Clinical inertia in newly diagnosed type 2 diabetes mellitus among patients attending selected healthcare institutions in Colombia.

BACKGROUND: The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. OBJECTIVE: To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. METHODS: An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. RESULTS: A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86). CONCLUSIONS: In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

Factores preoperatorios de riesgo asociados a conversión a técnica abierta en colecistectomía laparoscópica de urgencia / Preoperative risk factors associated with conversion to open technique in emergency laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio, el 20 % de estos requieren conversión a técnica abierta. En este estudio se evaluaron los factores preoperatorios de riesgo para conversión en colecistectomía laparoscópica de urgencia. Metodología. Se llevó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de las variables de interés de los registros de las historias clínicas de los pacientes operados entre el 2013 y el 2016. Se identificaron los motivos de conversión de la técnica quirúrgica. Se caracterizó la población de estudio y se estimaron las asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron las posibles variables de confusión. Resultados. Se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5 %). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo clínico de Murphy positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano fueron los factores de riesgo para la conversión. Se encontró un área bajo la curva ROC de 0,743 (IC95% 0,692-0,794, p≤0,001). Discusión. Existen factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relaciona con un proceso inflamatorio avanzado, por lo que la intervención temprana y oportuna debe ser el estándar de manejo en el abordaje de pacientes con patología quirúrgica de la vesícula

Introduction: Laparoscopic cholecystectomy is the preferred technique for patients with indication for gallbladder extraction. Nevertheless, up to near 20% of them require conversion to open surgery. In this study we evaluated preoperative risk factors for conversion in patients undergoing emergency laparoscopic cholecystectomy. Methodology: a case-control unmatched study was conducted. Sociodemographic Information and other variables were obtained from the medical records of patients that underwent surgery in the period 2013 to 2016. Reasons for conversion were identified and the study population was characterized. Correlations tests were established and logistic regression was performed for evaluating the role of confounding factors. Results: we analyzed the medical records of 444 patients (111 cases and 333 controls). The most common reasons for conversion were technical difficulty (50,5%), older age, male sex, previous open upper abdominal surgery, Murphy´s sign, bile duct dilation, total white cell count >12.000/mm3 , and a more experienced surgeon. Area under COR was 0.743 (CI95% 0.692­0.794, p= <0.001). Discussion: some factors increase the risk for conversion to open surgery in laparoscopic cholecystectomy. Most of them are related to an advanced gallbladder inflammatory process, thus early and timely intervention should be the gold standard in the management of patients with surgical gallbladder pathology

Proximity of first sexual intercourse to menarche and risk of high-grade cervical disease.

BACKGROUND: We assessed if risk of developing cervical intraepithelial neoplasia grade 2/3 (CIN2/3) or adenocarcinoma in situ (AIS) is associated with a short interval between menarche and first sexual intercourse (FSI). METHODS: A total of 1009 Colombian and 1012 Finnish females, aged 16-23, who were enrolled in the phase 3 trials of a quadrivalent human papillomavirus (HPV) 6/11/16/18 vaccine had nonmissing data for age of menarche and FSI. The impact of menarche interval on the odds of developing CIN2-3/AIS was evaluated in placebo recipients who were DNA negative to HPV 6/11/16/18/31/33/35/39/45/51/52/56/58/59 and seronegative to HPV 6/11/16/18 at day 1, and had a normal Pap result at day 1 and month 7, thus approximating sexually naive adolescents (n = 504). RESULTS: The mean age of menarche and FSI was 12.4 and 16.0 years, respectively. Among the women approximating sexually naive adolescents, 18 developed CIN2-3/AIS. Compared with women who postponed FSI beyond 3 years of menarche, those with FSI within 3 years of menarche had a greater risk of cytologic abnormalities (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.02-2.68; P = .04) and CIN2-3/AIS (OR, 3.56; 95% CI, 1.02-12.47; P = .05). CONCLUSIONS: A short interval between menarche and FSI was a risk factor for cytologic abnormalities and high-grade cervical disease. These data emphasize the importance of primary prevention through education and vaccination. CLINICAL TRIALS REGISTRATION: NCT00092521 and NCT00092534.