Burden of Respiratory Failure in Pediatric Patients: Analysis of a Prospective Multicenter Cohort in Bogotá, Colombia

BACKGROUND AND AIMS: The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. METHODS: This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. RESULTS: Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. CONCLUSION: ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients

Tipología de experiencias en la Transferencia-Intercambio-Diálogo (TID) de conocimientos en salud materna y perinatal: un enfoque intercultural

Introducción: En el año 2000, los líderes de 189 países se unieron en las Naciones Unidas para formular los Objetivos del Desarrollo del Milenio (ODM) con el fin de combatir la pobreza en sus múltiples dimensiones.Sin embargo, para el 2017 los avances de dichas metas no fueron los esperados, registrándose una Razón de Mortalidad Materna (RMM) en Colombia de 51 muertes maternas por 100.000 nacidos vivos, siendo esta mayor en mujeres vulnerables y aquellas que viven en áreas dispersas. Objetivo: caracterizar las distintas tipologías de experiencias existentes que describen las formas de relación (el continuo transferencia-intercambio-diálogo) entre saberes tradicionales y saberes institucionales para la atención de la salud materno-perinatal en Chocó, Guajira y Cesar con el fin de marcar un primer momento y ser un insumo primordial para la puesta en marcha de la propuesta piloto de dicho objetivo. Metodología: Análisis descriptivo, de revisión primaria y secundaria de datos con enfoque participativo e interpretativo para la construcción de un marco y propuesta para el intercambio y transferencia de conocimientos y experiencias entre saberes comunitarios y profesionales sobre atención materno-perinatal. Discusión: La medicina occidental/biomedicina al igual que la medicina tradicional tienen como objetivo que sus prácticas y cuidados estén dirigidos a la búsqueda del bienestar de las comunidades. La búsqueda de una disminución en la brecha de ambos mundos, no busca que los médicos occidentales se vuelvan expertos en partería y viceversa; sino que se busca que trabajen en conjunto y se reconozca la importancia de la medicina tradicional y la partería en las zonas rurales de nuestro país. Este proyecto, demostró que existen una variedad de barreras y limitaciones para la posibilidad de que se de una adecuada transferencia-intercambio-diálogo de conocimientos entre ambos mundos, pero también demostró que existen oportunidades para ir abriendo puertas y posibilidadesIntroduction: In 2000, the leaders of 189 countries joined the United Nations to formulate the Millennium Development Goals (MDGs) in order to combat poverty in its multiple dimensions. These goals were not as expected, registering a Maternal Mortality Ratio (MMR) in Colombia of 51 maternal deaths per 100,000 live births, this being higher in vulnerable women and those who live in dispersed areas. Objective: to characterize the different typologies of existing experiences that describe the forms of relationship (the continuous transfer-exchange-dialogue) between traditional knowledge and institutional knowledge for maternal-perinatal health care in Chocó, Guajira and Cesar in order to mark a first moment and be a primary input for the implementation of the pilot proposal of said objective. Methodology: Descriptive analysis, primary and secondary review of data with a participatory and interpretive approach for the construction of a framework and proposal for the exchange and transfer of knowledge and experiences between community knowledge and professionals on maternal-perinatal care. Discusion:Western medicine / biomedicine as well as traditional medicine have the objective that their practices and care are directed to the search for the well-being of the communities. The search for a decrease in the gap of both worlds, does not look for western doctors to become experts in midwifery and vice versa; rather, it is intended that they work together and the importance of traditional medicine and midwifery in rural areas of our country is recognized. This project demonstrated that there are a variety of barriers and limitations for the possibility of an adequate transfer-exchange-dialogue of knowledge between both worlds, but it also demonstrated that there are opportunities to open doors and possibilities.Magíster en EpidemiologíaMaestrí

Benefits and harms of replacement therapy with Alpha 1 Antitrypsin in patients with documented enzyme deficiency and Chronic Obstructive Pulmonary Disease: A systematic review and network meta-analysis

ABSTRACT TITLE: Benefits and harms of replacement therapy with Alpha 1 Antitrypsin in patients with documented enzyme deficiency and Chronic Obstructive Pulmonary Disease: A systematic review and network meta-analysis. OBJECTIVE: To identify the available scientific evidence regarding the benefits and safety of replacement therapy with Alpha 1-Antitrypsin compared with endobronchial or surgical management for reduction of lung volume, lung transplantation, standard of care for chronic obstructive pulmonary disease, and placebo or control/no treatment in patients with documented enzyme deficiency, presenting with chronic obstructive pulmonary disease. METHODS: A systematic review and meta-analysis was conducted. MEDLINE-PubMed (via Ovid), EMBASE (via Elsevier), LILACS and the Cochrane Library of Controlled Register of Trials (CENTRAL) were assessed for randomized controlled trials (RCT); cluster, factorial, parallel-design and cross-over designs were included, from inception to May of 2021. Any restrictions regarding language, setting, report status or date of publication were included. Non-published articles in clinicaltrials.gov, and grey literature in ProQuest were also considered. Trials studying adult patients with documented Alpha-1 Antitrypsin Deficiency (A1AD) and diagnosed with Chronic Obstructive Pulmonary Disease (COPD), treated with A1A augmentation therapy or other standard care interventions (according to current guidelines for COPD treatment1) such as inhaled corticosteroids, phosphodiesterase 4 inhibitors, antibiotics, inhaled anticholinergic or beta 2 agents, anti-oxidant, lung volume reduction interventions or lung transplant were included. Patient important outcomes as well as surrogate outcomes were assessed. Risk of bias (ROB) for each included trial was independently assessed, using the Cochrane Risk of Bias tool (ROB2). DerSimonian-Laird random-effects models for all pairwise comparisons were used. Heterogeneity was calculated with Q statisticABSTRACT TITLE: Benefits and harms of replacement therapy with Alpha 1 Antitrypsin in patients with documented enzyme deficiency and Chronic Obstructive Pulmonary Disease: A systematic review and network meta-analysis. OBJECTIVE: To identify the available scientific evidence regarding the benefits and safety of replacement therapy with Alpha 1-Antitrypsin compared with endobronchial or surgical management for reduction of lung volume, lung transplantation, standard of care for chronic obstructive pulmonary disease, and placebo or control/no treatment in patients with documented enzyme deficiency, presenting with chronic obstructive pulmonary disease. METHODS: A systematic review and meta-analysis was conducted. MEDLINE-PubMed (via Ovid), EMBASE (via Elsevier), LILACS and the Cochrane Library of Controlled Register of Trials (CENTRAL) were assessed for randomized controlled trials (RCT); cluster, factorial, parallel-design and cross-over designs were included, from inception to May of 2021. Any restrictions regarding language, setting, report status or date of publication were included. Non-published articles in clinicaltrials.gov, and grey literature in ProQuest were also considered. Trials studying adult patients with documented Alpha-1 Antitrypsin Deficiency (A1AD) and diagnosed with Chronic Obstructive Pulmonary Disease (COPD), treated with A1A augmentation therapy or other standard care interventions (according to current guidelines for COPD treatment1) such as inhaled corticosteroids, phosphodiesterase 4 inhibitors, antibiotics, inhaled anticholinergic or beta 2 agents, anti-oxidant, lung volume reduction interventions or lung transplant were included. Patient important outcomes as well as surrogate outcomes were assessed. Risk of bias (ROB) for each included trial was independently assessed, using the Cochrane Risk of Bias tool (ROB2). DerSimonian-Laird random-effects models for all pairwise comparisons were used. Heterogeneity was calculated with Q statisticMagíster en EpidemiologíaMaestrí

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia

Abstract Background and Aims The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability‐adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. Methods This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed‐up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow‐up according to the age group. The results were used to calculate DALYs Results Six hundred and eighty‐five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. Conclusion ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients

Table4_Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study.xlsx

BackgroundAcute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce.ObjectiveTo determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic.MethodsA multicenter prospective cohort study called the FARA cohort was developed between April 2020 – December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included.Results685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-day CI 95%, (37.3–47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72 h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce.ConclusionsThis multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.</p