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Introducción: el Odds Ratio es una medida de efecto para la cual existen diversas traducciones al español. En este documento lo denominaremos OR (Razón de Odds). Es una medida que a través de la historia ha contribuido a establecer asociaciones relevantes para la salud pública. Objetivo: realizar una nota epidemiológica donde se presentan los principales aspectos teórico práctico de la razón de Odds. Metodología: búsquedas en las bases de datos biomédica (Pubmed, Cochrane Library, LILACS), metabuscadores (Google) y a través de la estrategia en bola de nieve y referencias claves. Esta nota metodológica contiene introducción, escenario clínico, desarrollo de concepto, ejemplos, discusión y conclusiones. Resultados: un Odds es el cociente entre la probabilidad de ocurrencia de un evento (p) sobre la probabilidad de que dicho evento no ocurra (1-p). El OR o razón de Odds, es un cociente entre dos Odds. Es una medida del efecto que permite a los investigadores plantear posibles asociaciones entre una exposición y un desenlace. Conclusiones: el OR puede determinarse en diferentes tipos de diseños y por medio del análisis estratificado (método Mantel-Haenszel) y el multivariado utilizando regresión logística, controla variables de confusión.

Introduction: The Odds ratio (OR) is a measure of effect, which has many Spanish equivalents. The term Razón de Odds will be used in this document to designate OR. Throughout history OR has contributed to establish associations in public health. Objective: to conduct an epidemiologic note presenting the main theoretical and practical aspects of Odds ratio. Methodology: a search was conducted in the Pubmed, Cochrane Library and LILACS biomedical databases, Google meta-searchers and through the snowball key references strategy. This methodologic note includes an introduction, clinical scenario, concept development, examples, discussion and conclusions. Results: an Odds is the quotient between the probability of occurrence of an event (p) over the probability of absence of said event (1-p), OR (Odds ratio), is the quotient between two Odds. It is a measure of effect which allows researchers to identify how strongly an exposure is associated with an outcome. Conclusions: OR may be determined using different types of study designs and by means of a stratified analysis (Mantel-Haenszel method) and the multivariate method by logistic regression and control for confounding variables.

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To describe the population with early malignant melanoma, we performed a cohort study on the basis of the Epidemiological Registry of Malignant Melanoma in Colombia-Asociacion Colombiana de Hematologia y Oncologia. From January 2011 until December 2021, 759 patients were included; the average age was 66 years, 57% were women, acral lentiginous histology was found in 27.8% of patients, and the median follow-up was 36.5 months. The prognostic factors for overall survival in our population are Eastern Cooperative Oncology Group 3-4 (hazard ratio [HR], 13.8), stage III (HR, 5.07), received radiotherapy (HR, 3.38), ulceration on histology (HR, 2.68), chronic sun exposure (HR, 2.3), low income (HR, 2.04), previous local surgery (HR, 0.27), and have received adjuvant treatment (HR, 0.41).

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Introduction: Rheumatoid arthritis is a chronic inflammatory disease diagnosed in a productive stage of life. Patients with RA experience changes in their musculoskeletal system, overall health and quality of life. It has been identified that patients with RA do not have appropriate knowledge about their condition. Educational programs can provide new knowledge, accompaniment, and closer follow-up to improve empowerment and quality of life in patients with RA. Purpose: To describe rheumatoid arthritis patients' experiences, perceptions, and expectations when enrolling on a multicomponent educational program in a specialized RA setting. Patients and Methods: A qualitative study was done. Patients with RA who attended a specialized center and enrolled in an educational program participated in two focus groups. The focus group discussions and the interviews were recorded, transcribed verbatim, analyzed, and emerging themes were constructed. Results: Thirty-one participants were included in the focus groups. The median age was 60 years IQR (54-67), 92% were female. Two relevant categories emerged: first, the experience of being diagnosed with RA. Second, the program's ability to empower participants with knowledge and the possibility of transferring knowledge to other patients with the same condition. In addition, patients gave a high score to the expectations regarding the educational program. Conclusion: Understanding patients' expectations when enrolling in an educational program allows educators and clinicians to understand their motivations to create tailored programs that can contribute to acquiring empowerment in the educational process and managing their disease. Stakeholders should consider patients' expectations when implementing these interventions for patients with RA to adapt the intervention according to the patient's context and needs, which will directly affect the patient's adherence and lead to better use and allocation of resources for educational activities.

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La rinosinusitis (RS) se define como la inflamación de la nariz y los senos paranasales con dos o más síntomas como bloqueo/obstrucción/congestión o secreción nasal (goteo nasal anterior/posterior) más dolor/presión facial y/o reducción o pérdida del sentido del olfato. Adicional, se tienen en cuenta los hallazgos objetivos como la presencia de pólipos nasales y/o descarga mucopurulenta en meato medio y/o edema u obstrucción de la mucosa en el meato medio en la endoscopia nasal. Se pueden considerar o no, los cambios tomográficos como cambios mucosos en el complejo osteomeatal y la mucosa de los senos paranasales. Se reconoce que los síntomas tienen alta sensibilidad, pero baja especificidad, de ahí la necesidad de hallazgos objetivos.

Rhinosinusitis (RS) is defined as inflammation of the nose and sinuses with two or more symptoms such as blockage/obstruction/congestion or nasal discharge. with two or more symptoms such as nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior runny nose) plus facial pain/pressure and/or reduction or loss of the sense of smell. sense of smell. In addition, objective findings such as the presence of nasal polyps and/or nasal presence of nasal polyps and/or mucopurulent discharge from the middle meatus and/or edema or mucosal obstruction or mucosal obstruction in the middle meatus on nasal endoscopy. Tomographic changes may or may not tomographic changes may or may not be considered as mucosal changes in the osteomeatal complex and mucosal osteomeatal complex and the mucosa of the paranasal sinuses. It is recognized that the symptoms symptoms have high sensitivity but low specificity, hence the need for objective findings. findings.

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La rinosinusitis (RS) se define como la inflamación de la nariz y los senos paranasales con dos o más síntomas como bloqueo/obstrucción/congestión o secreción nasal (goteo nasal anterior/posterior) más dolor/presión facial y/o reducción o pérdida del sentido del olfato. Adicional, se tienen en cuenta los hallazgos objetivos como la presencia de pólipos nasales y/o descarga mucopurulenta en meato medio y/o edema u obstrucción de la mucosa en el meato medio en la endoscopia nasal.

Rhinosinusitis (RS) is defined as inflammation of the nose and sinuses with two or more symptoms such as blockage/obstruction/congestion or nasal discharge with two or more symptoms such as nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior runny nose) plus facial pain/pressure and/or reduced or lost sense of smell sense of smell. Additionally, objective findings such as the presence of nasal polyps and/or nasal presence of nasal polyps and/or mucopurulent discharge in the middle meatus and/or edema or mucous or mucosal obstruction in the middle meatus on nasal endoscopy.

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Purpose: To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM). Patients and Methods: An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar's Chi2 test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure. Results: A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found. Conclusion: A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.

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Background: Multidisciplinary care (MDC) remains a cornerstone for breast cancer management as it is associated with improved quality of care and patient outcomes. However, the adoption of MDC practice is heterogeneous and has been poorly explored in Latin America. The objective was to describe barriers and possible facilitators for providing MDC to breast cancer patients in five Latin American countries. Methods: A panel of experts with an active clinical practice in Bolivia, Colombia, Ecuador, Mexico, and Uruguay was convened to identify barriers and facilitators to MDC. This study is a qualitative synthesis of a structured discussion regarding the state of MDC in the setting of breast cancer. Findings: Experts recognized that most oncology practices in Latin America do not apply a multidisciplinary approach for breast cancer patients. Predominant barriers for MDC are fragmentation of health services, being understaffed, inadequate infrastructure, and geographic disparities. Access to MDC varies widely in the region, with significant heterogeneity documented within countries. MDC practice was described as being more common in the private sector in Ecuador and Uruguay, while it is more widely implemented in public institutions of Colombia and Bolivia. Interpretation: Establishing quality MDC remains a challenge for oncology practices in Latin America. Addressing regional issues and identifying specific local needs is warranted to encourage the adoption of an effective multidisciplinary approach and, consequently, improve clinical outcomes. Active involvement of all stakeholders is required to build locally solutions and should involve institutions, health professionals, and patients. Funding: Research was funded by Productos Roche S.A.

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La leucemia linfocítica crónica (LLC) es una neoplasia caracterizada por la proliferación y acumulación clonal de células B maduras, que típicamente co-expresan los antígenos de superficie CD5 ­ CD23, dentro de la sangre, la médula ósea, los ganglios linfáticos, el bazo y otros tejidos . Esta patología es considerada el tipo de leucemia más común en personas adultas en países occidentales, y se considera una enfermedad de adultos mayores, con una mediana de edad al diagnóstico de 70 años .

Chronic lymphocytic leukemia (CLL) is a neoplasm characterized by the proliferation and clonal accumulation of mature B cells, which typically co-express the CD5 - CD23 surface antigens, within the blood, bone marrow, lymph nodes, spleen and other tissues. This pathology is considered the most common type of leukemia in adults in Western countries, and is considered a disease of older adults, with a median age at diagnosis of 70 years.

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La guía está dirigida al personal clínico asistencial especializado que brinda tratamiento a los pacientes con diagnóstico de LLC, en el contexto del SGSSS colombiano. Incluye a los siguientes profesionales potenciales: Hematólogos y Hematólogos-oncólogos. También está dirigida a los centros asistenciales que brindan cuidado a los pacientes con diagnóstico de LLC y a quienes toman decisiones administrativas, tanto en el medio hospitalario como en las aseguradoras, pagadores del gasto en la salud y en la generación de políticas de salud. Finalmente, las recomendaciones pueden ser de interés para pacientes con LLC, sus familiares y cuidadores. Se considera pertinente aclarar que la guía ofrecerá recomendaciones específicas frente a las preguntas definidas, y excede el alcance de esta, definir las competencias profesionales del equipo involucrado en el manejo de esta patología.

The guide is aimed at specialized clinical care personnel who provide treatment to patients diagnosed with CLL, in the context of the Colombian SGSSS. It includes the following potential professionals: hematologists and hematologist-oncologists. It is also addressed to health care centers that provide care to patients diagnosed with CLL and to administrative decision makers, both in the hospital environment and in the insurance companies, health care payers and health policy makers. Finally, the recommendations may be of interest to CLL patients, their families and caregivers. It is considered pertinent to clarify that the guide will offer specific recommendations in response to the questions defined, and it is beyond the scope of this guide to define the professional competencies of the team involved in the management of this pathology.

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Resumen Objetivo: Determinar la prevalencia de sífilis, hepatitis B y virus de la inmunodeficiencia humana en una población privada de la libertad de un establecimiento carcelario masculino de Bogotá D.C.-Colombia en 2019. Materiales y métodos: Se realizó un estudio de corte transversal en un establecimiento carcelario masculino de Bogotá, se incluyeron personas privadas de la libertad, mayores de 18 años. Los sujetos fueron sometidos a pruebas de detección de anticuerpos contra el Treponema pallidum, Antígenos de Superficie contra hepatitis B (HBsAg) y Virus de Inmunodeficiencia Humana (VIH) y respondieron un cuestionario estructurado para la descripción de conductas de riesgo. Resultados: Participaron 447 sujetos, ubicados en 7 pabellones del establecimiento carcelario. La prevalencia de sífilis fue del 5.8% (IC95% 3.8 - 8.4), del 1.1% para VIH (IC95% 0.4 - 2.6), y del 0.45% para hepatitis B crónica (IC95% 0.05 - 1.6). Discusión: A pesar de que la prevalencia documentada para estas patologías es más alta que en la población general, los resultados son más bajos que los reporta dos en instituciones de condiciones similares en otras latitudes. Se recomienda que el establecimiento continúe desarrollando políticas de promoción y prevención de estas patologías dentro de su población.

Abstract Objective: To determine the prevalence of syphilis, hepatitis B and the human immunodeficiency virus (HIV) in the male prison population in Bogotá, Colombia in 2019. Materials and methods: A cross-sectional study was carried out in a male prison center in Bogotá, in which sequential sampling, stratified by ward, included people deprived of liberty, over 18 years of age and who voluntarily agreed to participate in the investigation. Subjects underwent tests for antibodies to Treponema pallidum, Surface Antigens against hepatitis B (HBsAg) and Human Immunodeficiency Virus (HIV) and they answered a structured questionnaire for the description of risk behaviors. Results: A total of 447 subjects were included, belonging to 7 prison wards. The prevalence of syphilis was 5.8% (95% CI 3.8 - 8.4), 0.5% for chronic hepatitis B (95% CI 0.05 - 1.6) and 1.1% for HIV (95% CI 0.4 - 2.6). Discussion: Although the documented prevalence for these pathologies is higher than in the general population, the results are lower than those reported in other institutions with similar conditions in other latitudes. It is recommended that the institution continue to strengthen its policies for the promotion and prevention of these pathologies within its population.

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Objetivo: describir los conocimientos, las prácticas y la prevalencia de uso de medidas de protección adecuadas frente a la radiación ultravioleta (RUV) en una muestra de habitantes de Bogotá D.C., Colombia (2013-2018). Método: estudio de corte transversal a partir de encuestas realizadas por la Secretaría Distrital de Salud (SDS) en diferentes sectores de Bogotá. Se entrevistaron transeúntes de áreas públicas de concentración masiva en las 20 localidades de Bogotá, los cuales fueron incluidos de forma secuencial y por conveniencia. Se estudiaron aspectos sociodemográficos, fenotípicos, antecedente de interés, conocimientos y prácticas relacionadas con la exposición a la RUV. Resultados: se analizaron 8.420 encuestas, donde el 66 % (n: 5.560) eran sujetos de género femenino, con una mediana de edad de 38 años. La mayoría de los encuestados se ubicaron en los estratos socioeconómicos del I al III (95,6 %; n: 8.051). El 27 % declaró una ocupación laboral al aire libre (n: 2.268) y el 50 % reportaron exponerse a la RUV los siete días de la semana (n: 4.255). El 70 % de los participantes (n: 5.870) reconoció que la RUV es un factor de riesgo de cáncer de piel, pero tan sólo el 20,8 % (n: 1.753) reportó prácticas adecuadas de protección. Conclusiones: a pesar del alto nivel de conocimiento frente a los riesgos de la RUV existe un bajo porcentaje de uso de medidas de protección en esta muestra de habitantes de Bogotá. Se deben reforzar las estrategias que conduzcan a incrementar la protección frente a la RUV en este grupo poblacional.

Objective: To describe knowledge, practices, and prevalence of the use of appropriate protective measures facing ultraviolet radiation (UVR) in a sample of inhabitants of Bogotá D.C., Colombia (2013-2018). Method: A cross-sectional study from surveys carried out by the District Secretariat of Health (SDS according to its Spanish initials) in different sectors of Bogotá. Transients of public areas of mass concentration in 20 localities of Bogotá were interviewed. These were included in a sequential way and by convenience. Sociodemographic, phenotype aspects were studied, along with interests, knowledge, and practices related to UVR exposure. Results: 8,420 surveys were analyzed, where 66% (n: 5,560) were female, with an average age of 38 years. Most people surveyed were in socioeconomic levels I to III (95.6%; n: 8,051). 27% declared that they worked outside (n: 2,268), and 50% reported exposure to UVR seven days a week (n: 4,255). 70% of participants (n: 5,870) recognized that UVR is a skin cancer risk factor, but only 20.8% (n: 1,753) reported appropriate protection measures. Conclusions: Despite high levels of knowledge regarding the risk of UVR, there is a low level of use of protection measures in this sample of inhabitants in Bogotá. Strategies must be reinforced that lead to an increase of protection against UVR in this population group.

Objetivo: descrever os conhecimentos, as práticas e a prevalência do uso de medidas de proteção adequadas contra a radiação ultravioleta (RUV) em uma amostra de habitantes de Bogotá D.C., Colômbia (2013-2018). Método: estudo transversal baseado em inquéritos realizados pela Secretaria Distrital de Saúde (SDS) em diferentes setores de Bogotá. Foram entrevistados transeuntes de áreas públicas de maior concentração nas 20 localidades de Bogotá; eles foram incluídos sequencialmente e por conveniência. Foram estudados aspectos sociodemográficos e fenotípicos, histórico de interesse, conhecimentos e práticas relacionadas à exposição à RUV. Resultados: foram analisados 8.420 inquéritos, dos quais 66% (n: 5.560) eram do sexo feminino, com mediana de idade de 38 anos. A maioria dos entrevistados estava localizados nos estratos socioeconômicos de I a III (95,6%; n: 8.051). 27% declararam ocupação ao ar livre (n: 2.268) e 50% relataram exposição à RUV sete dias por semana (n: 4.255). 70% dos participantes (n: 5.870) reconheceram que a RUV é um fator de risco para câncer de pele, mas apenas 20,8% (n: 1.753) relataram práticas de proteção adequadas. Conclusões: apesar do alto nível de conhecimento sobre os riscos da RUV, há um baixo percentual de uso de medidas de proteção nesta amostra de habitantes de Bogotá. Estratégias que levem ao aumento da proteção contra RUV nesse grupo populacional devem ser reforçadas.

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Resumen Introducción. Las caídas intrahospitalarias son eventos adversos que se relacionan con múltiples factores de riesgo y que tienen implicaciones importantes para los pacientes y los sistemas de salud. Objetivo. Determinar los factores de riesgo asociados a las caídas intrahospitalarias en tres hospitales de tercer nivel de Colombia. Materiales y métodos. Estudio observacional analítico de casos y controles. La muestra mínima requerida fue de 270 casos y 270 controles (error alfa del 5%). Se incluyeron 690 pacientes y se analizaron 17 variables. El análisis de los datos se realizó mediante el cálculo del OR y el desarrollo de un modelo de regresión logística con un nivel de significancia del 5%. Resultados. Los factores de riesgo fueron tener catéter venoso periférico (OR: 2.92, IC95%: 1.01-8.43), contar con medidas de sujeción o sedación (OR: 2.35, IC95%: 1.11-4.97), tener una estancia hospitalaria mayor a ocho días (OR: 2.85, IC95%: 2.0-4.06), estar en tratamiento con medicamentos de alto riesgo (OR: 2.82, IC95%: 1.86-4.28), no contar con acompañante permanente (OR: 2.68, IC95%: 1.87-3.83) y, por último, ser un paciente no colaborador (OR: 1.61, IC95%: 0.84-3.0), variable sin significancia estadística, pero clínicamente relevante. Conclusión. Fue posible determinar factores de riesgo relacionados a las caídas intrahospitalarias que requieren ser abordados por estas tres instituciones para prevenir y disminuir la presentación de estos eventos adversos. Asimismo, otros hospitales del país pueden utilizar los resultados aquí reportados para mejorar el cuidado de sus pacientes y prevenir este fenómeno dentro de sus instalaciones.

Abstract Introduction: Falls in the hospital are adverse events that are associated with multiple risk factors and have important implications for patients and health systems. Objective: To determine risk factors associated with inpatient falls in three tertiary Colombian hospitals. Materials and methods: Analytical observational case-control study. The minimum sample required for the study was 270 cases and 270 controls (5% alpha error). In total, 690 patients were included and 17 variables were analyzed. Data analysis was conducted by calculating the OR and developing a logistic regression model with a significance level of 5%. Results: Risk factors associated with inpatient falls were having a peripheral venous catheter (OR: 2.92, 95%CI: 1.01-8.43), being restrained or sedated (OR: 2.35, 95%CI: 1.11-4.97), having a hospital stay longer than eight days (OR: 2.85, 95%CI: 2.0-4.06), being treated with high risk medications (OR: 2.82, 95%CI: 1.86-4.28), not having a permanent hospital sitter (OR 2.68 95%CI 1.87-3.83) and finally being an uncooperative patient (OR: 1.61, 95%CI: 0.84-3.0), a variable without statistical significance, but clinically relevant. Conclusions: It was possible to determine risk factors associated with inpatient falls that need to be addressed by these three hospitals in order to prevent and reduce the occurrence of these adverse events. Likewise, other hospitals in the country may use the findings reported here to improve the care they provide to their patients and prevent inpatient falls in their facilities.

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OBJECTIVE: To compare the clinical response at 24 months and evaluate the adverse events (AEs) of patients with rheumatoid arthritis (RA) treated with etanercept 50 (injectable solution 50 mg prefilled syringe), etanercept 25 (lyophilized 25 mg), infliximab, adalimumab, or golimumab. METHODS: A cohort study was carried out in patients with RA, in treatment with etanercept (injectable solution 50 mg prefilled syringe or lyophilized 25 mg), infliximab, adalimumab, or golimumab. Duration of study: follow-up was carried out for 24 months. The difference of initial and final 28-joint Disease Activity Score, remission incidence, difference of initial and final Health Assessment Questionnaire score, disability recovery, and AE rate were evaluated. RESULTS: The study enrolled 435 patients (108 adalimumab, 107 infliximab, 92 etanercept 25 mg, 81 etanercept 50 mg, and 47 golimumab). For etanercept 50, the median difference between basal and at the end of follow-up 28-joint Disease Activity Score was 1.7. For golimumab, it was 1.4; for adalimumab, it was 1.1; for etanercept 25, it was 1.02; and for infliximab, it was 0.96 (p = 0.001). The median difference between basal and final Health Assessment Questionnaire ranged was 1.66 for etanercept 50, 1.34 for etanercept 25, 1.3 for golimumab, 1.24 for adalimumab, and 1.07 for infliximab (p = 0.0005). Comparatively, etanercept 50 presented the highest cumulative incidence (77%; 95% confidence interval [CI], 67%-86%) and remission incidence (64 cases per 100 person-months; 95% CI, 4.9-8.1 cases per 100 person-months) and the lowest AE rate (8.6 per 100 person-years; 95% CI, 5.3-15 per 100 person-years). CONCLUSIONS: In patients with RA treated with anti-tumor necrosis factor α drugs, the highest incidence of remission and the lowest rate of AEs were documented for the cohort exposed to etanercept 50 mg.

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The present research was carried out with the objective to establish the clinical effect and safety of betahistine (48 mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia. An observational prospective cohort study was conducted including patients older than 15 years with clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48 mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks. Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. We calculated average weekly improvement, cumulative incidence of complete improvement, incidence rate of complete improvement, and the probability of complete improvement as a function of time. After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one percent of the patients had achieved complete improvement at the end of the second week. After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19). We concluded that Betahistine (48 mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile.

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To estimate the cost-effectiveness of available diagnosis alternatives for Mucosal Leishmaniasis (ML) in Colombian suspected patients. A simulation model of the disease's natural history was built with a decision tree and Markov models. The model´s parameters were identified by systematic review and validated by expert consensus. A bottom-up cost analysis to estimate the costs of diagnostic strategies and treatment per case was performed by reviewing 48 clinical records of patients diagnosed with ML. The diagnostic strategies compared were as follows: 1) no diagnosis; 2) parasite culture, biopsy, indirect immunofluorescence assay (IFA), and Montenegro skin test (MST) combined ; 3) parasite culture, biopsy, and IFA combined; 4) PCR-miniexon; and 5) PCR-kDNA. Three scenarios were modeled in patients with ML clinical suspicion, according to ML prevalence scenarios: high, medium and low. Adjusted sensitivity and specificity parameters of a combination of diagnostic tests were estimated with a discrete event simulation (DES) model. For each alternative, the costs and health outcomes were estimated. The time horizon was life expectancy, considering the average age at diagnosis of 31 years. Incremental cost-effectiveness ratios (ICERs) were calculated per Disability Life Year (DALY) avoided, and deterministic and probabilistic sensitivity analyses were performed. A threshold of willingness to pay (WTP) of three-time gross domestic product per capita (GDPpc) (US$ 15,795) and a discount rate of 3% was considered. The analysis perspective was the third payer (Health System). All costs were reported in American dollars as of 2015. PCR- kDNA was the cost-effective alternative in clinical suspicion levels: low, medium and high with ICERs of US$ 7,909.39, US$ 5,559.33 and US$ 4,458.92 per DALY avoided, respectively. ML diagnostic tests based on PCR are cost-effective strategies, regardless of the level of clinical suspicion. PCR-kDNA was the most cost-effective strategy in the competitive scenario with the parameters included in the present model.

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BACKGROUND: In Colombia, hemophilia is considered a high-cost disease, and hemophilia A with high-titer inhibitors may be responsible for a significant economic pressure on the Colombian health system. OBJECTIVES: To estimate the direct cost of care for patients with hemophilia A with high-titer inhibitors in Colombia, from the perspective of the health system. METHODS: A cost-of-illness study was carried out using standard case methodology, which was designed based on literature review and validation by expert consensus. Scenarios were established for adults and children, including cases of prophylaxis, immune tolerance induction, bleeding, and surgery. The frequencies were taken from the official report for Colombia, issued by the High-Cost Account 2017 (reported 2018). The prices were obtained from the list of regulated medicines in the country. The cost estimate is presented with a range of values by weight (between 10 kg and 90 kg). RESULTS: The total estimated cost per year for Colombia was US $44 905 252 (between US $32 260 497 and US $58 202 393). The average cost per year calculated for a patient was US $498 947 (between US $358 450 and US $646 693). A total of 99.8% of the estimated cost was directly related to the cost of the coagulation factors and bypassing agents. CONCLUSIONS: Hemophilia A with high-titer inhibitors is a disease that generates significant pressure on the Colombian health system, mainly linked to the cost of factors and bypassing agents.

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Abstract Introduction: Administrating intravenous fluids is one of the most frequent practices in the care of critically ill patients, since most of them present shock or hypotension from any cause. The rapid and aggressive administration of these fluids may lead to adverse results, including acute renal failure and hydroelectrolytic disorders which are highly associated with fatal outcomes. Objectives: To establish the association between hyperchloremia and mortality in patients admitted to the intensive care unit (ICU) of Hospital Universitario de San José between August 2013 and January 2017, in addition to their demographic characteristics, the incidence of chloride abnormalities, and its association to renal failure. Methods: Analytic retrospective cohort study in the adult ICU at the Hospital Universitario de San José from August 1, 2013 to January 31, 2017. Results: A total of 839 patients were evaluated, 210 exposed and 629 not exposed. The relative risk of death for those who developed hyperchloremia was 3.12 (95% confidence interval [CI] 2.16^.49) (P <0.001). The multivariate analysis generated an hazard ratio of 2.31 (95% CI 1.47-3.63) adjusted for age, sex, APACHE II at admission, sepsis, neurocritical state, and development of renal failure. Conclusion: Hyperchloremia is a frequent event in patients in the ICU; it may act as an independent variable for mortality in critical patients.

Resumen Introducción: La administración de líquidos endovenosos es de los actos que con mayor frecuencia se realizan en el cuidado de los pacientes críticamente enfermos, dado que gran parte de los mismos cursan con choque o hipotensión de cualquier causa, ésta se realiza de forma agresiva y rápida, dicha administración puede conllevar a eventos desfavorables como la falla renal aguda y alteraciones hidroelectrolíticas que están altamente relacionadas con desenlaces fatales. Objetivos: Establecer la asociación entre hipercloremia y mortalidad en los pacientes hospitalizados en cuidados intensivos del hospital Universitario de San José entre agosto de 2013 y enero de 2017, así como sus características demográficas, incidencia de anormalidades del cloro y su asociación con falla renal. Métodos: Estudio analítico de cohortes retrospectiva, en la Unidad de Cuidados intensivos (UCI) adultos del Hospital Universitario de San José, en el período comprendido entre el 1 de agosto de 2013 y el 31 de enero de 2017. Resultados: Fueron evaluados 839 pacientes, 210 expuestos y 629 no expuestos. El riesgo relativo para muerte en los que desarrollaron hipercloremia fue 3.12 (IC95% 2.16-4.49) (p <0.001). En el análisis multivariado se obtuvo un HR de 2.31 (IC95% 1.473.63) ajustado por las variables de edad, sexo, APACHE II al ingreso, sepsis, estado neurocrítico y desarrollo de falla renal. Conclusiones: La hipercloremia es un evento frecuente durante la atención de los pacientes en la unidad de cuidados intensivos; puede actuar como una variable independiente de mortalidad en los pacientes críticos.

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Resumen Objetivo: Reportar el desempeño clínico de dos medicamentos indicados para tratamiento del síndrome de flujo vaginal (fluconazol, secnidazol y terconazol, clindamicina) y comparar el efecto clínico. Materiales y métodos: Estudio observacional, comparativo y analítico de cohortes al que se incluyeron pacientes con diagnóstico de síndrome de flujo vaginal susceptibles de ser tratadas con fluconazol-secnidazol o terconazol-clindamicina en 12 ciudades de Colombia, con seguimiento de 8 días (± 3 días). Este proyecto fue aprobado por un comité de ética en investigación con seres humanos. Resultados: Se incluyeron 176 pacientes, pero solo 153 (87%) completaron el seguimiento. Los límites de edad fueron 18 y 67 años; 134 (76%) iniciaron con fluconazol-secnidazol y 42 (24%) con terconazol-clindamicina. Por lo que se refiere a la comparación en disminución de los síntomas, fluconazol-secnidazol y terconazol-clindamicina: flujo (p = 0.0000), prurito (p = 0.002), irritación (p = 0.0000), mal olor (p = 0.001) y dispareunia (p = 0.4). Conclusión: La prescripción de la combinación fluconazol-secnidazol fue más frecuente. El apego al tratamiento fue de 86%. La proporción de disminución de los síntomas tuvo límites de 15 y 40%; para el flujo vaginal fue superior a 70% (fluconazol-secnidazol: 115 de 121 y terconazol-clindamicina: 29 de 41).

Abstract Objective: To know the real life clinical performance of the prescription of two drugs for the treatment of vaginal discharge syndrome (Fluconazole-Secnidazole and Terconazole-Clindamycin) and to compare the clinical outcomes. Materials and methods: An analytical cohort study was conducted. We included women older than 18 years with a diagnosis of vaginal discharge syndrome who were candidates to be treated with Fluconazole-Secnidazole or Terconazole-Clindamycin with 8 days (±3) of follow-up, in 12 cities of Colombia. This project was approved by a research with human being's ethics committee. Results: 176 patients were included, 153 (86.9%) completed the follow-up, their age ranged between 18 and 67 years. 134 (76.1%) started treatment with Fluconazole-Secnidazole and 42 (23.8%) Terconazole-Clindamycin. Symptoms improvement was compared (Enrollment vs. Control), finding for Fluconazole-Secnidazole and Terconazole-Clindamycin: discharge (p=0.0000), pruritus (p=0.002), irritation (p=0.0000), bad smell (p=0.001) and dyspareunia (p=0.4). Conclusions: The prescription of the combination Fluconazole-Secnidazole was more frequent. The adherence to treatment was 86%. The proportion of improvement in symptoms ranged between 15% and 40%, however, for the case of vaginal discharge it was greater than 70% (Fluconazole-Secnidazole: 115/121 and Terconazole-Clindamycin: 29/41).