Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis.

BACKGROUND: The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. METHODS: Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. RESULTS: From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). CONCLUSIONS: Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation.

Air pollution, sociodemographic and health conditions effects on COVID-19 mortality in Colombia: An ecological study.

OBJECTIVE: The present study aimed to determine the association between chronic exposure to fine particulate matter (PM2.5), sociodemographic aspects, and health conditions with COVID-19 mortality in Colombia. METHODS: We performed an ecological study using data at the municipality level. We used COVID-19 data obtained from government public reports up to and including July 17th, 2020. We defined PM2.5 long-term exposure as the 2014-2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fitted a logit-negative binomial hurdle model for the mortality rate adjusting for sociodemographic and health conditions. RESULTS: Estimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in either of the two components of the hurdle model (i.e., the likelihood of reporting at least one death or the count of fatal cases). We found that having 10% or more of the population over 65 years of age (MRR = 3.91 95%CI 2.24-6.81), the poverty index (MRR = 1.03 95%CI 1.01-1.05), and the prevalence of hypertension over 6% (MRR = 1.32 95%CI1.03-1.68) are the main factors associated with death rate at the municipality level. Having higher hospital beds capacity is inversely correlated to mortality. CONCLUSIONS: There was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics, health system capacity, and social conditions did have evidence of an ecological effect on COVID-19 mortality. The use of model-based estimations of long-term PM2.5 exposure includes an undetermined level of uncertainty in the results, and therefore they should be interpreted as preliminary evidence.

Prevalencia etiológica de infección del tracto urinario en gestantes sintomáticas, en un hospital de alta complejidad de Medellín, Colombia, 2013-2015 / Etiological prevalence of urinary tract infections in symptomatic pregnant women in a high complexity hospital in Medellín, Colombia, 2013-2015

Objective: To determine the prevalence of urinary tract infections (UTIs), the microbiological profile and antibiotic resistance in pregnant women with suspected urinary tract infection. Materials and methods: Cross-sectional study of pregnant women with suspected community- acquired urinary tract infection referred to the outpatient clinic by prenatal care practitioners or seen in the emergency room, and hospitalized be- tween August 2013 and September 2015 in a referral teaching hospital located in Medellin, Colombia. Pregnant women who had received antibiotics on the day before admission were excluded. Random sampling. Measured variables: sociodemographic, clinical and bacteriological. Descriptive statistics were applied. Results: The prevalence of urinary tract infections was 29%. Gram negative bacteria isolates were found predominantly, the main ones being E. coli and K. pneumoniae at 57.7 and 11.4%, respectively. Resistance to trimethoprim- sulfamethoxazole and to ampicillin-sulbactam was observed in 19.5% and 17.5% of isolates, respectively. Conclusions: Population-based studies are needed to provide a better approach to bacterial resistance in community-acquired UTIs. On the other hand, the high resistance observed may suggest that some of the exposed antibiotics might not be included in the local guidelines for the management of UTIs.

TITULO: PREVALENCIA ETIOLÓGICA DE INFECCIÓN DEL TRACTO URINARIO EN GESTANTES SINTOMÁTICAS, EN UN HOSPITAL DE ALTA COMPLEJIDAD DE MEDELLÍN, COLOMBIA, 2013-2015. Objetivo: Determinar la prevalencia de infección del tracto urinario (ITU), el perfil microbiológico y la resistencia a los antibióticos en mujeres gestantes con sospecha de infección del tracto urinario. Materiales y métodos: Estudio de corte transversal. Ingresaron gestantes con sospecha de infección del tracto urinario adquirida en la comunidad, remitidas a consulta externa desde su control prenatal o atención por urgencias, y hospitalizadas entre agosto de 2013 y septiembre de 2015 en un hospital universitario de referencia ubicado en Medellín, Colombia. Se excluyeron gestantes que hubieran recibido antibióticos el día anterior a la admisión. Muestreo aleatorio simple. Variables medidas: sociodemográficas, clínicas y bacteriológicos. Se aplicó estadística descriptiva. Resultados: La prevalencia de infección del tracto urinario fue del 29 %. Predominaron los aislamientos de bacterias Gram negativas, principalmente E. coli y K. pneumoniae en un 57,7 y 11,4 % respectivamente. Se observó resistencia a trimetoprim- sulfametoxazol en el 19,5 % y ampicilina-sulbactam en el 17,5 % de los aislamientos. Conclusiones: Se requieren estudios de base poblacional para una mejor aproximación a la resistencia de las bacterias causantes de la ITU en la comunidad. Por otra parte, la alta resistencia observada podría sugerir que algunos antibióticos expuestos no sean incluidos en las guías locales de manejo de la ITU.

Etiological prevalence of urinary tract infections in symptomatic pregnant women in a high complexity hospital in Medellín, Colombia, 2013-2015 / Prevalencia etiológica de infección del tracto urinario en gestantes sintomáticas, en un hospital de alta complejidad de medellín, colombia, 2013-2015

RESUMEN Objetivo: determinar la prevalencia de infección del tracto urinario (ITU), el perfil microbiológico y la resistencia a los antibióticos en mujeres gestantes con sospecha de infección del tracto urinario. Materiales y métodos: estudio de corte transversal. Ingresaron gestantes con sospecha de infección del tracto urinario adquirida en la comunidad, remitidas a consulta externa desde su control prenatal o atención por urgencias, y hospitalizadas entre agosto de 2013 y septiembre de 2015 en un hospital universitario de referencia ubicado en Medellín, Colombia. Se excluyeron gestantes que hubieran recibido antibióticos el día anterior a la admisión. Muestreo aleatorio simple. Variables medidas: sociodemográficas, clínicas y bacteriológicos. Se aplicó estadística descriptiva. Resultados: la prevalencia de infección del tracto urinario fue del 29 %. Predominaron los aislamientos de bacterias Gram negativas, principalmente E. coli y K. pneumoniae en un 57,7 y 11,4 % respectivamente. Se observó resistencia a trimetoprim-sulfametoxazol en el 19,5 % y ampicilina-sulbactam en el 17,5 % de los aislamientos. Conclusiones: se requieren estudios de base poblacional para una mejor aproximación a la resistencia de las bacterias causantes de la ITU en la comunidad. Por otra parte, la alta resistencia observada podría sugerir que algunos antibióticos expuestos no sean incluidos en las guías locales de manejo de la ITU.

ABSTRACT Objective: To determine the prevalence of urinary tract infections (UTIs), the microbiological profile and antibiotic resistance in pregnant women with suspected urinary tract infection. Materials and methods: Cross-sectional study of pregnant women with suspected community- acquired urinary tract infection referred to the outpatient clinic by prenatal care practitioners or seen in the emergency room, and hospitalized between August 2013 and September 2015 in a referral teaching hospital located in Medellin, Colombia. Pregnant women who had received antibiotics on the day before admission were excluded. Random sampling. Measured variables: sociodemographic, clinical and bacteriological. Descriptive statistics were applied. Results: The prevalence of urinary tract infections was 29%. Gram negative bacteria isolates were found predominantly, the main ones being E. coli and K. pneumoniae at 57.7 and 11.4%, respectively. Resistance to trimethoprim- sulfamethoxazole and to ampicillin-sulbactam was observed in 19.5% and 17.5% of isolates, respectively. Conclusions: Population-based studies are needed to provide a better approach to bacterial resistance in community-acquired UTIs. On the other hand, the high resistance observed may suggest that some of the exposed antibiotics might not be included in the local guidelines for the management of UTIs.