The Association of Teen Pregnancy and Violence: A Multilevel Study in Colombia.

Background: Colombia has a high teen pregnancy (TP) rate. In 2018, one in five pregnancies was from teen mothers between 10 and 19 years of age. While TP rates are declining globally, Colombia's TP rate decline has been particularly low, despite sexual education and contraception campaigns. Other factors must be studied to prevent TP. Colombia has a long history of violence. We aim to assess whether there is a relationship between TP and exposure to violence in Colombia. Methods: Data from the Colombian Demographic and Health Survey 2015 and the Colombian National Department of Statistics were analyzed for association between TP and sexual violence, physical violence, physical punishment as a child, and community violence. Univariate, bivariate, multivariate, and multilevel binary logistic regression models were calculated using SPSS v.25 and HLM v.7. Results: Fifteen percent of teens were pregnant. Emotional violence was reported by 47%, sexual harassment by 27%, physical violence by 17%, physical punishment as a child by 7%, and unwanted sex by 2%. Unwanted sex (odds ratio [OR]: 3.18, 95% confidence interval [95% CI]: 1.96-5.16), sexual harassment (OR: 2.43, 95% CI: 1.89-3.14), and physical punishment (OR: 20.30, 95% CI: 7.96-22.81) were associated with adolescent pregnancy. In unadjusted models, emotional violence was associated (OR: 1.22, 95% CI 1.06-1.40) and community violence showed a tendency (OR: 1.24, 95% CI: 0.99-1.55). Physical violence was not associated. Conclusions: Violence exposure and particularly physical punishment, unwanted sex and sexual harassment were associated with TP incidence and should be considered risk factors for TP.

Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19.

INTRODUCTION: The diagnosis of acute respiratory distress syndrome (ARDS) includes the ratio of pressure arterial oxygen and inspired oxygen fraction (P/F) ≤ 300, which is often adjusted in locations more than 1,000 meters above sea level (masl) due to hypobaric hypoxemia. The main objective of this study was to develop a prediction model for in-hospital mortality among patients with ARDS due to coronavirus disease 2019 (COVID-19) (C-ARDS) at 2,600 masl with easily available variables at patient admission and to compare its discrimination capacity with a second model using the P/F adjusted for this high altitude. METHODS: This study was an analysis of data from patients with C-ARDS treated between March 2020 and July 2021 in a university hospital located in the city of Bogotá, Colombia, at 2,600 masl. Demographic and laboratory data were extracted from electronic records. For the prediction model, univariate analyses were performed to screen variables with p <0.25. Then, these variables were automatically selected with a backward stepwise approach with a significance level of 0.1. The interaction terms and fractional polynomials were also examined in the final model. Multiple imputation procedures and bootstraps were used to obtain the coefficients with the best external validation. In addition, total adjustment of the model and logistic regression diagnostics were performed. The same methodology was used to develop a second model with the P/F adjusted for altitude. Finally, the areas under the curve (AUCs) of the receiver operating characteristic (ROC) curves of the two models were compared. RESULTS: A total of 2,210 subjects were included in the final analysis. The final model included 11 variables without interaction terms or nonlinear functions. The coefficients are presented excluding influential observations. The final equation for the model fit was g(x) = age(0.04819)+weight(0.00653)+height(-0.01856)+haemoglobin(-0.0916)+platelet count(-0.003614)+ creatinine(0.0958)+lactate dehydrogenase(0.001589)+sodium(-0.02298)+potassium(0.1574)+systolic pressure(-0.00308)+if moderate ARDS(0.628)+if severe ARDS(1.379), and the probability of in-hospital death was p (x) = e g (x)/(1+ e g (x)). The AUC of the ROC curve was 0.7601 (95% confidence interval (CI) 0.74-0, 78). The second model with the adjusted P/F presented an AUC of 0.754 (95% CI 0.73-0.77). No statistically significant difference was found between the AUC curves (p value = 0.6795). CONCLUSION: This study presents a prediction model for patients with C-ARDS at 2,600 masl with easily available admission variables for early stratification of in-hospital mortality risk. Adjusting the P/F for 2,600 masl did not improve the predictive capacity of the model. We do not recommend adjusting the P/F for altitude.

Effectiveness of the Booster Dose in Protecting against COVID-19, Colombia 2022.

Vaccination has proven to be one of the most effective strategies against the COVID-19 pandemic. Several studies have evaluated and confirmed its effectiveness in different populations, particularly in reducing severe outcomes such as hospitalization and death. Some studies have investigated the effectiveness of vaccination against the infection, identifying the need for booster doses. This study aimed to explore the effectiveness of the vaccination schedule on the probability of infection in a sample of Colombian patients during the fourth wave of the COVID-19 pandemic, which was associated with the emergence and predominance of the Omicron variant. A cross-sectional study was conducted on individuals who underwent RT-PCR testing for COVID-19 detection in a dedicated laboratory in Bogotá, Colombia, between 30 December 2021 and 7 February 2022. A total of 1468 subjects was included in the study, of whom 36.6% (n = 538) had a positive PCR test for COVID-19. The comparison between fully vaccinated individuals with a booster dose and those without the booster dose revealed a 28% reduction in the odds of infection (OR = 0.719 CI 0.531-0.971). Age (OR = 1.009 CI 1.001-1.018) and low economic status (OR = 1.812 CI 1.416-2.319) were associated with an increased risk of infection. These findings suggest the need for a booster vaccination in the general population to improve the prevention rates of SARS-CoV-2 infection and mitigate severe outcomes.

Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality: an observational study from Bogotá, Colombia.

Purpose: We aimed to assess the effect of hemoglobin (Hb) concentration and oxygenation index on COVID-19 patients' mortality risk. Patients and Methods: We retrospectively reviewed sociodemographic and clinical characteristics, laboratory findings, and clinical outcomes from patients admitted to a tertiary care hospital in Bogotá, Colombia, from March to July 2020. We assessed exploratory associations between oxygenation index and Hb concentration at admission and clinical outcomes. We used a generalized additive model (GAM) to evaluate the observed nonlinear relations and the classification and regression trees (CART) algorithm to assess the interaction effects. Results: We included 550 patients, of which 52% were male. The median age was 57 years old, and the most frequent comorbidity was hypertension (29%). The median value of SpO2/FiO2 was 424, and the median Hb concentration was 15 g/dL. The mortality was 15.1% (83 patients). Age, sex, and SpO2/FiO2, were independently associated with mortality. We described a nonlinear relationship between Hb concentration and neutrophil-to-lymphocyte ratio with mortality and an interaction effect between SpO2/FiO2 and Hb concentration. Patients with a similar oxygenation index had different mortality likelihoods based upon their Hb at admission. CART showed that patients with SpO2/FiO2 < 324, who were less than 81 years with an NLR >9.9, and Hb > 15 g/dl had the highest mortality risk (91%). Additionally, patients with SpO2/FiO2 > 324 but Hb of < 12 g/dl and a history of hypertension had a higher mortality likelihood (59%). In contrast, patients with SpO2/FiO2 > 324 and Hb of > 12 g/dl had the lowest mortality risk (9%). Conclusion: We found that a decreased SpO2/FiO2 increased mortality risk. Extreme values of Hb, either low or high, showed an increase in the likelihood of mortality. However, Hb concentration modified the SpO2/FiO2 effect on mortality; the probability of death in patients with low SpO2/FiO2 increased as Hb increased.

Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia.

BACKGROUND: There are few data on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) in cities over 1000 m above sea level (masl). OBJECTIVES: To describe the clinical characteristics and mortality of patients with COVID-19 treated at a high complexity hospital in Bogotá, Colombia, at 2640 masl. METHODS: This was an observational study of a cohort including 5161 patients with confirmed COVID-19 infection from 19 March 2020 to 30 April 2021. Demographic data, laboratory values, comorbidities, oxygenation indices, and clinical outcomes were collected. Data were compared between survivors and nonsurvivors. An independent predictive model was performed for mortality and invasive mechanical ventilation (IMV) using classification and regression trees (CART). RESULTS: The median cohort age was 66 years (interquartile range (IQR) 53-77), with 1305 patients dying (25%) and 3856 surviving (75%). The intensive care unit (ICU) received 1223 patients (24%). Of 898 patients who received IMV, 613 (68%) of them perished. The ratio of partial pressure arterial oxygen (PaO2) to fraction inspired oxygen (FiO2), or the P/F ratio, upon ICU admission was 105 (IQR 77-146) and 137 (IQR 91-199) in the deceased and survivors, respectively. The CART model showed that the need for IMV, age greater than 79 years, ratio of oxygen saturation (SaO2) to FiO2, or the S/F ratio, less than 259, and lactate dehydrogenase (LDH) greater than 617 U/L at admission were associated with a greater probability of death. CONCLUSION: Among more than 5000 patients with COVID-19 treated in our hospital, mortality at hospital discharge was 25%. Older age, low S/F ratio, and high LDH at admission were predictors of mortality.

Genomic characterization of SARS-CoV-2 and its association with clinical outcomes: a 1-year longitudinal study of the pandemic in Colombia.

OBJECTIVES: This study aimed to explore associations between the molecular characterization of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and disease severity in ambulatory and hospitalized patients in two main Colombian epicentres during the first year of the coronavirus disease 2019 pandemic. METHODS: In total, 1000 patients with SARS-CoV-2 infection were included in this study. Clinical data were collected from 997 patients, and 678 whole-genome sequences were obtained by massively parallel sequencing. Bivariate, multi-variate, and classification and regression tree analyses were run between clinical and genomic variables. RESULTS: Age >88 years, and infection with lineages B.1.1, B.1.1.388, B.1.523 or B.1.621 for patients aged 71-88 years were associated with death [odds ratio (OR) 6.048036, 95% confidence interval (CI) 1.346567-32.92521; P=0.01718674]. The need for hospitalization was associated with higher age and comorbidities. The hospitalization rate increased significantly for patients aged 38-51 years infected with lineages A, B, B.1.1.388, B.1.1.434, B.1.153, B.1.36.10, B.1.411, B.1.471, B.1.558 or B.1.621 (OR 8.368427, 95% CI 2.573145-39.10672, P=0.00012). Associations between clades and clinical outcomes diverged from previously reported data. CONCLUSIONS: Infection with lineage B.1.621 increased the hospitalization and mortality rates. These findings, plus the rapidly increasing prevalence in Colombia and other countries, suggest that lineage B.1.621 should be considered as a 'variant of interest'. If associated disease severity is confirmed, possible designation as a 'variant of concern' should be considered.

Mutation profile of SARS-CoV-2 genome in a sample from the first year of the pandemic in Colombia.

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the etiopathogenic agent of COVID-19, a condition that has led to a formally recognized pandemic by March 2020 (World Health Organization -WHO). The SARS-CoV-2 genome is constituted of 29,903 base pairs, that code for four structural proteins (N, M, S, and E) and more than 20 non-structural proteins. Mutations in any of these regions, especially in those that encode for the structural proteins, have allowed the identification of diverse lineages around the world, some of them named as Variants of Concern (VOC) and Variants of Interest (VOI), according to the WHO and CDC. In this study, by using Next Generation Sequencing (NGS) technology, we sequenced the SARS-CoV-2 genome of 422 samples from Colombian residents, all of them collected between April 2020 and January 2021. We obtained genetic information from 386 samples, leading us to the identification of 14 new lineages circulating in Colombia, 13 of which were identified for the first time in South America. GH was the predominant GISAID clade in our sample. Most mutations were either missense (53.6%) or synonymous mutations (37.4%), and most genetic changes were located in the ORF1ab gene (63.9%), followed by the S gene (12.9%). In the latter, we identified mutations E484K, L18F, and D614G. Recent evidence suggests that these mutations concede important particularities to the virus, compromising host immunity, the diagnostic test performance, and the effectiveness of some vaccines. Some important lineages containing these mutations are the Alpha, Beta, and Gamma (WHO Label). Further genomic surveillance is important for the understanding of emerging genomic variants and their correlation with disease severity.

Assessment of nutrition and learning skills in children aged 5-11 years old from two elementary schools in Chocó, Colombia.

BACKGROUND: Malnutrition has been identified as a factor in growth and learning. The current study aimed to determine the nutritional status and basic learning skills of children from Chocó, Colombia. METHODS: We conducted a cross-sectional study of 631 children aged 5-11 years from two schools, collecting anthropometric measurements, nutritional quality surveys and sociodemographic data. Neuropsychological batteries were applied. RESULTS: A total of 523 children were evaluated, with an average age of 8.49 ± 2.1 years. The results revealed that 2.9% of children were underweight, 0.4% were severely underweight, and 4.8% were diagnosed as having stunted growth. In addition, 71.8% of children were unable to draw a human figure. Beery-Buktenica Visual-Motor Integration test (VMI) performance was below the scores expected for these age groups in 73.9% of children. Battery of Differential and General Abilities (BADYG) performance revealed limited verbal skills. In a subsample of 117 children, anemia was detected in 12.8% of cases, and iron deficiency was present in 44.4% of cases. Global malnutrition was associated with impairments in BADYG performance (OR: 1.98; 95% CI: 1.07-3.86). CONCLUSIONS: The current results revealed that learning performance was below the expected level for children in these age groups across all of the applied tests. Although malnutrition could partially explain the poor performance of children in tests of learning abilities, additional factors are likely to be involved.

Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test.

BACKGROUND: There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. METHODS: We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. RESULTS: The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered "asymptomatic" as they didn't present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5-99.5%] and 98.7% [CI] [92.8-99.8%] respectively, with a range of confidence [CI] of 95%. CONCLUSIONS: Our study's main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.

Premenopausal breast cancer is a health challenge: nutritional habits show potential to prevent this disease.

BACKGROUND: The incidence of breast cancer had increased around the world. More premenopausal women suffer from this condition with great economic and social impact. The objective of this study is to establish possible associations between lifestyle and the presence of breast cancer in premenopausal women. METHODS: The study population was composed of 330 premenopausal patients younger than 55 years with breast disease, cared between 2013 and 2017 at the University Hospital Mayor Méderi. Two comparison groups were formed. Patients with a tumor diagnosed as malignant considering cases and control group of patients with a tumor diagnosed as benign. With factors associated significantly in the bivariate analysis (P < .10), the hierarchically organized multiple regression model controlled by the confounding variables was constructed. The logistic regression model was adjusted by the age variable, to avoid residual confounder. RESULTS: The population included 330 premenopausal women with benign and malignant breast disease: 134 cases and 196 controls. From the multivariate analysis, it was identified that the whole-grain consumption was inversely associated with presence of breast cancer (odds ratio [OR] = 0.579; 95% confidence interval [CI]: 0.339, 0.991; P = .046). On the other hand, consumption of fish was associated with the presence of breast malignancy (OR = 2.560; 95% CI: 1.200, 5.460; P = .015). CONCLUSIONS: Considering the epigenetic and multiomics individual profiles in the development of premenopausal breast cancer and its social and economic impact can be useful in development of modern clinical strategies with crucial interventions at the primary, secondary, and tertiary prevention levels for this disease.

Association of nutritional support programs with zinc deficiency in Colombian children: a cross-sectional study.

BACKGROUND: Zinc is an essential trace element that plays a key role in the immune, gastrointestinal, respiratory and nervous systems. In Colombia, a vast percentage of children live in low-income households with food insecurity and nutritional deficiencies, including zinc. In an effort to improve children's well-being, public health measures such as nutritional support programs that provide meals have targeted the poorest populations. The aim of the present study was to assess the role of nutritional support programs on zinc deficiency in Colombian children, while considering their wealth and food security. METHODS: Cross-sectional study using data from the 2010 Colombian National Nutrition Survey, a population-based study representative of Colombia. A total of 4275 children between 12 and 59 months of age were included in the study. Stepwise logistic regressions were modelled with SPSS, first for zinc deficiency on wealth and food security, then adding enrolment in a nutritional support program, and finally, adjusting for socio-demographic variables. RESULTS: A zinc deficiency prevalence of 49% was found. The adjusted models showed an association of wealth quintiles: very poor (OR = 1.48) and poor (OR = 1.39), food security (OR = 0.75) and enrolment in a nutritional support program (OR = 0.76) with zinc deficiency. Enrolment in nutritional programs did not modify the relationship of wealth and food security to zinc deficiency. CONCLUSION: Zinc deficiency is associated with wealth, food security and enrolment in nutritional support programs. Nutritional programs may be a good alternative against zinc deficiency, if they focus appropriately on the needs of children according to their wealth and food security.

Factores asociados al inicio de vida sexual y al embarazo adolescente en Colombia. Estudio de corte transversal / Factors associated with the beginning of sexual life and adolescent pregnancy in Colombia. Cross-sectional study

RESUMEN Introducción: En Colombia, entre el año 2008 y 2014 el 23.4% de los nacimientos fueron producto de embarazos adolescentes, los cuales tienen graves consecuencias a nivel social, emocional y biológico tanto para la madre joven como para el bebé. Material y métodos: Estudio de corte transversal con componente analítico dónde se tomó una muestra representativa de 13.313 mujeres entre 13 y 19 años quienes respondieron la Encuesta Nacional de Demografía y Salud (ENDS) 2010. Se realizaron análisis bivariados y análisis de regresión logística multinomial con el fin de identificar factores individuales, del hogar y del comportamiento sexual asociados con el inicio de la vida sexual y con el embarazo en adolescentes colombianas. Resultados: A través del análisis multivariado se encontró que tener mayor edad, convivir en pareja, haber sufrido violencia parental y haber sufrido violencia sexual fueron factores de riesgo tanto para inicio de vida sexual como para embarazo adolescente. Se identificó que el hecho de estar asistiendo al colegio es un factor protector para ambos eventos. La pobreza, el hacinamiento y la falta de educación estuvieron asociados con el embarazo adolescente pero no con el inicio de la vida sexual. Conclusiones: Existen múltiples factores asociados con el inicio temprano de vida sexual y con el embarazo adolescente susceptibles de intervención. Este estudio presenta factores clave para generar programas de prevención para esta problemática.

ABSTRACT Introduction: In Colombia, between 2008 and 2014, 23.4% of births were product of adolescent pregnancies, which have serious social, emotional and biological consequences for both the young mother and the baby. Materials and methods: Cross-sectional study with analytical component, with a sample of 13,313 women between 13 and 19 years of age who answered the National Survey of Demography and Health (ENDS) 2010. Bivariate analyzes and multinomial logistic regression analysis were carried out in order to identify individual, home-related, and sexual behavior factors associated with sexual debut and adolescent pregnancy among Colombian adolescents in 2010. Results: Multivariate analysis shown that being older, living together as a couple, having suffered parental violence, and having suffered sexual violence, were risk factors for initiation of sexual life and teenage pregnancy. School attendance was found to be a protective factor for both events. Poverty, overcrowding and lack of education were associated with teen pregnancy but not with sexual debut. Conclusions: There are multiple factors associated with early sexual debut and adolescent pregnancy which are susceptible to intervention. This study presents key factors to generate prevention programs for these situations.

Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women.

BACKGROUND: A 9-valent human papillomavirus (HPV6/11/16/18/31/33/45/52/58; 9vHPV) vaccine was developed to expand coverage of the previously developed quadrivalent (HPV6/11/16/18; qHPV) vaccine. METHODS: Efficacy, immunogenicity, and safety outcomes were assessed in Latin American participants enrolled in 2 international studies of the 9vHPV vaccine, including a randomized, double-blinded, controlled with qHPV vaccine, efficacy, immunogenicity, and safety study in young women aged 16-26 years, and an immunogenicity and safety study in girls and boys aged 9-15 years. Participants (N=5312) received vaccination at Day 1, Month 2, and Month 6. Gynecological swabs were collected regularly in young women for cytological and HPV DNA testing. Serum was analyzed for HPV antibodies in all participants. Adverse events (AEs) were also monitored in all participants. RESULTS: The 9vHPV vaccine prevented HPV 31-, 33-, 45-, 52-, and 58-related high-grade cervical, vulvar, and vaginal dysplasia with 92.3% efficacy (95% confidence interval 54.4, 99.6). Anti-HPV6, 11, 16, and 18 geometric mean titers at Month 7 were similar in the 9vHPV and qHPV vaccination groups. Anti-HPV antibody responses following vaccination were higher among girls and boys than in young women. Most (>99%) 9vHPV vaccine recipients seroconverted for all 9 HPV types at Month 7. Antibody responses to the 9 HPV types persisted over 5 years. The most common AEs were injection-site related, mostly of mild to moderate intensity. CONCLUSIONS: The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Latin American young women, girls, and boys. These data support 9vHPV vaccination programs in Latin America, a region with substantial cervical cancer burden.

Vólvulo en el embarazo: reporte de un caso / Volvulus in pregnancy: a case report / Volvulus na gravidez: relato de caso

El vólvulo del colon es la causa más común de obstrucción intestinal durante la gestación, y representa una causa importante de morbimortalidad materna y fetal. Su diagnóstico clínico es difícil, debido a que el embarazo dificulta la adecuada identificación de signos y de síntomas. Ello explica que las imágenes diagnósticas sean indispensables como herramienta confirmatoria. La instauración de un rápido tratamiento es esencial para los pronósticos materno y fetal. Se presenta el caso clínico de una mujer de 33 años en el último mes de su gestación, y quien ingresa a un hospital de tercer nivel en la ciudad de Bogotá, Colombia, por un cuadro clínico sugestivo de obstrucción intestinal. La Resonancia Nuclear Magnética (RNM) evidencia signos radiológicos sugestivos de vólvulo, por lo cual se decide realizar laparotomía de urgencia, que confirma vólvulo del sigmoide sin necrosis. Se devolvula manualmente y se fija a la gotera parietocólica, como medida transitoria, para posterior sigmoidectomía, como tratamiento definitivo. Se analiza el caso a la luz de la literatura científica disponible. El objetivo de este trabajo es familiarizar al personal de la salud con este cuadro clínico, para garantizar una rápida instauración del tratamiento, con el fin de evitar las complicaciones que se pueden desencadenar en quienes lo padecen.

Colonic volvulus is the most common cause of bowel obstruction during gestation and is an important cause of maternal and fetal morbidity and mortality. Its clinical diagnosis is challenging because pregnancy hinder an adequate identification of signs and symptoms. This explains why diagnostic imaging is currently considered as the gold-standard for diagnosis. Placement on effective therapy is essential to ensure adequate maternal and fetal prognosis. We present the case of a 33-year-old woman in the last month of pregnancy, who was admitted into a third-level hospital in Bogotá, Colombia. She had a clinical scenario consistent with intestinal obstruction. Magnetic Nuclear Resonance (MRI) shows radiological findings suggestive of volvulus, so emergency laparotomy was performed. Non-necrotic sigmoid volvulus was confirmed. It was manually corrected and fixed to the parietal-like leak as a transient measure for subsequent sigmoidectomy as a definitive treatment. We present a review of the literature available in electronic databases and a critical analysis of the case management. The objective of this study is to familiarize health personnel with this clinical scenario, in order to ensure efficient treatment strategies and avoid common and potentially lethal complications

Vólvulo do cólon é a mais comum causa de obstruçãointestinal durante a gestaçãoe representa das principaiscausas de mortalidade e morbidade materna e fetal.diagnóstico clínico é difícil, porque a gravidez dificulta aidentificação adequada dos sinais e síntomas ou vólvulo de colon é para causar comum de mais de obstrução intestinal durante para gestação e representa uma que causa importante de morbimortalidad materno e fetal. Diagnosticar deles / delas clínico é difícil porque para gravidez impeça a apropriada de sinais de identificação e síntomas a ressonância magnética (RNM) nuclear comprova sinais sugestivos radiológicos de vólvulo para o que decide levar a cabo laparotomía de urgência que confirma vólvulo do sigmoide sem necrose. você devolvula manualmente e ele/ela nota ao parietocólica de vazamento goste de medida transitória para sigmoidectomía posterior goste de tratamento definitivo. Discutte o caso a luz da literatura científica disponivel objetivo deste trabalho é tornarse familiarizado com estepessoal saúde queadro clínico para asegurar um rápido establecimento do tratamento, a fin de evitar acomplições que podem ser acionadas em pessoas quesofrem com isso

Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial.

BACKGROUND: Primary analyses of a study in young women aged 16-26 years showed efficacy of the nine-valent human papillomavirus (9vHPV; HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine against infections and disease related to HPV 31, 33, 45, 52, and 58, and non-inferior HPV 6, 11, 16, and 18 antibody responses when compared with quadrivalent HPV (qHPV; HPV 6, 11, 16, and 18) vaccine. We aimed to report efficacy of the 9vHPV vaccine for up to 6 years following first administration and antibody responses over 5 years. METHODS: We undertook this randomised, double-blind, efficacy, immunogenicity, and safety study of the 9vHPV vaccine study at 105 study sites in 18 countries. Women aged 16-26 years old who were healthy, with no history of abnormal cervical cytology, no previous abnormal cervical biopsy results, and no more than four lifetime sexual partners were randomly assigned (1:1) by central randomisation and block sizes of 2 and 2 to receive three intramuscular injections over 6 months of 9vHPV or qHPV (control) vaccine. All participants, study investigators, and study site personnel, laboratory staff, members of the sponsor's study team, and members of the adjudication pathology panel were masked to vaccination groups. The primary outcomes were incidence of high-grade cervical disease (cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, invasive cervical carcinoma), vulvar disease (vulvar intraepithelial neoplasia grade 2/3, vulvar cancer), and vaginal disease (vaginal intraepithelial neoplasia grade 2/3, vaginal cancer) related to HPV 31, 33, 45, 52, and 58 and non-inferiority (excluding a decrease of 1·5 times) of anti-HPV 6, 11, 16, and 18 geometric mean titres (GMT). Tissue samples were adjudicated for histopathology diagnosis and tested for HPV DNA. Serum antibody responses were assessed by competitive Luminex immunoassay. The primary evaluation of efficacy was a superiority analysis in the per-protocol efficacy population, supportive efficacy was analysed in the modified intention-to-treat population, and the primary evaluation of immunogenicity was a non-inferiority analysis. The trial is registered with ClinicalTrials.gov, number NCT00543543. FINDINGS: Between Sept 26, 2007, and Dec 18, 2009, we recruited and randomly assigned 14 215 participants to receive 9vHPV (n=7106) or qHPV (n=7109) vaccine. In the per-protocol population, the incidence of high-grade cervical, vulvar and vaginal disease related to HPV 31, 33, 45, 52, and 58 was 0·5 cases per 10 000 person-years in the 9vHPV and 19·0 cases per 10 000 person-years in the qHPV groups, representing 97·4% efficacy (95% CI 85·0-99·9). HPV 6, 11, 16, and 18 GMTs were non-inferior in the 9vHPV versus qHPV group from month 1 to 3 years after vaccination. No clinically meaningful differences in serious adverse events were noted between the study groups. 11 participants died during the study follow-up period (six in the 9vHPV vaccine group and five in the qHPV vaccine group); none of the deaths were considered vaccine-related. INTERPRETATION: The 9vHPV vaccine prevents infection, cytological abnormalities, high-grade lesions, and cervical procedures related to HPV 31, 33, 45, 52, and 58. Both the 9vHPV vaccine and qHPV vaccine had a similar immunogenicity profile with respect to HPV 6, 11, 16, and 18. Vaccine efficacy was sustained for up to 6 years. The 9vHPV vaccine could potentially provide broader coverage and prevent 90% of cervical cancer cases worldwide. FUNDING: Merck & Co, Inc.

Association of rule of law and health outcomes: an ecological study.

OBJECTIVES: To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes. SETTING: Global project. PARTICIPANTS: Data set of 96 countries, comprising 91% of the global population. PRIMARY AND SECONDARY OUTCOME MEASURES: The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice. RESULTS: The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries' level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population. CONCLUSIONS: It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement.

Country characteristics and acute diarrhea in children from developing nations: a multilevel study.

BACKGROUND: Each year 2.5 billion cases of diarrheal disease are reported in children under five years, and over 1,000 die. Country characteristics could play a role on this situation. We explored associations between country characteristics and diarrheal disease in children under 5 years of age, adjusting by child, mother and household attributes in developing countries. METHODS: This study included 348,706 children from 40 nations. We conducted a multilevel analysis of data from the Demographic and Health Surveys and the World Bank. RESULTS: The prevalence of acute diarrhea was 14 %. Country inequalities (OR = 1.335; 95 % CI 1.117-1.663) and country's low income (OR = 1.488; 95 % CI 1.024-2.163) were associated with diarrhea, and these country characteristics changed the associations of well-known determinants of diarrhea. Specifically, living in poor countries strengthens the association of poor household wealth and mother's lack of education with the disease. Other factors associated with diarrhea were female sex of the child (OR = 0.922; 95 % CI 0.900-0.944), age of the child (OR = 0.978; 95 % CI 0.978-0.979), immunization status (OR = 0.821; 95 % CI 0.799-0.843), normal birthweight (OR = 0.879; 95 % CI 0.834-0.926), maternal age (OR = 0.987; 95 % CI 0.985-0.989), lack of maternal education (OR = 1.416; 95 % CI 1.283-1.564), working status of the mother (OR = 1.136; 95 % CI 1.106-1.167), planned pregnancy (OR = 0.774; 95 % CI 0.753-0.795), a nuclear family structure (OR = 0.949; 95 % CI 0.923-0.975), and household wealth (OR = 0.948; 95 % CI 0.921-0.977). CONCLUSIONS: Inequalities and lack of resources at the country level in developing countries -but not health expenditure- were associated with acute diarrhea, independently of child, family and household features. The broad environment considerably modifies well-known social determinants of acute diarrhea and public health campaigns designed to target diarrhea should consider macro characteristics of the country.

Safety of hormonal replacement therapy and oral contraceptives in systemic lupus erythematosus: a systematic review and meta-analysis.

BACKGROUND: There is conflicting data regarding exogenous sex hormones [oral contraceptives (OC) and hormonal replacement therapy (HRT)] exposure and different outcomes on Systemic Lupus Erythematosus (SLE). The aim of this work is to determine, through a systematic review and meta-analysis the risks associated with estrogen use for women with SLE as well as the association of estrogen with developing SLE. METHODS AND FINDINGS: MEDLINE, EMBASE, SciElo, BIREME and the Cochrane library (1982 to July 2012), were databases from which were selected and reviewed (PRISMA guidelines) randomized controlled trials, cross-sectional, case-control and prospective or retrospective nonrandomized, comparative studies without language restrictions. Those were evaluated by two investigators who extracted information on study characteristics, outcomes of interest, risk of bias and summarized strength of evidence. A total of 6,879 articles were identified; 20 full-text articles were included. Thirty-two meta-analyses were developed. A significant association between HRT exposure (Random model) and an increased risk of developing SLE was found (Rate Ratio: 1.96; 95%-CI: 1.51-2.56; P-value<0.001). One of eleven meta-analyses evaluating the risk for SLE associated with OC exposure had a marginally significant result. There were no associations between HRT or OC exposure and specific outcomes of SLE. It was not always possible to Meta-analyze all the available data. There was a wide heterogeneity of SLE outcome measurements and estrogen therapy administration. CONCLUSION: An association between HRT exposure and SLE causality was observed. No association was found when analyzing the risk for SLE among OC users, however since women with high disease activity/Thromboses or antiphospholipid-antibodies were excluded from most of the studies, caution should be exercised in interpreting the present results. To identify risk factors that predispose healthy individuals to the development of SLE who are planning to start HRT or OC is suggested.

Automedicación y términos relacionados: una reflexión conceptual / Self-medication and related terms: a conceptual reflection / Automedicação e termos relacionados: urna reflexão conceitual

Introducción: la automedicación se ha convertido en una práctica creciente en la población mundial. Este fenómeno ha sido promovido como una forma de autocuidado, con impacto positivo en la reducción del gasto dentro de los sistemas de salud; sin embargo, también se ve con preocupación, por los potenciales efectos negativos relacionados con diagnósticos y manejos inadecuados, que pueden afectar la salud de los individuos. Esta doble percepción del fenómeno se relaciona, en parte, con una gran diversidad de términos y conceptos relacionados, que hacen difícil su abordaje teórico-empírico. Para hacer comparaciones epidemiológicas adecuadas se requiere armonizar las definiciones implicadas. Objetivo: analizar el concepto de automedicación y términos relacionados a partir de las definiciones que aparecen en la literatura especializada del tema. Conclusiones: en las últimas cuatro décadas ha habido una evolución tanto de los términos como de las definiciones relacionadas con automedicación, desde un concepto muy simple que implica la ausencia de prescripción médica, hasta conceptos más complejos que abarcan conductas de muy diversa índole; aun aquellas en las que media un acto de prescripción no seguido o no cumplido por el paciente. Adicionalmente se aprecia una proliferación conceptual que justifica el ordenamiento de los términos relacionados con automedicación. Este artículo presenta una propuesta de clasificación en cuatro grupos: a. automedicación, b. autocuidado, c. preparaciones farmacéuticas y medicamentos, y d. prescripción. Esta propuesta puede facilitar la exploración y análisis del fenómeno y permitir futuras aproximaciones teóricas.

Introduction: self-medication has become a growing practice in the world population. This phenomenon has been promoted as a form of self-care, with a positive impact on reducing spending in health systems, however there is concern about the potential negative effects related to inadequate diagnosis and treatment, which can affect health of individuals. This dual perception of the phenomenon is partly related to a variety of terms and concepts used, that make difficult its theoretical and empirical approach. Harmonization of the definitions involved is required in order to make adequate epidemiological comparisons. Objectives: analyze the concept of self medication and related terms from the definitions in the literature of the subject. Conclusions: in the last four decades it has been an evolution of both the wording and the definitions related to self-medication, from a very simple concept that implies the absence of prescription, to more complex ones that encompass very diverse behaviors, even those mediated by an act of prescription but not followed or not completed by the patient. Additionally the conceptual proliferation seen, justify the ordering of the terms related to self-medication. This paper presents a proposal for classification in four groups: a. self-medication, b. self care, c. pharmaceutical preparations and medicines, and d. prescription. This proposal should facilitate the exploration and analysis of the phenomenon and allow future theoretical approaches.

Introdução: A automedicação tem se convertido em uma prática crescente na população mundial. Este fenômeno tem sido promovido como uma forma de auto-cuidado, com impacto positivo na redução do gasto dentro dos sistemas de saúde; por enquanto, também se vê com preocupação pelos potenciais efeitos negativos relacionados com diagnósticos e gestões inadequadas, que podem afetar a saúde dos indivíduos. Esta dupla percepção do fenômeno se relaciona, em parte, com uma grande diversidade de termos e conceitos relacionados, que fazem difícil sua abordagem teórico-empirica. Para fazer comparações epidemiológicas adequadas se requere harmonizar as definições implicadas. Objetivo: Analisar o conceito de automedicação e termos relacionados a partir das definições que aparecem na literatura especializada do tema. Conclusões: Nas últimas quatro décadas tem havido uma evolução tanto dos termos quanto das definições relacionadas com automedicação desde um conceito muito simples que implica a ausência de prescrição médica, até conceitos mais complexos que abarcam condutas de muita diversa índole; ainda aquelas nas que intervém um ato de prescrição não seguido ou não cumprido pelo paciente. Adicionalmente se aprecia uma proliferação conceitual que justifica o ordenamento dos termos relacionados com automedicação. Este artigo apresenta uma proposta de classificação em quatro grupos: a. automedicação b. auto-cuidado c. preparações farmacêuticas e medicamentos, e d. prescrição. Esta proposta pode facilitar a exploração e análise do fenômeno e permitir futuras aproximações teóricas.

Prevalencia y factores asociados a dismenorrea en estudiantes de ciencias de la salud / Prevalence and factors associated with dysmenorrheal in health science students / Prevalência e fatores associados à dismenorréia em estudantes de ciências da saúde

Introducción: La dismenorrea presenta una prevalencia entre el 60 y el 93%. Se han descrito factores asociados como edad de la menarquia, índice de masa corporal, actividad física, tabaquismo, antecedente de dismenorrea materna, entre otros. Materiales y métodos: Se realizó un estudio de corte transversal, basado en una encuesta anónima aplicada a una muestra aleatoria de 127 mujeres de la Universidad del Rosario pertenecientes a las facultades de Medicina y Psicología. Resultados: Se encontró una prevalencia de dismenorrea del 73%. El 67% de las participantes que presentaron dolor menstrual refirió tomar medicamentos para aliviar el dolor (66,7% automedicado). El 32,5% de las encuestadas con dismenorrea se han ausentado de sus labores académicas o sociales, con un porcentaje de ausentismo escolar a causa del dolor del 74,5%, en al menos un día. El riesgo de dismenorrea fue 2,36 veces mayor en las mujeres que tenían madres con este antecedente (OR =2,36 IC 95% 1,03-5,40). No se encontró asociación con los otros factores estudiados. Conclusiones: La dismenorrea es una enfermedad con una alta prevalencia y con impacto importante sobre el ausentismo académico. El antecedente materno de dismenorrea fue el único factor asociado positivamente en este estudio.

Introduction: Dysmenorrhea has a prevalence between 60 and 93%. Different factors have been associated such as age at menarche, body mass index, exercise, smoking and maternal history of dysmenorrhea among others. Materials and methods: A cross-sectional study was conducted, based on an anonymous survey applied to a random sample of 127 women from the school of medicine and psychology at the Universidad Del Rosario. Results: The prevalence of dysmenorrheal was 73%. 67% of participants presenting with menstrual pain, reported they have taken medication for pain relief, (66.7% self medicated). 32.5% of respondents with dysmenorrheal have been absent from their academic or social work, with a percentage of school absenteeism due to pain from 74.5% in at least one day. The risk of dysmenorrhoea was 2.36 times higher in women who had mothers with this history (OR = 2.36, 95% CI 1.03 to 5.40). No associations with other factors were found. Conclusions: Dysmenorrhea is a disease with a high prevalence and significant impact on school absenteeism. Maternal history of dysmenorrhea was the only factor positively associated in this study.

Introdução: A dismenorréia apresenta uma prevalência entre o 60% e o 93%. Tem-se descrito fatores associados como idade da menarquia, índice de massa corporal, atividade física, tabaquismo, antecedente de dismenorréia materna, entre outros. Materiais e métodos: se realizou um estudo de corte transversal, baseado em uma enquête anônima aplicada a uma amostra aleatória de 127 mulheres da Universidad del Rosario pertencentes às faculdades de Medicina e Psicologia. Resultados: Se encontrou uma prevalência de dismenorréia do 73%. O 67% das participantes que apresentaram dor menstrual preferiu tomar medicamentos para aliviar a dor (66,7% automedicado). O 32,5% das pesquisadas com dismenorréia tem se ausentado de seus trabalhos acadêmicos ou sociais, com uma porcentagem de absentismo escolar a causa da dor do 74,5%, em ao menos um dia. O risco de dismenorréia foi 2,36 vezes maior nas mulheres que tinham mães com este antecedente (OR =2,36 IC 95% 1,03-5,40). Não se encontrou associação com os fatores estudados. Conclusões: A dismenorréia é uma enfermidade com uma alta prevalência e com impacto importante cobre o absentismo acadêmico. O antecedente materno de dismenorréia foi o único fator associado positivamente neste estudo.