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Reliable, timely and detailed information on lung cancer prevalence, mortality and costs from middle-income countries is essential to policy design. Thus, we aimed to develop an electronic algorithm to identify lung cancer prevalent patients in Colombia by using administrative claims databases, as well as to estimate prevalence rates by age, sex and geographic region. We performed a cross-sectional study based on national claim databases in Colombia (Base de datos de suficiencia de la Unidad de Pago por Capitación and Base de Datos Única de Afiliados) to identify lung cancer prevalent patients in 2017, 2018 and 2019. Several algorithms based on the presence or absence of oncological procedures (chemotherapy, radiotherapy and surgery) and a minimum number of months that each individual had lung cancer ICD-10 codes were developed. After testing 16 algorithms, those with the closest prevalence rates to those rates reported by aggregated official sources (Global Cancer Observatory and Cuenta de Alto Costo) were selected. We estimated prevalence rates by age, sex and geographic region. Two algorithms were selected: i) one algorithm that was defined as the presence of ICD-10 codes for 4 months or more (the sensitive algorithm); and ii) one algorithm that was defined by adding the presence of at least one oncological procedure (the specific algorithm). The estimated prevalence rates per 100,000 inhabitants ranged between 11.14 and 18.05 for both, the contributory and subsidized regimes over years 2017, 2018 and 2019. These rates in the contributory regime were higher in women (15.43, 15.61 and 17.03 per 100,000 for years 2017, 2018 and 2019), over 65-years-old (63.45, 56.92 and 61.79 per 100,000 for years 2017, 2018 and 2019) who lived in Central, Bogota and Pacific regions. Selected algorithms showed similar aggregated prevalence estimations to those rates reported by official sources and allowed us to estimate prevalence rates in specific aging, regional and gender groups for Colombia by using national claims databases. These findings could be useful to identify clinical and economical outcomes related to lung cancer patients by using national individual-level databases.

Resumen Introducción. La hipocalcemia es la complicación más frecuente de la tiroidectomía. La profilaxis con calcio/calcitriol es una alternativa costo-efectiva, sencilla y expedita para disminuir esta situación, sin alterar la función paratiroidea residual. Lo que no está claro es si hay superioridad de una dosis frente a otra, por lo que el objetivo de este estudio fue evaluar el comportamiento entre diferentes esquemas de profilaxis para hipocalcemia. Métodos. Estudio de cohorte retrospectivo de adultos operados en un hospital de cuarto nivel, entre febrero de 2017 y diciembre de 2020. Se calculó la tasa de síntomas, la hipocalcemia e hipercalcemia bioquímica en el control postquirúrgico durante las siguientes dos semanas. Se hizo análisis bivariado y multivariado entre dosis de calcio/calcitriol, otros factores asociados y los desenlaces mencionados. Resultados. Se incluyeron 967 pacientes. El 10 % presentaron síntomas. No hubo diferencias significativas en el calcio sérico del control posquirúrgico entre los grupos con distintas dosis de calcio. La dosis de carbonato de calcio >3600 mg/día y el calcio en las primeras 24 horas de cirugía se asociaron a la presencia de síntomas. La dosis de calcitriol 3600 mg/day and calcium in the first 24 hours of surgery were associated with the presence of symptoms. The dose of calcitriol

Background: Across the world, the COVID-19 pandemic has disproportionately affected economically disadvantaged groups. This differential impact has numerous possible explanations, each with significantly different policy implications. We examine, for the first time in a low- or middle-income country, which mechanisms best explain the disproportionate impact of the virus on the poor. Methods: We use primary data from the CoVIDA project, including the results of 59,770 RT-PCR tests in Bogota´, targeted on a mostly asymptomatic adult population June 2020 to March 3rd, 2021. This is combined with administrative data that covers all reported cases in Bogota´. We estimate a number of parameters that are likely to drive inequality in COVID-19 infection rates across socioeconomic groups, then use these estimates in an individual-level branching process model of the epidemic. We use counterfactual scenarios to estimate the relative importance of different channels for explaining inequality in infection rates. Findings: Total infections and inequalities in infections are largely driven by inequalities in the ability to work remotely and in within-home secondary attack rates. Inequalities in isolation behavior are less important but non-negligible, while access to testing and contract-tracing plays practically no role. Interventions that mitigate transmission are found to be more effective when targeted on socioeconomically disadvantaged groups. Interpretation: Socioeconomically disadvantaged groups are particularly vulnerable to COVID-19 infections, and this appears to be driven by the need to work out of home, and higher transmission within home. Policies that can successfully reduce these channels of transmission among the poor are likely to have large benefits. Funding: The authors acknowledge generous support from the Interamerican Development Bank, the Development Bank of Latin America (CAF), the University of Los Andes and the Universidad Nacional de Colombia. Duncan Webb gratefully acknowledges support from the ED 465 at University Paris 1, and the EUR project ANR-17-EURE-0001. Declaration of Interest: The authors have no competing interests to declare. Ethical Approval: Ethics approval was obtained from the ethics committee of Universidad de los Andes (Act number 1278 of 2020). The ethics committee approved that the participants would receive the information via telephone and give their verbal consent, in order to comply with physical distancing and limit the restriction for a study is part of a public health surveillance strategy implemented jointly with the Health Secretary of Bogota.

Symptoms-based models for predicting SARS-CoV-2 infection may improve clinical decision-making and be an alternative to resource allocation in under-resourced settings. In this study we aimed to test a model based on symptoms to predict a positive test result for SARS-CoV-2 infection during the COVID-19 pandemic using logistic regression and a machine-learning approach, in Bogotá, Colombia. Participants from the CoVIDA project were included. A logistic regression using the model was chosen based on biological plausibility and the Akaike Information criterion. Also, we performed an analysis using machine learning with random forest, support vector machine, and extreme gradient boosting. The study included 58,577 participants with a positivity rate of 5.7%. The logistic regression showed that anosmia (

Introduction: Minimally invasive surgery (MIS) in pediatric surgery is now the standard of care for various surgical conditions. We have seen an increase in MIS with some of the procedures...

While there is evidence of obstetric and neonatal outcomes from non-obstetric surgery during pregnancy, surgery during the third trimester of gestation has not been evaluated as a prognostic factor for those outcomes. The objective of this study was to determine whether appendectomies during the third trimester are associated with adverse neonatal outcomes, in comparison with appendectomies during the first two trimesters, based on national administrative data in Colombia. A retrospective cohort study was performed using administrative health records. It included all women who had live births and who underwent an appendectomy during any stage of pregnancy, between the years 2011 and 2016, and who belonged to Colombia’s contributory health system. The main outcome was preterm birth. Birth weight and 1-min and 5-min Apgar scores were also measured, as well as outcomes used to identify neonatal near-miss cases. Propensity score matching was used in order to balance baseline characteristics (age, weeks of gestation, obstetric comorbidity index, and region and year the procedure was performed). Relative risks were estimated with Poisson regressions. This study included a total of 2507 women in Colombia’s contributory health system who underwent an appendectomy during pregnancy. Appendectomy was performed on 885 women (35.30%) in their first trimester, 1205 women (48.07%) in their second trimester, and 417 women (16.63%) in their third trimester. For the entire population, the preterm birth rate was 11.85 per 100 appendectomies. With the matched sample, this study found that women in their third trimester had a 1.65 greater risk of preterm birth [95% CI, 1.118–2.423], a 3.43 greater risk of birth at gestational ages

Lung cancer imposes a significant economic burden on most countries. Nevertheless, there is scarce information about this burden on health systems in low- and middle-income countries. This study aims to estimate the economic burden of lung cancer on the Colombian health system, a middle-income country with universal health coverage in Latin America.We conducted a cost-of-illness study that included all direct costs generated by prevalent cases of lung cancer in Colombia during 2017. We used administrative databases containing patient-level information on consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. To decrease the probability of misallocation of costs, we used propensity score matching to estimate the marginal costs of delivering healthcare services to patients with lung cancer. Additionally, ordinary least squares and variations in case definitions were used to assess the robustness of all estimates.Total costs attributable to lung cancer in 2017 ranged from $50 039 588 to $74 468 111, with important differences across insurance regimes (from $4 629 938 for the subsidized regime to $55 342 357 for the contributory regime). Notably, 43% of all costs ($27 081 348) were caused by the consumption of services not included in the health benefit package. There were no significant differences between inpatient and outpatient costs.Lung cancer imposes a significant economic burden on the Colombian health system. Although all affiliates are entitled to a unique health benefit package, there were important differences in costs across insurance regimes. Further research is needed to identify the main mechanisms underlying these differences.

espanolObjetivo. Determinar la relacion entre el nivel de cuota moderadora y la frecuencia de consulta a los servicios de urgencias en pacientes con asma que pertenecen al regimen contributivo en Colombia. Metodos. Se llevo a cabo un estudio observacional analitico de cohorte retrospectivo en el cual se incluyeron las personas mayores de 18 anos cotizantes con diagnostico de asma, usuarios del regimen contributivo registrados en la base de datos para el calculo de la Unidad por Capitacion entre los anos 2012 y 2014. Se hizo reclutamiento de los pacientes durante el ano 2013 y posterior seguimiento a la cohorte durante un ano, desde la fecha de ingreso. Se tomo como variable de desenlace la frecuencia de consulta al servicio de urgencias, se evaluo la influencia de las principales variables de confusion y se aplico un modelo de regresion binomial negativa para el analisis de los datos. Resultados. Se incluyeron 54 516 pacientes asmaticos con sus comorbilidades, de los cuales un 13,69% consulto a urgencias. Luego de controlar por el indice de Charlson y la edad de consulta a urgencias, el riesgo de consultar a urgencias es 1,1 veces mas frecuente en el nivel 3 de cuota moderadora con respecto al nivel 1. Conclusiones. Se sugiere que las cuotas moderadoras podrian comportarse como una barrera de acceso a los servicios de salud en pacientes asmaticos. Se recomienda la realizacion de estudios que evaluen de modo mas preciso esta hipotesis. EnglishObjective. To determine the relation between the moderating fee and the frequency of consultations to emergency services in patients with asthma who belong to the contributory insurance regime in Colombia. Methods. A retrospective cohort - analytical observational study was conducted which included contributors over the age of 18 with a diagnosis of asthma, users of the contributory regime who were registered in the database for calculating the Capitation Unit between the years 2012 and 2014; the patients were recruited during 2013 and the cohort was followed for one year from the admission date; the consultation frequency at the emergency service was used as the outcome variable, the influence of the principal confounding variables was evaluated, and a model of negative binomial regression for data analysis was applied. Results. 54 516 asthmatic patients with their comorbidities were included, of which 13.69% consulted emergency services. After controlling by the Charlson index and age of emergency consultation, the risk of consulting emergency services is 1.1 times more frequent in level 3 of the moderating fee with respect to level 1. Conclusions. It is suggested that moderating fee could behave as an access barrier to health services in asthmatic patients. It is recommended that studies to evaluate this hypothesis more precisely be carried out. portuguesObjetivo. Determinar a relacao entre o nivel da taxa moderadora e a frequencia de consulta aos servicos de urgencia em pacientes com asma que pertencem ao regime contributivo na Colombia. Metodos. Estudo observacional analitico, de coorte retrospectiva, no qual se incluiram as pessoas de idade superior aos 18 anos, diagnosticadas com asma, e que pagam uma mensalidade dentro do regime contributivo, segundo seu registo na base de dados para o calculo da Unidade por Capitacao entre os anos 2012 e 2014. A selecao dos pacientes aconteceu durante o ano 2013 e a coorte de estudo foi monitorada durante um ano desde a data de ingresso. A variavel de saida empregada foi a frequencia de consulta ao servico de urgencias. Foi avaliada a influencia das principais variaveis de confusao e utilizado um modelo de regressao binomial negativa para a analise dos dados. Resultados. Se incluiram 54 516 pacientes asmaticos com suas comorbidades, dos quais um 13,69% consultaram o servico de urgencias. Depois de controlar pela idade deste tipo de consulta e o indice de Charlson, a probabilidade de consulta do servico de urgencias foi 1,1 vezes mais frequente no nivel 3 de taxa moderadora, se comparado com o nivel 1. Conclusoes. As taxas moderadoras poderiam se comportar como um obstaculo ao acesso aos servicos de saude em pacientes asmaticos. Recomenda-se a realizacao de estudos que avaliem de modo mais preciso esta hipotese.

BACKGROUNDThe effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir, and of their combined use in hospitalized patients with coronavirus disease 2019 (Covid-19) pneumonia is unclear.METHODSIn each hospital, hospitalized adults with Covid-19 pneumonia, were randomly assigned, in a 1:1 ratio, to receive: a) standard of care; or b) emtricitabine/tenofovir; or c) colchicine + rosuvastatin; or d) emtricitabine/tenofovir + colchicine + rosuvastatin. The primary outcome was all-cause mortality within the first 28 days after randomization. Severe adverse events (SAE) were those with a high probability of being treatment-related.RESULTS633 patients were randomized in 6 hospitals in Bogota, Colombia. Overall, 98% of the patients received glucocorticoids during hospitalization. The cumulative incidence of death through day 28 was 10.7% in the emtricitabine/tenofovir + colchicine + rosuvastatin arm, 14.4% in the colchicine + rosuvastatin arm, 13.8% in the emtricitabine/tenofovir arm, and 17.4% in the standard of care arm, with adjusted risk differences (aRD) against the standard treatment of -0.07 (95% confidence interval [CI], -0.17 to 0.04), aRD -0.03 (95%CI: -0.11 to 0.05) and aRD: -0.05 (95%CI: -0.15 to 0.05), respectively. Need for invasive mechanical ventilation was lower in the emtricitabine/tenofovir + colchicine + rosuvastatin arm compared to the standard treatment arm, aRD: -0.06 (95%CI: -0.11 to -0,01), but no differences were found between the other comparisons. SAE occurred in 3 patients distributed in the 3 treatment arms.CONCLUSIONSAmong patients hospitalized with moderate and severe SARS Covid-19, the use of the emtricitabine/tenofovir + colchicine + rosuvastatin combination emerges as a treatment alternative.ClinicalTrials.gov number:NCT04359095

Given the lack of a gold standard, the clinical usefulness of Comprehensive Genomic Profiling (CGP) has not been established. This systematic review aimed to evaluate evidence about the clinical benefit of CGP for patients with Non-small cell lung carcinoma (NSCLC). All controlled studies that evaluated the ability of CGP to detect actionable targets (ATs) reported increases in the number of samples with ATs. The frequency of ATs detected in uncontrolled case series ranged from 0.7 % for RET mutations to 45 % for EGFR mutations. The studies that evaluated therapies targeted to EGFR, ALK, ROS-1, MET, and RET mutations documented significant improvement in clinical outcomes. This review suggests that CGP tests may be clinically helpful for treating patients with NSCLC. Although current evidence is associated with a high risk of bias, the significant impact of NSCLC on individuals and society may justify the routine use of CGP testing for this disease.

Introduction: Comparisons of survival between dialysis modalities is of great importance to patients with kidney failure, their families, and healthcare systems. Objective: This study’s objective was to compare mortality of patients on chronic hemodialysis (HD) or peritoneal dialysis (PD) and identify variables associated with mortality. Methods: This retrospective cohort study included adult incident patients with kidney failure treated with HD or PD by the Baxter Renal Care Services network in Colombia. The study was conducted between January 1, 2008, and December 31, 2013 (recruitment period), with follow-up until December 31, 2018. The outcome was the cumulative mortality rate at 1, 2, 3, 4, and 5 years. Propensity score matching (PSM) and the Gompertz parametric survival model were used to compare mortality in HD versus PD. Results: The analysis included 12,499 patients, of whom 57.4% were on PD at inception. The overall mortality rate was 14.0 events per 100 patient-years (95% confidence interval [CI], 13.61–14.42). Using an intention-to-treat approach, crude mortality rates were significantly lower in patients receiving HD (HD: 12.3 deaths per 100 patient-years [95% CI, 11.7–12.8] vs. PD: 15.5 [14.9–16.1], p < 0.01). Using a Gompertz parametric survival model, dialysis modality was not significantly associated with mortality (hazard ratio HD vs. PD 1.0, 95% CI, 0.9–1.1). After PSM, the mortality cumulative incidence functions between HD and PD were not statistically significantly different (p = 0.88). Conclusions: The present study in a large cohort of incident dialysis patients with at least 5 years follow-up and using PSM methods showed no differences in cumulative mortality between HD and PD patients. This evidence from a middle-income country may facilitate the process of dialysis modality selection globally.

Background and Aims According to emerging evidence, medium cut-off membrane improves clearance of molecules larger than 25 kDa, including larger uremic toxins. There is growing evidence on clinical effectiveness outcomes associated with the use of these membranes. Our aim was to evaluate clinical effectiveness of medium cut-off (HDx) versus high flux (HF-HD) dialyzers in terms of hospitalization rate and duration, cardiovascular event rate and survival in a HD prevalent cohort in Colombia through an observational, multicenter retrospective cohort analysis. Method Adult Prevalent HD patients (> 90 days in HD) at Baxter Renal Care Services Colombia were included between September 1st, 2017 to November 30th, 2017 (follow-up until 2 years). Socio-demographic and clinical characteristics of all patients were summarized descriptively. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on indicators of baseline socio-demographic and clinical characteristics. Weighted incidence rate ratios (IRRs) and rates and duration of hospitalization and cardiovascular events according to dialyzer type were obtained using binomial negative regression with the weighting sample. Results We evaluated 1098 patients (37.7% women): 534 in HF-HD vs 564 in HDx (Table 1), median age was 60.6 years. Mean time on HD was 5.6 years (SD 5.51) for HF-HD and 5.88 for HDX (SD 5.48) We observed lower hospitalization rates in HDx group, (IRR HDx/HF-HD: 0.82 95% CI 0.69 to 0.98; p=0.03); and cardiovascular events rate, (IRR HDx/HF-HD: 0.65 95% CI 0.47 to 0.91; p=0.01) see Table 2. Main cause of hospitalization was cardio-cerebrovascular (Table 3). We observed no differences in hospitalization duration or survival. Conclusion We evaluated 1098 patients (37.7% women): 534 in HF-HD vs 564 in HDx (Table 1), median age was 60.6 years. Mean time on HD was 5.6 years (SD 5.51) for HF-HD and 5.88 for HDX (SD 5.48) We observed lower hospitalization rates in HDx group, (IRR HDx/HF-HD: 0.82 95% CI 0.69 to 0.98; p=0.03); and cardiovascular events rate, (IRR HDx/HF-HD: 0.65 95% CI 0.47 to 0.91; p=0.01) see Table 2. Main cause of hospitalization was cardio-cerebrovascular (Table 3). We observed no differences in hospitalization duration or survival.

Patient cost-sharing in medical care constrains total health spending, presumably with little harm to underlying patient health. This paper re-evaluates the link between cost-sharing and health, studying Colombia’s entire formal sector workforce with individual-level health care utilization records linked to payroll data and vital statistics. Given discrete breaks in outpatient cost-sharing imposed at multiple income thresholds by Colombia’s national health system, we use a regression discontinuity design and find that outpatient cost-sharing reduces use of outpatient care, resulting in fewer diagnoses of common chronic diseases and increasing subsequent emergency room visits and hospitalizations. Ultimately, these effects measurably increase mortality, and disproportionately so among the poor – raising the absolute difference in 7-year mortality risk by 0.80 and 0.23 deaths per 1,000 individuals at lower- and higher-income thresholds, respectively. To the best of our knowledge, this study is the first to show a relationship between cost-sharing and adult mortality risk in lower-income countries, a relationship important to incorporate into social welfare analyses of cost-sharing policies.One Sentence SummaryOutpatient cost-sharing in medical care discourages use – but over time, also increases costly hospital service use and raises mortality risk.

Introducción. Los microcarcinomas papilares de tiroides son tumores de hasta 10 mm en su diámetro mayor. Su tratamiento es sujeto de debate y se propone, desde seguimiento clínico, hasta intervención quirúrgica temprana. Este estudio buscó identificar factores de riesgo relacionados con compromiso ganglionar, que permitan una mejor selección de los pacientes en nuestro medio, en quienes se propone manejo quirúrgico inmediato o vigilancia activa, en consonancia con la clasificación del riesgo de progresión. Métodos. Estudio de cohorte analítica ambispectiva que incluyó pacientes con microcarcinoma papilar de tiroides llevados a tiroidectomía más vaciamiento central. Se caracterizó la población y se realizó un análisis de regresión logística multivariado para definir factores preoperatorios asociados al compromiso ganglionar. Adicionalmente, se evaluó de manera retrospectiva la eventual asignación a grupos de riesgo de progresión, según los criterios de Miyauchi, y su comportamiento respecto al estado nodal. Resultados. Se incluyeron 286 pacientes. El 48,9 % presentó compromiso ganglionar, y de estos, el 33,5 % presentó compromiso ganglionar significativo, que modificó su clasificación de riesgo de recaída. De estos últimos, el 59,5 % hubiesen sido manejados con vigilancia activa, según los criterios propuestos por Miyauchi. Se identificó que la edad menor de 55 años, los ganglios sospechosos en la ecografía y los nódulos mayores de 5 mm, se relacionan con compromiso ganglionar significativo. Discusión. El manejo quirúrgico inmediato parece ser una opción adecuada para pacientes con sospecha de compromiso ganglionar en ecografía preoperatoria, pacientes menores de 55 años y nódulos mayores de 5 mm. Es posible que los actuales criterios para definir vigilancia activa no seleccionen adecuadamente a los pacientes en nuestro medio.

Objective To examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict. Methods Using birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score Results Among the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar Conclusion The lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.

Resumen Introducción. La mortalidad perioperatoria se considera una de las herramientas clave para medir la fuerza del sistema de salud de un país en el área quirúrgica. Actualmente, no se cuenta con las cifras totales de las apendicectomías realizadas en nuestro pais, a pesar de ser un procedimiento quirúrgico extremadamente común. Métodos. Estudio de cohorte retrospectivo con datos de pacientes de todas las edades, reportados como afiliados al sistema de salud contributivo de Colombia y a quienes se les realizó una apendicectomía entre el 1° de enero de 2011 y el 31 de diciembre de 2016. La información se obtuvo de bases de datos nacionales y se procesó a partir del cálculo de variables, como la tasa de mortalidad perioperatoria y el volumen quirúrgico, estimando una tasa de mortalidad a treinta días, por sexo, grupo etario y región geográfica. Resultados. Entre las 231.570 apendicectomías que se identificaron, se halló una mayor tasa de mortalidad perioperatoria en el grupo etario de hombres mayores de 80 años con 17,3 %. La región oriental presentó la menor tasa de mortalidad con 0,01 %. El mayor volumen quirúrgico se presentó en el año 2012 y el menor en el año 2016. Discusión. La tasa de mortalidad de apendicectomía en diferentes grupos etarios es similar a la de otros países de ingresos medios y bajos, en tanto que la mayor heterogeneidad de la tasa de mortalidad entre las diferentes regiones, se percibe en los grupos de menores de un año y de mayores de 65 años. Este estudio se constituye como una aproximación inicial a la tasa de mortalidad en apendicectomías realizadas en Colombia. Abstract Introduction. Perioperative mortality is considered one of the key tools to measure the strength of a country’s health system, in the surgical area. Currently, there are no total figures for appendectomies performed in our country, despite being an extremely common surgical procedure. Methods. Retrospective cohort study with data from patients of all ages, reported as affiliated to the contributory health system in Colombia and who underwent an appendectomy between 01/01/2011 and 12/31/2016. The information, which was obtained from national databases, was processed by calculating variables such as perioperative mortality rate and surgical volume, estimating a 30-day mortality rate, by sex, age group and geographic region. Results. Among the 231,570 appendectomies that were identified, a higher perioperative mortality rate was found in the age group of men older than 80 years with 17.31%. The eastern region had the lowest mortality rate with 0.01%. The highest surgical volume occurred in 2012 and the lowest in 2016. Discussion. The mortality rate from appendectomies in different age groups is similar to that of other low- and middle-income countries, while the greater heterogeneity of the mortality rate between the different regions is seen in the groups of children under one year of age and older over 65 years old. This study constitutes an initial approximation to the mortality rate in appendectomies performed in Colombia.

In many developing countries, the COVID-19 pandemic has spread much faster and wider than the number of detected cases implies. By combining data from 59,770 RT-PCR tests on mostly asymptomatic individuals with administrative data on all detected cases, we capture the spread and dynamics of the COVID-19 pandemic in Bogota from June 2020 to early March 2021. Our data provide unusually broad and detailed information on mostly asymptomatic adults in Bogota, allowing to describe various features of the pandemic that appear to be specific to a developing country context. We find that, by the end of March 2021, slightly more than half of the population in Bogota has been infected, despite only a small fraction of this population being detected. In July 2020, after four months of generalized quarantine that mitigated the pandemic without curving it, the initial buildup of immunity contributed to the end of the first wave. We also show that the share of the population infected by February 2021 varies widely by occupation, socio-economic stratum, and location. This, in turn, has affected the dynamics of the spread: while the first wave of infections was driven by the lowest economic strata and highly-exposed occupations, the second peak affected the population more evenly. A better understanding of the spread and dynamics of the pandemic across different groups provides valuable guidance for efficient targeting of health policy measures and restrictions.

Across the world, the SARS-CoV-2 (COVID-19) pandemic has disproportionately affected economically disadvantaged groups. This differential impact has numerous possible explanations, each with significantly different policy implications. We examine, for the first time in a low- or middle-income country, which mechanisms best explain the disproportionate impact of the virus on the poor. Combining an epidemiological model with rich data from BogotAi, Colombia, we show that total infections and inequalities in infections are largely driven by inequalities in the inability to work remotely and in within-home secondary attack rates. Inequalities in isolation behavior are less important but non-negligible, while access to testing and contract-tracing plays practically no role. Interventions that mitigate transmission are often more effective when targeted on socioeconomically disadvantaged groups.

Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative. Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes. Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods. Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index. Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.

Background Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU. Objective To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU Methods Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching. Results Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of − 1.86 (95% CI − 2.01 to to1.65; p < 0.001). Conclusions The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.

Chagas disease represents an important cause of heart failure (HF) and affects health-related quality of life (HRQoL). The study aimed to evaluate and compare the HRQoL of patients with chagasic HF and matched non-Chagas controls to identify factors associated with HRQoL. A cross-sectional study with pair-matched controls was conducted in Colombia. From October 2018 to December 2019, a total of 84 HF patients were screened for study subjects. Four were excluded, resulting in 80 patients for the analysis, among whom 40 patients with Chagas were enrolled as cases and 40 gender- and age-matched non-Chagas patients as controls. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) were used to measure HRQoL. Demographic, clinical, and laboratory data were obtained from each subject. Health-related quality of life scores were significantly worse among the Chagas group than among the non-Chagas group in the KCCQ domains of physical functioning and symptoms and in the MLWHFQ scale. In the multivariate analysis, the variables associated with lower HRQoL scores were living alone, obesity, having less than 12 years of education, and an increase in left ventricular diameters in the systole and diastole. Health-related quality of life in patients with chronic HF is impaired across all domains. Chagas patients showed worse HRQoL scores than non-Chagas patients. Six variables, some potentially modifiable, were independently associated with worse HRQoL.

Although many studies have compared outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA), some clinical and economic outcomes continue to be controversial, particularly in low–medium-income countries. We aimed at determining clinical and economic outcomes associated with LA versus OA in adult patients in Colombia. Retrospective, cohort study based on administrative healthcare records included all patients who underwent LA or OA in Colombia’s contributory regime between July 1, 2013, and September 30, 2015. Outcomes were 30-day mortality rates, ICU admissions rates, length of stay (LOS), and hospital costs provided until discharge. Propensity score matching techniques were used to balance the baseline characteristics of patients (age, sex, comorbidities based on the Charlson index, insurer, and geographic location) and to estimate the average treatment effect (ATE) of LA as compared to OA over outcomes. A total of 65,625 subjects were included, 92.9% underwent OA and 7.1% LA. For the entire population, 30-day mortality was 0.74 per 100 appendectomies (95% CI 0.67–0.81), the mean and median LOS were 3.83 days and 1 day, respectively, and the ICU admissions rate during the first 30 days was 7.92% (95% CI 7.71–8.12). The ATE shows an absolute difference in the mortality rate after 30 days of −0.35 per 100 appendectomies (p = 0.023), in favor of LA. No effects on ICU admissions or LOS were identified. LA was found to increase costs by 514.13 USD on average, with total costs of 772.78 USD for OA and 1286.91 USD for LA (p

In this paper, we present the most currently available data on real access to high quality diagnostic and curative and palliative care in Colombia, a middle income country with relatively recent large healthcare reforms. We will focus on cancer types with a good average prognosis when detected and treated adequately and which are prioritized in national policies and cancer plans: cancers of the breast, cervix, prostate, colorectum and childhood cancers. These cancers have a quite poor prognosis compared to high-income countries. We find that, despite having achieved an almost “universal health coverage”, Colombia suffers serious problems in accessibility to preventative, diagnostic and treatment services for patients with cancer. People living in poverty have lower real access to all types of care, but other problems are due to lack of health literacy, beliefs and knowledge. Much can be gained by early detection, the advanced stages at diagnosis of many cancers can be avoided by increasing awareness amongst both the general public and health care professionals. Delays in diagnosis and treatment can be reduced, changes in legislation and bureaucratic processes, and increases in trained human resources and equipment is needed. The economic impact of getting a cancer diagnosis to patients and their families is understudied but seems to be substantial, as well as studies on quality of life of cancer patients and survivors - providing ample room for improvement.

Internal armed conflicts have become more common and more physically destructive since the mid-20th century, with devastating consequences for health and development in low- and middle-income countries. This paper investigates the causal impacts of the long-term internal conflict on child health in Colombia, following an identification strategy based on the temporal and geographic variation of conflict intensity. We estimate the effect of different levels of conflict intensity on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height z-scores among children under five years old, and explore the underlying potential mechanisms, through maternal health behavior and health care utilization. We find a harmful effect of exposure to conflict violence in utero and in early childhood for HAZ and WAZ, in the full sample and even more strongly in the rural sample, yet these estimates are smaller than those found for shorter term conflicts. The underlying pathways appear to operate around the time of the pregnancy and birth (in the form of maternal alcohol use, use of antenatal care and skilled birth attendance), rather than during the post-birth period (via breastfeeding or vaccination), and the impacts accumulate over the childhood. The most adverse impacts of conflict violence on child health and utilization of maternal healthcare were observed in municipalities which suffered from intermittent presence of armed groups.

The aim of this article is to estimate the type of selection that exists in the supplemental health insurance market in Colombia where compulsory coverage is implemented through managed care competition. We build a panel database that combines individuals' information from the Ministry of Health and a database provided by two private health insurers. We perform the correlation test for consumption of health services frequency and supplemental coverage. Following Fang et al. (2008), we condition the estimation on health controls that are available to the econometrician but not to insurers. In both cases we obtain a positive correlation, suggesting that adverse selection predominates. In order to rule out some moral hazard effects, we estimate the correlation between previous frequency of healthcare service consumption and supplemental insurance purchase. The positive correlation obtained is robust to the inclusion of controls for diagnosis implemented by health insurers, suggesting that despite some risk selection strategies, they are not protected from adverse selection. We conclude that some subsidies to supplemental coverage purchase would lower public expenditure in Colombia.

Introducción. El objetivo del estudio fue estimar los factores pronóstico asociados con el parto prematuro y otros resultados clínicos en mujeres embarazadas sometidas a apendicectomía en Colombia. Métodos. Se llevó a cabo un estudio retrospectivo de cohorte a partir de las bases de datos administrativos, que incluyó mujeres embarazadas afiliadas al sistema de salud contributivo en Colombia y sometidas a apendicectomía, entre enero de 2013 y noviembre de 2016. Se estimaron la tasa de parto prematuro, la tasa de mortalidad a los 30 días, el ingreso materno a la unidad de cuidados intensivos a 30 días, el reingreso de la madre a los 30 días y el bajo peso al nacer. Se utilizaron regresiones logísticas multivariadas para identificar estos tres factores pronóstico. Resultados. Se incluyeron 1.589 mujeres en el estudio. La edad media fue de 26,43 ± 5,79 años, el 17,94 % de las apendicectomías se practicaron en el tercer trimestre, el 6,10 % fueron apendicectomías laparoscópicas y el 22,03 % requirió drenaje por peritonitis. Las tasas de parto prematuro, mortalidad a 30 días, ingreso a la unidad de cuidados intensivos a 30 días, reingreso a los 30 días y bajo peso al nacer, fueron 12,08 %, 0,13 %, 9,75 %, 16,93 % y 3,34 %, respectivamente. La edad menor de 18 años, la apendicectomía en el tercer trimestre y el drenaje por peritonitis se asociaron con un mayor riesgo de parto prematuro. El índice de comorbilidad de Charlson, la apendicectomía en el tercer trimestre y el drenaje por peritonitis, se asociaron con un mayor ingreso materno a la unidad de cuidados intensivos. Conclusiones. La apendicectomía en el tercer trimestre y la apendicitis complicada, son factores pronóstico asociados a parto prematuro en mujeres colombianas embarazadas sometidas a apendicectomía.

Summary Background & aims Between 30 and 50% of Colombian patients are malnourished or at-risk of malnutrition on hospital admission. Malnutrition is associated with poor outcomes and increased costs. We used cost modeling to estimate savings that could be derived from implementation of a nutrition therapy program for patients at malnutrition risk. Methods The budget impact analysis was performed using previously-published outcomes data. Outcomes included length of stay, 30-day readmissions, and infectious/non-infectious complications. We developed a Markov model that compared patients who were assigned to receive early nutrition therapy (started within 24–48 h of hospital admission) with those assigned to receive standard nutrition therapy (not started early). Our model used a 60-day time-horizon and estimated event probabilities based on published data. Results Average total costs over 60 days were $3770 US dollars for patients with delayed nutrition therapy vs $2419 for patients with early nutrition therapy—a savings of $1351 (35.8% decrease) per nutrition-treated patient. Cost differences between the groups were: $2703 vs $1600 for hospital-associated costs; $883 vs $665 for readmissions; and $176 vs $94 for complications. Taken broadly, the potential costs savings from a nutrition care program for an estimated 638,318 hospitalized Colombian patients at malnutrition risk is $862.6 million per year. Conclusions Our budget impact analysis demonstrated the potential for hospital-based nutrition care programs to improve health outcomes and reduce healthcare costs for hospitalized patients in Colombia. These findings provide a rationale for implementing comprehensive nutrition care in Colombian hospitals.

Acute appendicitis is the most common acute surgical abdominal pathology in children, and it has a large impact on morbidity and the costs incurred by health care systems. In low- and median-income countries, national information on the clinical and economic outcomes associated with this surgery does not exist. This study aimed to identify and describe the clinical and economic outcomes for children undergoing appendectomy in Colombia’s contributory system and to determine the prognostic factors associated with these outcomes. A retrospective cohort study was conducted using administrative data from patients under 18 years of age who underwent an appendectomy between July 1, 2013, and September 30, 2015, in Colombia’s contributory health system. Thirty-day mortality rates, intensive care unit (ICU) admission rates, length of stay (LOS), readmission rates and median costs were estimated for the entire country by geographic region and insurer. The prognostic factors associated with these outcomes were identified using generalized multilevel mixed models. A total of 21,674 children were included. The 30-day postoperative mortality rate was 0.06% [95% CI 0.02–0.9], the ICU admission rate was 8.00% [95% CI 7.63–8.36], the mean LOS was 2.48 days (SD 5.24), the readmission rate was 1.5% [95% CI 1.33–1.66] and the median cost for Colombia was 394 USD [p25–p75: 256–555]. The prognostic factors that were associated with the 30-day ICU admission rate, LOS and readmission rate were the insurer, geographic region, age, occurrence of an appendectomy with peritoneal drainage, and certain comorbidities, such as cancer and neurological, respiratory and gastrointestinal illnesses. The prognostic factors associated with costs were those previously mentioned as well as the occurrence of a laparoscopic appendectomy. In Colombia’s contributory health system, large differences in clinical outcomes and the costs incurred by the system exist, and these differences are associated with the geographic region, the insurer, and some of the clinical characteristics of the children undergoing appendectomy.

Parathyroidectomy (PTX) is one of the most frequently performed surgeries in chronic kidney disease (CKD) patients. The objective of this study was to determine the intensive care unit (ICU) admission, mortality and hospital readmission rates within the 30-day postoperative period, and the total cost of the care episode and to determine possible prognostic factors in end-stage renal disease (ESRD) adult patients taken to PTX in the Colombian contributory health system.Methods. Retrospective cohort study of ESRD adult patients affiliated to the Colombian contributory health system, on dialysis for at least 3 months, undergoing PTX between January 1, 2012, and November 30, 2016. The clinical outcomes evaluated were rehospitalization at 30 days, hospital stay, and ICU requirement. The costs associated with the hospitalization event in which the PTX was performed from the perspective of the third payer were estimated.Results. The study included 478 patients. The mortality rate was 2.09 per 100 surgeries, the ICU admission rate was 32.64 per 100 surgeries, the 30-day hospital readmission percentage of the postoperative period was 16.74%, and the average length of hospital stay was 5.02 days. The median total costs of care for the entire procedure was USD $ 7,814.27 (p25-p75: 3,922.03–9,372.68), with significant regional differences. The geographical region was shown as a prognostic factor associated with clinical outcomes and the cost of care.Conclusions. There are large regional differences in readmission, ICU admission and mortality rates, and costs of dialysis ESRD patients undergoing PTX belonging to the Colombian contributory regime. The geographic region behaves as an independent predictor of clinical outcomes and costs.

Objective: The CoVIDA project is a public-private collaboration led by Universidad de los Andes that contributed to the SARS-CoV-2 epidemiological surveillance in Bogota and nearby municipalities. We aimed to describe the development and performance of the Drive/Walk-through free RT- PCR for SARS-CoV-2 testing strategy implemented by CoVIDA. Material and method: We performed a descriptive analysis of the characteristics and performance of the CoVIDA Drive/Walk-through testing centers. The model and the process indicators to assess the model’s performance were based on international experiences and scientific literature. Two screening centers were implemented in shopping centers in the north and south of Bogota. We reported the number of tests taken, the number of positive tests, and the number of participants that used the model by the type of occupations. Results: In total, 36,689 nasopharyngeal RT-PCR tests for SARS-CoV-2 were performed with a 5.75% cumulative positivity. Process indicators showed an excellent performance and an important contribution in reducing barriers to access to testing. Conclusions: the CoVIDA Drive/Walk-through testing centers supported the epidemiological surveillance in asymptomatic or mild-symptomatic population in Bogota. Low and middle-income countries can use this model as a cost-effective and innovative solution strategy to intensify testing and help mitigate the pandemic.

e18808 Background: Fragmentation in healthcare leads to adverse outcomes in cancer patients. Currently there is no fragmentation measurement that has been acknowledged to reliably assess healthcare fragmentation across different health systems. We aimed to measure cancer healthcare fragmentation through administrative databases in Colombia and to calculate its effect on breast, stomach and colorectal cancer mortality. Methods: We conducted a cohort study based on health administrative databases from 2013 to 2017. We combined data from two Colombian national health databases (Capitation Payment Unit database and Vital Statistics from DANE). We developed an algorithm based on ICD-10 codes and oncological procedures to select incident cases of breast, stomach and colorectal cancer. To measure healthcare fragmentation, we identified the number of providers between the dates of the first and last registered services. For patients who died during observation we adjusted the number of providers for survival time in days, otherwise survival time was set to 31 december, 2017. We categorized fragmentation in quartiles and evaluated its effect on mortality rate by Kaplan Meier estimates. Results: We identified three cohorts of patients based on primary tumor site. Age distribution was similar in stomach and colorectal cancer. Fragmentation measured as a continuous variable has a non-parametric distribution in all cohorts. The median of follow-up time ranged between 2.4 to 4.4 years. All-cause mortality rates were highest in stomach cancer, lowest in breast cancer. When measured as quartiles, fragmentation has a consistent dose-response effect increasing all-cause mortality rates. Conclusions: Healthcare fragmentation can be measured through algorithms applied to administrative databases in Colombia. Fragmentation is a predictor for all-cause mortality across different oncologic populations. This measurement based on real-world national administrative data could be used as an indicator of high-quality oncological healthcare for the Colombian healthcare system.[Table: see text]

e18810 Background: Breast, stomach and colorectal cancers have high incidence in Colombia. Official cancer incidence registries depend upon sentinel site reports as there is no nationwide surveillance system. We aimed to identify administrative database algorithms for breast, stomach and colorectal cancer case selection and to compare their cancer incidence estimates to official registries. Methods: We conducted a systematic review to identify algorithms with high positive predictive values (VPP) for breast, stomach and colorectal cancer case identification in administrative databases. For each cancer we selected two algorithms: a sensitive algorithm, based on cancer-specific ICD-10 codes, and a specific algorithm, combining cancer-specific ICD-10 codes with at least one code for oncological procedures. We varied the number of months a cancer-specific ICD-10 code was registered within each algorithm to test for algorithm stability. We conducted a cohort study to estimate incident cancer cases for 2013 in four cancer sentinel cities in Colombia and one cancer reference center using both algorithms. We defined incident cases as cases lacking a cancer-specific ICD-10 code in the preceding two years and adjusted incident cases for type of regimen affiliation. Algorithms with results closest to official sources were selected as best performing algorithms. We used the contributive regimen Capitation Payment Unit administrative database of Colombia for 2011-2014 as source of information. Results: Breast cancer case-identification algorithms have a higher VPP reported in literature (83-100%) compared to colorectal (41.7-94%) and stomach cancer (35-59.7%) algorithms. The closest breast cancer incidence estimates to the official registries Infocancer and National Cancer Institute were yielded by the specific algorithm with ICD-10 codes persisting for four months (n= 672 vs 649 and 397 vs 212, respectively). The closest colorectal cancer cancer incidence estimates to official registries were yielded by the specific algorithm with ICD-10 codes persisting for three months (n= 219 vs 230 and 168 vs 139, respectively). The closest stomach cancer incidence estimates to official registries were yielded by the specific algorithm with ICD-10 codes persisting for one month (n= 122 vs 146 and 99 vs 153, respectively). Sensitive algorithms were less stable than specific algorithms across all three cancer types. Conclusions: Breast, stomach and colorectal incident cancer cases can be identified through administrative databases. VPP vary among types of algorithms and cancers. Specific algorithms provide better breast and colorectal incident cancer case-identification in Colombian administrative databases, compared to stomach cancer algorithms. This is a potential approach for estimating nationwide cancer incidence in Colombia.

e18784 Background: There is need for high quality data about the economic burden of disease in low- and middle-income countries. We aimed to determine the annual incremental cost of health care services utilized by lung cancer patients in the Colombian health system. Methods: We conducted a national cohort study of prevalent patients with lung cancer in Jan-2017 and followed-up until Dec-2017. We used two electronic algorithms to identify all lung cancer prevalent patients in the Contributory regime, using national health claims databases ( Base de datos de suficiencia de la Unidad de Pago por Capitación and Base de Datos Única de Afiliados), based on identification of ICD-10 codes for 4 months or more during the previous 3 years (sensitive algorithm) and adding the presence of at least one oncological procedure (specific algorithm). We identified all health services cost from the health system perspective (2017 USD). We performed a propensity score analysis to estimate the annual incremental cost of care of patients with lung cancer compared to those without the disease. Standardized differences lower than 0.1 were used to measure the balance of baseline variables. We used generalized linear models as a sensitivity analysis. Results: We identified 4,827 and 3,238 lung cancer prevalent patient using the sensitive and specific algorithm, respectively. Each cohort was matched 1:1 with a no-exposed cohort of 14,968,202 individuals without a diagnosis of lung cancer using a caliper of 0.0001. Matched samples showed good balance on baseline characteristics. Annual incremental cost for patients diagnosed with lung cancer in Colombia ranged between USD $ 3,146.92 and USD $ 4,156.23. We also estimated incremental cost for outpatient and inpatient healthcare services as shown in table. Conclusions: In 2017, each patient with lung cancer represented an incremental cost to the Colombian health system between 49.35% and 65.19% of GDP per capita. This information is paramount to understand lung cancer spending in Colombia and for other low- and middle-income countries. [Table: see text]

Resumen Antecedentes La violencia en Colombia tiene una historia de mas de 50 anos. se calcula que entre 1985 y 2012 han fallecido 220.000 colombianos y cerca de 6.000.000 han sido desplazados por la violencia. Objetivo Describir y comparar las prevalencias de algunos problemas y trastornos mentales en la poblacion adulta colombiana teniendo en cuenta las caracteristicas del municipio respecto a su historia de violencia o conflicto armado. Metodos Se utilizaron los resultados de los adultos (mayores de 18 anos) sobre algunos problemas y trastornos mentales de la ENSM de 2015, y se clasificaron los municipios segun la presencia y la intensidad del conflicto utilizando la clasificacion propuesta por la CERAC. Se realizo la medicion de trastorno (con el CIDI-CAPI), problemas (con AUDIT, PCL modificado) y consumo de sustancias psicoactivas. Resultados Se entrevisto a 10.870 personas, de las que 5.429 no habian cambiado de residencia. El 21,8% de los municipios sufrian conflicto permanente; el 65,5%, interrumpido, y solamente el 12,7% habia sido pacificado o no tenia conflicto. La intensidad del conflicto se reporto alta en el 31,8%. Los municipios violentos presentaban prevalencias mas altas de trastornos de ansiedad, depresivos, posible trastorno de estres postraumatico y consumo de cigarrillo. El consumo de alcohol era mas frecuente en municipios con menor intensidad del conflicto. Conclusiones Los municipios clasificados como con altos niveles de violencia presentaban mayor prevalencia de trastornos mentales y de la mayoria de los problemas mentales.

Este articulo presenta una revision de la literatura relacionada con la integracion vertical en sistemas de salud, con un enfasis especial en el sector colombiano de la salud. Empezamos introducien...

Summary Background & aims Hospitalized patients show a high rate of malnutrition, which is associated with poor patient outcomes and high healthcare costs. However, relatively few studies have investigated the association between clinical and economic outcomes and malnutrition in hospitalized patients, particularly those with cardiac and pulmonary conditions. Methods This multicenter prospective observational cohort study included 800 patients hospitalized at four Colombian hospitals with a diagnosis of congestive heart failure, acute myocardial infarction, community-acquired pneumonia, or chronic obstructive pulmonary disease. All patients were screened for malnutrition using the Malnutrition Screening Tool (MST). A descriptive analysis of baseline variables was followed by multivariate analysis and inverse probability weighting (IPW) to compare the clinical outcomes, i.e., length of stay (LOS), mortality, and readmission, and hospital costs associated with a positive MST result. Results The prevalence of a positive MST result was 24.62% (n = 197) and was more common in patients with older age and greater comorbidities. Multivariate analysis controlling for age, gender, healthcare plan, university degree, hospitalization, entrance disease and Charlson co-morbidity index showed that a positive MST result was associated with increased LOS (1.43 ± 0.61 days) and both in-hospital mortality (odds ratio, 2.39) and global mortality (odds ratio, 2.52). IPW analysis confirmed the association between a positive MST result and increased hospital LOS and 30-day mortality, as well as a relative increase of 30.13% in the average cost associated with hospitalization. Conclusions This study of hospital inpatients demonstrated a high burden of malnutrition at the time of hospital admission, which negatively impacted LOS and mortality and increased the costs of hospitalization. These findings underscore the need for improved diagnosis and treatment of hospital malnutrition to improve patient outcomes and reduce healthcare costs.

BackgroundDespite the adoption of campaigns to interrupt the main vector and to detect Trypanosoma cruzi in blood banks, millions of people are still chronically infected; however, the prevalence data are limited, and the epidemiology of Chagas disease has not been systematically evaluated. This study aimed to estimate the prevalence of Chagas disease in Colombia.MethodsA systematic literature review and meta-analysis was conducted to select all observational studies reporting the prevalence of Chagas disease in Colombia, based on serological diagnosis in participants of any age and published between January 2007 and November 2017. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random-effects models. In addition, the I2 statistic was calculated.ResultsThe literature search yielded a total of 1,510 studies; sixteen articles with relevant prevalence data were included in the systematic review. Of these, only 12 articles were included for entry in the meta-analysis. The pooled prevalence of Chagas disease across studies was 2.0% (95% CI: 1.0-4.0). A high degree of heterogeneity was found among studies (I2 > 75%; p < 0.001). The publication bias was not statistically significant (Egger's test, p = 0.078). The highest pooled prevalences were found in the adult population (3.0%, 95% CI: 1.0-4.0), pregnant women (3.0%, 95% CI: 3.0-4.0) and the Orinoco region (7.0%, 95% CI: 2.2-12.6).ConclusionsThe results indicate that the T. cruzi-infected population is aging, the adult population, pregnant women and that the Orinoco region (department of Casanare) have the highest prevalences. These results highlight the need to maintain screening and surveillance programs to identify people with chronic T. cruzi infections.

Background Automated peritoneal dialysis (APD) is a growing PD modality but as with other home dialysis methods, the lack of monitoring of patients’ adherence to prescriptions is a limitation with potential negative impact on clinical outcome parameters. Remote patient monitoring (RPM) allowing the clinical team to have access to dialysis data and adjust the treatment may overcome this limitation. The present study sought to determine clinical outcomes associated with RPM use in incident patients on APD therapy. Methods A retrospective cohort study included 360 patients with a mean age of 57 years (diabetes 42.5%) initiating APD between 1 October 2016 and 30 June 2017 in 28 Baxter Renal Care Services (BRCS) units in Colombia. An RPM program was used in 65 (18%) of the patients (APD-RPM cohort), and 295 (82%) were treated with APD without RPM. Hospitalizations and hospital days were recorded over 1 year. Propensity score matching 1:1, yielding 63 individuals in each group, was used to evaluate the association of RPM exposure with numbers of hospitalizations and hospital days. Results After propensity score matching, APD therapy with RPM ( n = 63) compared with APD-without RPM ( n = 63) was associated with significant reductions in hospitalization rate (0.36 fewer hospitalizations per patient-year; incidence rate ratio [IRR] of 0.61 [95% confidence interval (CI) 0.39 – 0.95]; p = 0.029) and hospitalization days (6.57 fewer days per patient-year; IRR 0.46 [95% CI 0.23 – 0.92]; p = 0.028). Conclusions The use of RPM in APD patients is associated with lower hospitalization rates and fewer hospitalization days; RPM could constitute a tool for improvement of APD therapy.

Patients with excellent response to initial therapy have a low rate of tumor recurrence. The objectives of this study were to evaluate the rate of early tumor recurrence in patients with intermediate-risk papillary thyroid cancer who had an excellent response to initial treatment and to identify risk factors.This retrospective cohort study included 217 patients with American Thyroid Association intermediate-risk papillary thyroid cancer who had a documented excellent response to initial treatment (total thyroidectomy and adjuvant therapy with 100-150 mCi [3.7-5.5 GBq] of radioactive iodine [RAI]). The assessed outcome was recurrence, defined as new evidence of disease after any disease-free period. Multivariate logistic regression and Cox regression models were used to determine the factors associated with recurrence upon recording clinical, surgical, and pathology variables.Sixteen (7.4%) cases of recurrent disease were documented after a median follow-up period of 42 months (range 17-88 months). Structural recurrence was documented in 10 (62.5%) patients, and biochemical recurrence was documented in the remaining six patients. The logistic regression model identified a significant association between early recurrence and pN1b involvement (odds ratio [OR] = 10.81 [confidence interval (CI) 1.87-62.59]), lateral neck RAI uptake (OR = 6.06 [CI 1.67-22]), and pre-ablation thyroglobulin10 ng/mL (OR = 4.01 [CI 1.16-13.85]). Variables that proved significant in the Cox regression model were: pN1b involvement (hazard ratio = 9.6 [CI 1.91-48.52]) and lateral neck RAI uptake (hazard ratio = 5.95 [CI 1.86-18.97]).The observed early recurrence rate of 7.4% is uncharacteristically high for a population of patients who had an excellent response to initial treatment. The significant association that was found between recurrent disease and lateral neck lymph node metastasis, lateral neck I

a b s t r a c t Introduction: Post-anesthetic care reduces the anesthesia-related postoperative complica- tions and mortality, shortens the length of stay at the postoperative care units and improves patient satisfaction. Objective: To establish a set of recommendations for immediate post-anesthetic care of patients that received general/regional anesthesia or profound/moderate sedation at the postoperative care units. Methodology: This is a process of "rapid" clinical practice guidelines adaptation, including systematic search. The illegible guidelines for adaptation were rated using AGREE II. The guideline selected to be adapted as the clinical practice handbook was Practice guidelines for post-anesthetic care of the American Society of Anesthesiologists. The manual was evaluated in terms of implementation ability, up-to-date information, relevancy, ethical considerations and patient safety by the group of anesthesiologists and epidemiologists based on Delphi. Result: The manual kept the recommendations on evaluation and monitoring, pharmacolog- ical management of postoperative nausea and vomiting, antagonistic actions for sedatives and analgesics and neuromuscular block agents, emergency management and anesthesia recovery, as well as the criteria for discharge from the unit. Indications about the conditions and requirements of the unit and patient admission were also included.

Background: On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. Aim: To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). Material and Methods: In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Results: Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). Conclusions: The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Resumen Objetivos El tratamiento actual de las neoplasias busca mejorar la sobrevivencia mediante la aplicacion de esquemas de quimioterapia intensificada, que produce una neutropenia mas profunda y duradera, que favorece el desarrollo de infecciones bacterianas y micoticas invasoras. Este articulo resume las recomendaciones de una guia para el diagnostico y tratamiento de las infecciones bacterianas y micoticas en pacientes oncologicos mayores de 15 anos con neutropenia febril posquimioterapia de alto riesgo. Metodos Guia de practica clinica basada en la evidencia. Se realizo la definicion de preguntas clinicas, la busqueda sistematica de literatura, la evaluacion critica de la evidencia y la formulacion de recomendaciones. Se desarrollo una evaluacion economica sobre la eficiencia de dos esquemas diferentes de tratamiento antimicotico. Resultados El presente documento incluye recomendaciones para el diagnostico de infecciones bacterianas y micoticas en paciente con neutropenia, el uso de profilaxis antibiotica y antimicotica, el tratamiento antibiotico empirico, y el tratamiento antimicotico empirico y anticipado en pacientes mayores de 15 anos, acorde con la microbiologia del contexto colombiano. Conclusiones La implementacion oportuna de las recomendaciones de la guia acorde con el contexto clinico de cada paciente debe contribuir a mejorar la supervivencia y morbilidad infecciosa de los pacientes con neutropenia febril derivada de la quimioterapia.