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Reumatol. clín. (Barc.) ; 16(4): 286-289, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET6-427


OBJETIVO: Calcular la prevalencia y describir las principales características demográficas del síndrome de Sjögren en Colombia. MATERIAL Y MÉTODOS: Estudio descriptivo de corte transversal en el que se tomaron los datos del Sistema Integral de Información de la Protección Social del Ministerio de Salud de Colombia, durante los años 2012 a 2016. RESULTADOS: Se identificaron 58.680 casos, calculándose una prevalencia en mayores de 18 años de 0,12%. El 82% son mujeres, con una relación mujer:hombre de 4,6:1, con prevalencia mayor entre el grupo etario de 65 a 69 años. Los departamentos con mayor número de casos son Bogotá DC (24.885), Antioquia (9.040) y Valle del Cauca (5.277), sin embargo, los departamentos con mayor prevalencia fueron Caldas (0,42%), Bogotá DC (0,32%) y Antioquia (0,14%). CONCLUSIONES: Se presenta información demográfica y epidemiológica del síndrome de Sjögren en Colombia. Existen muy pocos estudios epidemiológicos de esta enfermedad, sin embargo, se documentó una prevalencia similar a la reportada a países de la región como Brasil (0,17%) y Argentina (0,17%)

OBJECTIVE: To calculate the prevalence and describe the main demographic characteristics of Sjögren's syndrome in adults in Colombia. MATERIAL AND METHODS: Descriptive cross-sectional study which utilized data from the Integral Information System of Social Protection of the Ministry of Health of the Republic of Colombia during the years 2012 to 2016. RESULTS: 58,680 cases of Sjögren's syndrome were identified, with a prevalence in those over 18 years of age of 0.12%; 82% were women, with a female:male ratio of 4.6:1, with a higher prevalence in the age group of 65 to 69 years. The departments with the highest numbers of cases were Bogotá DC (24,885), Antioquia (9,040) and Valle del Cauca (5,277); however, the departments with the highest prevalences were Caldas (0.42%), Bogotá DC (0.32%) and Antioquia (0.14%). CONCLUSIONS: We present demographic and epidemiological information on Sjögren's syndrome in Colombia. There are very few epidemiological studies of this disorder. However, a prevalence similar to that reported in countries of the region such as Brazil (0.17%) and Argentina (0.17%) was documented

Dermatol Ther ; : e14135, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32761749


The current systematic review aimed to evaluate the efficacy and safety of dabrafenib plus trametinib (dabrafenib-trametinib) with those of other therapeutic alternatives in the treatment of patients with BRAF V600 mutation unresectable or metastatic melanoma. The search was carried out on four databases up to July-2018. Two separate network meta-analyses (NMA) were performed using the frequentist method (random effects): one with an exclusive population with BRAF V600 mutation (NMA-pBRAFV600) and another with a mixed population (with or without the mutation: NMA-pMixed). An evidence profile was included using the GRADE method for NMA. The validity of the final estimator in the NMA-pMixed was assessed via sensitivity analysis. Five clinical trials were included in the NMA-pBRAFV600. In the NMA-pBRAFV600 population, dabrafenib-trametinib had a favorable effect on overall survival (OS) and progression-free survival (PFS) compared with dabrafenib, vemurafenib, and dacarbazine, and on partial response rate (PRR) and overall response rate (ORR) compared with dacarbazine and vemurafenib. In the NMA-pMixed population, dabrafenib-trametinib had a positive effect on OS vs ipilimumab 3 mg/kg and on PFS and PRR vs ipilimumab (3 and 10 mg/kg), nivolumab, and pembrolizumab. However, dabrafenib-trametinib, and vemurafenib-cobimetinib were comparable in terms of clinical efficacy. In addition, dabrafenib-trametinib was associated with less grades 3 and 4 adverse events.

J Prev Med Public Health ; 53(4): 266-274, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32752596


OBJECTIVES: Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. METHODS: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. RESULTS: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). CONCLUSIONS: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Value Health Reg Issues ; 23: 37-48, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32688214


OBJECTIVES: To characterize at a global level the concept of therapeutic value (TV) and describe the experience of value-based pricing (VBP) policies in 6 reference countries. METHODS: We conducted a rapid review of the literature that addressed 2 exploratory research questions. A systematic and exhaustive search was carried out up to July 2018 in MEDLINE (Ovid), Embase, Scopus, and Web of Science. RESULTS: The concepts of TV and VBP are related; value frameworks for medicines should include social preferences, comparative effectiveness, safety, adoption viability, social impact, high quality of evidence, severity of illness, and innovation. The added therapeutic value (ATV) is the manner of measuring the therapeutic advantages of new medicines compared with existing ones in terms of comparative effectiveness and safety. There are variations in the mechanisms of reimbursement and drug pricing regulation between the countries of study. CONCLUSION: In a VBP system it is essential to establish the TV and ATV of a new medicine. Although there are no methodological guidelines for the implementation of VBP policies, the process implies from the beginning the definition of TV categories that will be included in the drug pricing and reimbursement systems. Agreements between the pharmaceutical industry and governments have become a useful tool as a negotiating mechanism in most countries.

Iatreia ; 33(2): 167-176, abr.-jun. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1114788


SUMMARY Epilepsy is a common neurological disorder that affects approximately 1% of the world's pop7u-lation. About one third of those patients suffer from treatment-resistant epilepsy (TRE8), defined as failure to stop seizures despite adequate trials of at least two medications at therapeutic dosa-ges. There has been a growing interest in the development of novel antiepileptic drugs with diffe-rent mechanisms of action. This narrative review, based on 42 references retrieved from Scopus and Medline, discusses the scientific data from human and animal studies regarding the efficacy of cannabis-based treatment for epilepsy. Benefits have been described in preclinical and cli-nical studies in children, but ongoing research will clarify the real role of cannabinoids in TRE.

RESUMEN La epilepsia es un desorden neurológico común que afecta aproximadamente al 1% de la pobla-ción mundial. Alrededor de un tercio de los pacientes sufren de epilepsia resistente al tratamiento, que se define como la falla de parar las crisis epilépticas a pesar de haber recibido tratamiento con dos medicamentos a dosis terapéuticas. Se ha visto interés en el desarrollo de medicamentos antiepilépticos con dife-rentes mecanismos de acción. Esta revisión narrativa se basó en 42 referencias extraídas de Scopus y Medli-ne, que discuten hallazgos científicos sobre estudios en humanos y animales acerca de la eficacia del cannabis para el tratamiento de epilepsia. Los beneficios se des-cribieron en estudios preclínicos y clínicos en niños, sin embargo investigaciones en curso clarificarán el papel real de los cannabinoides para la epilepsia resistente al tratamiento.

Artigo em Inglês | MEDLINE | ID: mdl-32498573


OBJECTIVE: To estimate the cost-effectiveness of sequences starting with tyrosine kinase inhibitors (TKI), afatinib and osimertinib, for the treatment of epidermal growth factor receptor (EGFR) mutation-positive (Exon 19 deletion or L858R) non-small cell lung cancer (NSCLC), stages IIIB - IV in Colombia. METHODS: A partitioned survival model was designed, using information from global and progression-free survival curves. For first and second-generation TKI, second line treatment was assumed according to the presence of T790M mutation to define the use of osimertinib or chemotherapy. The cost of the states without progression and post-progression was estimated using the base case approach, identified through consultation with clinical experts. RESULTS: The cost of treatment starting with afatinib in the first line was of 222,247 USD (1 USD = 3171.99 COP) and produced 1.36 QALYs. The strategy with afatinib was dominant with respect to that of first line TKI (227,289 USD and 1.34 QALY). The strategy with osimertinib resulted in more QALYs and higher costs, with ICERs of 35,062 USD, exceeding the current willingness to pay threshold for Colombia. CONCLUSIONS: Treatment starting with afatinib in the first line is dominant with respect to the strategy with first line TKI. The ICER of osimertinib sequence exceeds the threshold when compared with afatinib one.

Infectio ; 24(1): 9-14, ene.-mar. 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1090537


Abstract Objective: To evaluate the cost-effectiveness of ceftolozane/tazobactam + metronidazole (C/T+M) and ceftolozane/tazobactam (C/T) compared with 8 alternatives used in the treatment of complicated intraabdominal infection (cIAI) and complicated urinary tract infection (cUTI) respectively. Methods: A Monte Carlo simulation decision model was used for the estimation and comparison of treatment-related costs, and quality adjusted life years for patients with cIAI treated with C/T+M in comparison with cefepime + metronidazole, ciprofloxacin + metronidazole, doripenem, levofloxacin + metronidazole, meropenem, piperacillin/tazobactam, ceftazidime + metronidazole or imipenem/cilastatin and patients with cUTI treated with C/T in comparison with cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin. Local costs were estimated using base cases identified by experts and consulting local databases. Sensitivity values of the PACTS (Program to Assess Ceftolozane/Tazobactam Susceptibility) study in Latin America were used in the model. Results: C/T+M and C/T obtained incremental cost-effectiveness ratios (ICER) that were below the Colombian cost-effectiveness threshold (3 GDP per capita) in most comparisons, and were dominated by meropenem, considering only gram-negative microorganisms. Sensitivity assessments were also carried out, in which only the population with P. aeruginosa infections was considered, showing positive results for C/T+M and C/T (cost-effective or dominant with regards to all comparators). Conclusions: C/T+M and C/T could be cost-effective alternatives in the treatment of CIAI and CUTI in Colombia, when there is an adequate and rational use of antibiotics. The results of the sensitivity analyses showed dominance and cost-effectiveness with regards to every comparator in patients infected with P. aeruginosa

Resumen Objetivo: Evaluar la costo-efectividad de ceftolozano/tazobactam + metronidazol (C/T + M) y ceftolozano/tazobactam (C/T) en comparación con 8 alternativas utilizadas en el tratamiento de las infecciones intraabdominales complicadas (IAAc) e infecciones del tracto urinario complicadas (ITUc) respectivamente. Métodos: Se usó un modelo de decisión de simulación de Monte Carlo para la estimación y comparación de los costos relacionados con el tratamiento y los años de vida ajustados por calidad para pacientes con IAAc tratados con C/T + M, en comparación con cefepima + metronidazol, ciprofloxacina + metronidazol, doripenem , levofloxacina + metronidazol, meropenem, piperacilina / tazobactam, ceftazidima + metronidazol o imipenem/cilastatina, y pacientes con ITUc tratados con C/T en comparación con cefepime, ciprofloxacina, doripenem, levofloxacina, meropenem, piperacilina / tazobactam, ceftazidima o imipenem/cilastatina . Los costos locales se estimaron por medio de casos base identificados por expertos y consultando bases de datos locales. Se utilizaron los valores de sensibilidad bacteriana del estudio PACTS (Programa para evaluar la susceptibilidad al ceftolozano/tazobactam) en América Latina para poblar el modelo. Resultados: C/T + M y C/T obtuvieron razones de costo-efectividad incrementales (RCEI) que estaban por debajo del umbral de costo-efectividad colombiano (3 PIB per cápita) en la mayoría de las comparaciones, y fueron dominados por meropenem, considerando solo microorganismos gran-negativos También se llevaron a cabo análisis de sensibilidad, en los que solo se consideró la población con infecciones por P. aeruginosa, mostrando resultados positivos para C/T + M y C/T (costo efectivo o dominante con respecto a todos los comparadores). Conclusiones: C/T + M y C/T podrían ser alternativas costo efectivas en el tratamiento de IAAc e ITUc en Colombia, cuando existe un uso adecuado y racional de antibióticos. Los resultados de los análisis de sensibilidad mostraron dominio y costo-efectividad en relación con todos los comparadores en pacientes infectados con P. aeruginosa.

Artigo em Inglês | MEDLINE | ID: mdl-31967209


Rabies encephalitis is a fatal zoonotic viral disease transmitted to humans either by domestic animals like dogs and cats or by wild animals like bats, skunks and raccoons. We present the case of a 25-year-old woman admitted due to behavioral disorders, generalized paresthesiasand acute respiratory deterioration compatible with a respiratory distress syndrome (ARDS) requiring orotracheal intubation, mechanical ventilation and empirical initiation of antibiotic and antiviral therapy. Chest tomography showed pneumomediastinum and changes suggestive of pulmonary infection. In the presence of neurological symptoms, a central nervous system (CNS) infection was suspected and the cerebrospinal fluid showed no pleocytosis, hiperproteinorrachy without glucose consumption; cranial CT scan was normal. During hospitalization, the family reported that the patient was bitten by a cat 30-day prior to the onset of rabies-like symptoms, and the animal was sacrificed. The patient had an unfavorable clinical evolution, with electroencephalographic activity dissociation evidenced by video telemetry. The zoonotic exposure led to the suspected diagnosis of rabies infection. The patient died and the suspected diagnosis was confirmed by histopathology, with presence of Negri bodies on cerebellum Purkinje cells and a positive immunofluorescence test for rabies virus. Both, initial extra-neural manifestations and late reporting of rabies exposure led to delayed diagnosis.

Mordeduras e Picadas/complicações , Encefalite/virologia , Raiva/complicações , Adulto , Animais , Gatos , Evolução Fatal , Feminino , Humanos , Raiva/transmissão
Value Health Reg Issues ; 23: 13-18, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31999987


OBJECTIVES: Multiple sclerosis (MS) is a degenerative neurological disorder. Treatment aims to avoid relapses and disability progression. The purpose of this study was to evaluate the cost-effectiveness of natalizumab compared with fingolimod for treating highly active relapsing-remitting MS (RRMS) patients from the Colombian third-party payer perspective. METHODS: We used a Markov economic model from the perspective of the Colombian healthcare system to estimate the cost-effectiveness of natalizumab compared with fingolimod for RRMS with high disease activity or failure of interferons as first-line therapy. This model was centered on disability progression and relapses. We considered a 5-year time horizon with a 5% discount rate. We included only direct medical costs. Local experts were consulted to obtain resource utilization estimates, and local standardized costing methodologies and sources were used. Outcome was considered in terms of quality-adjusted life-years (QALYs). Utilities were extracted or calculated from the literature. Transition probabilities were calculated from available efficacy and safety information (1 USD = 3050.98 COP). RESULTS: Natalizumab showed lower total costs (USD 80 024 vs USD 98 137) and higher QALY yield (3.01 vs 2.94) than fingolimod, dominating it (incremental cost-effectiveness ratio = -$1861). Univariate sensitivity analysis showcased the relevance of the measures of effect on disability progression for natalizumab on model results. Probabilistic sensitivity analysis replicated base-case results in most simulations. CONCLUSIONS: This study showed that natalizumab dominated fingolimod with lower costs and higher QALYs in patients with high-activity RRMS. These results are consistent with previous published international literature.

Rheumatol Int ; 40(1): 17-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31659428


To estimate prevalence and describe the main demographic characteristics of Behcet disease in Colombia. Cross-sectional study, based on official Ministry of Health registry data. 523 cases of Behcet disease (ICD-10 code: M352) were reported between 2012 and 2016, for a prevalence in people over 18 years old of 1.10 per 100,000 inhabitants, of which 68% are women, with a female-to-male ratio of 2.2:1, with greater prevalence within the 45-49 age group. This is the first study that shows demographic and epidemiological information on Behcet disease in Colombia. Prevalence seems to be low when compared with other similar studies in the region.

Dermatol Ther ; 33(2): e13145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31664762


The current systematic review aimed to evaluate and compare the efficacy and safety of dabrafenib-trametinib with those of other therapeutic alternatives in the treatment of patients with unresectable advanced/metastatic melanoma with BRAF-V600 mutation. The search was carried out on four databases up to July 2018. Two separate network meta-analyses (NMA) were performed using the frequentist method (random effects): one with an exclusive population with BRAF-V600 mutation (NMA-pBRAFV600) and another with mixed population (with or without the mutation: NMA-pMixed). An evidence profile was included using the GRADE method for NMA. The validity of the final estimator in the NMA-pMixed was assessed via a sensitivity analysis. Nine clinical trials were included in the NMA-pBRAFV600. Dabrafenib-trametinib was found to have a favorable effect on overall survival (OS) and progression-free survival (PFS) compared with dabrafenib, vemurafenib, and dacarbazine and on partial response rate (PRR) and overall response rate compared with dacarbazine and vemurafenib. In the NMA-pMixed, dabrafenib-trametinib was found to have a positive effect on OS versus ipilimumab 3 mg/kg and on PFS and PRR versus ipilimumab, nivolumab, and pembrolizumab. However, dabrafenib-trametinib and vemurafenib-cobimetinib significantly differed in terms of efficacy. In addition, dabrafenib-trametinib has a favorable effect on Grades 3 and 4 adverse events.

Rev. colomb. gastroenterol ; 35(1): 104-113, 2020.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1115605


Resumen Introducción: si bien los cannabinoides se han utilizado durante varios años, apenas recientemente se han descrito los descubrimientos sobre sus mecanismos de acción y blancos terapéuticos, así como las alteraciones en el sistema endocannabinoide, observadas en diversas enfermedades y condiciones que se manifiestan con dolor, inflamación, patologías autoinmunes y distintos desórdenes específicos de los órganos. La enfermedad inflamatoria intestinal (EII) agrupa dos condiciones idiopáticas crónicas con patogénesis incierta, en las que se ha identificado que una desregulación del sistema inmune desempeña un papel importante. Así, pues se necesita desarrollar tratamientos alternativos para estos pacientes, ya que solo una minoría de ellos alcanza una remisión de la enfermedad. Nuestro objetivo es revisar las evidencias recientes relacionadas con el uso de cánnabis en la colitis ulcerativa (CU) y en la enfermedad de Crohn (EC). Métodos: se realizó una revisión narrativa focalizada, a partir de las bases de datos de búsqueda de Pubmed y Embase. Los artículos pertinentes fueron revisados y resumidos en forma narrativa. Resultados: los dos componentes principales del cannabis, el cannabidiol (CBD) y el tetrahidrocannabinol (THC), han sido estudiados extensivamente y han probado causar efectos antiinflamatorios y antinociceptivos. Se han descrito ampliamente las propiedades de estos componentes en el control sintomático de la CU y de la EC. No obstante, se sugieren estudios de alta calidad para seguir evaluando la eficacia y la seguridad del uso del cannabis en pacientes con la EII.

Abstract Introduction: Although cannabinoids have been used for several years, only recently have their mechanisms of action and therapeutic targets been described. Alterations in the endocannabinoid system have been observed in various diseases and conditions such as pain, inflammation, autoimmune diseases and various specific disorders. Inflammatory bowel disease groups two chronic idiopathic conditions with uncertain pathogeneses in which deregulation of the immune system plays an important role. Alternative treatments need to be developed for these patients since only a minority of patients achieve disease remission. Our goal is to review recent evidence related to the use of cannabis to treat ulcerative colitis and Crohn's disease. Methods: This is a focused narrative review based on searches of Pubmed and Embase. Relevant articles have been reviewed and summarized in narrative form. Results: The two main components of cannabis, CBD and THC, have been extensively studied, and their anti-inflammatory and antinociceptive effects have been tested. The effects of these components for control of the symptoms of ulcerative colitis and Crohn's disease have been widely described. However, high quality studies are needed to continue evaluating the efficacy and safety of cannabis use in patients with inflammatory bowel disease.

Iatreia ; 32(3): 232-235, Jul-Set. 2019. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1040002


SUMMARY Munchausen syndrome is rarely considered as a first diagnosis, especially in a type 1 diabetic patient presenting with hyperinsulinemic hypoglycemia. The diagnosis should be considered when episodes of hypoglycemia are persistent, and tests suggest a possible exogenous source of insulin. We report a case of a 26-year-old man with multiple hypoglycemic episodes and a long known diagnosis of diabetes type 1 who was referred to our institution after multiple in and out patient consultations in other institutions. He arrived with persistent hypoglycemia, even after withdrawal of insulin therapy on medical record, but persistent self-administration and misuse, without health care professional knowledge, of insulin therapy. He was diagnosed with factitious hypoglycemia after psychiatric evaluation. The patient improved with psychotherapy and family support as well as strict vigilance of insulin administration.

RESUMEN El síndrome de Munchausen rara vez es considerado como primer diagnóstico, especialmente en pacientes diabéticos tipo 1 con cuadro de hipoglicemia hiperinsulinémica. Debe pensarse en este diagnóstico cuando los episodios de hipoglicemia sean persistentes y los exámenes paraclínicos sugieran una fuente exógena de insulina. El siguiente es un reporte de caso de un paciente masculino de 26 años con múltiples episodios de hipoglicemia y diagnóstico conocido de diabetes mellitus tipo 1, quien fue referido a nuestro hospital universitario después de haber consultado en varias ocasiones y haber sido hospitalizado y dado de alta en otras instituciones. Ingresa por múltiples episodios de hipoglicemias, y que incluso al retirar las insulinas por orden médica, persistían los síntomas. Se encontró auto-administración de uso de insulinas sin el conocimiento de los profesionales de la salud, llegando al diagnóstico de hipoglicemia facticia después de valoración por psiquiatría. El paciente presentó mejoría con psicoterapia y apoyo familiar, además de vigilancia estricta de la administración de insulinas.

Rheumatol Int ; 39(9): 1631-1635, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31327052


Polymyalgia rheumatica (PMR) affects elderly patients and is characterized by pain and stiffness of the shoulder girdle, pelvic girdle and cervical region, which can be associated with the presence of giant cell arteritis. Data on the epidemiology of this disease in Latin America are scarce. In Colombia, the Ministry of Health introduced SISPRO, a tool to collect nation-wide information from the health system. The information collected from SISPRO is available for scientific analysis. Using SISPRO data for the years 2012-2016, an analysis was made on the prevalence and characteristics of patients diagnosed with PMR. This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to PMR, based on SISPRO data. Criteria for diagnosis are not explicitly addressed in each individual case. National records report 19,901 individuals diagnosed with PMR and estimated prevalence of 2 cases per 1000 inhabitants over 50 years old (based on a total population of 47,663,162), being more frequent in women (86% of cases), with a female/male ratio of 6.2:1. This is the first study that describes the demographic characteristics of PMR in Colombia. Our results are consistent with the age-related increase in prevalence and gender ratio. Likewise, there are differences between regions, which may be related to ancestry and environmental factors, which require further studies.

Polimialgia Reumática/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Colômbia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimialgia Reumática/diagnóstico , Prevalência , Sistema de Registros , Distribuição por Sexo , Fatores de Tempo