I N V E S T I G A C I Ó N O R I G I N A L Gestational and congenital toxoplasmosis in two hospitals in Bogota, Colombia Toxoplasmosis gestacional y congénita en dos hospitales de Bogotá, Colombia

| Summary | Background. Gestational toxoplasmosis is acquired during pregnancy and involves a risk of the parasite crossing the placenta, thereby leading to foetal infection, which can lead to serious sequelae in children, mainly chorioretinitis, cerebral calcification, hydrocephalus and intellectual disability

Making sense of big data in health research: Towards an EU action plan.

Medicine and healthcare are undergoing profound changes. Whole-genome sequencing and high-resolution imaging technologies are key drivers of this rapid and crucial transformation. Technological innovation combined with automation and miniaturization has triggered an explosion in data production that will soon reach exabyte proportions. How are we going to deal with this exponential increase in data production? The potential of "big data" for improving health is enormous but, at the same time, we face a wide range of challenges to overcome urgently. Europe is very proud of its cultural diversity; however, exploitation of the data made available through advances in genomic medicine, imaging, and a wide range of mobile health applications or connected devices is hampered by numerous historical, technical, legal, and political barriers. European health systems and databases are diverse and fragmented. There is a lack of harmonization of data formats, processing, analysis, and data transfer, which leads to incompatibilities and lost opportunities. Legal frameworks for data sharing are evolving. Clinicians, researchers, and citizens need improved methods, tools, and training to generate, analyze, and query data effectively. Addressing these barriers will contribute to creating the European Single Market for health, which will improve health and healthcare for all Europeans

Obstetricia integral siglo XXI. Tomo II

El libro Obstetricia Integral siglo XXI, Tomo II, es una publicación virtual de la Facultad de Medicina, se trata de la continuación sobre el análisis detallado de los principales tópicos en el área de la obstetricia, realizada por un grupo interdisciplinario de investigadores comprometidos con el mejoramiento de la calidad en el cuidado de la salud de la mujer gestante. Se ha procurado un balance entre los aspectos básicos de fisiopatología y las guías de atención clínica soportadas en evidencias científicas, con el ánimo de brindarle al lector un equilibrio entre las bases biopsico-sociales de la salud y la enfermedad y los aspectos prácticos de la atención clínica.Vargas Fiesco, Diana Carolina and Rubio Romero, Jorge Andrés and Ruiz Parra, Ariel Iván and Rodríguez, Luis Martín and Aragón, Miguel Eduardo and Arteaga Díaz, Clara Eugenia and Riaño, Jorge Enrique and Arenas Gamboa, Jaime and Ramírez Martínez, Javier Andrés and Amaya Guío, Jairo and Gaitán , Magda Alexandry and Gallego Arbeláez, Jaime and Cortés Díaz, Daniel Otálvaro and Ángel Müller, Edith and Bracho Ch., Alcides C. and Bautista Charry, Alejandro and Rodríguez Ramos, Marcela and Navarro Milanés, Alfonso and Díaz Cruz, Luz Amparo and Mercado Pedroza, Manuel Esteban and Gaitán Duarte, Hernando and Gómez Sánchez, Pio Iván and Peña, Diana Marcela and Calvo Gómez, José Manuel and Parra Pineda, Mario Orlando and Cárdenas Muñoz, María Luisa (2010) Obstetricia integral siglo XXI. Tomo II. Facultad de Medicina, Universidad Nacional de Colombia, Bogotá. ISBN 978958447618

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Late puerperal sepsis, case report and literature review

A case of extremely rare puerperal sepsis is presented in this paper. Postpartum infection is an entity given in between 0.1% and 10% of postpartum patients and has a mortality rate ranging from 2% to 11%. In this case report, a primigravida patient, age 19, presented hypogastric pain, emesis and fever five days after delivery. Postpartum endometritis and retained products of conception were diagnosed; uterine curettage was performed and antibiotic treatment was formulated with satisfactory outcome. The patient was discharged on the fourth day. The patient was readmitted 27 days after delivery with hypogastric persistent pain and fever, vomiting, hypotension and pulmonary dysfunction; gynecological examination showed findings consistent with salpingitis and a laparotomy was performed to confirm the diagnosis, finding salpingitis along with pelvic peritonitis. An intravenous antibiotic treatment, laparotomy and peritoneal washings were provided with satisfactory evolution. The literature on puerperal sepsis, myometritis and postpartum salpingitis is reviewed because, in order to improve morbidity and mortality, timely diagnosis and treatment are determining

Caso clínico y revisión de la literatura sepsis puerperal tardía

A case of extremely rare puerperal sepsis is presented in this paper. Postpartum infection is an entity given in between 0.1% and 10% of postpartum patients and has a mortality rate ranging from 2% to 11%.In this case report, a primigravida patient, age 19, presented hypogastric pain, emesis and fever five days after delivery. Postpartum endometritis and retained products of conception were diagnosed; uterine curettage was performed and antibiotic treatment was formulated with satisfactory outcome. The patient was discharged on the fourth day.The patient was readmitted 27 days after delivery with hypogastric persistent pain and fever, vomiting, hypotension and pulmonary dysfunction; gynecological examination showed findings consistent with salpingitis and a laparotomy was performed to confirm the diagnosis, finding salpingitis along with pelvic peritonitis. An intravenous antibiotic treatment, laparotomy and peritoneal washings were provided with satisfactory evolution.The literature on puerperal sepsis, myometritis and postpartum salpingitis is reviewed because, in order to improve morbidity and mortality, timely diagnosis and treatment are determining.Se presenta un caso de sepsis puerperal de evolución poco frecuente. La infección pos-parto es una entidad que se da entre el 0.1% y 10% de las pacientes en posparto y tie-ne una mortalidad que varía del 2% al 11%.En este reporte de caso, se presenta una paciente primigestante de 19 años, quién a los cinco días posparto presenta cuadro de dolor en hipogastrio, emesis y fiebre. Se diagnostica endometritis posparto y reten-ción de restos, se realiza legrado uterino y se le formula tratamiento antibiótico con evolu-ción satisfactoria y salida al cuarto día.La paciente reingresó a los 27 días pos-parto con dolor en hipogastrio y fiebre, persis-tencia del dolor, vómito, hipotensión y disfun-ción pulmonar; el examen ginecológico arrojó hallazgos compatibles con salpingitis, por lo que fue llevada a laparotomía confirmándose el diagnóstico de salpingitis con pelvi-perito-nitis. Se comenzó tratamiento antibiótico intra-venoso, laparostomía y lavados peritoneales con evolución satisfactoria. Para mejorar la morbimortalidad, es im-portante un diagnóstico y tratamiento oportu-no, por lo cual se revisa la literatura de sepsis puerperal, miometritis y salpingitis posparto

Candidiasis sistémica en un feto de 12 semanas de edad gestacional

We present a case of a 12 week fetus with an intrauterine infection by Candida documented in the histopathologic study. We discuss the possibility that the fetus acquired this infection during pregnancy because vulvovaginitis  by Candida are frequent during this period. The anatomopathologic study of the fetus is important for the diagnosis of this disease

Frecuencia de infecciones del tracto genital femenino en mujeres sintomáticas y uso de pruebas rápidas para su diagnóstico en dos poblaciones de Bogotá (Colombia) 2008: Estudio piloto A pilot study of the frequency of genital tract infection in symptomatic women and the use of rapid diagnostic tests in two groups of women from Bogotá, Colombia, 2008

Objetivo: describir la frecuencia y etiología de las infecciones del tracto genital (ITG), en mujeres con flujo vaginal. Metodología: este fue un estudio de corte transversal en el que participaron mujeres de 14 a 49 años con sintomatología genital que consultaron durante 2007 y 2008 a tres centros de atención especializada en Bogotá (Colombia). Se excluyeron mujeres que presentaban condiciones médicas severas, con antecedente de histerectomía, embarazadas y aquellas que hubieran recibido algún tipo de tratamiento antibiótico en los últimos14 días. En este estudio se realizó un muestreo secuencial consecutivo. El diagnóstico sindromático se realizó de acuerdo con las guías de la OMS y el diagnóstico definitivo se determinó por medio de PCR (reacción en cadena de la polimerasa) para C. trachomatis, cultivo para N. gonorrhoeae y Candida, pruebas treponémicas para sífilis, examen directo para Trichomonas vaginalis, test de Nugent para vaginosis bacteriana (VB) y detección serológica de virus de la inmunodeficiencia humana (VIH). Resultados: en este estudio se incluyó un total de 131 pacientes. La VB se presentó en el 46% de las pacientes, seguida por la infección por Candida con el 16%. La sífilis fue la infección de transmisión sexual (ITS) mas frecuente con el 7% de los casos mientras que C. trachomatis se aisló en el 6%. La Trichomonas vaginalis se observó en 2 pacientes y no hubo aislamientos para N. gonorrhoeae. Las pruebas rápidas estudiadas mostraron una especificidad cercana al 100%; la sensibilidad mostró gran variabilidad con valores elevados del 90% para sífilis, 81% para la prueba utilizada para VB y menores del 60% para el frotis en fresco para Candida. La frecuencia de aislamientos de Chlamydia y N. gonorrhoeae fue muy baja como para poder evaluar sus características operativas. Conclusiones: las ITG en las mujeres sintomáticas estudiadas fueron principalmente de causa endógena. La frecuencia global de ITS en las poblaciones seleccionadas fue de 16%. El uso de pruebas diagnósticas rápidas en el punto de atención es posible. Se deberá ampliar el número de sujetos a incluir para hacer una adecuada evaluación de las características operativas de dichas pruebas.Objectives: describing the frequency and etiology of genital tract infections in two selected groups of women. Methodology: this was a cross-sectional study which included females having symptoms of vaginal discharge or itching who consulted during 2007-2008 at three sites in Bogotá, Colombia. They were aged 14 to 49. The following exclusion criteria were used: females having severe medical conditions, a history of hysterectomy, being pregnant, presenting menstrual discharge, having no history of sexual activity or those who reported having received antibiotic therapy during the previous 14 days. Sequential sampling. Syndromic diagnosis was stablished according to the World Health Organization guidelines. Definitive diagnosis was made by PCR (Polymerase Chain Reaction) for C. trachomatis, culturing for N. gonorrhoeae and Candida, treponemal tests for syphilis, direct exam for Trichomonas vaginalis, nugent’s test for bacterial vaginosis and serological detection for human immunodeficiency virus (HIV). Sensitivity and specificity of the rapid diagnostic tests used were determined against the “gold standard” diagnostic test for each infection. Results: one hundred and thirty-one females were included. Bacterial vaginosis was present in 46% of the patients, followed by candidiasis in 16%. Syphilis was the most frequently diagnosed sexually-transmitted infection in 7% of cases and C. trachomatis in 6%. Trichomonas vaginalis was observed in two patients but no cases of N. gonorrhoeae were identified. The most frequent syndromic diagnosis was vaginitis. The rapid diagnostic tests had close to 100% specificity; sensitivity varied from 90% for syphilis, to 81% for bacterial vaginosis and 60% for Candida. The frequency of positive cases for Chlamydia and gonorrhoeae was too low to assess the rapid tests’ diagnostic precision. Conclusions: genital tract infections in the symptomatic women studied here were mainly endogenous. The overall frequency of sexually transmitted infection in these selected populations was 16%. Rapid diagnostic tests may be used at the point-of-care. Additional research is urgently needed; a larger sample should be used for accurately assessing rapid tests’ diagnostic precision

Prevalencia y factores asociados a la infección Por C. trachomatis, N. gonorrheae, t. vaginalis, C. albicans, sífilis, VIH y vaginosis bacteriana en mujeres con síntomas de infección vaginal en tres sitios de atención de Bogotá, Colombia, 2010 The prevalence of and factors associated with C. trachomatis, N. gonorrheae, t. vaginalis, C. albicans infection, syphilis, HIV and bacterial vaginosis in females suffering lower genital tract infection symptoms in three healthcare attention sites in Bogotá, Colombia, 2010

Objetivo: estimar la prevalencia y etiología de las infecciones de transmisión sexual, y de las infecciones endógenas en mujeres en edad reproductiva con síntomas de infección del tracto genital inferior sintomáticas, y describir los factores asociados. Materiales y métodos: estudio de corte transversal en tres centros de atención en Bogotá. Se realizó el diagnóstico etiológico mediante puntaje de Nugent para vaginosis bacteriana (VB), cultivo para Candida, y frotis en fresco para trichomonas. En un subgrupo de pacientes se realizó cultivo In Pouch TM para T. vaginalis (TV), PCR para C. trachomatis (CT) y N. gonorroheae (NG), y pruebas serológicas para sífilis y VIH. Los factores de riesgo fueron evaluados comparando los dos grupos por medio del Odds Ratio (OR) y el intervalo de confianza del 95%. Resultados: 1385 mujeres fueron incluidas, de ellas 115 (8,3%) eran trabajadoras sexuales. Se confirmó la presencia de alguna infección del tracto genital (ITG) en 731 (52,7%) de las mujeres; 560 (40,4%) presentaron infecciones endógenas y 170 (12,3%) infecciones de transmisión sexual (ITS). La etiología más frecuente fue la VB en 549 (39,6%), seguida por candidiasis en 153 (11%). CT fue detectada en 134 (9,7%) y NG en 19 (1,4%). TV fue detectada por frotis en fresco en 11 (0,8%) y por cultivo en 8 de 634 (1,2%), sífilis en 12 (0,8%) y VIH en 1 (0,07%). Las mujeres trabajadoras sexuales tuvieron mayor riesgo de presentar cualquier ITS (OR: 2,0; IC 95% 1,2-3,3). Las mujeres con ITS tuvieron una edad promedio de 27,9 (± 7,8), y aquellas que no tenían ITS de 31,9 (± 8,9) años. El consumo de licor con frecuencia entre diaria y semanal fue mayor en las mujeres con ITS (OR: 2,6; IC 95%: 1,4-4,5). Conclusiones: se identificó la etiología en el 52,7% de las mujeres que consultaron por síntomas de infección del tracto genital inferior. Las infección más frecuente fue vaginosis bacteriana, y clamidia dentro de la infecciones de transmisión sexual. No se identificó ninguna etiología infecciosa específica en el 47,3% de las mujeres aun cuando se utilizó el patrón de oro diagnóstico para los diferentes microorganismos.Objective: Determining the prevalence and aetiology of sexually-transmitted infections and endogenous infections in women of childbearing age having lower genital tract infection symptoms and describing the pertinent risk factors. Materials and methods: This cross-sectional study was carried out at three outpatient healthcare centres in Bogotá, Colombia. Etiologic diagnosis was made using Nugent’s criteria for bacterial vaginosis, blood agar culture for Candida and wet mount for T. vaginalis. The In-pouch culture technique was used for T. vaginalis, the polymerase chain reaction for C. trachomatis and N. gonorroheae and serological tests for syphilis (RPR, TPHA) and HIV on a sample of the aforementioned population. Results: 1,385 females were recruited in 2010. 115 (8.3%) were sex workers. An LGTI was confirmed in 731 (52.7%); 560 (40.4%) had an endogenous infection and 170 (12.3%) a sexually-transmitted infection (STI). The most frequent aetiology were bacterial vaginosis (39.6%), candidiasis (11%), C. trachomatis (9.7%) and N. gonorroheae (1.4%); Trichomona was detected by wet mount (0.8%) and culture (1.2%), as were syphilis (0.8%) and HIV (1 case). Sex workers had a higher risk of having an STI (2.0 OR; 1.2-3.3 95% CI), as were younger females (28 ± 7.8 cf 32 ± 8.9) (p = 0.001) and alcohol users (2.6 OR; 1.4-4.5 95% CI). Conclusions: Aetiology was identified for 52.7% of the females who consulted for lower genital tract infection symptoms; bacterial vaginosis was the most common and Chlamydia the most frequent sexually-transmitted infection. No specific aetiology was identified in almost the same number of females (47.3%), even when using gold-standard diagnostic technology for each microorganism

Comparative effectiveness of single and dual rapid diagnostic tests for syphilis and HIV in antenatal care services in Colombia

ABSTRACT Objective To assess the effectiveness of a dual rapid test compared to a single rapid test for syphilis and HIV screening. Methods A cluster-randomized open-label clinical trial was performed in 12 public antenatal care (ANC) centers in the cities of Bogotá and Cali, Colombia. Pregnant women who were over 14 years of age at their first antenatal visit and who had not been previously tested for HIV and syphilis during the current pregnancy were included. Pregnant women were randomized to single HIV and single syphilis rapid diagnostic tests (Arm A) or to dual HIV and syphilis rapid diagnostic tests (Arm B). The four main outcomes measured were: (1) acceptability of the test, (2) uptake in testing, (3) treatment on the same day (that is, timely treatment), and (4) treatment at any time for positive rapid test cases. Bivariate and multivariate analyses were calculated to adjust for the clustering effect and the period. Results A total of 1 048 patients were analyzed in Arm A, and 1 166 in Arm B. Acceptability of the rapid tests was 99.8% in Arm A and 99.6% in Arm B. The prevalence of positive rapid tests was 2.21% for syphilis and 0.36% for HIV. Timely treatment was provided to 20 of 29 patients (69%) in Arm A and 16 of 20 patients (80%) in Arm B (relative risk (RR), 1.10; 95% confidence interval (CI): (1.00 −1.20). Treatment at any time was given to 24 of 29 patients (83%) in Arm A and to 20 of 20 (100%) in Arm B (RR, 1.11; 95% CI: 1.01−1.22). Conclusions There were no differences in patient acceptability, testing and timely treatment between dual rapid tests and single rapid tests for HIV and syphilis screening in the ANC centers. Same-day treatment depends also on the interpretation of and confidence in the results by the health providers