The need for creating a unified knowledge of cardiovascular diseases in Latin America

Cardiovascular diseases (CVDs) have persistently been the principal cause of disease burden and mortality throughout the world as well as in Latin America (LATAM)[1,2]. Congruently, as CVDs continue to grow, the research production in this discipline has followed the same trend; global CVD publications have been increasing in the last decades[3,4]. However, as with other health-related topics, disparities in the quantity of research exist when comparing low- and middle-income countries with high-income nations

Epidemiología de las cardiopatías congénitas en Bogotá, Colombia en el período comprendido entre 2001 y 2014: ¿Mejoría en la vigilancia o aumento en la prevalencia

Introduction: Congenital heart diseases are functional and structural alterations of the heart, circulatory system, and large vessels, which develop during cardiac embryogenesis. These defects are significant causes of morbidity and mortality in children worldwide.Objective: To determine the prevalence of congenital heart diseases in Bogotá, Colombia, through the period 2001 to 2014 and evaluate the trend in time.Materials and methods: We analyzed 405,408 births from the Programa de Vigilancia y Seguimiento de Niños con Anomalías Congénitas de la Secretaría Distrital de Salud de Bogotá. We calculated the prevalence of congenital heart diseases through a daily registry of births, the clinical evaluation, and the work-up. Congenital heart diseases were classified as isolated, complex or associated. We estimated the prevalence per year and the mortality in the first hours of life.Results: The total prevalence of congenital heart diseases was 15.1 per 10,000 newborns; however, we obtained values above 20 per 10,000 newborns in the previous 3 years. Of the newborns analyzed, 46% were females, 53.16% were males, and 0.33% undetermined. Out of the newborns with congenital anomalies, 397 had congenital heart diseases, 142 of which were classified as associated and 74 as complex.Conclusion: Congenital heart diseases have a significant impact on childhood morbidity and mortality. Although the prevalence continues to be low compared to other countries, this could be due to under registry nationwide. There was an increase in prevalence during the previous three years, which might be explained by the implementation of local and national programs. Therefore, we suggest continuing the development and promotion of such programs aimed at increasing screening and registration of these anomalies.Introducción. Las cardiopatías congénitas son alteraciones estructurales y funcionales del corazón, sistema circulatorio y grandes vasos que se desarrollan durante la embriogénesis cardiaca. A nivel mundial dichos defectos son una causa importante de morbi-mortalidad en la población infantil.Objetivo. Determinar la prevalencia de cardiopatías congénitas en la ciudad de Bogotá, durante el periodo de 2001 a 2014 y evaluar la tendencia en el tiempo.Material y métodos. Se analizaron 405.408 recién nacidos del Programa de Vigilancia y Seguimiento de Niños con Anomalías Congénitas de la Secretaría de Salud de Bogotá calculando la prevalencia de las cardiopatías congénitas a través de un registro diario de nacimientos y su evaluación clínica y paraclínica. Se clasificaron en aisladas, complejas y asociada y se halló la prevalencia por año. Se evaluó la mortalidad en las primeras horas de vida.Resultados. La prevalencia de cardiopatías congénitas fue de 15,1 por cada 10.000 recién nacidos en todo el período, pero se evidenciaron valores por encima de 20x10.000 en los últimos 3 años. Del total, 46% fueron de sexo femenino, 53,16% de sexo masculino y 0.33% indeterminado. De los nacidos malformados, 397 cardiopatías fueron aisladas, 142 asociadas a otras malformaciones extracardiacas y 74 complejas.Conclusiones. Las cardiopatías tienen gran impacto en la salud de la población infantil y aunque la prevalencia es menor que en otros países, esto puede deberse a subregistro a nivel nacional. Se nota un aumento en la prevalencia en los últimos 3 años que puede corresponder a la implementación de los programas de vigilancia nacional y local. Sugerimos continuar el desarrollo de programas que incrementen e incentiven el tamizaje y registro de estas patologías.

Associated factors for mortality in a COVID-19 colombian cohort : is the third wave relevant when Mu variant was predominant epidemiologically?

Q1Q1Pacientes con COVID-19Objectives: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. Methods: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. Results: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84–1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36–0.86). Conclusions: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.https://orcid.org/0000-0003-1833-1599https://orcid.org/0000-0001-5363-5729https://orcid.org/0000-0001-6964-2229https://orcid.org/0000-0003-3975-2835https://orcid.org/0000-0001-9441-4375Revista Internacional - IndexadaA1N

Neumonía adquirida en la comunidad: una revisión narrativa

Community acquired pneumonia (CAP) is one of the first mortality causes in Colombia it accounts for 13 of every 100,000 deaths per year. Its principal etiologic agent is still Streptococcus pneumoniae, followed by Haemophilus influenzae and Staphylococcus aureus. Several risk factors have been described for CAP and specific pathoghens, such as coomorbidities and exposition factors. Diagnosis is made by clinical findings associated to laboratory workup and radiological evidence. CURB-65 and PSI are the most known and used tools that, in association with clinical evaluation, calculate the mortality risk and evaluate the setting of management. This literature review aims to consider crucial aspects for the correct assessment of CAP patients, biomarkers used in CAP, particular situations such as severe CAP as well as prevention strategies.La neumonía adquirida en la comunidad (NAC) continúa siendo una de las principales causas de mortalidad en Colombia, pues es responsable de 13 de cada 100.000 muertes. Su principal agente etiológico es el Streptococcus pneumoniae, seguido por Haemophilus influenzae y Staphylococcus aureus. Se han identificado algunos factores de riesgo como comorbilidades y factores de exposición epidemiológica, los cuales incrementan la posibilidad de contraer una infección por microrganismos específicos. Su diagnóstico debe basarse tanto en la clínica como en hallazgos paraclínicos e imagenológicos. Herramientas como las escalas CURB-65 y PSI asociadas al criterio clínico permiten calcular el riesgo de mortalidad y el área de atención del paciente según su clasificación. En esta revisión se consideran los diferentes elementos para una adecuada evaluación y manejo del paciente que cursa con NAC, el uso de algunos biomarcadores, situaciones especiales para apreciar, como la neumonía severa, y estrategias para una adecuada prevención

Community Acquired Pneumonia as a Result of Singultus in an-HIV Patient : Case Report and Literature Review

El singulto es una manifestación clínica común, de etiología multifactorial, que funciona como un arco reflejo frente a noxas irritativas y es mediado por estimulación simpática. Dentro de las causas se han descrito procesos infecciosos como la neumonía; sin embargo, con una baja representatividad. El artículo presenta el caso de un hombre de 34 años con diagnóstico de infección por virus de la inmunodeficiencia humana (VIH) en estadio 3 con única manifestación clínica inicial de singulto que documenta neumonía adquirida en la comunidad como causa. Este caso ilustra la importancia del estudio etiológico del singulto, ya que puede ser una manifestación clínica atípica de un proceso infeccioso subyacente, sobre todo en pacientes en contexto de inmunosupresión.Singultus is a common clinical manifestation of multifactorial etiology. It works as a reflex arc against irritative noxas and is mediated by sympathetic stimulation. Among its causes it has been described that infectious processes such as pneumonia can result in singultus, however, it corresponds to a low percentage of the causes. We present a case of a 34-year-old man with history of stage 3 HIV infection that presents to emergency room with singultus with no other clinical signs, in whom the presence of community acquired pneumonia as etiology is demonstrated. This case highlights the importance of the study of singultus especially in patients with immunosuppression since in these patients the clinical presentation that underlies an infectious process is not usually evident.https://orcid.org/0000-0001-5363-5729https://orcid.org/0000-0002-1769-7735https://orcid.org/0000-0002-1186-4010https://orcid.org/0000-0002-5385-696Revista Nacional - IndexadaS

Extrapulmonary Tuberculosis: A Current Clinical Challenge

Los dos tipos de manifestación clínica de la tuberculosis (TB) son la pulmonar y la extrapulmonar, de las cuales la primera es la más frecuente. No obstante, si bien se ha logrado disminuir la prevalencia de la TB en general, las cifras de TB extrapulmonar se mantienen estables; se notificaron aproximadamente 1’050.000 casos nuevos en el mundo en 2018. Por lo general, se presenta por diseminación hematógena o linfática del bacilo del complejo Mycobacterium tuberculosis a otros órganos. Los sitios afectados más frecuentes son pleural, ganglionar, tubo digestivo y osteoarticular. Otros menos habituales son el sistema nervioso central, las vías genitourinarias, las vías aéreas superiores, el pericardio y la piel. Las manifestaciones clínicas de la TB extrapulmonar son variables por su naturaleza paucibacilar y constituye un verdadero reto para los clínicos. La aproximación diagnóstica depende del sitio de afectación, la facilidad de toma de la muestra, la sensibilidad de las pruebas y la distribución de la micobacteria en el tejido. La enfermedad usualmente responde al tratamiento estándar para TB y el tiempo ideal del régimen varía según el sitio afectado. El propósito de esta revisión es describir la presentación clínica y el proceso diagnóstico de la TB extrapulmonar.The two types of clinical presentation of tuberculosis (TB) are pulmonary, which is the most frequent, and extrapulmonary. Although TB prevalence has been coming down, extrapulmonary TB numbers remain stable; with approximately 1’050.000 new cases reported in the world in 2018. It usually presents by hematogenous or lymphatic dissemination of the Mycobacterium tuberculosis complex to other organs. The more often affected organs are pleura, lymph nodes, gastrointestinal tract, bone and joints. Rarely it can affect the central nervous system, urinary tract, upper respiratory airway, pericardium and skin. Clinical manifestations of extrapulmonary TB are heterogeneous due to its paucibacillary nature representing a clinical challenge for clinicians. Diagnostic work up depends on the affected organ, the quality and accessibility of the sample, the sensitivity of the test and the distribution of the mycobacteria in the tissue. EPTB usually respond to standard TB treatment and optimal time duration depends on the organ involved. The purpose of this review is to describe the clinical presentation and diagnosis workup of extrapulmonary TB.https://orcid.org/0000-0002-7756-1805https://orcid.org/0000-0002-4033-9987https://orcid.org/0000-0001-5363-5729https://orcid.org/0000-0002-3061-5212https://orcid.org/0000-0002-2071-3142Revista Nacional - IndexadaS

Anal cytology screening in men who have sex with men with HIV at a university hospital in Bogotá, Colombia

BackgroundRisk of anal squamous cell carcinoma (anal cancer) is greater among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). We describe the frequency of and factors associated with abnormal anal cytology results in Colombian MSM living with HIV.MethodsThis retrospective observational cohort study included MSM ≥18 years old living with HIV screened with anal cytology at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2019 and February 2020. A multivariable log-binomial regression model estimated associations with abnormal anal cytology.ResultsA total of 211 patients were included. Mean age was 35.6 years. Sixty-eight (32.3%) had an abnormal anal cytology result: ASC-US 33.8% (n = 23); LSIL 60.3% (n = 41); and HSIL 5.9% (n = 4). MSM with an STI diagnosis in the previous 12 months (RR 1.48, [95% CI 1.03-2.12], p = 0.032) or with a CD4+ T cell count <200 (RR 2.08 [95% CI 1.16-3.73], p = 0.014) were significantly more likely to have abnormal anal cytology.ConclusionsThese data provide crucial information to guide scale up of anal cancer screening at select centers in Colombia. Our results also suggest STI prevention efforts and improved virological control among MSM living with HIV may have the secondary benefit of reducing the risk of anal cancer

Screening With Anal Cytology in Colombia: Initial Experience and Need for High-Resolution Anoscopy

BackgroundMen who have sex with men (MSM) living with human immunodeficiency virus (HIV) are at increased risk of anal cancer. Anal cytology can be used to screen for dysplasia, with high-resolution anoscopy (HRA) required for diagnostic confirmation. We describe the impact lack of HRA had on management of abnormal screening results in Bogotá, Colombia.Material and methodsThis retrospective cohort study includes MSM with HIV who underwent anal cytology screening between January 2019February 2020, with colorectal surgery (CRS) follow-up through July 2020. Cytology results included atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). Categorical and continuous variables were compared via Fisher's exact test and Wilcoxon rank-sum, respectively.ResultsOf 211 MSM screened, 68 had abnormal cytology: ASC-US (n = 23), LSIL (n = 41), HSIL (n = 4). Sixty (88.2%) were referred to CRS, and 51 (75.0%) attended ≥ 1 appointment. At initial assessment, 17 were referred for anal exam under anesthesia (EUA) for tissue resection, and 21 for rectosigmoidoscopy. Having perianal condyloma was associated with recommendation for EUA (P < 0.001), while cytology grade of dysplasia was not (P = 0.308). Eleven (16.2%) underwent EUA for condyloma resection.ConclusionsFew studies have described anal cancer screening in settings without HRA. We found lack of HRA limited management of abnormal cytology in Colombia. Those with condyloma underwent resection, but HRA remains necessary to localize and treat microscopic disease. Next steps include implementation of HRA in order to further develop the anal cancer screening program for MSM with HIV in Bogotá

Cumulative incidence, prevalence, seroconversion, and associated factors for SARS-CoV-2 infection among healthcare workers of a University Hospital in Bogotá, Colombia

Q2Q1This study aimed to determine the cumulative incidence, prevalence, and seroconversion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its associated factors among healthcare workers (HCWs) of a University Hospital in Bogotá, Colombia. An ambispective cohort was established from March 2020 to February 2021. From November 2020 to February 2021, SARS-CoV-2 antibodies were measured on two occasions 14–90 days apart to determine seroprevalence and seroconversion. We used multivariate log-binomial regression to evaluate factors associated with SARS-CoV-2 infection. Among 2,597 HCWs, the cumulative incidence of infection was 35.7%, and seroprevalence was 21.5%. A reduced risk of infection was observed among those aged 35–44 and ≥45 years (adjusted relative risks [aRRs], 0.84 and 0.83, respectively), physicians (aRR, 0.77), those wearing N95 respirators (aRR, 0.82) and working remotely (aRR, 0.74). Being overweight (aRR, 1.18) or obese (aRR, 1.24); being a nurse or nurse assistant (aRR, 1.20); working in the emergency room (aRR, 1.45), general wards (aRR, 1.45), intensive care unit (aRR, 1.34), or COVID-19 areas (aRR, 1.17); and close contact with COVID-19 cases (aRR, 1.47) increased the risk of infection. The incidence of SARS-CoV-2 infection found in this study reflects the dynamics of the first year of the pandemic in Bogotá. A high burden of infection calls for strengthening prevention and screening measures for HCWs, focusing especially on those at high risk.https://orcid.org/0000-0003-1833-1599https://orcid.org/0000-0001-8888-9411https://orcid.org/0000-0001-6623-5337https://orcid.org/0000-0001-5363-5729https://orcid.org/0000-0003-4946-8774https://orcid.org/0000-0003-4745-5339https://orcid.org/0000-0003-4579-6033https://orcid.org/0000-0002-2536-4471https://orcid.org/0000-0002-9013-5384https://orcid.org/0000-0002-0265-0563Revista Internacional - IndexadaA1N

Fungemia in Hospitalized Adult Patients with Hematological Malignancies: Epidemiology and Risk Factors

Q2Q1Pacientes con Neoplasias malignas hematológicasPacientes con FungemiaFungemia in hematologic malignancies (HM) has high mortality. This is a retrospective cohort of adult patients with HM and fungemia between 2012 and 2019 in institutions of Bogotá, Colombia. The epidemiological, clinical, and microbiological characteristics are described, and risk factors related to mortality are analyzed. One hundred five patients with a mean age of 48 years (SD 19.0) were identified, 45% with acute leukemia and 37% with lymphomas. In 42%, the HM was relapsed/refractory, 82% ECOG > 3, and 35% received antifungal prophylaxis; 57% were in neutropenia, with an average duration of 21.8 days. In 86 (82%) patients, Candida spp. was identified, and other yeasts in 18%. The most frequent of the isolates were non-albicans Candida (61%), C. tropicalis (28%), C. parapsilosis (17%), and C. krusei (12%). The overall 30-day mortality was 50%. The survival probability at day 30 in patients with leukemia vs. lymphoma/multiple myeloma (MM0 group was 59% (95% CI 46–76) and 41% (95% CI 29–58), p = 0.03, respectively. Patients with lymphoma or MM (HR 1.72; 95% CI 0.58–2.03) and ICU admission (HR 3.08; 95% CI 1.12–3.74) were associated with mortality. In conclusion, in patients with HM, non-albicans Candida species are the most frequent, and high mortality was identified; moreover, lymphoma or MM and ICU admission were predictors of mortality.https://orcid.org/0000-0001-6396-3267https://orcid.org/0000-0001-5363-5729Revista Internacional - IndexadaA1N