Effectiveness of Yoga and Acupuncture in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Introduction: Rheumatoid arthritis is a form of inflammatory joint disease; sometimes, patients need prolonged cycles of nonsteroidal anti-inflammatory drugs and/or glucocorticoids for symptomatology management in addition to traditional disease-modifying drugs and biologics. On some occasions, doses are increased without improvement of symptoms associated with side effects; this is why, on some occasions, patients seek other types of nonpharmacological therapies, such as alternative therapies. Objective: To establish the effectiveness of alternative therapies such as yoga and acupuncture in rheumatoid arthritis by measuring disease activity with the disease activity score 28. Methods: A systematic review of the literature and meta-analysis was performed; databases such as PubMed and Embase were used to find the best available evidence of randomized clinical trials from 2017 to 2021, two researchers independently screened and extracted the necessary data, and the methodological quality and the risk of bias were assessed through the Cochrane risk-of-bias tool. The articles that applied for meta-analysis were analyzed in Jamovi version 2.2 and EPIDATA version 3.1 software. Results: Eight studies were included for qualitative analysis of which seven were included in the meta-analysis, with 550 rheumatoid arthritis patients, predominantly female. The meta-analysis evidenced a significant effect of yoga and acupuncture interventions in decreasing DAS 28 in patients with rheumatoid arthritis (four RCTs; SMD -2.51 95% CI [-2.89, -2.14], p ≤ 0.001, I2 25.9%); in the yoga subgroup analysis, there was also evidence of improvement in the evaluated outcome (three RCTs; SMD -0.51 95% CI [-0.71, -0.30], p ≤ 0.001, I2 0%). Conclusion: It was demonstrated that the practice of yoga and acupuncture in patients with rheumatoid arthritis helped to decrease disease activity through the improvement of pain and joint inflammation; we recommend the implementation of this type of alternative intervention associated with conventional therapies for the management of patients diagnosed with rheumatoid arthritis.

Confirmed cases of COVID-19 after vaccination against COVID in health personnel in Bogotá, Colombia.

OBJECTIVE: The present study aims to estimate the frequency of COVID 19 infections in vaccinated health personnel at a Los CObos Medical Center in Bogotá, Colombia. The percentage of people positive to the PCR test and their clinical characteristics were analyzed. METHODS: We performed a cross-sectional study. The primary study variable was the COVID vaccination registry. We analyzed sex, age, signs, and symptoms. Multivariable logistic regression was applied to assess changes over time and to identify variables associated with vaccination in target groups. RESULTS: A cohort of 999 people working at Los Cobos Medical Center and followed from March to August 2021. The average age of this cohort was 37.0 years (devest = 10.5 years), 67.7 % were women. Two hundred eleven physicians, 287 nurses, 305 assistants, and 196 clerks follows. In addition, 8.4 % to be PCR positive after vaccination. The average age was 36.0 (devest = 23.4 years), 59 women and 25 men. Of these, 15 were administrative, 14 were doctors, 29 nurses, and 26 nursing assistants. The vaccination status found that 21.4 % do not vaccinates, 7.1 % were partially vaccinated, and 71.4 % with a complete schedule. When questioned about symptoms in these patients, 4.0 % were symptomatic, and 5.9 % were asymptomatic. CONCLUSIONS: A recent epidemiological study involving 12,364 health workers with a mean age of 38 years quantifies the protection in six months from the vaccine. The presence of antibodies was associated with 83 % protection against active SARS-CoV-2 infection (PCR positivity during the study period), which confirms the existence of protective Immunity at levels comparable to those obtained by the approved vaccines; our study found effectiveness of 92.6 %. Higher than that found in this study, possibly explained by the characteristics of the individuals included.

Micronuclei frequency and exposure to chemical mixtures in three Colombian mining populations.

The Colombian mining industry has witnessed significant growth. Depending on the scale and mineral extracted, complex chemical mixtures are generated, impacting the health of occupationally exposed populations and communities near mining projects. Increasing evidence suggests that chromosomal instability (CIN) is an important link between the development of certain diseases and exposure to complex mixtures. To better understand the effects of exposure to complex mixtures we performed a biomonitoring study on 407 healthy individuals from four areas: three located in municipalities exploiting different-scale mining systems and a reference area with no mining activity. Large, medium, and small-scale mining systems were analyzed in Montelibano (Córdoba), artisanal and small-scale mining (ASGM) in Nechí (Antioquia), and a closed mining system in Aranzazu (Caldas). The reference area with no mining activity was established in Montería (Córdoba). ICP-MS measured multi-elemental exposure in hair, and CIN was evaluated using the cytokinesis-block micronucleus technique (MNBN). Exposure to mixtures of chemical elements was comparable in workers and residents of the mining areas but significantly higher compared to reference individuals. In Montelibano, increased MNBN frequencies were associated with combined exposure to Se, Hg, Mn, Pb, and Mg. This distinct pattern significantly differed from other areas. Specifically, in Nechí, Cr, Ni, Hg, Se, and Mg emerged as the primary contributors to elevated frequencies of MNBN. In contrast, a combination of Hg and Ni played a role in increasing MNBN in Aranzazu. Interestingly, Se consistently correlated with increased MNBN frequencies across all active mining areas. Chemical elements in Montelibano exhibit a broader range compared to other mining zones, reflecting the characteristics of the high-impact and large-scale mining in the area. This research provides valuable insights into the effects of exposure to chemical mixtures, underscoring the importance of employing this approach in the risk assessment of communities, especially those from residential areas.

Economic burden of liver disease in Colombia

Introduction: Liver diseases have a significant impact on global morbidity and mortality rates, primarily attributed to cirrhosis and hepatocellular carcinoma. However, the true extent of their impact on patients, healthcare systems, and countries is often underestimated. Materials and methods: This descriptive, cross-sectional study aimed to determine the economic burden associated with premature deaths caused by cirrhosis and primary liver cancer. The economic assessment was conducted by analyzing potentially productive years of life lost (PPYLL) due to liver diseases in Colombia between 2009 and 2016. Results and conclusions: The total burden of liver disease accounted for 687,861 disability-adjusted life years (DALYs). Men experienced a higher number of years of life lost from mortality (YLL), while women had a greater number of years lived with a disability (YLD). The economic burden of deaths caused by cirrhosis and primary liver cancer exceeded USD 8.6 million, highlighting the urgency to enhance intervention strategies ranging from promotion and prevention to timely diagnosis and treatment.

Introducción: la enfermedad hepática representa una de las principales causas de morbimortalidad a nivel mundial, principalmente por cirrosis y hepatocarcinoma; sin embargo, se subestima su impacto para el paciente, sistema de salud y el país. Materiales y métodos: estudio descriptivo de corte transversal que determinó la carga económica asociada a las muertes prematuras por cirrosis y tumores primarios del hígado, mediante la valoración económica de los años productivos de vida potencialmente perdidos (APVPP) en Colombia y de enfermedad hepática en Colombia entre 2009 y 2016. Resultados y conclusiones: la carga total de enfermedad hepática representó 687,861 años de vida saludable perdidos ajustados por discapacidad (AVAD), los hombres con mayores años de vida perdidos por muerte prematura (APMP) y las mujeres con mayores años vividos con discapacidad (AVD). Las muertes por cirrosis y tumores primarios del hígado representan una carga económica que supera los 8,6 millones de dólares, lo cual refleja la necesidad de fortalecer las estrategias de intervención desde la promoción y prevención hasta el diagnóstico y tratamiento oportuno.

Caracterización de los registros de atención en una institución prestadora de servicios de salud mental en Bogotá, 2001-2017 / Characteristics of care delivery records in a mental health service providerinstitution in Bogota, 2001-2017 / Caracterização dos registros de atendimento em uma instituição prestadora deserviços de saúde mental em Bogotá, 2001-2017

Introducción:el abordaje integral de la salud mental es uno de los retos del país en salud pública, dado que la población colombiana ha presentado un deterioro en ese aspectoen los últimos veinte años de acuerdo con el documentoCONPES 3992del2020.Objetivo:Caracterizar los registros individuales de prestación de servicios en atención desalud mental en unainstitución prestadora de servicios enBogotá,Colombia, entre el 2001 y el2017. Métodos:estudio descriptivo trasversal. Se usaron los registros individuales de prestación de servicios como fuente de informacióny se tuvo en cuentaclasificación internacional de enfermedades (CIE-10) Entotal de registros RIPS en salud mental, por equipo interdisciplinario: médico general, médico psiquiatra, enfermería, psicología, trabajo social y terapia ocupacional. Resultados:se analizaron 2.360.295 registros individuales de prestación de servicios en salud mental de la institución seleccionada. Según los registros,el promedio de edad de las personas atendidas era de 47 añosypredominó el sexo femenino con el 52,5%. Los servicios utilizados fueronhospitalización (49,82%), consulta externa (43,42%), urgencias (4,54%)y hospital de día (0,39%). Elmayor número de registros (64,47%) se presentó en el grupo entre los 18 y 59 años de edad; seguido del grupo de 60 años o más (28,50%)y de menores de 18 años (7,03%). Los grupos de diagnóstico principales fueron trastorno psicótico con el 33,38%,depresióncon el 15,39%y ansiedad con el 13,71%. Conclusiones:Son las mujeres quienes más utilizan el servicio (52.5%). Es la hospitalización el servicio más utilizado (49.82%). Son los adultos entre 18 y 59 años quienes más utilizan los servicios (64.47%). Se observa un progresivo incremento en el número de atenciones. Los trastornos mentales severos esquizofrenia y bipolar son los másatendidos (33.38%) seguidos de trastornos de depresión y ansiedad (29%). Las enfermedades medicas generales se presentaron en el (10.95%)de las atenciones.

Introduction: The comprehensive approach to mental health is one of the country's public health challenges, as the Colombian population has deteriorated in this area over the past twenty years, according to the CONPES Document 3992, 2020. Objective:To characterize the individual mental health service delivery records at a service provider institution in Bogota, Colombia, between 2001 and 2017. Methods:Descriptive cross-sectional study. Individual service delivery records were used as a source of information, and the International Classification of Diseases (ICD-10) was considered. Total mental health RIPS by interdisciplinary team: general practitioner, psychiatrist, nurse, psychologist, social worker, and occupational therapist. Results:A total of 2,360,295 individualmental health service delivery records from the selected institution were analyzed. According to the records, the average age of the patients was 47 years, and females predominated with 52.5% of the patients. Inpatient (49.82%), outpatient (43.42%), emergency room (4.54%), and day hospital (0.39%) services were used. The highest number of records (64.47 %) were found among the 18-59 years age group, followed by the 60+ year age group (28.50 %) and those under 18 years of age (7.03 %). The main diagnostic groups were psychotic disorder (33.38%), depression (15.39%), and anxiety (13.71%). Conclusions:Women are the main users of the service (52.5%). Hospitalization is the service most frequently used (49.82%). Adults between the ages of 18 and 59 use the services the most (64.47%). There has been a progressive increase in the number of attendances. Severe schizophrenia and bipolar mental disorders are the most treated (33.38%), followed by depression and anxiety (29%). General medical conditions were present in 10.95% of attendances

Introdução:a abordagem integral da saúde mental é um dos desafios do país em saúde pública, visto que a população colombiana tem apresentadouma deterioração neste aspecto nos últimos vinte anos de acordo com o documento Conpes 3992de 2020. Objetivo:Caracterizar os registros individuais de prestação de serviços em saúde mental em uma instituição prestadora de serviços em Bogotá, Colômbia, entre 2001 e 2017. Métodos:estudo descritivo transversal. Usaram-se os registros individuais de prestação de serviços como fonte de informação e considerou-sea classificação internacional de doenças (CID-10). No total de registros RIPS em saúde mental, por equipe interdisciplinar: clínico geral, psiquiatra, enfermagem, psicologia, serviço social e terapia ocupacional. Resultados:Foram analisados 2.360.295 prontuários individuais de prestação de serviço de saúde mental da instituição selecionada. De acordo com os registros, a média de idade das pessoas atendidas foi de 47 anos e o sexo feminino predominou com 52,5%. Os serviços utilizados foram internação (49,82%), ambulatorial (43,42%), emergência (4,54%) e hospital-dia (0,39%). O maior número de registros (64,47%) foi apresentado no grupo entre 18 e 59 anos; seguido pelo grupo de 60 anos ou mais (28,50%) e os menores de 18 anos(7,03%). Os principais grupos diagnósticos foram transtorno psicótico com 33,38%, depressão com 15,39% e ansiedade com 13,71%. Conclusões:As mulheres são as que mais utilizam o serviço (52,5%). A internação é o serviço mais utilizado (49,82%). Os adultosentre 18 e 59 anos são os que mais utilizam os serviços (64,47%). Observa-se um aumento progressivo no número de atenções. Os transtornos mentais graves esquizofrenia e bipolaridadesão os mais atendidos (33,38%) seguidos de depressão e transtornos de ansiedade (29%). Doenças médicas gerais estiveram presentes em (10,95%) dos atendimentos

The Burden of Gastric Cancer Disease from 2010 to 2019 in Tunja, Boyacá, Colombia

Introduction: Gastric cancer (GC) is the first cause of death by neoplasm in Colombia, with 6,451 deaths in 2020. This pathology and its chronic manifestations pose a public health challenge. The objective is to estimate the disease burden of GC in Tunja, Boyacá, from 2010 to 2019. Materials and methods: An exploratory ecological study was conducted using disability-adjusted life years (DALYs) as the unit of measurement. The National Administrative Department of Statistics (DANE) mortality databases and prevalence information from the Integrated Social Protection Information System (SISPRO) records were used. Deaths and GC cases were pooled and then adjusted to control for bias. Results: In 2010-2019, 34.2 DALYs were lost for every 1,000 people secondary to GC in Tunja, 30.5 were due to years lost due to premature death, and 3.72 were due to years lived with disability. DALYs due to premature death were found to exceed DALYs due to disability. Conclusion: The morbidity burden of GC from 2010 to 2019 for Tunja was similar to that of other cancers because of years of life lost due to premature death, so public health efforts should be made to increase early detection.

Introducción: el cáncer gástrico (CG) es la primera causa de muerte por neoplasia en Colombia, con 6451 muertes durante el 2020. Esta patología y sus manifestaciones crónicas plantean un desafío en la salud pública. El objetivo fue estimar la carga de enfermedad por CG en Tunja, Boyacá, durante los años 2010 a 2019. Metodología: se realizó un estudio ecológico exploratorio en el que se utilizó como unidad de medida los años de vida ajustados por discapacidad (AVAD). Se emplearon las bases de datos de mortalidad del Departamento Administrativo Nacional de Estadística (DANE) e información de la prevalencia desde los registros del Sistema Integrado de Información de la Protección Social (SISPRO). Las muertes y los casos de CG se agruparon y luego se ajustaron para controlar sesgos. Resultados: en el período 2010-2019 se perdieron 34,2 AVAD por cada 1000 personas secundarios a CG en Tunja, de los cuales 30,5 fueron debido a años perdidos por muerte prematura y 3,72 por años vividos con discapacidad. Se encontró que los AVAD por muerte prematura superan a los AVAD por discapacidad. Conclusión: la carga de morbilidad por CG en el período 2010 a 2019 para la ciudad de Tunja fue similar a la carga de otros cánceres y fue debido a años de vida perdidos por muerte prematura, motivo por el cual se deben realizar esfuerzos de salud pública para aumentar la detección temprana.

Epidemiological characteristics of hypertensive disorders during pregnancy in a high-risk population / Características epidemiológicas de los trastornos hipertensivos durante el embarazo en una población de alto riesgo

Abstract Objectives: the aim is to determine the prevalence of hypertensive disorders and to describe the sociodemographic aspects and risk factors for preeclampsia, gestational hypertension and intrauterine growth restriction. Methods: a descriptive cross-sectional study. Maternal characteristics, history from the first prenatal visit and outcomes were obtained. The prevalence and percentages were calculated and described. Results: the prevalence of hypertensive disorders was 12.7%, preeclampsia was 8.0%, followed by gestational hypertension at 4.7%. Of the preeclampsia, 54.8% were severe and 11.9% were of early onset. Moreover, 56.5% of the severe preeclampsia had preterm deliveries. IUGR had a prevalence of 5.3%. Based on maternal history, the most relevant risk factors were a family and personal history of preeclampsia and IUGR. Conclusions: we found a considerable prevalence of preeclampsia with a high percentage of preterm deliveries, associated with varying severity. This data helps health professionals to be aware of the risk factors that can be followed up for preventing complications. The determination of the risk of developing a hypertensive disorder during pregnancy is fundamental to encouraging proper counseling and care for these women through gestation.

Resumen Objetivos: determinar la prevalencia de trastornos hipertensivos y describir los aspectos sociodemográficos y los factores de riesgo de preeclampsia, hipertensión gestacional y restricción del crecimiento intrauterino (RCIU). Métodos: estudio descriptivo de corte transversal. Se obtuvieron características maternas, antecedentes del primer control prenatal y los resultados obstétricos. Se calcularon y describieron las prevalencias y porcentajes. Resultados: la prevalencia de trastornos hipertensivos fue del 12.7%, la de la preeclampsia fue del 8.0%, seguida de la hipertensión gestacional con el 4.7%. Del total de gestantes con preeclampsia, el 54.8% fueron graves y el 11.9% fue de inicio temprano. Además, el 56.5% de las gestantes con preeclampsia severa tuvieron partos prematuros. La RCIU tuvo una prevalencia del 5.3%. Según los antecedentes maternos, los factores de riesgo más relevantes fueron los antecedentes familiares y personales de preeclampsia y RCIU. Conclusiones: se encontró una prevalencia considerable de preeclampsia con un alto porcentaje de partos prematuros, asociada a una severidad variada. Estos datos ayudan a los profesionales de la salud a conocer los factores de riesgo que se pueden monitorear para prevenir complicaciones. La determinación del riesgo de desarrollar un trastorno hipertensivo durante el embarazo es fundamental para fomentar el asesoramiento y la atención adecuados para estas mujeres durante la gestación.

Eficacia de la tafenoquina en la profilaxis y tratamiento de la malaria por Plasmodium vivax, revisión sistemática y metaanálisis / Efficacy of tafenoquine in the prophylaxis and treatment of malaria by Plasmodium vivax, systematic review and meta-analysis

Introducción. La tafenoquina fue aprobada en el 2018 por la Food and Drug Administration de Estados Unidos y, en el 2019, por la Therapeutic Goods Administration en Australia. Su administración en dosis única y su mecanismo de acción en las fases aguda y latente han sido objeto de estudio para cambiar el esquema de tratamiento de la malaria por Plasmodium vivax. Objetivo. Evaluar la evidencia científica disponible sobre la eficacia de la tafenoquina en la profilaxis y el tratamiento de la malaria por P. vivax, entre el 2009 y el 2019. Materiales y métodos. Se establecieron los descriptores MeSH y DeCS. Se utilizó la sintaxis ((Malaria Vivax) AND (tafenoquine) AND (prophylaxis)) OR [(Malaria Vivax) AND (tafenoquine) AND (relapse)] en las siguientes bases de datos: Pubmed, The Cochrane Central Register of Controlled Clinical Trials (CENTRAL), ISIS Web of Science, Lilacs y Scopus. Los resultados obtenidos se sometieron a análisis crítico (matriz CASPE). El análisis cuantitativo se realizó utilizando la diferencia de riesgos en análisis de supervivencia (Kaplan-Meier) en los tres artículos finales. Resultados. Se sometieron tres estudios a metaanálisis (Llanos-Cuentas, 2014; Llanos- Cuentas, 2019, y Lacerda, 2019) para evaluar la eficacia del tratamiento con tafenoquina en comparación con primaquina. Se obtuvo una diferencia de riesgo global de 0,04 (IC95% 0-0,08; p=0,07). La tafenoquina no mostró inferioridad en la eficacia del tratamiento frente al esquema de primaquina. Conclusión. La tafenoquina es una alternativa que mejora el cumplimiento del tratamiento, lo que podría acercar a Colombia a las metas de la Estrategia Técnica Mundial contra la Malaria, 2016-2030.

Introduction: Tafenoquine was approved in 2018 by the Food and Drug Administration in the United States and in 2019 by the Therapeutic Goods Administration in Australia. Its administration in a single dose and its mechanism of action in the acute and latent phases of the disease have been studied to change the treatment regimen for Plasmodium vivax malaria. Objective: To evaluate the available scientific evidence of the efficacy of tafenoquine in prophylaxis and treatment between 2009 and 2019. Materials and methods: We established the MeSH and DeCS descriptors and we used the syntax ((Malaria Vivax) AND (tafenoquine) AND (prophylaxis)) OR [(Malaria Vivax) AND (tafenoquine) AND (relapse)] in the following databases: Pubmed, The Cochrane Central Register of Controlled Clinical Trials (CENTRAL), ISIS Web of Science, Lilacs, and Scopus. The results obtained were subjected to critical analysis (CASPE matrix). The quantitative analysis was performed with risk differences in survival analysis (Kaplan Meier) in the final three articles. Results: Three studies underwent meta-analysis (Llanos-Cuentas, 2014; Llanos-Cuentas, 2019, and Lacerda, 2019) to evaluate the efficacy of the treatment with tafenoquine compared to primaquine. A global risk difference of 0.04 was obtained (95% CI: 0.00-0.08; p=0.07). Tafenoquine did not show inferiority in the efficacy of treatment compared to the primaquine scheme. Conclusion: Tafenoquine is a therapeutic alternative to primaquine that improves adherence, which could bring Colombia closer to the goals of the World Technical Strategy against Malaria 2016-2030.

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries? / O tratamento com aspirina pode modificar a avaliação das artérias uterinas?

Abstract Objective To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. Methods This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) werecalculated. Results A total of 72 participants with a mean UtA-PI>95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p=0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant. Conclusion The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

Resumo Objetivo Analisar se a ingestão de acetilsalicílico (ASA) modifica o índice médio de pulsatilidade das artérias uterinas (UtA-PI) no 2° ou 3° trimestre em uma coorte de gestantes com média anormal de UtA-PI entre 11 e 14 semanas. Métodos Este é um estudo de coorte retrospectivo. Gravidezes únicas com média anormal de UtA-PI entre 11 e 14 semanas foram estudadas. As participantes foram divididas em 3 grupos: 1) Se a participante não tomou ASA durante a gravidez, 2) Se a participante tomou AAS antes das 14 semanas e 3) Se a participante tomou ASA após 14 semanas. A média do UtA-PI foi avaliada nos 2° e 3° trimestres e considerou-se que melhorava quando diminuía<95° percentil. Foram calculados a razão de prevalência (RP) e o número necessário para tratar (NNT). Resultados Foram avaliadas 72 participantes com média de UtA-PI>95° percentil no 1° trimestre de gravidez. Das 18 participantes que tomaram ASA, 8 participantes começaram antes de 14 semanas e 10 depois. Um total de 33,3% desses participantes melhoraram a média de UtA-PI nos 2° e 3° trimestres, embora não tenha sido estatisticamente significante (p=0,154). A razão de prevalência foi de 0,95 (intervalo de confiança [IC95%]: 0,31-1,89), mas entre os 1° e o 2° trimestres, a RP foi de 0,92 (IC95%: 0,21-0,99) e foi estatisticamente significativa. Conclusão O presente trabalho demonstra uma modificação da média de UtA-PI em participantes que faziam uso de ASA em comparação com aqueles que não faziam. É importante verificar se o ASA pode modificar os limites normais das artérias uterinas porque isso pode ter um impacto na vigilância.

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

OBJECTIVE: To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. METHODS: This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated. RESULTS: A total of 72 participants with a mean UtA-PI > 95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant. CONCLUSION: The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

OBJETIVO: Analisar se a ingestão de acetilsalicílico (ASA) modifica o índice médio de pulsatilidade das artérias uterinas (UtA-PI) no 2° ou 3° trimestre em uma coorte de gestantes com média anormal de UtA-PI entre 11 e 14 semanas. MéTODOS: Este é um estudo de coorte retrospectivo. Gravidezes únicas com média anormal de UtA-PI entre 11 e 14 semanas foram estudadas. As participantes foram divididas em 3 grupos: 1) Se a participante não tomou ASA durante a gravidez, 2) Se a participante tomou AAS antes das 14 semanas e 3) Se a participante tomou ASA após 14 semanas. A média do UtA-PI foi avaliada nos 2° e 3° trimestres e considerou-se que melhorava quando diminuía < 95° percentil. Foram calculados a razão de prevalência (RP) e o número necessário para tratar (NNT). RESULTADOS: Foram avaliadas 72 participantes com média de UtA-PI > 95° percentil no 1° trimestre de gravidez. Das 18 participantes que tomaram ASA, 8 participantes começaram antes de 14 semanas e 10 depois. Um total de 33,3% desses participantes melhoraram a média de UtA-PI nos 2° e 3° trimestres, embora não tenha sido estatisticamente significante (p = 0,154). A razão de prevalência foi de 0,95 (intervalo de confiança [IC95%]: 0,31­1,89), mas entre os 1° e o 2° trimestres, a RP foi de 0,92 (IC95%: 0,21­0,99) e foi estatisticamente significativa. CONCLUSãO: O presente trabalho demonstra uma modificação da média de UtA-PI em participantes que faziam uso de ASA em comparação com aqueles que não faziam. É importante verificar se o ASA pode modificar os limites normais das artérias uterinas porque isso pode ter um impacto na vigilância.

Multilevel analysis of social, climatic and entomological factors that influenced dengue occurrence in three municipalities in Colombia.

According to the World Health Organization, dengue is a neglected tropical disease. Latin America, specifically Colombia is in alert regarding this arbovirosis as there was a spike in the number of reported dengue cases at the beginning of 2019. Although there has been a worldwide decrease in the number of reported dengue cases, Colombia has shown a growing trend over the past few years. This study performed a Poisson multilevel analysis with mixed effects on STATA® version 16 and R to assess sociodemographic, climatic, and entomological factors that may influence the occurrence of dengue in three municipalities for the period 2010-2015. Information on dengue cases and their sociodemographic variables was collected from the National Public Health Surveillance System (SIVIGILA) records. For climatic variables (temperature, relative humidity, and precipitation), we used the information registered by the weather stations located in the study area, which are managed by the Instituto de Hidrologia, Meteorologia y Estudios Ambientales (IDEAM) or the Corporación Autónoma Regional (CAR). The entomological variables (house index, container index, and Breteau index) were provided by the Health office of the Cundinamarca department. SIVIGILA reported 1921 dengue cases and 56 severe dengue cases in the three municipalities; of them, three died. One out of four cases occurred in rural areas. The age category most affected was adulthood, and there were no statistical differences in the number of cases between sexes. The Poisson multilevel analysis with the best fit model explained the presentation of cases were temperature, relative humidity, precipitation, childhood, live in urban area and the contributory healthcare system. The temperature had the biggest influence on the presentation of dengue cases in this region between 2010 and 2015.

Trends in all-cause pneumonia and otitis media in children aged <2 years following pneumococcal conjugate vaccine introduction in Colombia.

In Colombia, pneumococcal conjugate vaccines (PCVs) were implemented into the infant universal mass vaccination program in a stepwise manner; PCV-7 between 2009 and 2011 in different geographic regions/cities, with nationwide introduction of a 10-valent vaccine (PHiD-CV) in 2012. We aimed to describe trends in all-cause pneumonia mortality and overall mortality, and in the incidence of all-cause pneumonia and otitis media (OM) in Colombian children <2 y (y = years) of age, before and after PCV introduction. We obtained mortality and incidence data, nationally and for five major cities (Bogota, Medellin, Barranquilla, Cali and Cartagena) from 2005-2016 and 2008-2016, respectively, comparing mortality and incidence proportions in the post-PCV introduction period with those in the pre-PCV period. Overall mean reductions in all-cause pneumonia mortality was observed in the post-PCV period nationally (48.8%; 95%CI: 45.5-51.8%) and in four cities including Bogota (77.1%; 71.1-81.8%) and Medellin (56.4%; 44.1-65.9%); no substantial reduction was observed in Cartagena. Similar findings were observed for overall mortality. Reductions in all-cause pneumonia incidence were observed in Bogota (66.0%; 65.5-66.6%), Medellin (40.6%; 39.3-41.9%) and Cartagena (15.0%; 11.2-18.6%), while incidence increased in Barranquilla (78.5%; 68.4-89.2%) and Cali (125.5%; 119.2-132.0%). All-cause OM incidence fell in Medellin and Bogota (42.1-51.1%) but increased (95.8%) in Barranquilla. In conclusion, overall reductions in disease outcomes were observed following PCV introduction in most cities and nationwide. Decreasing trends in outcomes were observed prior to PCV introduction, and limited data points and data reporting issues may have influenced our results. (ClinicalTrials.gov: NCT02567747).

Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high-risk population.

AIM: To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders. METHODS: This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves. RESULTS: For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively. CONCLUSION: Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.

Burden of disease due to microcephaly associated with the Zika virus in Colombia.

In 2015, the Zika virus was introduced in Colombia. The emergence of this arbovirus is a public health challenge for the country, considering the association between the infection and congenital disorders such as microcephaly. Thus, we estimated the burden of disease due to microcephaly associated with Zika in Colombia and its administrative subdivisions for the period 2015-2016. We conducted an exploratory ecological study, using as unit of measurement disability-adjusted life years (DALYs). The cases of microcephaly were obtained from the Zika national and departmental databases built by the National Public Health Surveillance System (SIVIGILA). Deaths attributed to microcephaly were estimated from previous studies. Finally, we calculated mortality rates and incidences, then we performed a sensitivity analysis under three scenarios (conservative, medium, and extreme) to estimate the DALYs. In the 2015-2016 period, 10,609.4 DALYs were caused by microcephaly associated with Zika in Colombia. 71% of the total DALYs were years of life lost and 29% were years lived with disability. Five out of 32 departments (Meta, Córdoba, Tolima, Valle del Cauca, and Norte de Santander) contributed 71% of total DALYs. The burden of microcephaly associated with Zika outweighed the burden of other congenital anomalies such as neural tube defects and Down syndrome in children aged between 0 and 4 years in Colombia. Public health efforts must be made to prevent and monitor these cases.

Relación entre patrones alimentarios, diabetes, hipertensión arterial y obesidad según aspectos sociogeográficos, Colombia 2010 / Relation among food patterns, diabetes, arterial hypertension and obesity according to socio-demographic aspects, Colombia, 2010

Introducción: La prevalencia de hipertensión arterial, diabetes y obesidad es un problema de salud pública en Colombia. Objetivo: Determinar la relación entre patrones alimentarios e hipertensión arterial, diabetes y obesidad según aspectos sociogeográficos en Colombia, 2010. Métodos: Estudio ecológico de grupos múltiples, muestra representativa 5216 sujetos entre 18 y 64 años. Se realizó análisis por regresión multinivel con los datos de frecuencia de consumo de alimentos disponibles en la Encuesta Nacional de Situación Nutricional de Colombia y la prevalencia por hipertensión arterial, diabetes y obesidad según edad, sexo y regiones geográficas de Colombia, a partir de los datos del Ministerio de Salud y Protección Social del año 2010. Resultados: Las mujeres entre 18 y 39 años son quienes más le aportan a la prevalencia de las tres enfermedades (diabetes, hipertensión arterial y obesidad), en Bogotá 5038 (p < 0,05; IC: 3246,2; 6829,8) y en la región Oriental 2891 (p < 0,05; IC: 1964,5; 3818). Las mujeres entre 18 y 49 años son quienes más contribuyen a la prevalencia de la obesidad en las regiones de Bogotá, Central y Oriental, destacándose el alto consumo de embutidos, golosinas, postres y bajo en alimentos integrales. No se encontró relación de la hipertensión arterial en ningún grupo de edad. Los resultados fueron ajustados por edad y sexo. Conclusiones: Los patrones alimentarios reportados en el estudio según región, sexo y grupos de edad son un acercamiento para ofrecer recomendaciones de consumo por grupos de alimentos de forma más específica, de tal manera que se prevengan las enfermedades no transmisibles como la hipertensión arterial, diabetes mellitus y la obesidad(AU)

Introduction: The prevalence of arterial hypertension, diabetes and obesity is a public health problem in Colombia. Objective: To determine the relation among food patterns and arterial hypertension, diabetes and obesity according to socio-demographic aspects in Colombia, 2010. Methods: Ecologic study in multiple groups; representative sample of 5216 individuals from 18 to 64 years old. It was carried out an analysis of multilevel regression with the data of food consumption's frequency available in the National Survey on Nutritional Situation of Colombia, and the prevalence of arterial hypertension, diabetes and obesity according to age, sex and geographical regions of Colombia from the data of the Ministry of Health and Social Welfare in 2010. Results: Women in the ages from 18 to 39 years are the ones with the highest prevalence in the three disease (diabetes, arterial hypertension and obesity), in Bogotá with 5038 (p<0,05; IC: 3246,2; 6829,8) and in the Eastern region with 2891 (p<0,05; IC: 1964,5; 3818). Women in the ages from 18 to 49 years are the ones with the highest prevalence of obesity in the regions of Bogotá, Central and East with predominance of a high consumption of cold meats, candies, desserts and a low consumption of integral food. There was not found relation of arterial hypertension in any age group. The results were adjusted according to age and sex. Conclusions: The reported food patterns in the study according to region, sex and age groups are a rapprochement to provide recommendations of consumption by food groups in a more specific way, so there can be prevented non-communicable diseases as arterial hypertension, diabetes mellitus and obesity(AU)

Prevalence of liver disease in Colombia between 2009 and 2016.

BACKGROUND AND AIM: Liver disease refers to a set of pathologies resulting from the interruption of liver function or the poor functioning of the liver. The estimation of morbidity and mortality due to liver disease and the context in which the disease develops are determining factors for public policies related to liver disease and its causes. The primary etiologies are cirrhosis and hepatocellular carcinoma, which are directly related to hepatitis B and C virus and alcohol consumption. Followed by hepatotoxic drug use, autoimmune hepatitis, cholestatic diseases, genetic abnormalities, and nonalcoholic steatohepatitis. METHODS: A descriptive cross-sectional study was conducted to estimate the prevalence of liver disease in Colombia between 2009 and 2016. Using the Data Warehouse-Cube of SISPRO as the primary source of the data, prevalence proportions were calculated and adjusted according to the Bennett Horiuchi method. The relationship with alcohol consumption and the index of unsatisfied basic needs based on estimates from 2005 were considered as sociodemographic variables. RESULTS: The prevalence of liver disease differs with regard to the type of illness, sex and age of the patient, access to medical attention, and geographical location. CONCLUSIONS: As liver disease is a public health problem, it requires early intervention such as raising awareness and prevention strategies, along with postdiagnosis care channels for treatment, rehabilitation, and palliation. By implementing these strategies, public health will be positively impacted, health care resources will be optimized, and more productive years of life are available for the citizens of the country.

Estimating the burden of arboviral diseases in Colombia between 2013 and 2016.

OBJECTIVE: During the 2013-2016 period, Dengue, Chikungunya, and Zika affected more than 1 million people in Colombia. These arboviruses and their chronic manifestations pose a public health challenge. Therefore, we estimated the burden of disease by Dengue, Chikungunya, and Zika in Colombia between 2013 and 2016. METHODS: An exploratory ecological study was carried out using the disability-adjusted life years (DALYs) as a unit of measure. The mortality databases of the National Administrative Department of Statistics (DANE) and the morbidity databases of the National Public Health Surveillance System (SIVIGILA) were used. Deaths and cases for each arbovirus were grouped and then adjusted to control biases. Subsequently, we performed a sensitivity analysis. RESULTS: In the 2013-2016 period, 491,629.2 DALYs were lost due to arboviruses in Colombia. By disease, 26.6% of the total DALYs were caused by Dengue, 71.3% by Chikungunya, and the remaining 2.2%, by Zika. The majority of DALYs (68.2%) were caused by chronic complications. Five out of 32 departments (Valle del Cauca, Tolima, Norte de Santander, Huila, and Bolívar) contributed 50.5% of total DALYs. CONCLUSION: The burden of disease by arboviruses in the 2013-2016 period exceeded the burden of other infectious diseases such as HIV/AIDS and tuberculosis in Colombia. Public health efforts must be made to mitigate new epidemics of these arboviruses.

Chronic Joint Pain 3 Years after Chikungunya Virus Infection Largely Characterized by Relapsing-remitting Symptoms.

OBJECTIVE: To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort. METHODS: A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014-2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases. RESULTS: Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. CONCLUSION: To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.

Epidemiologia de cáncer de ovario colombia 2009- 2016 / Epidemiology of ovarian cancer colombia 2009- 2016

Resumen Introducción el cáncer es una de las enfermedades más temidas por la humanidad y el tumor maligno de ovario no es la excepción. Se caracteriza por su alta agresividad y por presentar síntomas inespecíficos, además de no contar, hasta el momento, con pruebas de tamizaje que permitan una detección precoz, convirtiéndose en uno de los cánceres femeninos con alta mortalidad ocupando el séptimo lugar a nivel mundial. Objetivo Medir la prevalencia, mortalidad y la letalidad asociadas al cáncer de ovario entre 2009 a 2016 en la población colombiana. Método se realizó un estudio descriptivo, transversal, ecológico. A partir de una base de datos en el RIPS de SISPRO y DANE se seleccionaron las mujeres con diagnóstico de tumor maligno de ovario. Resultados se hallaron 36.798 mujeres con diagnóstico de cáncer de ovario, la edad media fue de 63 años con una prevalencia de 31,66 por 100.000 mujeres, en los departamentos de Antioquia, Santander, y Bogotá. Se estimó una tasa de mortalidad de 3,9 por 100.000 mujeres, predominio en educación básica primaria, y régimen de seguridad social contributivo. La letalidad fue de 15,75%. Conclusiones En Colombia la prevalencia, mortalidad y letalidad entre 2009 a 2016 presentó una tendencia al incremento, predominio en casadas, bajo nivel educativo y menor acceso a los servicios de salud. En virtud de lo anteriormente expuesto, se abre la posibilidad de establecer prioridades sanitarias, diseño de futuras estrategias en prevención de la enfermedad en salud pública, detención precoz y con la consecuente disminución de la mortalidad.