays of peripheral blood samples from infected patients and NHP (Aotus sp.). Histological analyses of P. vivax parasites in organs of 13 infected NHP (Aotus and Saimiri species) demonstrated a major fraction of immature gametocytes in the parenchyma of the bone marrow, while asexual schizont forms were enriched to a somewhat lesser extent in this region of the bone marrow as well as in sinusoids of the liver. These findings suggest that the bone marrow is an important reservoir for gametocyte development and proliferation of malaria parasites.IMPORTANCEPlasmodium vivax malaria continues to cause major public health burdens worldwide. Yet, significant knowledge gaps in the basic biology and epidemiology of P. vivax malaria remain, largely due to limited available tools for research and diagnostics. Here, we present a systematic examination of tissue sequestration during P. vivax infection. Studies of nonhuman primates and malaria patients revealed enrichment of developing sexual stages (gametocytes) and mature replicative stages (schizonts) in the bone marrow and liver, relative to those present in peripheral blood. Identification of the bone marrow as a major P. vivax tissue reservoir has important implications for parasite diagnosis and treatment.

[Helicobacter pylori, nodular gastritis and premalignant stomach lesions: a case-control study]. / Helicobacter pylori, gastritis nodular y lesiones premalignas de estómago: un estudio de casos y controles.

INTRODUCTION: Nodular gastritis (GN) is a type of gastritis strongly related to Helicobacter pylori and may be a risk factor for gastric cancer. It is a highly prevalent pathology in children infected with H. pylori. In Colombia there are no studies on this entity and for this reason we decided to carry out the present investigation. MATERIALS AND METHODS: Case studies and controls. Case; endoscopic and histological nodular gastritis, controls, chronic gastritis without lymphoid follicles to histology. POPULATION: adults older than 18 years, who underwent a high digestive endoscopy and signed informed consent. All patients were biopsied with the OLGA system. RESULTS: We included 344 patients, 172 in each group. The cases had 10 years less than the controls (40.9 vs 50.9, p = 0.045). In the cases H. pylori was found in 91.9% vs 47.8% (p <0.001). Lymphoid follicles were more frequent in the antrum than in the body (60.5 vs 4.7% p < 0.00001). OLGA II in cases 6.4% versus 1.2% (p = 0.01), OLGA III was similar. There was no OLGA IV in any patient. In the cases a gastric cancer was found. CONCLUSIONS: Patients with nodular gastritis are younger than controls. 92% of the cases had H. pylori. RECOMMENDATIONS: It is recommended that this infection be investigated and eradicated in patients with this type of gastritis.

Avances en la búsqueda de la vacuna contra Helicobacter pylori / Advances in the search for the Helicobacter pylori vaccine

Resumen Helicobacter pylori es una bacteria que infecta la mucosa gástrica de alrededor de la mitad de la población mundial y está involucrada en la patogénesis de un gran número de enfermedades gástricas y extragástricas en el huésped. Varios antígenos, adyuvantes y rutas de inmunización han sido evaluados buscando una vacuna que ayude a prevenir o erradicar la infección, consiguiéndose diferentes grados de éxito, si bien la inmunidad esterilizante solo se ha conseguido en algunos modelos animales. Varios mecanismos se han propuesto para explicar los resultados obtenidos con las vacunas potenciales evaluadas y para explicar cómo esta bacteria elude la respuesta inmune inducida por ella misma o por intentos de inmunización. El panorama hasta el momento, si bien no parece sencillo, no deja de ser esperanzador por los favorables resultados que vendrían tras la obtención de una vacuna eficaz y por algunos estudios que motivan a la posibilidad de su consecución. MÉD.UIS. 2017;30(3):111-20.

Abstract Helicobacter pylori is a bacteria that infects the gastric mucosa of around half of the world's population and it's implicated in the pathogenesis of various gastric and extragastric diseases in the infected host. Several antigens, adyuvants and routes of immunization have been tested in order to find a vaccine that helps in the control of this bacteria, with varying degrees of success so far, however, sterilizing immunity has been achieved only in animals. Various mechanisms have been proposed to explain the outcomes obtained by testing the potential vaccines and to understand how this bacteria avoids the immunity triggered by itself or by the vaccines tested so far. The current picture does not seem easy but it's still encouraging since some studies have given hope to the possibility of achieving an effective vaccine. MÉD.UIS. 2017;30(3):111-20.

A Plasmodium vivax Plasmid DNA- and Adenovirus-Vectored Malaria Vaccine Encoding Blood-Stage Antigens AMA1 and MSP142 in a Prime/Boost Heterologous Immunization Regimen Partially Protects Aotus Monkeys against Blood-Stage Challenge.

Malaria is caused by parasites of the genus Plasmodium, which are transmitted to humans by the bites of Anopheles mosquitoes. After the elimination of Plasmodium falciparum, it is predicted that Plasmodium vivax will remain an important cause of morbidity and mortality outside Africa, stressing the importance of developing a vaccine against P. vivax malaria. In this study, we assessed the immunogenicity and protective efficacy of two P. vivax antigens, apical membrane antigen 1 (AMA1) and the 42-kDa C-terminal fragment of merozoite surface protein 1 (MSP142) in a plasmid recombinant DNA prime/adenoviral (Ad) vector boost regimen in Aotus monkeys. Groups of 4 to 5 monkeys were immunized with plasmid DNA alone, Ad alone, prime/boost regimens with each antigen, prime/boost regimens with both antigens, and empty vector controls and then subjected to blood-stage challenge. The heterologous immunization regimen with the antigen pair was more protective than either antigen alone or both antigens delivered with a single vaccine platform, on the basis of their ability to induce the longest prepatent period and the longest time to the peak level of parasitemia, the lowest peak and mean levels of parasitemia, the smallest area under the parasitemia curve, and the highest self-cure rate. Overall, prechallenge MSP142 antibody titers strongly correlated with a decreased parasite burden. Nevertheless, a significant proportion of immunized animals developed anemia. In conclusion, the P. vivax plasmid DNA/Ad serotype 5 vaccine encoding blood-stage parasite antigens AMA1 and MSP142 in a heterologous prime/boost immunization regimen provided significant protection against blood-stage challenge in Aotus monkeys, indicating the suitability of these antigens and this regimen for further development.

Pólipos postinflamatorios y enfermedad inflamatoria intestinal: Reporte de caso y revisión de la literatura / Literature Review and Case Report of Post-Inflammatory Polyps and Inflammatory Bowel Disease

En pacientes con enfermedad inflamatoria intestinal (EII) de larga duración, pueden aparecer pólipos postinflamatorios o seudopólipos, los cuales se presentan en los sitios en donde previamente hubo inflamación severa. Se describe el caso de un paciente con colitis ulcerativa de 5 años de evolución, en quien se encontró una poliposis postinflamatoria generalizada durante la colonoscopia de control. Se hace una revisión del significado de esta alteración, su clasificación y de su tratamiento.

Post-inflammatory polyps or “pseudopolyps” may occur in patients who have long-term inflammatory bowel disease (IBD). They occur at sites where severe inflammation had previously occurred. We describe the case of a patient who had suffered from ulcerative colitis for five years when generalized post-inflammatory polyposis was discovered during a follow-upl colonoscopy. We review the meaning of this condition as well as its classification and treatment

Impacto del sistema OLGA en la detección de gastritis crónica atrófica en Colombia: un estudio de casos y controles / A Case and Control Study of the OLGA System’s Impact on Detection of Chronic Atrophic Gastritis in Colombia

Introducción: la gastritis crónica atrófica (GCA) es una entidad clinicopatológica relacionada con cáncer gástrico (CG) de tipo intestinal. Su principal causa es Helicobacter pylori. Actualmente, además del diagnóstico, se recomienda evaluar la extensión de la atrofia o de la metaplasia intestinal, para estadificar el riesgo de CG. El método más preciso para la atrofia es el OLGA, que exige 5 biopsias: 2 del cuerpo, 2 del antro y 1 de la incisura angularis, marcadas y enviadas en frascos separados. En Colombia, no se ha evaluado el rendimiento de OLGA en el estudio de la atrofia gástrica. Materiales y métodos: estudio de casos y controles. Los casos son pacientes en quienes se hizo el muestreo de biopsias para el OLGA. Los controles pacientes con menos de 5 biopsias gástricas, sin el muestreo del OLGA. Resultados: 1599 casos y 4191 controles. Edad promedio de los casos: 49±12 años versus controles 54±10 años (p: NS). H. pylori: 60% versus 57%. GCA en casos: 42% versus 26%. El 12,3% tenía OLGA III/IV y el 88%, OLGA 0, I o II, los cuales no ameritarían vigilancia endoscópica. Conclusión: el sistema OLGA permite detectar un 61,8% más de atrofia que la detectada con un muestreo insuficiente de biopsias gástricas. La mayoría de los casos (88%) tuvo bajo riesgo de CG (estado 0-II) y no se justificaría vigilancia endoscópica.

Introduction: Chronic atrophic gastritis (GCA) is a clinicopathological entity related to intestinal type gastric cancer (GC) whose main cause is helicobacter pylori. Currently, in addition to the diagnosis, it is recommended that the extent of atrophy or intestinal metaplasia be evaluated in order to stage the GC risk. The most accurate method for atrophy is OLGA which requires five biopsies: two from the corpus, two from the antrum and one from the angular incisure. Each biopsy is marked placed in a separate tube and marked. In Colombia, the use of OLGA to study gastric atrophy had not been evaluated previously. Materials and methods: This is a case and control study whose cases are patients who had biopsies taken to be studied with OLGA. Control patients had less than five gastric biopsies, without OLGA sampling. Results: This study includes 1,599 cases and 4,191 controls. The average age of cases was 49 +/- 12 years, and the average age of controls was 54 +/- 10 years (p: NS). H. pylori infections were found in 60% of the cases and in 57% of the controls while 42% of the cases were found to have gastric cancer and 26% of the cases were found to have GC. 12.3% had OLGA III or IV and 88% had OLGA 0, I or II and did not merit endoscopic monitoring. Conclusion: The OLGA system detects 61.8% more atrophy than is detected with less sampling of gastric biopsies. Most of the cases (88%) had low risk of GC (stages 0-II) and did not require endoscopic monitoring

Surveillance of Levofloxacin Resistance in Helicobacter pylori Isolates in Bogotá-Colombia (2009-2014).

Increased resistance of Helicobacter pylori to clarithromycin and metronidazole has resulted in recommendation to substitute fluoroquinolones for eradication therapy. The aims of the study were to determine the prevalence and changes in primary levofloxacin resistance related to H. pylori gyrA sequences. The study utilized H. pylori strains isolated from patients undergoing gastroscopy in Bogotá, Colombia from 2009 to 2014. Levofloxacin susceptibility was assessed by agar dilution. Mutations in gyrA sequences affecting the quinolone resistance-determining region (QRDR) were evaluated by direct sequencing. Overall, the mean prevalence of primary levofloxacin resistance was 18.2% (80 of 439 samples). Resistance increased from 11.8% (12/102) in 2009 to 27.3% (21/77) in 2014 (p = 0.001). gyrA mutations in levofloxacin resistant strains were present in QRDR positions 87 and 91. The most common mutation was N87I (43.8%, 35/80) followed by D91N (28.8%, 23/80) and N87K (11.3%, 9/80). Levofloxacin resistance increased markedly in Colombia during the six-year study period. Primary levofloxacin resistance was most often mediated by point mutations in gyrA, with N87I being the most common QRDR mutation related to levofloxacin resistance.