Evaluation of dengue fever reports during an epidemic, Colombia

OBJETIVO Evaluar la validez de la notificación de casos de dengue y su correspondencia con las definiciones de caso y de gravedad. MÉTODOS Evaluación de prueba diagnóstica con muestreo transversal a partir de un universo de 13.873 pacientes atendidos durante quinto periodo epidemiológico en instituciones de salud de 11 departamentos de Colombia, en 2013. La prueba en evaluación fue la notificación al Sistema Nacional de Vigilancia en Salud Pública y el estándar de referencia fue la revisión de historias identificadas mediante búsqueda activa institucional. Se revisó todas las historias de pacientes con diagnóstico de dengue y una muestra aleatoria de pacientes con síndromes febriles. Se estimó especificidad y sensibilidad de notificación ponderando por el inverso de la probabilidad de ser seleccionado. Se calculó la concordancia entre notificación y los hallazgos de la búsqueda activa institucional usando el estadístico Kappa. RESULTADOS Se incluyeron 4.359 pacientes febriles, 31,7% fueron clasificados compatibles con dengue (17 con dengue grave; 461 con dengue y signos de alarma; 904 con dengue sin signos de alarma). La sensibilidad global de la notificación fue 13,2% (IC95% 10,9;15,4) y la especificidad 98,4% (IC95% 97,9;98,9). La sensibilidad varió de acuerdo con la gravedad: 12,1% (IC95% 9,3;14,8) en pacientes con dengue sin signos de alarma; 14,5% (IC95% 10,6;18,4) en aquellos con dengue y signos de alarma y 40,0% (IC95% 9,6;70,4) en aquellos con dengue grave. La concordancia entre la notificación y los hallazgos de la búsqueda activa institucional mostró Kappa de 10,1%. CONCLUSIONES Se observó baja concordancia entre la notificación y la revisión de historias clínicas, que estuvo asociada a baja notificación de los casos compatibles con dengue, especialmente aquellos menos graves.OBJECTIVE: To assess the validity of dengue fever reports and how they relate to the definition of case and severity. METHODS: Diagnostic test assessment was conducted using crosssectional sampling from a universe of 13,873 patients treated during the fifth epidemiological period in health institutions from 11 Colombian departments in 2013. The test under analyses was the reporting to the National Public Health Surveillance System, and the reference standard was the review of histories identified by active institutional search. We reviewed all histories of patients diagnosed with dengue fever, as well as a random sample of patients with febrile syndromes. The specificity and sensitivity of reports were estimated for this purpose, considering the inverse of the probability of being selected for weighting. The concordance between reporting and the findings of the active institutional search was calculated using Kappa statistics. RESULTS: We included 4,359 febrile patients, and 31.7% were classified as compatible with dengue fever (17 with severe dengue fever; 461 with dengue fever and warning signs; 904 with dengue fever and no warning signs). The global sensitivity of reports was 13.2% (95%CI 10.9;15.4) and specificity was 98.4% (95%CI 97.9;98.9). Sensitivity varied according to severity: 12.1% (95%CI 9.3;14.8) for patients presenting dengue fever with no warning signs; 14.5% (95%CI 10.6;18.4) for those presenting dengue fever with warning signs, and 40.0% (95%CI 9.6;70.4) for those with severe dengue fever. Concordance between reporting and the findings of the active institutional search resulted in a Kappa of 10.1%. CONCLUSIONS: Low concordance was observed between reporting and the review of clinical histories, which was associated with the low reporting of dengue fever compatible cases, especially milder cases.OBJECTIVE To assess the validity of dengue fever reports and how they relate to the definition of case and severity. METHODS Diagnostic test assessment was conducted using cross-sectional sampling from a universe of 13,873 patients treated during the fifth epidemiological period in health institutions from 11 Colombian departments in 2013. The test under analyses was the reporting to the National Public Health Surveillance System, and the reference standard was the review of histories identified by active institutional search. We reviewed all histories of patients diagnosed with dengue fever, as well as a random sample of patients with febrile syndromes. The specificity and sensitivity of reports were estimated for this purpose, considering the inverse of the probability of being selected for weighting. The concordance between reporting and the findings of the active institutional search was calculated using Kappa statistics. RESULTS We included 4,359 febrile patients, and 31.7% were classified as compatible with dengue fever (17 with severe dengue fever; 461 with dengue fever and warning signs; 904 with dengue fever and no warning signs). The global sensitivity of reports was 13.2% (95%CI 10.9;15.4) and specificity was 98.4% (95%CI 97.9;98.9). Sensitivity varied according to severity: 12.1% (95%CI 9.3;14.8) for patients presenting dengue fever with no warning signs; 14.5% (95%CI 10.6;18.4) for those presenting dengue fever with warning signs, and 40.0% (95%CI 9.6;70.4) for those with severe dengue fever. Concordance between reporting and the findings of the active institutional search resulted in a Kappa of 10.1%. CONCLUSIONS Low concordance was observed between reporting and the review of clinical histories, which was associated with the low reporting of dengue fever compatible cases, especially milder cases

Influencia de la rehabilitación cardíaca sobre la tasa de re-hospitalización en pacientes con infarto agudo de miocardio, santander, colombia

Objetivo Estimar el efecto de la rehabilitación cardiaca (RC) pos-infarto, según sus niveles de intervención, sobre las tasas de re-hospitalización. Métodos  Resultados  Conclusiones  La RC debe tener un enfoque multidisciplinario, que además del componente físico, incluya el psicológico, nutricional y educativo.Se incluyeron 96 pacientes de ambos sexos con IAM. En 72 se contó con información sobre RC; 5 de los cuales recibieron RC basada únicamente en actividad física; 49 pacientes recibieron una RC más completa que integró actividad física, educación, psicología y nutrición; 18 pacientes no recibieron RC. Durante el seguimiento, se registraron 10 nuevas hospitalizaciones y una muerte. En un modelo de Poisson, los pacientes cuya RC se basó sólo en la actividad física presentaron una tasa de re-hospitalizaciones significativamente mayor que la de los pacientes que recibieron un esquema completo de RC (Razón de tasas: 5,89; IC 95 %:1,14-30,49; ρ=0,04). Estudio de cohorte prospectiva de pacientes con diagnóstico de IAM. Se obtuvieron datos sobre gravedad del infarto, antecedentes, historia médica, evolución intrahospitalaria, clasificación Killip, estancia y condición de egreso. A través de la historia clínica electrónica y mediante contacto telefónico se constató si el paciente recibió RC y cuáles fueron sus componentes; el seguimiento se extendió hasta por un año

Correlation between variation of hematocrit and other indicators of severity in dengue

Objetivos: Establecer la asociación entre la magnitud del viraje del hematocrito y otros hallazgos de severidad en dengue. Diseño: Estudio observacional analítico de corte transversal. Población y métodos: Pacientes con diagnóstico clínico y serológico (IgM positiva) de dengue, hospitalizados en instituciones de Santander (Colombia), durante 1993-1998. Se evaluó la asociación entre la intensidad de la hemoconcentración y complicaciones como hemorragias espontáneas, efusiones pleurales y trombocitopenia (<50,000 plt/μl). Resultados: Se incluyeron 780 pacientes. En un análisis multivariado, las variables asociadas con una mayor hemoconcentración fueron: edad <15 años, hematemesis y trombocitopenia. Hubo 363 pacientes con hemoconcentración 20%. La frecuencia de efusiones pleurales no fue diferente entre estos grupos. La hematemesis y la trombocitopenia fueron menos frecuentes en el grupo con hemoconcentración <10%. Además, estas complicaciones fueron más frecuentes con hemoconcentración >20% vs. 10%-20% (p<0.05). Comparado con un viraje >20%, un criterio más flexible de hemoconcentración (>10%) se asoció con un aumento de la sensibilidad de 31% a 63% y una disminución de la especificidad de 88.5% a 66.3%, para detectar alguna complicación (hematemesis, trombocitopenia o efusión pleural). Conclusión: Este estudio sugiere una fuerte correlación entre la intensidad de la hemoconcentración y la severidad del dengue. Además, sugiere que al emplearse un criterio más flexible para definir la extravasación plasmática, se obtiene un importante incremento en la sensibilidad con una aceptable disminución en la especificidad. Estos resultados deben evaluarse prospectivamente, en un estudio de cohortes. Objectives: To determine the association of hemoconcentration with other signs of severity of dengue. Design: Cross sectional study. Population and methods: Patients with clinical and serologic diagnosis (IgM positive test) of dengue, who consulted hospitals in Santander (Colombia), during 1993-1998. The clinical findings and laboratory tests were registered. Associations among hemoconcentration and complications, such as spontaneous hemorrhages (petechiae, ecchymoses, bleeding from gums, epistaxis, hematemesis, hematuria and metrorrhagia), pleural effusions and thrombocytopenia (<50,000 plt/μl), were evaluated. Results: A sampling of 780 patients was included. In a multi-varied analysis, thrombocytopenia (p <0.001), hematemesis (p=0.04), and age under 15 years (p=0.02) were associated to greater hemoconcentration. There were 363 patients with hemoconcentration 20%. There were no significant differences in frequency of pleural effusions within these groups. Hematemesis and thrombocytopenia were less frequent in patients with hemoconcentration 20% groups. Moreover, patients with hemoconcentration >20% had more complications than the group with hemoconcentration of 10%-20% (p20%, a hematocrit change >10% was associated to increasing sensitivity from 31% to 63.4% and diminishing of specificity from 88.5% to 66.3%, to detect some complications (hematemesis, thrombocytopenia, or pleural effusion). Conclusions: This study suggests a strong correlation between hemoconcentration and severity of dengue. Also, more liberal criteria to define plasma leakage could be used. The present results should be prospectively evaluated in cohort studies

Evaluación de Marcadores Bioquímicos como Predictores de Dengue Hemorrágico

RESUMEN INTRODUCCIÓN: En las formas severas del dengue, se han descrito alteraciones de la concentración sérica de lípidos y proteínas, incluyendo enzimas hepáticas y marcadores de inflamación. Sin embargo, el valor pronóstico de estas alteraciones no ha sido claramente determinado. OBJETIVO: Evaluar algunas alteraciones bioquímicas tempranas en la predicción del Dengue Hemorrágico (DH). DISEÑO: Casos y Controles anidado en una cohorte. POBLACIÓN: Pacientes con dengue del área metropolitana de Bucaramanga, Colombia. PERIODO: Abril/2003 a Enero/2004. MEDICIONES: Al ingreso, entre la hora 48 y 96 de enfermedad, se tomó una muestra de suero que fue almacenada. Los pacientes fueron seguidos hasta el día 8 de enfermedad. Se realizaron pruebas bioquímicas en quienes desarrollaron DH y en cuatro controles por caso, seleccionados al azar. RESULTADOS: De 112 pacientes incluidos, 6 desarrollaron DH durante el seguimiento. Las pruebas asociadas con DH fueron: Proteína C Reactiva (PCR) > o = 12mg/L (p=0.002), Creatinquinasa >190u/L (p=0.02), Aspartato Aminotransferasa >100u/L (p=0.03), Alanino Aminotransferasa >100u/ L (p=0.03), colesterol >150mg/dl (p=0.04) y Lipoproteínas de baja densidad >90mg/dL (p=0.03). En un análisis multivariado, la PCR elevada se asocia a DH, independientemente, de las otras alteraciones bioquímicas (p=0.048).CONCLUSIÓN: En el presente estudio, la elevación temprana de la PCR se asocia a DH. Otros marcadores séricos como la CPK, transaminasas y lípidos, también podrían ser predictores tempranos de severidad. Estos resultados deben validarse con un mayor número de pacientes. Palabras Claves: Dengue, Desenlace, Transaminasas, Proteína C Reactiva.  ABSTRACT BACKGROUND: In severe forms of dengue, alterations from lipid profile and serum levels of several proteins including hepatic enzymes and inflammation markers have been described. However, prognostic value of these alterations has not been clearly determined. OBJECTIVE: To evaluate some biochemical alterations in the prediction of the Dengue Hemorrhagic Fever (DHF). DESIGN: Nested case control study. Population: Patients with dengue from metropolitan area of Bucaramanga, Colombia. PERIOD: April/2003 to January/2004. MEASUREMENTS: At the beginning, between hour 48 and 96 of disease, a serum sample was taken and stored. The patients were followed until eight day of disease. Biochemical tests were made in those who developed DH and in four controls by case, selected at random. RESULTS: Of 112 included patients, 6 developed DHF. The following Biochemical tests were associated with DHF: Reactive C Protein (RCP) >o= 12mg/L (p=0.002), Creatine kinase >190u/L (p=0.02), Aspartate Aminotransferases >100u/L (p=0.03), Alanine Transaminase >100u/L (p=0.03), cholesterol >150mg/dl (p=0.04), low density lipoprotein >90mg/dl (p=0.03). In a multivaried analysis, RCP elevation was associated to DHF, independently of the other biochemical alterations (p=0.048).  CONCLUSIONS: The early elevation of RCP identifies the patients with greater probability of developing DHF. Other serum biomarkers also could be early predictors of severity. These results must be validated with a greater number of patients. Key words: Dengue, Transaminases, Outcome, Reactive C Protein

Evaluación de Marcadores Bioquímicos como Predictores de Dengue Hemorrágico

RESUMEN INTRODUCCIÓN: En las formas severas del dengue, se han descrito alteraciones de la concentración sérica de lípidos y proteínas, incluyendo enzimas hepáticas y marcadores de inflamación. Sin embargo, el valor pronóstico de estas alteraciones no ha sido claramente determinado. OBJETIVO: Evaluar algunas alteraciones bioquímicas tempranas en la predicción del Dengue Hemorrágico (DH). DISEÑO: Casos y Controles anidado en una cohorte. POBLACIÓN: Pacientes con dengue del área metropolitana de Bucaramanga, Colombia. PERIODO: Abril/2003 a Enero/2004. MEDICIONES: Al ingreso, entre la hora 48 y 96 de enfermedad, se tomó una muestra de suero que fue almacenada. Los pacientes fueron seguidos hasta el día 8 de enfermedad. Se realizaron pruebas bioquímicas en quienes desarrollaron DH y en cuatro controles por caso, seleccionados al azar. RESULTADOS: De 112 pacientes incluidos, 6 desarrollaron DH durante el seguimiento. Las pruebas asociadas con DH fueron: Proteína C Reactiva (PCR) > o = 12mg/L (p=0.002), Creatinquinasa >190u/L (p=0.02), Aspartato Aminotransferasa >100u/L (p=0.03), Alanino Aminotransferasa >100u/ L (p=0.03), colesterol >150mg/dl (p=0.04) y Lipoproteínas de baja densidad >90mg/dL (p=0.03). En un análisis multivariado, la PCR elevada se asocia a DH, independientemente, de las otras alteraciones bioquímicas (p=0.048).CONCLUSIÓN: En el presente estudio, la elevación temprana de la PCR se asocia a DH. Otros marcadores séricos como la CPK, transaminasas y lípidos, también podrían ser predictores tempranos de severidad. Estos resultados deben validarse con un mayor número de pacientes. Palabras Claves: Dengue, Desenlace, Transaminasas, Proteína C Reactiva.  ABSTRACT BACKGROUND: In severe forms of dengue, alterations from lipid profile and serum levels of several proteins including hepatic enzymes and inflammation markers have been described. However, prognostic value of these alterations has not been clearly determined. OBJECTIVE: To evaluate some biochemical alterations in the prediction of the Dengue Hemorrhagic Fever (DHF). DESIGN: Nested case control study. Population: Patients with dengue from metropolitan area of Bucaramanga, Colombia. PERIOD: April/2003 to January/2004. MEASUREMENTS: At the beginning, between hour 48 and 96 of disease, a serum sample was taken and stored. The patients were followed until eight day of disease. Biochemical tests were made in those who developed DH and in four controls by case, selected at random. RESULTS: Of 112 included patients, 6 developed DHF. The following Biochemical tests were associated with DHF: Reactive C Protein (RCP) >o= 12mg/L (p=0.002), Creatine kinase >190u/L (p=0.02), Aspartate Aminotransferases >100u/L (p=0.03), Alanine Transaminase >100u/L (p=0.03), cholesterol >150mg/dl (p=0.04), low density lipoprotein >90mg/dl (p=0.03). In a multivaried analysis, RCP elevation was associated to DHF, independently of the other biochemical alterations (p=0.048).  CONCLUSIONS: The early elevation of RCP identifies the patients with greater probability of developing DHF. Other serum biomarkers also could be early predictors of severity. These results must be validated with a greater number of patients. Key words: Dengue, Transaminases, Outcome, Reactive C Protein

A prospective cohort study to evaluate peridomestic infection as a determinant of dengue transmission: Protocol

<p>Abstract</p> <p>Background</p> <p>Vector control programs, which have focused mainly on the patient house and peridomestic areas around dengue cases, have not produced the expected impact on transmission. This project will evaluate the assumption that the endemic/epidemic transmission of dengue begins around peridomestic vicinities of the primary cases. Its objective is to assess the relationship between symptomatic dengue case exposure and peridomestic infection incidence.</p> <p>Methods/Design</p> <p>A prospective cohort study will be conducted (in Tepalcingo and Axochiapan, in the state of Morelos, Mexico), using the state surveillance system for the detection of incident cases. Paired blood specimens will be collected from both the individuals who live with the incident cases and a sample of subjects residing within a 25-meter radius of such cases (exposed cohort), in order to measure dengue-specific antibodies. Other subjects will be selected from areas which have not presented any incident cases within 200 meters, during the two months preceding the sampling (non-exposed cohort). Symptomatic/asymptomatic incident infection will be considered as the dependent variable, exposure to confirmed dengue cases, as the principal variable, and the socio-demographic, environmental and socio-cultural conditions of the subjects, as additional explanatory variables.</p> <p>Discussion</p> <p>Results indicating a high infection rate among the exposed subjects would justify the application of peridomestic control measures and call for an evaluation of alternate causes for insufficient program impact. On the other hand, a low incidence of peridomestic-infected subjects would support the hypothesis that infection occurs outside the domicile, and would thus explain why the vector control measures applied in the past have exerted such a limited impact on cases incidence rates. The results of the present study may therefore serve to reassess site selection for interventions of this type.</p

Infectious Diseases, Social, Economic and Political Crises, Anthropogenic Disasters and Beyond: Venezuela 2019 – Implications for Public Health and Travel Medicine

During last months, there have been a significant increase in the evidences showing the catastrophic health situation in Venezuela. There are multiple epidemics, increase in emerging and reemerging infectious, tropical and parasitic diseases as consequences of the social, economic and political crises, which would be considered today a clearly anthropogenic disaster. Venezuela is facing in 2019, the worse sanitary conditions, with multiple implications for public health and travel medicine. So far, from a global perspective, this situation will be an impediment for the achievement of the sustainable development goals (SDG) in 2030. In this multiauthor review, there is a comprehensive analysis of the situation for infectious diseases, non-communicable diseases, their impact in the Americas region, given the migration crisis as well as the comparative status of the SDG 2030. This discussion can provide input for prioritizing emerging health problems and establish a future agenda