Tendencias en la mortalidad por desnutrición en menores de 5 años y mayores de 60 años

Introduction: Children under 5 years of age living in poor areas and with low availability of healthy food have higher risk of undernutrition-related mortality. However, this relationship among older adults is not well established. Aim: To analyse trends in socioeconomic inequalities in undernutrition-mortality in children under five years of age and adults over 60 years old in municipalities of Colombia during 2003-2009 and 2010-2016. Methods: ecological study of trends during 2003 and 2016. The study population consisted of children under five years of age and adults over 60 years of age residing in the Colombian municipalities during the study period. We estimated smoothed and standardized mortality rates by fitting a hierarchical Bayesian model and explored their relationship with five socio-economic area-level variables. Results: In most of the municipalities, undernutrition-related mortality was three times higher in older adults compared to children. Moreover, the difference between municipalities in the risk of undernutrition-related mortality showed a marked reduction. Finally, it was observed that the poor and less developed municipalities have higher rates of undernutrition-related mortality in children, but on the contrary, wealthier territories have higher rates in older adults. Conclusions: although most of the municipalities have decreased their mortality rates due to undernutrition in children under five and older adults, the socioeconomic conditions of the municipalities influence differently the risk of mortality for children and for older adults. This implies the need to develop age-specific strategies to close social gaps when structural conditions of the areas are taking into account

Comparision of two anesthetic protocols for ovariohisterectomy in healthy female dogs

ABSTRACT: To determine the hemodynamic and physiologic changes and the characteristics of the recuperation phase in two anesthetic protocols to be used in healthy female dogs for elective ovary ohisterectomy, two groups of animals were used in order to test two protocols: Group I was given fentanyl + ethomidato and group II fentanyl + thiopental. For maintenance isofluorane was used in both groups. The following variables were measured at five minute intervals during the surgical procedure: cardiac frequency, breathing frequency, temperature, expired carbon dioxide, non- invasive blood pressure and oxygen saturation. Statistically, temperature and capnography were the only ones yielding significant results: temperature presented an average of 37.7 ± 1.4, in protocol I and 38.0 ± 1.2 in protocol II (p < 0.05); for capnography the average was of 50.9 ± 19.1 for protocol I and 51.9 ± 7.9 for protocol II (p < 0.01), the other variables did not present statistical differences between the tested protocols and maintained themselves within physiological parameters. For recuperation the fallowing variables were measured: time to gag reflex, esternal position, time of liquid ingestion and time of ingestion of solids. In summary, in spite of the significant differences in temperature and capnography, the values were always within physiological parameters therefore in practical terms the protocols behaved in a similar manner. It corresponds to the clinician to define which of the two protocols is more suitable depending of variables and circumstances other than those analyzed in this study such as costs and availability.RESUMEN: Para determinar los cambios hemodinámicos, y fisiológicos y la recuperación en dos protocolos anestésicos, en hembras caninas sanas durante ovariohisterectomia (OVH) electiva, se utilizaron dos grupos de animales, a cada uno de los cuales se les asignó un protocolo anestésico: Grupo I (fentanil + etomidato), grupo II (fentanil + tiopental). En ambos grupos el mantenimiento se hizo con isoflurano. Cada cinco minutos durante el procedimiento quirúrgico se midieron las siguientes variables: frecuencia cardíaca, frecuencia respiratoria, temperatura, dióxido de carbono expirado, presión arterial no invasiva, saturación de oxígeno. Las variables que presentaron significancia, desde el punto de vista estadístico, fueron: temperatura, con una media en el protocolo I de 37.7 ± 1.4, y de 38.0 ± 1.2 en el protocolo II (p < 0.05); y la variable capnografía con una media para el protocolo I de 50.9 ± 19.1 (p < 0.05) y en el protocolo II de 51.9 ± 7.9. Las demás variables se comportaron dentro de los parámetros normales, sin cambios significativos entre los protocolos. Durante el tiempo de recuperación se midieron las siguientes variables: tiempo de presentación del reflejo deglutorio, posición esternal, primera ingesta de líquidos y primera ingesta de alimentos. En resumen, desde el punto de vista estadístico los dos protocolos se comportaron de manera similar a pesar de las diferencias significativas de las variables temperatura y capnografía, por tanto corresponde al criterio clínico definir cuál de los dos protocolos utilizar, dependiendo de variables y circunstancias distintas a las analizadas en este estudio, como son la disponibilidad y el precio de los medicamentos, entre otros

COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study

Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February–June 2020; n = 769 (66%)) and later (July 2020–February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11–0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01–3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22–0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81–1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.Depto. de MedicinaFac. de MedicinaTRUEFundación Madrileña de Hematología y HemoterapiaFundación Leucemia y LinfomaAsociación Madrileña de Hematología y Hemoterapiapu

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

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

Tendencias de la mortalidad en los departamentos de la región del Pacífico de Colombia (2002-2014)

Objective: To describe the profile and trend of overall and cause-specific mortality, during the period 2002-2014, of the departments of the Pacific region of Colombia: Cauca, Chocó, Nariño and Valle del Cauca. Methodology: Descriptive-ecological study that uses secondary data on mortality, births and population projections from the National Administrative Department of Statistics (DANE). Annual overall and cause- specific mortality rates were calculated (by age, sex and for six large groups of causes of death), using the short list of causes of death 6/67 of the Pan American Health Organization (PAHO) (communicable diseases, neoplasms/tumors, diseases of the circulatory system, conditions originating in the perinatal period, external causes and other causes). Trends were evaluated using a Poisson regression model with random effects. Results: Higher mortality was found in males (male/female ratio between 1.26-1.61) and in the population over 65 years of age. A downward trend was observed in overall mortality in the four departments, with Valle del Cauca having the highest overall and cause-specific mortality rates. The main cause of death, and with an upward trend, were diseases of the circulatory system, followed by other causes, external causes and neoplasms. Conclusions: Overall mortality showed a downward trend, of greater magnitude in men, and differential risk according to sex from 15-19 years attributed to the group of external causes. The main cause of death was diseases of the circulatory system, followed by all other causes and neoplasms. External causes showed a marked downward trend Objetivo: Descrever o perfil e a tendência da mortalidade geral e específica, durante o período 2002-2014, dos departamentos da região do Pacífico da Colômbia: Cauca, Chocó, Nariño e Valle del Cauca. Metodologia: Estudo descritivo-ecológico que utiliza dados secundários sobre mortalidade, nascimentos e projeções populacionais do Departamento Administrativo Nacional de Estatística (dane). Calcularam-se taxas anuais de mortalidade geral e específica (por idade, sexo e para seis grandes grupos de causas de morte), usando a lista curta de classificação de causas de mortalidade 6/67 da Organização Pan-Americana da Saúde (paho) (doenças transmissíveis, neoplasias / tumores, doenças do sistema circulatório, condições originadas no período perinatal, causas externas e outras causas). As tendências foram avaliadas através de um modelo de regressão de Poisson com efeitos aleatórios. Resultados: Maior mortalidade foi encontrada no sexo masculino (razão homem / mulher entre 1,26-1,61) e na população acima de 65 anos. Uma tendência descendente na mortalidade geral foi observada nos quatro departamentos, sendo o Valle del Cauca aquele com as maiores taxas de mortalidade geral e específica. As principais causas de morte, e com tendência ascendente, foram as doenças do sistema circulatório, seguidas por outras causas, causas externas e neoplasias. Conclusões: A mortalidade geral apresentou tendência descendente, com maior magnitude nos homens, e risco diferencial segundo o sexo partindo de 15-19 anos, atribuído ao grupo de causas externas. As principais causas de morte foram as doenças do sistema circulatório, seguido por todas as outras causas e neoplasias. As causas externas mostraram uma tendência acentuada ao declínio.Objetivo: Describir el perfil y la tendencia de la mortalidad general y específica, durante el periodo 2002-2014, de los departamentos de la región del Pacífico de Colombia: Cauca, Chocó, Nariño y Valle del Cauca. Metodología: Estudio descriptivo-ecológico que usa datos secundarios de mortalidad, nacimientos y proyecciones poblacionales provenientes del Departamento Administrativo Nacional de Estadística. Se calcularon tasas anuales de mortalidad general y específicas (por edad, sexo y para seis grandes grupos de causas de muerte), utilizando la lista corta de clasificación de las causas de mortalidad 6/67 de la Organización Panamericana de la Salud (enfermedades transmisibles, neoplasias/tumores, enfermedades del sistema circulatorio, afecciones originadas en el período perinatal, causas externas y demás causas). Las tendencias fueron evaluadas mediante un modelo de regresión de Poisson con efectos aleatorios. Resultados: Se encontró mayor mortalidad en el sexo masculino (razón hombre / mujer entre 1,26-1,61) y en la población mayor a 65 años. Se observó una tendencia descendente en la mortalidad general en los cuatro departamentos, siendo Valle del Cauca el que presentó las mayores tasas de mortalidad general y específica. La principal causa de muerte, y con tendencia ascendente, fueron las enfermedades del sistema circulatorio, seguida de demás causas, causas externas y neoplasias. Conclusiones: La mortalidad general mostró una tendencia descendente, con mayor magnitud en hombres, y riesgo diferencial según sexo a partir de 15-19 años, atribuido al grupo de causas externas. La principal causa de muerte fueron las enfermedades del sistema circulatorio, seguido de todas las demás causas y neoplasias. Las causas externas mostraron una marcada tendencia al descenso.

Biodiversidad 2018. Reporte de estado y tendencias de la biodiversidad continental de Colombia

Las cifras y temáticas contenidos en el presente Reporte, aunque no son el panorama completo del estado del conocimiento de la biodiversidad en Colombia, son un compendio seleccionado de los temas que, desde el Instituto Humboldt, consideramos son relevantes y merecen ser discutidos por el público general. En muchos de los casos, las cifras no son esperanzadoras u son un llamado urgente a la acción. En otro casos son la evidencia de que se requieren acciones a nivel nacional, y más allá de esto, son muchas las iniciativas que están germinando desde los territorios, cada vez desde una mayor variedad de actores.Bogotá, D. C., Colombi

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field