INTRODUCTION: Hearing health is a public health concern that affects the quality of life and can be disturbed by noise exposure, generating auditory and extra-auditory symptoms. Objective. To identify the hearing health...INTRODUCTION: Hearing health is a public health concern that affects the quality of life and can be disturbed by noise exposure, generating auditory and extra-auditory symptoms. Objective. To identify the hearing health status in adults living in Bogotá and its association with environmental noise exposure and individual and otological factors. OBJECTIVE: To identify the hearing health status in adults living in Bogotá and its association with environmental noise exposure and individual and otological factors. MATERIALS AND METHODS: We conducted a cross-sectional study using a database with 10,311 records from 2014 to 2018, consigned in a structured survey of noise perception and hearing screening. We performed a descriptive, bivariate, and binary logistic regression analysis. RESULTS: Of the included participants, 35.4% presented hearing impairment. In the perception component, 13.0 % reported not hearing well; 28.8 % had extra-auditory symptoms, 53.3 % informed otological antecedents and 69.0 % presented discomfort due to extramural noise. In the logistic regression, the variables with the highest association for hearing impairment were living in noisy areas (OR = 1.50) (95% CI: 1.34-1.69), being male (OR = 1.85) (95% CI: 1.64-2.09), increasing age (for each year of life, the risk of hearing impairment increased 6%), and having history of extra-auditory symptoms (OR = 1.86) (95% CI: 1.66-2.08). CONCLUSIONS: Hearing impairment is multi-causal in the studied population. The factors that promote its prevalence are increasing age, being male, smoking, ototoxic medications, living in areas with high noise exposure, and extra-auditory symptoms.
Introduction. Altered serum zinc levels, lower and higher than values in healthy controls, have been observed in individuals affected by non-communicable chronic diseases. However, to date, studies describing potential d...Introduction. Altered serum zinc levels, lower and higher than values in healthy controls, have been observed in individuals affected by non-communicable chronic diseases. However, to date, studies describing potential determinants of zinc levels in general populations free of chronic diseases appear to be limited. Objective. To evaluate whether nutrient intake, biochemical and clinical measures, lifestyle, and family history of cardio-metabolic diseases are independently associated with zinc levels in apparently healthy individuals. Materials and methods. We evaluated 239 healthy subjects. Serum zinc was measured via flame atomic absorption spectrometry, and the remaining biochemical markers were assessed using enzymatic colorimetric methods. Standard techniques were employed to quantify waist circumference, height, and weight. Body fat was measured via bioimpedance, and blood pressure was measured using digital sphygmomanometers. We applied a survey to record the personal and family history of non-communicable chronic diseases, and nutrient intake was estimated using the 24-hour recall method. Results. Women had lower serum zinc levels than men. In multivariate analyzes, total fat intake (β = -0.15; standard error = 0.03; p < 0.001), plasma log-triglycerides (β = -10.18; standard error = 3.9; p = 0.010), and female gender (β = -6.81; standard error = 3.3; p = 0.043) were significant predictors for serum zinc levels. Zinc intake was not significantly related to serum zinc in univariate and multivariate analyses. Conclusions. Variables related to cardiometabolic risk, such as plasma triglyceride levels and total fat intake, were associated with serum zinc levels in individuals without a diagnosis of chronic or infectious/inflammatory diseases. Further studies are required to confirm our findings and to evaluate possible biological mechanisms for these relationships.
INTRODUCTION: Diabetes mellitus is one of the most common diseases worldwide, with a high morbidity and mortality rate. Its prevalence has been increasing, as well as its acute complications, such as hyperglycemic crises...INTRODUCTION: Diabetes mellitus is one of the most common diseases worldwide, with a high morbidity and mortality rate. Its prevalence has been increasing, as well as its acute complications, such as hyperglycemic crises. Hyperglycemic crises can present with combined features of diabetic ketoacidosis and hyperosmolar state. However, their implications are not fully understood. OBJECTIVE: To describe the characteristics, outcomes, and complications of the diabetic population with hyperglycemic crises and to value the combined state in the Latin American population. MATERIALS AND METHODS: Retrospective observational study of all hyperglycemic crises treated in the intensive care unit of the Fundación Valle del Lili between January 1, 2015, and December 31, 2020. Descriptive analysis and prevalence ratio estimation for deaths were performed using the robust Poisson regression method. RESULTS: There were 317 patients with confirmed hyperglycemic crises, 43 (13.56%) with diabetic ketoacidosis, 9 (2.83%) in hyperosmolar state, and 265 (83.59%) with combined diabetic ketoacidosis and hyperosmolar state. Infection was the most frequent triggering cause (52.52%). Fatalities due to ketoacidosis occurred in four patients (9.30%) and combined diabetic ketoacidosis/hyperosmolar state in 22 patients (8.30%); no patient had a hyperosmolar state. Mechanical ventilation was associated with death occurrence (adjusted PR = 1.15; 95 % CI 95 = 1.06 - 1.24). CONCLUSIONS: The combined state was the most prevalent presentation of the hyperglycemic crisis, with a mortality rate similar to diabetic ketoacidosis. Invasive mechanical ventilation was associated with a higher occurrence of death.
Echeverría LE, Saldarriaga C, Campbell-Quintero S
… +13 more, Morales-Rodríguez LN, López-Ponce de León JD, Buitrago AF, Martínez-Carreño E, Sandoval-Luna JA, Llamas A, Moreno-Silgado GA, Vanegas-Eljach J, Murillo-Benítez NE, Gómez-Paláu R, Rivera-Toquica AA, Gómez-Mesa JE, Research Group R
INTRODUCTION: Heart failure and type 2 diabetes mellitus are critical public health issues. OBJECTIVE: To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a lar...INTRODUCTION: Heart failure and type 2 diabetes mellitus are critical public health issues. OBJECTIVE: To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. MATERIALS AND METHODS: Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. RESULTS: A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. CONCLUSIONS: Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.
Alzheimer’s disease is the leading cause of dementia worldwide and a critical public health problem. While deaths from cardiovascular diseases have decreased, those attributed to Alzheimer’s disease have increased in rec...Alzheimer’s disease is the leading cause of dementia worldwide and a critical public health problem. While deaths from cardiovascular diseases have decreased, those attributed to Alzheimer’s disease have increased in recent years with no curative treatment to date. In this context, effective treatment development has become a global priority. Aducanumab is a human anti-amyloid β monoclonal antibody approved by the FDA in June 2021 for the treatment of Alzheimer’s disease but failed to show the expected clinical efficacy in phase III trials. This review analyzes the history of its controversial acceptance, implications, and prospects for future treatment.
Introduction. Alterations in the quality and duration of sleep are risk factors for the development of arterial hypertension in Eastern countries. However, in Latin America there are few studies researching this associat...Introduction. Alterations in the quality and duration of sleep are risk factors for the development of arterial hypertension in Eastern countries. However, in Latin America there are few studies researching this association. Objective. To analyze the association between the quality and duration of sleep and the rate of arterial hypertension in a Colombian population. Materials and methods. An observational, longitudinal, prospective and analytical study nested in the INEFAC population-based cohort, was conducted with participants over 18 years of age from Bucaramanga (Colombia). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Sleep duration was assessed using standardized questions. Multivariate analysis was performed with logistic regression models adjusted for possible confounding variables. Results. A total of 1,306 non-hypertensive participants with a mean age of 40 ± 12 years were included. In this population, 92.8% had one or more sleep issues. 45.15% slept 6 hours or less and 28.6% slept 8 hours or more. Multivariate analysis showed a higher risk of hypertension in participants with diabetes (OR = 5.27; 95% CI: 2.27-12.26), obesity (OR = 2.81; 95% CI: 1.11-7.13), active smoking (OR = 2.02; 95% CI: 1.01-4.04) and higher socioeconomic level (OR = 4.94; 95% CI: 1.59-15.38 for level 4), but no higher risk was found in participants with poor sleep quality or short sleep duration. Conclusions. No association was found between the duration or quality of sleep and the rate of arterial hypertension in the Colombian population. More studies are required in this population to reach definitive conclusions.
INTRODUCTION: In recent decades, new non-invasive brain stimulation techniques and protocols have been developed, such as transcranial magnetic stimulation and transcranial direct current stimulation. OBJECTIVE: To ident...INTRODUCTION: In recent decades, new non-invasive brain stimulation techniques and protocols have been developed, such as transcranial magnetic stimulation and transcranial direct current stimulation. OBJECTIVE: To identify and visualize the intellectual structure of non-invasive brain stimulation through document co-citation analysis. MATERIALS AND METHODS: We analyzed 30,854 Web of Science-indexed manuscripts and their 1,615,692 references regarding non-invasive brain stimulation, all published from 1988 to 2022. We drew a document co-citation network map using CiteSpace software. RESULTS: The most productive journal was Clinical Neurophysiology. The most published institution was the University College London, and the country with the most reports was the USA. The most productive author was Alvaro Pascual-Leone and the most cited author in the non-invasive brain stimulation field was J. C. Rothwell. In addition, the most cited study was that of Rossi et al. (2009). The safe application of non-invasive brain stimulation techniques and their effects on motor or executive functions is an emerging trend in this research area. CONCLUSIONS: The current investigation displayed a quantitative scientometric approach and delved into the advancement of non-invasive brain stimulation research by examining the references published in this domain. These findings can be valuable for professionals to picture the patterns of recognition and emerging directions in the field.
Introduction. The international consensus and the American Society of Hematology guidelines from 2019 established thrombopoietin analogues as the second-line therapy for primary immune thrombocytopenia cases. Objectives....Introduction. The international consensus and the American Society of Hematology guidelines from 2019 established thrombopoietin analogues as the second-line therapy for primary immune thrombocytopenia cases. Objectives. To describe romiplostim usefulness in patients with immune thrombocytopenia in a third-level hospital in Cuenca, Ecuador. Materials and methods. We conducted a descriptive and retrospective study in patients with immune thrombocytopenia treated with romiplostim. We evaluated the following variables: age, gender, previous therapies to romiplostim, dose, frequency, complications, change of thrombopoietin analogue, and treatment discontinuation. Results. We included 21 patients with immune thrombocytopenia treated with romiplostim, with a median age of 49 years. All patients received corticosteroids as first-line treatment. Three patients required longer administration intervals (over a week), with weekly doses lower than those recommended (< 1 μg/kg). Due to lack of efficacy, six patients replaced elthrombopag with romiplostim. Of the total, three suffered thrombotic complications: two had portal venous thrombosis, and one had pulmonary thromboembolism; five of the patients discontinued romiplostim scheme without resuming it. Conclusions. Romiplostim constitutes a convenient second-line therapy in immune thrombocytopenia. Despite the small sample size, romiplostim early use can minimize toxicities and infectious risks.
Agudelo MC, Torres-González E, Agudelo S
… +10 more, Ramírez AT, Castañeda KM, Kinslow CJ, Rodríguez-Herrera M, Garland L, Xie Y, Orozco CA, Stoler M, Dean M, Sánchez GI
INTRODUCTION: Low-cost, accurate high-risk HPV tests are needed for cervical cancer screening in limited-resource settings. OBJECTIVE: To compare the performance of the low-cost Hybribio-H13 test with the Hybrid Capture®...INTRODUCTION: Low-cost, accurate high-risk HPV tests are needed for cervical cancer screening in limited-resource settings. OBJECTIVE: To compare the performance of the low-cost Hybribio-H13 test with the Hybrid Capture® 2 to detect cervical intraepithelial neoplasia grade 2 or 3 (CIN2 and CIN3). MATERIALS AND METHODS: Archived baseline samples tested by the Hybrid Capture® 2 from women of the ASCUS-COL trial, aged 20 to 69 years, with biopsy-colposcopy directed diagnosis of CIN2+ (n = 143), CIN3+ (n = 51), and < CIN2 (n = 632) were blindly tested by the Hybribio-H13 test. RESULTS: The relative sensitivity of the Hybribio-H13 test versus the Hybrid Capture® 2 for detecting CIN2+ was 0.89 (90% CI = 0,80-0,98; NIT = 0,66), and for CIN3+ was 0,92 (90% CI = 0,85-0,98; NIT = 0,35). Relative specificity was 1.19 (90% CI = 1.05-1.33; NIT <0.00001). In the analysis restricted to women older than 30 years, the relative sensitivity of the Hybribio-H13 for CIN3+ was marginally below unity (ratio = 0.97; 90% CI = 0.95-0.99), and the specificity remained higher than the Hybrid Capture® 2 test. CONCLUSION: The Hybribio-H13 test was as specific as the Hybrid Capture® 2 for detecting CIN2+ or CIN3+ but less sensitive. Considering these results and the young age of the population recruited for screening because of ASCUS cytology, we suggest our results warrant the evaluation of the Hybribio-H13 for screening cervical cancer, especially in the evaluated population.
INTRODUCTION: Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. OBJECTIVE: To evaluate clinical outcomes in three groups...INTRODUCTION: Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. OBJECTIVE: To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. MATERIALS AND METHODS: A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. RESULTS: A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). CONCLUSIONS: Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.
Renal cystic diseases are common conditions whose etiology can be highly heterogeneous. They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic d...Renal cystic diseases are common conditions whose etiology can be highly heterogeneous. They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic diseases through some clinical cases managed in our service. We describe 11 clinical cases including clinical entities such as renal multicystic dysplasia, and autosomal dominant and autosomal recessive polycystic renal disease, among other pathologies. Renal cystic diseases are heterogeneous in their clinical presentation, natural history, radiological findings, and genetic and pathophysiological basis. An integral clinical approach is needed to get a clear etiological diagnosis and offer adequate individualized care and follow-up for patients.
INTRODUCTION: Stroke in young individuals is becoming increasingly prevalent worldwide. Its causes can vary widely, so a thorough investigation by a multidisciplinary team is needed. Pinpointing the precise underlying pa...INTRODUCTION: Stroke in young individuals is becoming increasingly prevalent worldwide. Its causes can vary widely, so a thorough investigation by a multidisciplinary team is needed. Pinpointing the precise underlying pathology responsible for the stroke yields benefits for patients, particularly in recurrent events. CASE PRESENTATION: A 38-year-old man presented to the emergency department with symptoms suggestive of stroke, including right hemiparesis, dysarthria, ataxic gait, and right central facial palsy. The brain magnetic resonance image revealed an ischemic lesion located in the left basal ganglia and near the corona radiata. Following an extensive workup, a diagnosis of nephrotic was reached. Histopathology and the exclusion of secondary causes confirmed primary membranous nephropathy as the underlying condition. The patient underwent treatment tailored to address the specific glomerulopathy, along with anticoagulation therapy and immunosuppression as per current guidelines. Subsequent assessments showed stabilization of renal function, resolution of the edema, and the absence of new thromboembolic events during follow-up. CONCLUSION: The nephrotic syndrome should be recognized as a potential underlying cause of stroke in young patients and, therefore, it should be included in the differential diagnosis during the evaluation of patients with coagulopathies. Nephrotic syndrome screening may be done by conducting a simple urinalysis readily available in most healthcare facilities. This underlines the importance of considering renal pathology in the assessment of stroke etiologies, especially when coagulation abnormalities are present.
INTRODUCTION: Cine-MRI (cine-magnetic resonance imaging) sequences are a key diagnostic tool to visualize anatomical information, allowing experts to localize and determine suspicious pathologies. Nonetheless, such analy...INTRODUCTION: Cine-MRI (cine-magnetic resonance imaging) sequences are a key diagnostic tool to visualize anatomical information, allowing experts to localize and determine suspicious pathologies. Nonetheless, such analysis remains subjective and prone to diagnosis errors. OBJECTIVE: To develop a binary and multi-class classification considering various cardiac conditions using a spatiotemporal model that highlights kinematic movements to characterize each disease. MATERIALS AND METHODS: This research focuses on a 3D convolutional representation to characterize cardiac kinematic patterns during the cardiac cycle, which may be associated with pathologies. The kinematic maps are obtained from the apparent velocity maps computed from a dense optical flow strategy. Then, a 3D convolutional scheme learns to differentiate pathologies from kinematic maps. RESULTS: The proposed strategy was validated with respect to the capability to discriminate among myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, abnormal right ventricle, and normal cardiac sequences. The proposed method achieves an average accuracy of 78.00% and a F1 score of 75.55%. Likewise, the approach achieved 92.31% accuracy for binary classification between pathologies and control cases. CONCLUSION: The proposed method can support the identification of kinematically abnormal patterns associated with a pathological condition. The resultant descriptor, learned from the 3D convolutional net, preserves detailed spatiotemporal correlations and could emerge as possible digital biomarkers of cardiac diseases.
Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective....Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients’ lipid and bone profiles are more favorable when metabolic control of the disease is achieved.
Introduction. Data in low- and middle-income countries on mortality and its related risk factors in patients with chronic obstructive pulmonary disease are limited. Objective. To identify the incidence of death and its r...Introduction. Data in low- and middle-income countries on mortality and its related risk factors in patients with chronic obstructive pulmonary disease are limited. Objective. To identify the incidence of death and its relationship with variables in a Colombian population during 12 months of follow-up. Materials and methods. We carried out a retrospective study in subjects diagnosed with chronic obstructive pulmonary disease in a third-level hospital in Colombia. Odds ratios were calculated using multivariable logistic regression analysis with the outcome variable “mortality at 12 months”. Results. We included 524 patients, 18.1% (95 / 524) died. The average age was 69.7 (SD = 8.92), and 59.2% (310 / 524) were women. The variables associated with mortality were age (OR = 6.54; 95% CI = 3.65-11.36; p < 0.001), years of exposure to wood smoke (OR = 4.59; 95% CI = 1.64-2.82; p = 0.002), chronic heart failure (OR = 1.81; 95% CI = 1.13-2.91; p = 0.014), cerebrovascular disease (OR = 3.35; 95% CI = 1.04-10.75; p = 0.032), and chronic kidney disease (OR = 6.96; 95% CI = 1.15-41.67; p=0.015). When adjusting the variables in the multivariate analysis, only an association was found for sex (OR = 1.55; 95% CI = 0.95-2.54; p = 0.008) and age (OR = 5.94; 95% CI = 3.3-10.69; p < 0.001). Conclusion. Age, years of exposure to wood smoke, chronic heart failure, and cerebrovascular and chronic kidney disease were the clinical variables associated with a fatal outcome. However, age and sex were the only variables related to mortality when adjusted for confounding factors.
INTRODUCTION: Choric obstructive pulmonary disease (COPD) is the third mortality cause in the world, and the development of useful diagnostic tools is necessary to improve timely diagnostic rates in primary care settings...INTRODUCTION: Choric obstructive pulmonary disease (COPD) is the third mortality cause in the world, and the development of useful diagnostic tools is necessary to improve timely diagnostic rates in primary care settings. OBJECTIVE: To develop a web application displaying spirometric and clinical information - including respiratory symptoms and risk factors- to facilitate a COPD diagnosis. MATERIALS AND METHODS: In this cross-sectional study, an expert consensus was carried out with three specialists using the Delphi method to choose the relevant variables for COPD diagnosis. We developed a Python-based web application to diagnose COPD, displaying the clinical variables deemed relevant by the experts along the spirometric curve. RESULTS: Twenty-six clinical variables were included in the web application for the diagnosis of COPD. A fourth expert used the web application to classify a cohort of 695 patients who had undergone spirometry in a third-level centre and had answered at least one of five questionnaires for COPD screening. Out of the 695 subjects, 34% had COPD, according to the expert that diagnosed them using the web application. Only 42% of the patients in the COPD group had received a previous COPD diagnosis and 19% of the patients in the no COPD group had been misdiagnosed with the disease. CONCLUSION: We developed a web application that displays demographic and clinical information, as well as spirometric data, to facilitate the process of diagnosing COPD in primary care settings.