Marcadores de respuesta inmune en pacientes con infección aguda, crónica y fatal por virus del Chikungunya en Colombia, durante la epidemia del 2015

El virus del chikungunya (VCHIK) se dió a conocer en América como enfermedad incapacitante y fatal, en 2014-2015. Objetivo: Determinar marcadores de respuesta inmune en pacientes con enfermedad aguda no fatal (EANF), crónica (EC) y fatal (EAF) por VCHIK en Colombia, durante la epidemia del 2015. Metodología: estudio transversal; se analizaron muestras serológicas de pacientes con enfermedad EANF, EC, y EAF confirmado por INS. Resultados: 50 muestras fueron de pacientes con EANF, 25 EAF y 89 EC. Mediana de tiempo toma de muestra 4.5 [RIQ-3] días para EANF y 7 [RIQ-1.75] días para EAF. Promedio de edad 48.2 años±24.4DE. Comparando pacientes con EANF y EC, se halló elevación significativa en IFN-γ, IL-5, IL-6, IL-10, IL-12, IL-17α, las cuales en EANF se encontraron hasta 200 veces más elevadas, incluyendo IL-2, IL-4, IL-13, TGF-α y TNF-α. En la EC a excepción de GM-CSF e IL-12, la comparación de medianas entre EAF y EC (IFN-gamma, IL-10, IL-13, IL-17a, IL-2, IL-4, IL-5, IL-6, LT-α/TNF-β, TGF-α, TNF-α) (p<0.05). Los niveles de IL-6 e IFN-γ estuvieron ocho y dos veces más elevados en EANF comparado con los de EC. Conclusión: primer estudio en Colombia sobre citocinas en EANF, EAF y EC. La EANF aumenta IFN-γ, IL-5, IL-6, IL-10, IL-12, IL-17a y TNF-α, su persistencia más de tres meses, con algo de disminución de IFN-γ e IL-6, puede ser progresión a EC. Pero, si además de las citocinas de EANF aumentan IL-2, IL-4, IL-13, LT- α /TNF-b, TGF-α, la enfermedad puede ser severa e incluso fatal

Problemas severos de vejiga: el principal síntoma menopáusico en indígenas zenúes colombianas

Objetivo: Identificar el síntoma menopáusico severo más prevalente en mujeres indíge- nas en etapa de climaterio. Metodología: Se estudiaron mujeres zenúes del resguardo indígena de San Andrés de Sotavento, departamento de Córdoba, en el Caribe colombiano, en diferentes estados me- nopáusicos y entre 40-59 años de edad. Valoradas con "Menopause Rating Scale" (MRS). Resultados: En el estudio se incluyeron 693 mujeres, 295 premenopáusicas y 398 en posmenopausia. Edad promedio de última menstruación: 49.4±3.0. El dominio más dete- riorado en las indígenas premenopáusicas fue el somático-vegetativo (2.9±1.6), influen- ciado por molestias músculo-articulares. En las posmenopáusicas, el más deteriorado fue el domino urogenital (5.5±3.0), por la alta prevalencia de problemas severos de vejiga. La manifestación severa más prevalente entre premenopáusicas fue la sequedad vaginal, junto a molestias músculo-articulares (10.8%), y en posmenopáusicas, los problemas de vejiga (60.3%). Tiene mala calidad de vida el 5.4% de las premenopáusicas y el 52.0% de las postmenopáusicas. Conclusiones: Las indígenas zenúes tienen elevada prevalencia de los síntomas que ha- cen parte del dominio urogenital, y son los que más influyen para deteriorar la calidad de vida. Las mujeres posmenopáusicas tienen peor calidad de vida y más prevalencia de problemas de vejiga. Palabras clave: Climaterio, posmenopausia, calidad de vida, urogenital, indígenas Abstract Objective: To identify the most prevalent severe menopausal symptoms among indig- enous women in menopause stage. Methodology: Women Zenúes in the indigenous reserve of San Andres de Sotavento, Department of Córdoba, in the Colombian Caribbean, in different stages of menopause. Ages 40-59 years old were studied. Rated with "Menopause Rating Scale" (MRS). Results: 693 women were included in the study, 295 premenopausal and 398 postmeno- pausal. Average age of last menstrual period: 49.4 ± 3.0. The domain more impaired in premenopausal indigenous somatic-vegetative was (2.9 ± 1.6), influenced by muscle-joint discomfort. In postmenopausal women the most impaired domain was urogenital (5.5 ± 3.0), the high prevalence of severe bladder problems. The severe occurrence was more prevalent among pre-menopausal vaginal dryness with muscle joint pains (10.8%) and postmenopausal bladder problems (60.3%). 5.4% of premenopausal and 52.0% of post- menopausal women 52.0% have a poor quality of life. Conclusions: Zenúes indigenous women have high prevalence of symptoms that are part of the urogenital domain and have the most influence to impair the quality of life. Post- menopausal women have worse quality of life and prevalence of bladder problems. Keywords: Climacteric, post menopause, quality of life, urogenital, indians

Costos de la otitis media aguda en niños de una ciudad de la costa caribe colombiana

Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimatedLa otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimad

Costs of acute otitis media in children in a city of the Colombian Caribbean coast

Introduction: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. Objective: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. Materials and methods: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD$308). Results: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP$254,903, i.e., USD $179). The total economic burden was COP$22,503,141 (USD $11,250), the indirect costs per episode were COP$101,402 (USD $51), and the average care time spent by parents was 3.7 days. Conclusion: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Problemas severos de vejiga: el principal síntoma menopáusico en indígenas zenúes colombianas

Objetivo: Identificar el síntoma menopáusico severo más prevalente en mujeres indíge- nas en etapa de climaterio. Metodología: Se estudiaron mujeres zenúes del resguardo indígena de San Andrés de Sotavento, departamento de Córdoba, en el Caribe colombiano, en diferentes estados me- nopáusicos y entre 40-59 años de edad. Valoradas con "Menopause Rating Scale" (MRS). Resultados: En el estudio se incluyeron 693 mujeres, 295 premenopáusicas y 398 en posmenopausia. Edad promedio de última menstruación: 49.4±3.0. El dominio más dete- riorado en las indígenas premenopáusicas fue el somático-vegetativo (2.9±1.6), influen- ciado por molestias músculo-articulares. En las posmenopáusicas, el más deteriorado fue el domino urogenital (5.5±3.0), por la alta prevalencia de problemas severos de vejiga. La manifestación severa más prevalente entre premenopáusicas fue la sequedad vaginal, junto a molestias músculo-articulares (10.8%), y en posmenopáusicas, los problemas de vejiga (60.3%). Tiene mala calidad de vida el 5.4% de las premenopáusicas y el 52.0% de las postmenopáusicas. Conclusiones: Las indígenas zenúes tienen elevada prevalencia de los síntomas que ha- cen parte del dominio urogenital, y son los que más influyen para deteriorar la calidad de vida. Las mujeres posmenopáusicas tienen peor calidad de vida y más prevalencia de problemas de vejiga. Palabras clave: Climaterio, posmenopausia, calidad de vida, urogenital, indígenas Abstract Objective: To identify the most prevalent severe menopausal symptoms among indig- enous women in menopause stage. Methodology: Women Zenúes in the indigenous reserve of San Andres de Sotavento, Department of Córdoba, in the Colombian Caribbean, in different stages of menopause. Ages 40-59 years old were studied. Rated with "Menopause Rating Scale" (MRS). Results: 693 women were included in the study, 295 premenopausal and 398 postmeno- pausal. Average age of last menstrual period: 49.4 ± 3.0. The domain more impaired in premenopausal indigenous somatic-vegetative was (2.9 ± 1.6), influenced by muscle-joint discomfort. In postmenopausal women the most impaired domain was urogenital (5.5 ± 3.0), the high prevalence of severe bladder problems. The severe occurrence was more prevalent among pre-menopausal vaginal dryness with muscle joint pains (10.8%) and postmenopausal bladder problems (60.3%). 5.4% of premenopausal and 52.0% of post- menopausal women 52.0% have a poor quality of life. Conclusions: Zenúes indigenous women have high prevalence of symptoms that are part of the urogenital domain and have the most influence to impair the quality of life. Post- menopausal women have worse quality of life and prevalence of bladder problems. Keywords: Climacteric, post menopause, quality of life, urogenital, indians