Evaluación de la estructura y procesos aplicados en la vigilancia de la letospirosis humana en la ciudad de Barranquilla en el periodo 2007-2010

La Leptospirosis es una enfermedad zoonótica endémica, reemergente, de distribución mundial, presente en Colombia y en particular en la ciudad de Barranquilla. Esta patología tiene un amplio espectro en su presentación desde formas asintomáticas hasta las graves, con una alta letalidad. Estas formas graves y letales se han presentado en la ciudad de Barranquilla, especialmente en los años 2007 a 2010.60. El objetivo principal de este estudio es la Evaluar la Vigilancia de la Leptospirosis Humana en la ciudad de Barranquilla en el periodo 2007-2010. La metodología de este estudio es de tipo descriptiva-evaluativa interpretativa, (diseño mixto) mediante la utilización del Modelo de Donabedian para evaluación de Estructura y Procesos. 111 Se destaca en los resultados del estudio como en la estructura de las UPGD la responsabilidad de vigilancia de la enfermedad, recae en un 75% en profesionales de enfermería. El 82% de las UPGD tienen instalado el software SIVIGILA. Con respecto a los indicadores de gestión en vigilancia epidemiológica de leptospirosis para el cuatrienio 2007-2010 la notificación alcanza un incremento de casi 5 veces; 5,3%; 6,9%; 15,2%; y 23,6% respectivamente. 180 no se logra cumplir con la oportunidad en la notificación en la mayoría de las UPGD (94%). La Evaluación del sistema vigilancia de la leptospirosis humana presenta limitaciones que no permiten conocer el verdadero comportamiento de la enfermedad y sus efectos en la población. La política pública no se cumple por parte de los actores involucrados en la ejecución, seguimiento y evaluación de las mismas.MaestríaMagister en Salud Public

Spatiotemporal Heterogeneity in the Distribution of Chikungunya and Zika Virus Case Incidences and Risk Factors During Their Epidemics in Barranquilla, Colombia, between 2014 and 2016: An Ecological Study

Chikungunya virus (CHIKV) and Zika virus (ZIKV) have recently emerged as global infections with consequential disability adjusted life years (DALYs) and economic burden. This study aimed to explore the spatiotemporal heterogeneity in the occurrence of CHIKV and ZIKV outbreaks throughout Barranquilla, Colombia during 2014 and 2016 and explored the potential for clustering. Incidence data were fitted using multiple Bayesian Poisson models based on a suite of explanatory variables as potential risk factors and multiple options for random effects. A best fit model was used to analyse the case incidence risk for both epidemics to identify any risk factors during their epidemics. Neighbourhoods in the northern region of Barranquilla were hotspots for the outbreaks of both CHIKV and ZIKV. Additional hotspots occurred in the south-western and central regions of the CHIKV and ZIKV outbreaks, respectively. Multivariate conditional autoregressive models strongly identified higher socioeconomic strata (SES) and residing in detached houses as risk factors for ZIKV case incidences. These novel findings challenge the belief that these infections are driven by social vulnerability and merits further study both in Barranquilla and throughout the tropical and subtropical regions of the world.&amp;nbsp;</jats:p

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Spatiotemporal Heterogeneity in the Distribution of Chikungunya and Zika Virus Case Incidences during their 2014 to 2016 Epidemics in Barranquilla, Colombia

Chikungunya virus (CHIKV) and Zika virus (ZIKV) have recently emerged as globally important infections. This study aimed to explore the spatiotemporal heterogeneity in the occurrence of CHIKV and ZIKV outbreaks throughout the major international seaport city of Barranquilla, Colombia in 2014 and 2016 and the potential for clustering. Incidence data were fitted using multiple Bayesian Poisson models based on multiple explanatory variables as potential risk factors identified from other studies and options for random effects. A best fit model was used to analyse their case incidence risks and identify any risk factors during their epidemics. Neighbourhoods in the northern region were hotspots for both CHIKV and ZIKV outbreaks. Additional hotspots occurred in the southwestern and some eastern/southeastern areas during their outbreaks containing part of, or immediately adjacent to, the major circular city road with its import/export cargo warehouses and harbour area. Multivariate conditional autoregressive models strongly identified higher socioeconomic strata and living in a neighbourhood near a major road as risk factors for ZIKV case incidences. These findings will help to appropriately focus vector control efforts but also challenge the belief that these infections are driven by social vulnerability and merit further study both in Barranquilla and throughout the world’s tropical and subtropical regions

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Memorias. Encuentro de Experiencias en Inventarios y Monitoreo Biológico

Las discusiones temáticas alrededor de la consolidación del Inventario Nacional de Biodiversidad para Colombia y la Red de Monitoreo de Biodiversidad como una estrategia de largo plazo, sin duda temas complejos que requerirán de grandes esfuerzos, coordinación y generosidad institucional y personal, los podrá apreciar el lector a lo largo del presente documento, esperando que pueda entender también la importancia que tienen los resultados y la agenda propuesta si en el futuro queremos tomar decisiones con bases científicas

Implementation of a University Guidance Service (SOU) in the Faculty of Biological Sciences: Comprehensive Student Support and Monitoring Program

El acompañamiento y el seguimiento académico de los estudiantes son tareas de gran importancia, necesarias para garantizar el éxito de su carrera profesional durante su vida universitaria, y después de ésta. Estos procesos no comienzan necesariamente con el ingreso de los estudiantes en la Universidad, sino que se extienden a los estudiantes de último curso de educación secundaria y bachillerato. Existe por tanto la necesidad de incluir dentro de las acciones que realizamos en la facultad (información, formación, inclusión) a los estudiantes de bachillerato, dándoles a conocer nuestro entorno de cara a su incorporación en la facultad. Por otro lado, la experiencia del equipo que trabajará en este proyecto, nos ha llevado a ser conscientes de los innumerables problemas que tienen los estudiantes de nuestra facultad para obtener información, formación, acompañamiento, seguimiento o inclusión en cuestiones que pueden afectar de una forma directa en sus actividades académica cotidianas y en su formación integral que reciben en nuestra facultad. La falta de una unidad o servicio centralizado para satisfacer estas necesidades ha sido aún más patente desde la pandemia. En la Facultad de Ciencias Biológicas se realizan multitud de actividades relacionadas con estas iniciativas y que son desconocidas por gran parte de la comunidad universitaria. Las acciones que se vienen realizando desde la facultad de Ciencias Biológicas estas dispersas entre distintos servicios y vicedecanatos (Vicedecanato de Calidad, Innovación y Sostenibilidad, Vicedecanato de Estudiantes, Practicas Externas y Movilidad, Vicedecanato de Estudios, Coordinadora de Grado, Oficina Erasmus, Vicedecanato de Investigación, Secretaría Académica, Delegación de Estudiantes, Oficina de Diversidad, etc.). En este sentido, con este proyecto pretendemos potenciar, sincronizar, coordinar y dar visibilidad a todas estas, mostrando la inmensa utilidad que suponen para nuestros estudiantes, cómo influyen en la mejora de sus actividades académicas curriculares y extracurriculares y su proyección hacia el mundo laboral. Analizaremos cómo cada una de estas actividades influyen positivamente generando una retroalimentación entre los distintos grupos de participantes del proyecto: Estudiantes, Profesores y Personal de Administración y Servicios. Todo ello, será evaluado cualitativa y cuantitativamente mediante la elaboración de encuestas a cada uno de los sectores y los comentarios y evaluaciones que el programa Docentia nos pueda aportar. La finalidad, por tanto, de este proyecto es crear de forma integrativa un Servicio de Orientación Universitario (SOU) para los estudiantes de nuestra facultad, donde se engloben todas las actividades de acompañamiento y seguimiento que venimos realizando, junto con otras que puedan surgir. Todo ello permitirá mejorar la integración y el desenvolvimiento de nuestros estudiantes en el centro mediante su participación en distintas acciones que, a su vez, redundarán en un mejor aprovechamiento de los recursos del centro, una mejora curricular y, en último término, facilitarán su proyección laboral. Este proyecto, también tiene por objetivo solventar la necesidad existente de dar visibilidad a las actividades de acompañamiento y seguimiento de estudiantes que los distintos colectivos de la facultad realizan, con la finalidad de mejorar su aprovechamiento y su optimización a través un análisis de fortalezas y debilidades, lo que nos permitirá generar futuras nuevas acciones que se integrarán en el SOU de la Facultad de Ciencias Biológicas.UCMDecanatoDepto. de Genética, Fisiología y MicrobiologíaFac. de Ciencias BiológicasFALSEsubmitte

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit