Biomedica : revista del Instituto Nacional de Salud最新文献

Introduction: Pediatric psoriasis has a prevalence ranging from 0.5 to 4.1%. It is more common in females, and the predominant type is the vulgar or plaque. It has been associated with comorbidities such as obesity and metabolic syndrome or even with a family history of psoriasis.

Objective: To describe the epidemiological and clinical characteristics of pediatric patients diagnosed with psoriasis attending pediatric dermatology consultations with dermatologists who are members of the Asociación Colombiana de Dermatología from January 2017 to June 2022.

Material and methods: We conducted a descriptive, retrospective, and multicenter study. We describe the prevalence, clinical characteristics, diagnostic methods, personal and family history, and treatments for patients with pediatric psoriasis. Stata 13™ software was used for data analysis.

Results: From 26,870 patients, 146 were diagnosed with psoriasis (0.54%), with a femaleto-male ratio of 1.5:1 and a median age of onset of eight years. The most common variant was vulgar psoriasis (72.6%), followed by guttate psoriasis (6.85%), and the scalp was the most frequently affected location (55.48%). The most common comorbidities were obesity and Crohn’s disease (5.5% each). Family history included 39 cases of psoriasis, 16 diabetes mellitus, and 7 dyslipidemia. Seventy-eight percent of the cases were classified as mild according to the Psoriasis Area Severity Index (PASI); 65% received topical treatment, and 18% received systemic treatment. Sixty-five percent received topical treatment, while systemic treatment and phototherapy was used in 19% and 2.7%, respectively. When using combined treatment (6%) received topical and systemic modalities, 1.3% used topical with phototherapy, and 0.68% received all treatments.

Conclusion: In the evaluated population, the most frequent variant of pediatric psoriasis was the vulgar type with mild severity. Most patients with this clinical presentation received opical treatment. The association with other systemic diseases implies the need for further studies.

Malaria is a tropical disease that is rarely reported in liver transplant recipients. However, some cases have been documented around the world and here we report two. Case 1. A 54-year-old male attended the emergency room 30 days after liver transplantation due to malaise, fever, chills, thrombocytopenia, and anemia. Plasmodium vivax was detected in the blood smear, and the patient was treated with artemether/lumefantrine, achieving resolution of the parasitemia. Neither chloroquine nor primaquine were prescribed because they were unavailable in the country. Two months later, the patient returned to the emergency room with the same symptoms and was diagnosed with a relapse of malaria caused by P. vivax. The patient received successful treatment with chloroquine and primaquine, which were already available. Given that the liver donor came from a malaria-endemic area, the infection was probably of donor origin, likely by hypnozoites present in the allograft. Case 2. A 58-year-old woman living in a malaria-endemic region attended the emergency service with fever, malaise, arthralgia, cytopenias, and hypertransaminasemia six months after undergoing a liver transplant. P. vivax was detected in the blood smear, so treatment with chloroquine and primaquine was started. After treatment, the blood smear was negative, and the patient was discharged.

The Dyke-Davidoff-Masson syndrome is characterized by the presence of cerebral hemiatrophy, craneal vault thickening, epileptic seizures, hemiparesis, and cognitive impairment. It is typically diagnosed in childhood and requires specific diagnostic tools for accurate assessment. This report describes the case of a 19-year-old woman who presented with epileptic seizures and regression in neurodevelopment. She was admitted to the emergency department due to high ictal frequency. During her hospitalization, imaging and electroencephalographic findings were consistent with Dyke-Davidoff-Masson syndrome. Additionally, neuropsychological tests revealed global cognitive impairment. After ten days of hospitalization and five days without epileptic seizures, the patient was discharged. Dyke-Davidoff-Masson syndrome is a rare and often unrecognized condition with high morbidity. Clinicians has the responsibility to identify the key characteristics of the syndrome and perform an adequate differential diagnosis.

Introduction: Prostate cancer staging is necessary to determine tumor extent. In recent years, new and more accurate imaging modalities that could provide a better framework for patient management have emerged. They are currently incorporated into the prostate cancer guideline recommendations. Clinical practice guidelines are important for implementing clinical research findings and high-quality evidence-based recommendations.

Objective: To review and evaluate the quality of evidence underpinning the categorization of prostate cancer staging guidelines using the AGREE II tool.

Material and methods: Systematic searches were performed on the PubMed, BiGG, and Epistemonikos databases. In addition, repositories and clinical practice guidelines websites were hand searched to identify GRADE recommendations for prostate cancer staging published in the last five years. The quality of clinical practice guidelines was assessed using the AGREE II tool. Recommendations and the certainty of evidence were also summarized.

Results: Seven guidelines that met the selection criteria were included. A narrative analysis of the staging recommendations and evidence mapping was performed. The AGREE II domain “clarity of presentation” had the highest score (mean = 71.59%), whereas “applicability” had the lowest score (mean = 45.15%). Five guidelines met the proposed AGREE II cutoff scores and provided staging and diagnostic recommendations.

Conclusions: Significant heterogeneity was observed in the methodological quality of the guidelines included, along with common deficits regarding applicability and stakeholder involvement. Thus, more rigorous and high-quality guidelines need to be developed to facilitate their implementation by clinicians in daily practice.

Introduction. Dental fluorosis is an endemic problem in southern Colombia, especially due to its proximity to volcanic areas and the composition of their waters.Objective. To identify the prevalence and factors associated with the development of dental fluorosis in the school population of the municipality of La Cruz, Nariño.Materials and methods. We conducted a cross-sectional observational study that included clinical and sociodemographic variables and data about habits, diet, and dental fluorosis knowledge. To collect the information, we used a questionnaire completed by the parents or guardians and a clinical evaluation –previously standardized by the researchers– of schoolchildren between 8 and 12 years from two educational institutions. A descriptive statistical analysis was performed with proportions and measures of central tendency. The multivariate analysis used a negative binomial regression with rate ratios and 95% confidence intervals.Results. We included 116 participants with a mean age of 9.80 (SD = 1.38) years and a mean of the Dean’s index of 2.36 (SD = 0.86). A higher Dean’s index was associated with older age (p < 0.003), brand of salt (p < 0.007), higher consumption of legumes (p < 0.001), cereals (p < 0.038), and fish (p < 0.025), and lower consumption of red meat (p < 0.017).Conclusion. Dental fluorosis is a multifactorial problem that requires different approaches according to the territories and their particularities and public health measures to control its high prevalence.

Introduction. Colombia presents a progressive increase in overweight and abdominal obesity in adults, with a higher impact on women.Objective. To design percentile curves of the waist-height index of Colombian adults by sex and age.Materials and methods. We did a secondary analysis of the data from the Encuesta Nacional de la Situación Nutricional 2015, which contained waist, weight, and height measurements of adults between 20 and 60 years of age. Generalized additive location, scale and shape additive models with box-cox power exponential transformation to construct the curves. An internal validation was performed to ensure the models fit the data.Results. We studied 23,759 multiethnic adults from Colombia, 49.8% of whom were women. The waist-height index curves of men were visualized with slight curvature, while those of women appeared flatter. The median waist-height index increased continuously in both sexes: up to 45 years in women (0.45 to 0.49) and up to 55 years in men (0.44 to 0.49). In men, a value of 0.50 was maintained after 55 years, but not in women, since it remained at 0.50 until 53 years and thereafter increased to 0.51.Conclusion. The curves fitted with the box-cox power exponential distribution explained the increasing behavior of the waist-height index by age and sex and the predictive capacity of the model. The total increase in the median of the waist-height index by age and sex was similar and incremental (women: 0.45-0.51; men: 0.44-0.50).

Introduction: In the Colombian context, research on victims of armed conflict has demonstrated that exposure to violence impacts different aspects of their lives and represents a challenge for their support workers.

Objective: To explore perceptions, beliefs, and knowledge about mental health and support sources among victims of forced migration -due to the internal armed conflict- and their support workers in Soacha, Colombia.

Materials and methods: We conducted a qualitative exploratory study. Data were collected from December 2018 to March 2019 using separate focus groups of victims and workers. Thematic content analysis established five deductive categories: perceptions of mental health; the impact of forced displacement and its relationship with mental health; knowledge or perception of institutional support; community networks; and knowledge or perception of the state measures concerning care, assistance, and reparation. We also included some inductive categories that emerged from the analysis.

Results: Victims demonstrated deteriorated mental health, expressed by emotional, cognitive, and behavioural disturbances. Many of these conducts were exacerbated by the traumatic stress of displacement and exposure to other forms of violence, in addition to social and material deprivation. Emotional avoidance and active search for self-improvement emerged as coping mechanisms used by the victims. Workers experienced high levels of stress assisting trauma victims, and they also needed support for their mental health.

Conclusions: The findings showed complex and mainly negative impacts on mental health in both groups. Interventions should aim to address poor mental health and strengthen cultural identity and support networks for victims.

Paragonimiasis is caused by the trematode Paragonimus spp. and is considered a foodborne trematodiasis; it is classified as a neglected tropical disease by the World Health Organization, primarily transmitted through the consumption of infected and undercooked freshwater crustaceans. In Ecuador, it predominantly affects tropical regions such as the Coast and the Amazon.We present the case of a ten-year-old Kichwa boy from a rural Amazonian community, diagnosed at the Hospital Pediátrico de Quito. The child presented persistent cough and rusty sputum for four years, with a history of eating crabs. Computed tomography indicated pulmonary parenchymal alterations. The diagnosis of pulmonary paragonimiasis was confirmed via microscopic identification of operculated Paragonimus spp. eggs in the sputum. Treatment with triclabendazole for two days resulted in subsequent negative sputum findings during follow-up examinations.We discuss the possibility of diagnosis in non-endemic regions and the lack of clinical suspicion and laboratory diagnosis in endemic areas. Furthermore, we highlight the shortage of the drugs of choice, triclabendazole, and praziquantel, in Ecuador.

Introduction. Previous reports have described a relationship between teamwork and burnout in health workers, involving variables associated with patients’ safety.Objective. To determine and describe the relationship between teamwork and burnout perceived by health workers from a tertiary-level hospital in Colombia.Materials and methods. We conducted a cross-sectional, observational, analytical study with a convenience sample of 510 participants. We applied the TeamSTEPPS Teamwork Perceptions Questionnaire and the Copenhagen Burnout Inventory to assess burnout. An additional survey was conducted to collect demographic and employment data. Data was collected digitally. Descriptive analyses were carried out to compare teamwork and burnout across units, by occupation, and according to the average number of hours worked per week. Finally, correlation matrices were calculated with the scores from both tests.Results. Teamwork levels were moderate to high, and 31.4% of workers reported moderate or high levels of burnout. No significant differences were found based on sex or work unit. Results from the TeamSTEPPS Teamwork Perceptions Questionnaire and the Copenhagen Burnout Inventory were correlated with a low and moderate strength of association, showing an inverse relationship between them.Conclusion. Teamwork and burnout may have an inverse relationship, where better teamwork results in a lower perception of burnout among healthcare workers. However, the results of this study should be interpreted with caution due to potential biases.