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1.
Sleep Sci ; 13(2): 125-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742583

RESUMO

Objective: Poor sleep quality is a common problem in the general population, frequently associated with personal habits and comorbid conditions. University students may be a vulnerable population because of their daily routine, habits and sleep hygiene behavior. There are few related studies on this subject in Colombian undergraduates. The aim of this study is to characterize sleep quality in Colombian university undergraduates and examine possible associated factors. Methods: Cross-sectional study was performed with self-administered questionnaires including demographic data, lifestyle habits, sleep hygiene habits and sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). The study group included 414 students from different schools enrolled at the Pontificia Universidad Javeriana in Bogotá, Colombia. Results: Prevalence of poor sleep quality according to PSQI was 58.9%. Multivariate analysis showed an association of poor sleep quality with smoking (OR = 3.17 [1.51-6.66]) and eating in bed (OR = 2.13 [1.31-3.47]), with probable protective factors in sleeping at the same time (OR = 0.37 [0.25-0.59]) and having breakfast 5 or more days of the week (OR = 0.53 [0.31-0.91]). Discussion: Poor sleep quality is frequent among undergraduates, regardless of their area of study. The identification of possible related factors may help to design targeted preventive measures, as it is promoting healthy lifestyle habits, adequate sleep hygiene practices and avoiding tobacco use.

2.
Rev. chil. nutr ; 47(3): 503-511, jun. 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1126150

RESUMO

RESUMEN El objetivo de este estudio fue establecer la relación entre consumo habitual de café y la mortalidad general y cardiovascular. En una búsqueda sistemática en Medline, EMBASE, LILACS y Cochrane se seleccionaron y analizaron revisiones sistemáticas y meta-análisis por una pareja de investigadores. De 181 referencias, 74 fueron seleccionadas por título y resumen; luego de eliminar duplicados y según el puntaje de calidad obtenido por AMSTAR, se consideraron 5 artículos para extracción y análisis. El consumo moderado de café (3 o 4 tazas) disminuye la mortalidad general, tanto comparado con el no consumo (RR= 0,83; IC95%: 0,79-0,88; I2= 83% para 3 tazas, y RR=0,84 IC95%: 0,82-0,87; I2= 58% para 4), como con un consumo mínimo (RR= 0,88; IC95%: 0,84-0,93; I2= 68,7% para 4 tazas, y RR= 0,87; IC95%: 0,83-0,91; I2= 59,8% para consumo entre 3 y 4 tazas). La mortalidad cardiovascular se reduce si se compara con el no consumo, para 4 tazas (RR= 0,80; IC95%: 0,74-0,86; I2= 58%) y (RR= 0,83; IC95%: 0,75-0,92, I2 = 92%) y para 3 tazas (RR= 0,81; IC95%: 0,72-0,90; I2= 92%) y RR (0,79; IC95% 0.74-0.84; I2= 58%). Como conclusión, el consumo habitual de 3 y 4 tazas de café reduce la mortalidad general y cardiovascular.


ABSTRACT The objective of this study was to establish the relationship between habitual coffee consumption and all-cause and cardiovascular mortality. A systematic review was conducted using Medline, EMBASE, LILACS and Cochrane databases. Systematic reviews and meta-analysis were selected and analyzed. From 181 systematic reviews, 74 were selected by title and summary; after eliminating duplicates. According to the quality score of the AMSTAR tool, five articles were selected for information extraction and analysis. Moderate coffee consumption (3 or 4 cups) decreased overall mortality, compared to non-consumption (RR= 0.83, 95% CI: 0.79-0.88; I2= 83% for 3 cups, and RR= 0.84, 95% CI: 0.82-0.87; I2= 58% for 4 cups) and minimum consumption (RR= 0.88, 95% CI: 0.84-0.93; I2= 68.7% for 4 cups, and RR= 0.87, 95% CI: 0.83-0.91; I2= 59.8% between 3 and 4 cups). Cardiovascular mortality was reduced when compared to non-consumption, for 4 cups (RR= 0.80, 95% CI: 0.74-0.86; I2= 58%) and (RR= 0.83, 95% CI: 0.75-0.92; I2= 92%), and for 3 cups (RR= 0.81, 95 CI: 0.72-0.90; I2= 92%; RR= 0.79, 95% CI: 0.74-0.84; I2= 58%). In conclusion, habitual coffee consumption between 3 and 4 cups reduces the risk of all-cause and cardiovascular mortality.

3.
Biomedica ; 36(4): 612-619, 2016 Dec 01.
Artigo em Espanhol | MEDLINE | ID: mdl-27992988

RESUMO

INTRODUCTION: Methicillin-resistant Staphylococcus aureus is a frequent pathogen at critical care services. Its presence leads to increased hospital stays and mortality risk in patients with bacteremia. However, the etiology of this resistance marker has not been fully studied. OBJECTIVE: To identify risk factors associated with the emergence of methicillin-resistant S. aureus bacteremia in critically ill patients treated at intensive care units in Bogotá, Colombia. MATERIALS AND METHODS: We conducted a retrospective paired case-control study, nested in a cohort of patients diagnosed with S. aureus bacteremia and treated at intensive care units between 2006 and 2008 in Bogotá. Cases were patients with positive blood culture to methicillin resistance, matched in a 1:1 ratio with methicillin-sensitive controls isolated from the same institution and hospitalization year. We used conditional logistic regression to analyze the risk factors associated with the presence of resistance, with emphasis on prior antibiotic therapy. RESULTS: We included 372 patients with S. aureus bacteremia. Factors such as the use of pre-hospital devices: vascular (OR=1.986, 95% CI 1.038 to 3.801) and urinary (OR=2.559, 95% CI: 1.170 to 5.596), along with the number of previously used antibiotics, were associated with the emergence of resistance. The number of antibiotics used previously was determined to have a gradient effect, particularly carbapenems. CONCLUSIONS: The rational use of antibiotics and surveillance of exposure to surgical procedures or use of invasive devices are interventions that could diminish the emergence of methicillin-resistant S. aureus bacteremia causes.


Assuntos
Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Adulto , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Estudos de Casos e Controles , Colômbia/epidemiologia , Comorbidade , Estado Terminal , Infecção Hospitalar/microbiologia , Feminino , Hospitalização , Hospitais Públicos , Humanos , Hospedeiro Imunocomprometido , Unidades de Terapia Intensiva , Masculino , Staphylococcus aureus Resistente à Meticilina/fisiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Fatores de Risco , Fatores Sexuais , Infecções Estafilocócicas/microbiologia , Centros de Atenção Terciária
4.
Biomédica (Bogotá) ; 36(4): 612-618, dic. 2016. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-950927

RESUMO

Abstract Introduction: Methicillin-resistant Staphylococcus aureus is a frequent pathogen at critical care services. Its presence leads to increased hospital stays and mortality risk in patients with bacteremia. However, the etiology of this resistance marker has not been fully studied. Objective: To identify risk factors associated with the emergence of methicillin-resistant S. aureus bacteremia in critically ill patients treated at intensive care units in Bogotá, Colombia. Materials and methods: We conducted a retrospective paired case-control study, nested in a cohort of patients diagnosed with S. aureus bacteremia and treated at intensive care units between 2006 and 2008 in Bogotá. Cases were patients with positive blood culture to methicillin resistance, matched in a 1:1 ratio with methicillin-sensitive controls isolated from the same institution and hospitalization year. We used conditional logistic regression to analyze the risk factors associated with the presence of resistance, with emphasis on prior antibiotic therapy. Results: We included 372 patients with S. aureus bacteremia. Factors such as the use of pre-hospital devices: vascular (OR=1.986, 95% CI 1.038 to 3.801) and urinary (OR=2.559, 95% CI: 1.170 to 5.596), along with the number of previously used antibiotics, were associated with the emergence of resistance. The number of antibiotics used previously was determined to have a gradient effect, particularly carbapenems. Conclusions: The rational use of antibiotics and surveillance of exposure to surgical procedures or use of invasive devices are interventions that could diminish the emergence of methicillin-resistant S. aureus bacteremia causes.


Resumen Introducción. Staphylococcus aureus resistente a la meticilina es uno de los agentes patógenos más frecuentes en las unidades de cuidados intensivos. Su presencia prolonga las hospitalizaciones y aumenta el riesgo de mortalidad en los pacientes con bacteriemia. Sin embargo, la etiología de este marcador de resistencia no ha sido completamente estudiada. Objetivo. Determinar los factores asociados con la aparición de S. aureus resistente a la meticilina causante de bacteriemia en pacientes atendidos en unidades de cuidados intensivos en Bogotá. Materiales y métodos. Se hizo un estudio retrospectivo de casos y controles emparejados, anidado en una cohorte de pacientes con diagnóstico de bacteriemia por S. aureus atendidos en unidades de cuidados intensivos de Bogotá entre 2006 y 2008. Los casos fueron pacientes con hemocultivo positivo para resistencia a la meticilina, emparejados 1 a 1 con controles con hemocultivos sensibles a la meticilina de la misma institución y año de hospitalización. Se analizaron mediante regresión logística condicional los factores de riesgo asociados con la presencia de resistencia, con énfasis en el tratamiento previo con antibióticos. Resultados. Se incluyeron 372 pacientes con bacteriemia por S. aureus. Factores como el uso de dispositivos previos a la hospitalización: vasculares (Odds ratio, OR=1,986; IC95% 1,038-3,801) y urinarios (OR=2,559; IC95% 1,170-5,596), así como el número de antibióticos administrado previamente, se asociaron con la aparición de resistencia. Se registró un efecto de gradiente con el número de antibióticos usados previamente, especialmente carbapenémicos. Conclusiones. El uso racional de antibióticos y la vigilancia de la exposición a procedimientos quirúrgicos o al uso de dispositivos invasivos, son intervenciones que podrían disminuir la aparición de S. aureus resistente a meticilina causante de bacteriemia.

5.
Rev. colomb. cancerol ; 18(4): 186-196, oct.-dic. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-959862

RESUMO

Objetivos: El tratamiento actual de las neoplasias busca mejorar la sobrevivencia mediante la aplicación de esquemas de quimioterapia intensificada, que produce una neutropenia más profunda y duradera, que favorece el desarrollo de infecciones bacterianas y micóticas invasoras. Este artículo resume las recomendaciones de una guía para el diagnóstico y tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo. Métodos: Guía de práctica clínica basada en la evidencia. Se realizó la definición de preguntas clínicas, la búsqueda sistemática de literatura, la evaluación crítica de la evidencia y la formulación de recomendaciones. Se desarrolló una evaluación económica sobre la eficiencia de dos esquemas diferentes de tratamiento antimicótico. Resultados: El presente documento incluye recomendaciones para el diagnóstico de infecciones bacterianas y micóticas en paciente con neutropenia, el uso de profilaxis antibiótica y antimicótica, el tratamiento antibiótico empírico, y el tratamiento antimicótico empírico y anticipado en pacientes mayores de 15 años, acorde con la microbiología del contexto colombiano. Conclusiones: La implementación oportuna de las recomendaciones de la guía acorde con el contexto clínico de cada paciente debe contribuir a mejorar la supervivencia y morbilidad infecciosa de los pacientes con neutropenia febril derivada de la quimioterapia.


Objective: Current cancer treatment is intended to improve survival by implementing intensified chemotherapy strategies, which increases the likelihood of neutropenia and favors the development of bacterial and invasive fungal infections. This paper summarizes clinical practice guideline recommendations for the diagnosis and treatment of bacterial and fungal infections in patients older than 15 years with febrile neutropenia after high risk chemotherapy. Methods: Evidence-based clinical practice guideline. A set of clinical questions was defined, a literature search performed, critical appraisal of the evidence, as the development of recommendations. An economic assessment was carried out on two alternative schemes for fungal therapy. Results: This article includes recommendations for the diagnosis of bacterial and fungal infections in neutropenic patients, prophylaxis for bacterial and fungal infections, empiric antimicrobial treatment, empiric and anticipated antifungal therapy in patients over 15 years, according to the microbiology setting in Colombia. Conclusions: Timely implementation of these recommendations according to each clinical context, should contribute to improve survival and reduce infection-derived morbidity in patients with chemotherapy-induced febrile neutropenia.


Assuntos
Humanos , Adolescente , Pacientes , Tratamento Farmacológico , Neutropenia Febril Induzida por Quimioterapia , Infecções Fúngicas Invasivas , Micoses , Infecções Bacterianas , Antibioticoprofilaxia
6.
Biomedica ; 34 Suppl 1: 58-66, 2014 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-24968037

RESUMO

INTRODUCTION: Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. OBJECTIVE: To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. MATERIALS AND METHODS: A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. RESULTS: One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). CONCLUSION: Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Estado Terminal/mortalidade , Farmacorresistência Bacteriana Múltipla , Infecções por Pseudomonas/tratamento farmacológico , APACHE , Adulto , Idoso , Antibacterianos/administração & dosagem , Bacteriemia/mortalidade , Colômbia/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Infecções por Pseudomonas/mortalidade , Estudos Retrospectivos , Choque Séptico/etiologia , Choque Séptico/mortalidade , Centros de Atenção Terciária/estatística & dados numéricos , Falha de Tratamento
7.
Biomédica (Bogotá) ; 34(supl.1): 58-66, abr. 2014. graf, tab
Artigo em Espanhol | LILACS | ID: lil-712422

RESUMO

Introducción. La bacteriemia es una de las infecciones hospitalarias de mayor mortalidad, especialmente en las unidades de cuidados intensivos, donde es más frecuente. Pseudomonas aeruginosa es uno de los causantes de bacteriemia más agresivos. Objetivo. Evaluar la asociación entre el tratamiento antibiótico inicial y la mortalidad hospitalaria en estos pacientes. Materiales y métodos. Se trata de un estudio de cohorte retrospectivo multicéntrico realizado entre 2005 y 2008. Se consideró tratamiento adecuado aquel iniciado en las primeras 48 horas del diagnóstico que incluyera, al menos, una dosis de antibiótico intravenoso al que P. aeruginosa fuera sensible y hubiera sido suministrado en la dosis y frecuencia recomendadas. El desenlace principal fue la mortalidad hospitalaria en un lapso de 30 días. Se hizo pareo según grado de exposición usando índices de propensión y, posteriormente, análisis paramétrico de supervivencia. Resultados. Se incluyeron 164 pacientes. La mediana de edad y la clasificación del APACHE II ( Acute Physiology and Chronic Health Evaluation II ) fue de 56 y 13, respectivamente. Se identificó la fuente de la bacteriemia en 68,3 % de los casos, y la más frecuente fue el tracto respiratorio; 44 % de los pacientes recibió tratamiento inadecuado, y la resistencia bacteriana fue la principal variable asociada. La proporción de incidencia de sepsis grave, choque séptico, falla orgánica múltiple y muerte en el lapso de 30 días fue de 67,7, 50, 41,5 y 43,9 %, respectivamente. El tratamiento adecuado se asoció a una prolongación del tiempo hasta el evento (razón de tiempo ajustada, 2,95, IC 95%, 1,63 a 5,33). Conclusión. El tratamiento antibiótico inicial adecuado es un factor protector contra la mortalidad hospitalaria en pacientes con bacteriemia por P. aeruginosa .


Introduction: Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. Objective: To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. Materials and methods: A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. Results: One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). Conclusion: Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Estado Terminal/mortalidade , Farmacorresistência Bacteriana Múltipla , Infecções por Pseudomonas/tratamento farmacológico , APACHE , Antibacterianos/administração & dosagem , Bacteriemia/mortalidade , Colômbia/epidemiologia , Seguimentos , Mortalidade Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Infecções por Pseudomonas/mortalidade , Estudos Retrospectivos , Choque Séptico/etiologia , Choque Séptico/mortalidade , Falha de Tratamento , Centros de Atenção Terciária/estatística & dados numéricos
8.
Braz. j. infect. dis ; 17(3): 346-352, May-June 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-676872

RESUMO

OBJECTIVE: The aim of this study was to describe the most frequently found bacterial microorganisms in bloodstream isolates taken from patients in intensive care units in Colombia and their resistance profiles. METHODS: This was a multicentre descriptive observational study that was carried out between January 2001 and June 2008 with laboratory data from 33 participating hospitals in a surveillance network. RESULTS: The most frequently found microorganisms were coagulase-negative Staphylococci 39.6%, Staphylococcus aureus 12.3%, Klebsiella pneumoniae 8.2%, Escherichia coli 5.7%, Acinetobacter baumannii, 4.0% and Pseudomonas aeruginosa 3.8%. Coagulase-negative Staphylococci registered greater than 70% oxacillin resistance rate. S. aureus presented a change in its multiresistance profile during the years of follow-up. There was a trend towards a lower resistance rate among E. coli and K. pneumoniae isolates during the study period while A. baumannii carbapenem resistance rate exceeded 50%. DISCUSSION: There has been a change in the frequency of species being isolated with a higher frequency of enterobacteriaceae compared to Gram-positive microorganisms, in general with a high resistance rate.


Assuntos
Humanos , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Unidades de Terapia Intensiva/estatística & dados numéricos , Bacteriemia/epidemiologia , Colômbia/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/classificação , Bactérias Gram-Positivas/isolamento & purificação , Testes de Sensibilidade Microbiana , Vigilância da População
9.
Biomédica (Bogotá) ; 33(2): 186-204, abr.-jun. 2013. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: lil-689556

RESUMO

Introducción. El tabaquismo es el principal factor de riesgo para enfermedades crónicas que constituyen la mayor carga en Colombia. Objetivos. Generar recomendaciones de práctica clínica sobre eficacia y seguridad del tratamiento para la cesación de la adicción al tabaco en adultos colombianos. Materiales y métodos. Se hizo una adaptación basada en la metodología ADAPTE. Se buscaron guías de práctica clínica en Medline, EMBASE, CINAHL, LILACS y Cochrane. Se evaluó la cesación a seis meses para consejería breve e intensiva, terapia de reemplazo nicotínico, bupropión, vareniclina, clonidina, nortriptilina, acupuntura, hipnosis, homeopatía y la combinación de tratamientos. Se utilizó el German Instrument for Methodological Guideline Appraisal (DELBI) para evaluar las guías de prácticalínica. Se seleccionaron las guías con puntaje mayor de 60 % en rigor metodológico y aplicabilidad en Colombia. Las preguntas sin evidencia fuerte se llevaron a consenso. Resultados. Se encontraron 925 referencias, se preseleccionaron 17 guías de práctica clínica y se escogieron 5 para adaptación. La consejería breve e intensiva, la terapia de reemplazo nicotínico, el bupropión, la nortriptilina y la vareniclina son eficaces en la cesación de tabaquismo (incrementó 5,1 % a 22,7 %). Los tratamientos alternativos no tienen eficacia demostrada en la cesación. El uso simultáneo de diferentes formas de terapia de reemplazo nicotínico es la única combinación con eficacia demostrada (OR 1,9; 95%: 1,3-2,7). Conclusiones. Existen diversas alternativas con eficacia demostrada para dejar de fumar. Los incrementos en las tasas de cesación son variables y la duración del efecto necesita mayor seguimiento. Para aplicar la consejería breve e intensiva en Colombia, se deben usar formatos estándar. Se requieren evaluaciones económicas para valorar el impacto y seleccionar las mejores intervenciones en el contexto colombiano.


Introduction: Chronic diseases represent the greatest burden of disease in Colombia for which smoking is the major risk factor. Objectives: To provide clinical practice recommendations based upon efficacy and safety of smoking cessation therapies for Colombian adults. Materials and methods: An adaptation of clinical practice guidelines (CPG) based on the ADAPT methodology was performed. We searched CPG on Medline, EMBASE, CINAHL, LILACS, and Cochrane databases. Six months’ cessation rates were appraised for brief and intensive counseling, nicotine replacement therapy (NRT), bupropion, varenicline, clonidine, nortriptyline, acupuncture, hypnosis, homeopathy, and combined treatments. CPG were evaluated with DELBI and selected when having a score above 60% for methodological rigor of development and applicability to the Colombian health system. Formal consensus was performed for questions without strong evidence. Results: 925 references were found, 17 CPG were pre-selected and 5 selected for adaptation. Brief and intensive counseling, NRT, bupropion, nortriptyline, and varenicline are effective for smoking cessation (cessation rates augment 5.1%-22.7%). Alternative therapies have not demonstrated cessation efficacy. Concomitant use of different NRT is the only combination with demonstrated efficacy (OR 1.9, 95%CI 1.3-2.7). Conclusions: Several alternatives for giving up tobacco smoking have confirmed efficacy. The absolute difference in cessation rates is variable among therapies and duration of effect requires further research. Brief and intensive counseling necessitate standardized formats for their implementation in Colombia. Economic evaluations are required to assess costs and benefits and to select the most suitable interventions for Colombia.


Assuntos
Humanos , Abandono do Hábito de Fumar/métodos , Colômbia , Guias de Prática Clínica como Assunto
10.
Braz J Infect Dis ; 17(3): 346-52, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23683574

RESUMO

OBJECTIVE: The aim of this study was to describe the most frequently found bacterial microorganisms in bloodstream isolates taken from patients in intensive care units in Colombia and their resistance profiles. METHODS: This was a multicentre descriptive observational study that was carried out between January 2001 and June 2008 with laboratory data from 33 participating hospitals in a surveillance network. RESULTS: The most frequently found microorganisms were coagulase-negative Staphylococci 39.6%, Staphylococcus aureus 12.3%, Klebsiella pneumoniae 8.2%, Escherichia coli 5.7%, Acinetobacter baumannii, 4.0% and Pseudomonas aeruginosa 3.8%. Coagulase-negative Staphylococci registered greater than 70% oxacillin resistance rate. S. aureus presented a change in its multiresistance profile during the years of follow-up. There was a trend towards a lower resistance rate among E. coli and K. pneumoniae isolates during the study period while A. baumannii carbapenem resistance rate exceeded 50%. DISCUSSION: There has been a change in the frequency of species being isolated with a higher frequency of enterobacteriaceae compared to Gram-positive microorganisms, in general with a high resistance rate.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Unidades de Terapia Intensiva/estatística & dados numéricos , Bacteriemia/epidemiologia , Colômbia/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/classificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Vigilância da População
11.
Salud Publica Mex ; 55(2): 196-206, 2013 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-23546412

RESUMO

OBJECTIVE: A systematic review on efficacy and safety of smoking cessation counseling was developed. MATERIALS AND METHODS: The ADAPTE methodology was used with a search of Clinical Practice Guidelines (CPG) in Medline, EMBASE, CINAHL, LILACS, and Cochrane. DELBI was used to select CPG with score over 60 in methodological rigor and applicability to the Colombian health system. Smoking cessation rates at 6 months were assessed according to counseling provider, model, and format. In total 5 CPG out of 925 references were selected comprising 44 systematic reviews and meta-analyses. RESULTS: Physician brief counseling and trained health professionals' intensive counseling (individual, group, proactive telephone) are effective with abstinence rates between 2.1% and 17.4%. Only practical counseling and motivational interview were found effective intensive interventions. The clinical effect of smoking cessation counseling is low and long term cessation rates uncertain. CONCLUSION: Cost-effectiveness analyses are recommended for the implementation of counseling in public health programs.


Assuntos
Aconselhamento Diretivo , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Humanos
12.
Salud pública Méx ; 55(2): 196-206, mar.-abr. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-669726

RESUMO

OBJETIVO: Presentar los resultados de una revisión sistemática de la literatura médica sobre eficacia y seguridad de la consejería para cesación del tabaquismo. MATERIAL Y MÉTODOS: Se siguió la metodología ADAPTE buscando guías de práctica clínica (GPC) en Medline, EMBASE, CINAHL, LILACS y Cochrane. Mediante DELBI se seleccionaron GPC con puntaje mayor a 60 en rigor metodológico y aplicabilidad. Se evaluó la cesación a seis meses según proveedor, modelo y formato de consejería. De 925 referencias se seleccionaron cinco GPC que incluyen 44 revisiones sistemáticas y metaanálisis. RESULTADOS La consejería breve por médicos y la intensiva por profesionales capacitados (individual, grupal, telefónica proactiva) son eficaces con incremento en la abstinencia de 2.1 a 17.4%. Únicamente el consejo práctico y la entrevista motivacional tienen eficacia en consejería intensiva. El efecto clínico es pequeño y la duración del efecto incierta. CONCLUSIÓN: Se requieren evaluaciones económicas para su implementación en programas de salud pública.


OBJECTIVE: A systematic review on efficacy and safety of smoking cessation counseling was developed. MATERIALS AND METHODS: The ADAPTE methodology was used with a search of Clinical Practice Guidelines (CPG) in Medline, EMBASE, CINAHL, LILACS, and Cochrane. DELBI was used to select CPG with score over 60 in methodological rigor and applicability to the Colombian health system. Smoking cessation rates at 6 months were assessed according to counseling provider, model, and format. In total 5 CPG out of 925 references were selected comprising 44 systematic reviews and metaanalyses. RESULTS: Physician brief counseling and trained health professionals' intensive counseling (individual, group, proactive telephone) are effective with abstinence rates between 2.1% and 17.4%. Only practical counseling and motivational interview were found effective intensive interventions. The clinical effect of smoking cessation counseling is low and long term cessation rates uncertain. CONCLUSION: Cost-effectiveness analyses are recommended for the implementation of counseling in public health programs.


Assuntos
Humanos , Aconselhamento Diretivo , Abandono do Hábito de Fumar/métodos , Fumar/prevenção & controle
13.
Biomedica ; 33(2): 186-204, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-24652129

RESUMO

INTRODUCTION: Chronic diseases represent the greatest burden of disease in Colombia for which smoking is the major risk factor. OBJECTIVES: To provide clinical practice recommendations based upon efficacy and safety of smoking cessation therapies for Colombian adults. MATERIALS AND METHODS: An adaptation of clinical practice guidelines (CPG) based on the ADAPT methodology was performed. We searched CPG on Medline, EMBASE, CINAHL, LILACS, and Cochrane databases. Six months' cessation rates were appraised for brief and intensive counseling, nicotine replacement therapy (NRT), bupropion, varenicline, clonidine, nortriptyline, acupuncture, hypnosis, homeopathy, and combined treatments. CPG were evaluated with DELBI and selected when having a score above 60% for methodological rigor of development and applicability to the Colombian health system. Formal consensus was performed for questions without strong evidence. RESULTS: 925 references were found, 17 CPG were pre-selected and 5 selected for adaptation. Brief and intensive counseling, NRT, bupropion, nortriptyline, and varenicline are effective for smoking cessation (cessation rates augment 5.1%-22.7%). Alternative therapies have not demonstrated cessation efficacy. Concomitant use of different NRT is the only combination with demonstrated efficacy (OR 1.9, 95%CI 1.3-2.7). CONCLUSIONS: Several alternatives for giving up tobacco smoking have confirmed efficacy. The absolute difference in cessation rates is variable among therapies and duration of effect requires further research. Brief and intensive counseling necessitate standardized formats for their implementation in Colombia. Economic evaluations are required to assess costs and benefits and to select the most suitable interventions for Colombia.


Assuntos
Abandono do Hábito de Fumar/métodos , Colômbia , Humanos , Guias de Prática Clínica como Assunto
14.
Rev. colomb. cancerol ; 16(4): 227-233, dic. 2012. tab, graf
Artigo em Espanhol | LILACS | ID: lil-669009

RESUMO

Objetivos: Describir las características clínicas y epidemiológicas de los pacientes con cáncer de colon metastásico a quienes se les administró bevacizumab en el Instituto Nacional de Cancerología (INC). Métodos: Se revisaron 38 historias clínicas de pacientes atendidos en la consulta de Oncología Clínica del INC con diagnóstico de cáncer colorrectal metastásico entre 2010 y 2011. Resultados: La edad promedio de los pacientes que recibieron bevacizumab fue de 57 años; los principales sitios de metástasis fueron el hígado y el peritoneo. Los esquemas de quimioterapia utilizados más a menudo con bevacizumab fueron 5 fluoruracilo/leucovorina y FOLFOX. En relación con los eventos adversos por el uso de bevacizumab, este fue, en general, bien tolerado; la supervivencia mediana global de los pacientes tratados con bevacizumab fue de 17,5 meses. Conclusiones: Esta serie de casos describe las características generales de pacientes en la consulta externa del INC con cáncer colorrectal metastásico, los cuales tuvieron una buena adherencia al tratamiento con bevacizumab, y su uso estuvo asociado a una baja toxicidad con los diferentes esquemas de quimioterapia utilizados en cáncer colorrectal metastásico.


Objectives: To describe the clinical and epidemiolgical features of patients with metastatic colon cancer treated with bevacizumab at the National Cancer Institute of Colombia (NCI). Methods: Review was undertaken on 38 clinical cases of patients diagnosed for metastatic colorectal cancer and treated at the NCI Oncology Clinic from 2010 to 2011. Results: Median patient age when treated with bevacizumab was 57 years; most frequent metastatic sites were the liver and peritoneum. Most commonly used chemotherapy regimen with bevacizumab included 5 fluoruracil/leucovorin and FOLFOX. Bevacizumab was generally well tolerated, with few adverse events reported; median survival rate for patients treated with bevacizumab was 17.5 months. Conclusions: Analysis on this series of medical cases describes the general characteristics of patients treated at the NCI for metastatic colorrectal cancer whose favorable adherence to treatment with bevacizumab was linked to the low toxicity of diverse chemotherapy regimens used for metastatic colorectal cancer.


Assuntos
Humanos , Adulto , Neoplasias do Colo , Metástase Neoplásica , Colômbia , Tratamento Farmacológico/métodos
15.
Gac Med Mex ; 148(5): 457-66, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23128887

RESUMO

BACKGROUND: smoking is a chronic disease in the group of addictions and its treatment includes two components:psychosocial and pharmacological intervention. Other types of therapeutic approaches have been used as treatment options for tobacco addiction. Acupuncture, hypnosis and homeopathy are the most used nonconventional interventions. OBJECTIVE: review the available evidence in regards to the use of alternative therapies for smoking cessation in the adult population from the published clinical practice guidelines (CPG). METHODS: we performed an adaptation process of clinical recommendations from a systematic review of the literature specifically related to the use of alternative therapies for smoking cessation. RESULTS: we found 925 references, 9 were pre-screened and selected 5 CPG for adaptation.Acupuncture and related techniques do not improve abstinence rates compared to the placebo effect. There is insufficient evidence to recommend the use of hypnosis as a therapy for smoking cessation. There is no evidence that justifies the use of homeopathic medicines for the treatment of smoking. CONCLUSIONS: alternative therapies have not demonstrated efficacy in cessation. It is recommended to use other treatment options with proven efficacy for smoking cessation.


Assuntos
Abandono do Hábito de Fumar/métodos , Fumar/terapia , Terapia por Acupuntura , Terapias Complementares , Humanos , Hipnose , Guias de Prática Clínica como Assunto
16.
Biomedica ; 31(1): 27-34, 2011 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22159481

RESUMO

INTRODUCTION: Bacterial resistance is a public health problem worldwide whose proper management requires knowledge of its presence and its behavior in each region and country. OBJECTIVES: A survey of the medical literature was conducted to identify levels of resistance to antibiotic markers in Gram positive bacterial isolates from Colombian hospitals. MATERIALS AND METHODS: A systematic review of the literature included articles indexed in MEDLINE and LILACS. A manual search was made of Colombian scientific journals and other infectious disease literature not available electronically. RESULTS: A total of 34 observational studies were located, including a series of consecutive reports initiated in 2001. Most of the reports came from the city of Bogota. The rate of methicillin resistance for Staphylococcus aureus and coagulase-negative staphylococci in non intensive care unit isolates ranged between 35%-50% and 72%-76%, respectively. Resistance in intensive care unit isolates had a range between 35%-71% and 74%-83%, respectively. The rate of vancomycin-resistant Enterococcus faecium averaged less than 20% over the years but with large annual variation . CONCLUSIONS: Resistance markers appeared in high frequency among Gram positive isolates identified in hospitals in major Colombian cities.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/fisiologia , Antibacterianos/uso terapêutico , Colômbia , Bases de Dados Factuais , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/isolamento & purificação , Hospitais , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Saúde Pública
17.
Rev Chilena Infectol ; 28(5): 423-8, 2011 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-22051618

RESUMO

UNLABELLED: Candidemia is a disease with high morbidity and mortality especially in critical care patients. Early diagnosis enables early treatment. OBJECTIVES: To conduct a systematic review of the literature in order to establish the best laboratory tests for the diagnosis of candidemia in critical patients. MATERIALS AND METHODS: We conducted a systematic review of available literature in PubMed. Serological studies were subjected to meta-analysis in metadisk-Beta 1.1.1. RESULTS: 4 studies of 1286 reviewed were included. Three were about serological tests and one about molecular testing (RT-PCR). The sensitivity and specificity for RT-PCR, antibody testing and antigen and antibody tests were 87% and 100%, 47.5% and 82.6%, 96% and 81%, respectively. Diagnostic Odds Ratio of antigenemia was 1.51 (95% CI = 0,032-70,964, p = 0.001). CONCLUSIONS: RT-PCR has better diagnostic performance, measuring antigenemia plus antibodies improves sensitivity, specificity, LR + and LR-- . There is insufficient evidence to support this.


Assuntos
Candidemia/diagnóstico , Infecção Hospitalar/diagnóstico , Anticorpos Antifúngicos/sangue , Antígenos de Fungos/sangue , Candida/genética , Candida/imunologia , Estado Terminal , Infecção Hospitalar/microbiologia , Humanos , Unidades de Terapia Intensiva , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade
18.
Rev. chil. infectol ; 28(5): 423-428, oct. 2011. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-603080

RESUMO

Candidemia is a disease with high morbidity and mortality especially in critical care patients. Early diagnosis enables early treatment. Objectives: To conduct a systematic review of the literature in order to establish the best laboratory tests for the diagnosis of candidemia in critical patients. Materials and Methods: We conducted a systematic review of available literature in PubMed. Serological studies were subjected to meta-analysis in metadisk-Beta 1.1.1. Results: 4 studies of 1286 reviewed were included. Three were about serological tests and one about molecular testing (RT-PCR). The sensitivity and specificity for RT-PCR, antibody testing and antigen and antibody tests were 87 percent and 100 percent, 47.5 percent and 82.6 percent, 96 percent and 81 percent, respectively. Diagnostic Odds Ratio of antigenemia was 1.51 (95 percent CI = 0,032-70,964, p = 0.001). Conclusions: RT-PCR has better diagnostic performance, measuring antigenemia plus antibodies improves sensitivity, specificity, LR + and LR-- . There is insufficient evidence to support this.


La candidemia es una patología con alta morbilidad y mortalidad, especialmente en los pacientes sometidos a servicios de cuidado crítico. El diagnóstico precoz permite realizar tratamiento temprano. Objetivos: Realizar una revisión sistemática de la literatura para establecer cuáles son las pruebas de laboratorio con mejor rendimiento diagnóstico y operativo para el diagnóstico de candidemia en cuidado intensivo. Materiales y Métodos: Se realizó una revisión sistemática de la literatura disponible en PubMed, se sometieron a meta-análisis estudios de pruebas serológicas en MetaDisc-Beta 1.1.1. Resultados: Se incluyeron 4 estudios de 1.286 revisados, 3 de pruebas serológicas y 1 de RPC-RT. La sensibilidad y especificidad fue de 87 y 100 por ciento para RPC-RT, 47,5 y 82,6 por ciento para pruebas de anticuerpos, 96 y 81 por ciento para pruebas de antígeno y anticuerpo. La ORD de antigenemia 1,51(IC95 por ciento = 0,03270,964; p = 0,001). Conclusiones: RPC-RT tiene mejor rendimiento diagnóstico, la medición de antigenemia más anticuerpos mejora la sensibilidad, especificidad, LR+ y LR-. No hay suficiente evidencia que soporte esto.


Assuntos
Humanos , Candidemia/diagnóstico , Infecção Hospitalar/diagnóstico , Anticorpos Antifúngicos/sangue , Antígenos de Fungos/sangue , Estado Terminal , Candida/genética , Candida/imunologia , Infecção Hospitalar/microbiologia , Unidades de Terapia Intensiva , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade
19.
Infectio ; 15(1): 25-32, mar. 2011. ilus, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-635673

RESUMO

Staphylococcus aureus es una de los principales causas de infección de pacientes en estado crítico. La información de vigilancia muestra 32,9 % de resistencia a la meticilina y una frecuencia de aislamiento como causante de infección de 12,15 % en las unidades de cuidados intensivos, especialmente infecciones del torrente sanguíneo. No se encontraron artículos de síntesis de de los datos sobre el impacto de la resistencia de esta bacteria en la mortalidad de los pacientes gravemente comprometidos. Esta revisión de la literatura resume los estudios de pronóstico sobre la infección del torrente sanguíneo por S. aureus resistente a meticilina (SARM) en pacientes de la unidad de cuidados intensivos. Se incluyeron los artículos que evaluaron la mortalidad por bacteriemias primarias o secundarias, comparándola con controles sensibles a la meticilina o infectados por otra bacteria. No se incluyeron estudios con bacteriemias polimicrobianas. De 387 referencias, seis estudios cumplieron los criterios de inclusión. Los datos disponibles no permiten generar una conclusión sobre la mortalidad relacionada con SARM en la unidad de cuidados intensivos. Los análisis bivariados muestran un incremento de la mortalidad, el cual tiende a desaparecer cuando se controla por otras variables, como el tratamiento inicial apropiado y la gravedad del cuadro clínico. La participación de este microorganismo en la mortalidad de pacientes de la unidad de cuidados intensivos y sus determinantes, permanecen aún sin explicar.


Staphylococcus aureus is an important infectious pathogen in critically ill patients. Local surveillance shows its isolation as infectious causative pathogen at intensive care units in 12.15% of cases and a methicillin resistance rate of 32.9%, specially related with bloodstream infections. This review summarizes available prognosis studies related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections at intensive care unit (ICU). References with primary or secondary bacteremia patients compared with susceptible pathogen controls or different pathogen were included. Polymicrobial bacteremias were not included. 387 references were retrieved, only six studies met the inclusion criteria. The available evidence does not support a definitive conclusion about MRSA-related mortality in ICU. Increased mortality registered in bivariate analysis disappears when other covariates as appropriate initial therapy and baseline severity are adjusted. The involvement of this marker in ICU patient´s mortality and their prognosis determinants still remain unexplained.

20.
Biomédica (Bogotá) ; 31(1): 27-34, mar. 2011. ilus, mapas, graf, tab
Artigo em Espanhol | LILACS | ID: lil-617510

RESUMO

Introducción. La resistencia bacteriana es un problema de salud pública a nivel mundial, cuyo adecuado manejo implica el conocimiento de su presencia y comportamiento en cada uno de los países y regiones del mundo.Objetivos. Describir el perfil de resistencia a los distintos antimicrobianos marcadores en microorganismos Gram positivos identificados en hospitales colombianos.Materiales y métodos. Se realizó una revisión sistemática de la literatura indexada en Medline y Lilacs, además de la búsqueda manual de todos los números en revistas colombianas reconocidas y afines a la infectología para identificar referencias no disponibles electrónicamente.Resultados. De 34 estudios observacionales, sólo se cuenta con reportes consecutivos en años a partir del 2001, estos principalmente para Bogotá. La tasa de resistencia a la meticilina de Staphylococcus aureus y estafilococos coagulasa negativos en Bogotá, de aislamientos en servicios diferentes a la unidad de cuidados intensivos, oscilan de 35 % a 50 % y de 72 % a 76 %, respectivamente; en aislamientos de la unidad de cuidados intensivos, la resistencia osciló de 35 % a 71 % y de 74 % a 83 %, respectivamente. La tasa de resistencia a vancomicina para Enterococcus faecium en Bogotá es menor de 20 % con variaciones muy grandes con el paso de los años. Conclusiones. Hay una alta resistencia a los antibióticos marcadores en los aislamientos de Gram positivos identificados en hospitales de las principales ciudades colombianas.


Introduction. Bacterial resistance is a public health problem worldwide whose proper management requires knowledge of its presence and its behavior in each region and country. Objectives. A survey of the medical literature was conducted to identify levels of resistance to antibiotic markers in Gram positive bacterial isolates from Colombian hospitals. Materials and methods. A systematic review of the literature included articles indexed in MEDLINE and LILACS. A manual search was made of Colombian scientific journals and other infectious disease literature not available electronically. Results. A total of 34 observational studies were located, including a series of consecutive reports initiated in 2001. Most of the reports came from the city of Bogota. The rate of methicillin resistance for Staphylococcus aureus and coagulase-negative staphylococci in non intensive care unit isolates ranged between 35%-50% and 72%-76%, respectively. Resistance in intensive care unit isolates had a range between 35%-71% and 74%-83%, respectively. The rate of vancomycin-resistant Enterococcus faecium averaged less than 20% over the years but with large annual variation . Conclusions. Resistance markers appeared in high frequency among Gram positive isolates identified in hospitals in major Colombian cities.


Assuntos
Resistência Microbiana a Medicamentos , Enterococcus , Cocos Gram-Positivos , Testes de Sensibilidade Microbiana , Staphylococcus , Vigilância Sanitária
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