Center In Colombia Research Articles

Terminal Complement Activation in Preeclampsia.

To evaluate whether C5b-9 concentrations in blood and urine are increased in preeclampsia with severe features. The Complement and Preeclampsia in the Americas study is a prospective, multicenter case-control study performed at six centers in Colombia from November 2015 to July 2016. The case group included women with preeclampsia with severe features, and the control group included women who were healthy or had chronic hypertension, gestational hypertension, or preeclampsia without severe features. We enrolled two women in the control group for every woman in the case group. Soluble C5b-9 concentrations were measured by enzyme-linked immunosorbent assays in blood and urine. The primary outcome was C5b-9 concentrations in women in the case group compared with all women in the control group, and the secondary outcome was C5b-9 levels in women in the case group compared with individual control subgroups. Differences were assessed by test of medians, and associations were further evaluated by receiver operating characteristic curve analysis and logistic regression with α=0.05. Three hundred fifty-two patients were enrolled. Plasma C5b-9 concentrations did not differ significantly between women in the case group and those in the control group, but urine C5b-9 concentrations were higher in women in the case group (median [interquartile range] 9.9 [1.6-43.7] vs 1.8 [0.54-4.1] ng/mL, P<.001). In subgroup analysis, plasma C5b-9 concentrations were increased in women in the case group compared with healthy women in the control group (median [interquartile range] 2,778 [1,633-4,230] vs 1,374 [1,064-2,332] ng/mL, P<.001), and urine C5b-9 concentrations were increased in women in the case group compared with all control subgroups (P<.001). Using receiver operating characteristic analysis, urine C5b-9 concentrations differentiated preeclampsia with severe features from hypertensive women in the control group (area under the receiver operating characteristic curve 0.74, 95% CI 0.68-0.80). Urine C5b-9 22 ng/mL or greater (range 0-158.4 ng/mL) was the optimal cut point for diagnosis of preeclampsia with severe features with adjusted odds ratio of 10.0 (95% CI 3.5-28.8, P<.001). Urinary excretion of terminal complement effector C5b-9 is higher in women with preeclampsia with severe features compared with women with other hypertensive disorders of pregnancy and women without hypertension.

Prognosis and Survival of Acute Myeloid Leukemia: Experience of a Single Center in Colombia

Background: Acute Myeloid Leukemia (AML) is the most common acute leukemia in adults in the United States with an incidence of 3 to 5 cases per 100,000 population [Siegel RL, CA Cancer J Clin 2018)]. Even though advances in therapies have increased the survival and improved outcomes in younger population, patients over 65 years of age carry a particularly poor prognosis. Previous results of treatment outcomes in AML have showed significant differences between low- and middle-income countries (LMIC) and high-income countries (HIC). The aim of this study is to assess survival rate for patients with diagnosis of AML in a single center in Colombia, South America.Methods: A retrospective cohort study was conducted at a tertiary referral center in Colombia on patients older than 15 years who were diagnosed with AML between July 2013 and November 2017. All patients were managed based on PETHEMA protocol for AML. Descriptive statistics were used to analyze patient's demographic characteristics. The Kaplan-Meier method was used to assess overall survival (OS) and relapse-free survival (RFS) rates at one and five years.Results: One hundred and seventeen patients were included. Fifty-nine were male (50.42%) and 58 were female (47.6%) with a mean age of 63 years (range 15-95). The most common type of AML based on the French-American-British (FAB) classification was M2 (AML with maturation) in 22.8% of the patients, followed by M1 (AML with no maturation) in 10.5%, and M5 (acute monoblastic leukemia with or without maturation) in 8.8% of the patients; however, classification data was missing in several of the patients (45.6%).OS was 54.6% (CI95% 44.4-63.7) at one year and 19.5% (CI95% 10.3-30.9) at five years. RFS was 91.4% (CI95% 84.0-95.4) at one year and 83.3% (CI95% 73.9-89.5) at five years. Classifying patients by age group, OS was 81.8% (CI95% 68.7-89.7) at one year and 36.5% (CI95%19.6-53.6) at five years for patients younger than 65 years, 22.8% (CI95% 10.8-37.5) at one year and 0% at five years for those between 60 and 80 years, and 19.1% (CI95% 1.4-52.4) at one year and 0% at five years for patients older than 80 years. While median OS for patients who achieved complete response after induction regimen was 35.7 months, it was only 8.9 months for those with either partial response or induction failure (HR 1.03, CI95% 1.01-1.05, P<0.01). Median OS by type of treatment was 32 months for idarubicin + cytarabine (3+7), 7 months for FLUGA - fludarabine + cytarabine, and 1 month for those who only received supportive therapy. Only four patients, all older than 60 years, received treatment with hypomethylating agents, none of them achieving any response. The most common cause of death was disease progression (26%), followed by infection (22%).Conclusions: Patients with diagnosis of AML receiving standard combination chemotherapy with idarubicin and cytarabine had better survival rates than patients receiving semi-intensive chemotherapy schemes. The most common cause of death in AML patients was primary disease, and treatment-related mortality was low. DisclosuresMontesinos:Novartis: Research Funding, Speakers Bureau; Daiichi Sankyo: Consultancy, Speakers Bureau.

Long-Term Survival after Autologous Stem Cell Transplantation in a Colombian Population

Introduction: Autologous hematopoietic stem cell transplantation (auto-HSCT) is a complex medical process that has evolved throughout the years, becoming a potentially curative therapy for many hematologic neoplasms and non-malignant marrow disorders, as well as a clinical option for some autoimmune diseases. During the past decades, HSCT has had important advances in technology and technique, patient supportive care, and conditioning protocols, making it a safer procedure. As a result, patient survival rates continue improving. Nonetheless, it is unclear if these improvements are also seen in developing countries. The aim of the present study is to assess survival rate for patients who underwent auto-HSCT in a Colombian population.Methods: A retrospective cohort study was conducted at a tertiary referral center in Colombia, South America, on patients who underwent auto-HSCT between November 2009 and December 2017. Descriptive statistics were used to analyze patient's demographic characteristics. The Kaplan-Meier method was used to assess overall survival (OS) and relapse-free survival (RFS) rates at 100 days, one year, and five years following auto-HSCT.Results: One hundred and fifty-seven patients were included, with a mean age of 49.54 years (range 14-71). Seventy-nine (50.31%) were men. Classifying patients by age group, 68.7% of the patients (n=108) were in the 20-60 years old group and 28% (n=44) were older than 60 years. The most common indication for auto-HSCT was multiple myeloma (42.7%), followed by non-Hodgkin lymphoma (35%) and Hodgkin lymphoma (13%). Peripheral blood stem cells were the graft source in all patients (100%). High-dose melphalan (MEL 200) was the conditioning regimen administered to patients with diagnosis of multiple myeloma, and BEAM (carmustine, etoposide, cytarabine, and melphalan) to patients with lymphoma. OS was 91.7% (CI95% 86.2-95.1) at 100 days, 81% (CI95% 73.9-86.4) at one year, and 60.9% (CI95% 51.3-69.1) at five years. RFS was 94.9% (CI95% 90-97.4) at 100 days, 86.3% (CI95% 79.7-90.8) at one year, and 70.5% (CI95% 66.6-80.7) at five years. Classifying patients by pre-transplantation disease stage as defined by the EBMT study group, OS for early disease was 85.5% (CI95% 75.6-91.8) at one year and 58.2% (CI95% 43.7-70.2) at 5 years, 88.1% (CI95% 76.5-94.1) at one year and 51.8% (CI95% 33.9-66.9) at 5 years for intermediate stage, and 100% at one year and 42.3% (CI95% 7.3-75.4) at 5 years for advanced disease.The most common cause of death was disease progression. There were 51 deaths (32.48%) post-transplantation, 5.73% (n=9) in the first 100 days, 7.6% (n=12) between 100 days and 1-year, and 18% (n=29) after the first-year post-transplantation. Non-relapse mortality was 3.2% at both 100 days and 5 years.Conclusion: OS and RFS of auto-HSCT were very similar to the outcomes reported in the existing literature mainly assessed in developed countries. The most common cause of death in patients who underwent auto-HSCT was progression of the primary disease, and transplant-related mortality was low. DisclosuresNo relevant conflicts of interest to declare.

Severe Aplastic Anemia (SAA) in Colombia: Characteristics and Treatment in 6 Centers

IntroductionAcquired severe aplastic anemia (SAA) is a low frequency hematologic disease associated with significant morbidity and mortality. The destruction by immunological mechanisms of hematopoietic progenitor cells appears to play a fundamental role in the pathophysiology of the disease, therefore, immunosuppressive treatment (IST) is one of the pillars of management. In Colombia and Latin-America there is lack of information about the characteristics of patients with SAA and the effectiveness of IST and other treatments. The main objective of this study was to assess the outcomes of a group of patients treated in different centers in Colombia during the last five years.Materials and methodsThis is a retrospective observational study, carried out within 6 institutions of 3 Colombian cities (Bogota, Medellín, Bucaramanga) of patients treated from 2013 to 2018. An anonymized database was constructed. All patients diagnosed with SAA and treated with IST as first line of therapy were included.ResultsWe analyzed the data of 37 patients; 22 of them were women. The average age was 37 years old (with a range of 7-68 years). The median time since the onset of the symptoms to the time of diagnosis was 88 days (with a range of 7-655 days). Clastogenic effect of diepoxybutane (DEB) tests were available only in 9 patients (7 of which were positive); Paroxysmal Nocturnal Hemoglobinuria (PNH) clone was detected in 9 of the 27 tested, all of which were under 5%. Mean leukocytes, hemoglobin concentration, and platelets at the moment of diagnosis were 3.090, 8.5 and 22.000. Bacterial infection was the most important clinical manifestation at diagnosis (in 16 of the 37 patients); 19 out of 37 patients had more than 5 red blood cell transfusions before the first treatment. As first line therapy, 25 patients received IST (most by antithymocyte globulin (ATG) of which 10 were treated with rabbit ATG, 12 with horse ATG and 3 combined with Eltrombopag); 4 patients had cyclosporin and prednisone, 2 had allogeneic transplant and 6 received other therapies. Those treated with IST patients, 8 had a complete response (CR) (32%), 6 had partial response (PR) (24%), 8 had no response (32%). 5 received a second course of IST and 3 had CR. 3 patients were lost in follow up. At a mean follow up of 18.7 months (1.7-65), 44% were alive in CR, 26% in PR, 9% were in relapse and 21% died. Causes of death were SAA related infection in 5 patients, transplant related in 1 and non-disease related in 1.ConclusionsThis is the first multicenter report of SAA treatment in Colombia, it includes children and adults, resulting in a very heterogeneous population. This preliminary information shows that there is a significant delay in the diagnosis and initiation of treatment in patients, most patients have more than 5 transfusions before treatment. This could, in part, explain the apparent low response rates to IST in comparison to that of what have been reported in literature. A larger registry of hematologic pathologies is required so we can confirm these findings, start proposing strategies applicable in our country to achieve better outcomes in these patients and planning clinical trials to answer questions relevant to our population. DisclosuresNo relevant conflicts of interest to declare.

Comorbidities among adults living with hiv from two healthcare centers in Colombia

Objective: To determine the prevalence of comorbidities among adults living with HIV from two healthcare centers in Colombia, and to identify factors associated with comorbidity-free years.Methods: Observational, retrospective medical chart review study. Summary statistics for demographic and clinical characteristics were developed and relationship between comorbidity-free years were analyzed through Kaplan-Meier analysis and Cox regression.Results: 669 clinical charts were included, 71.7% were male and 16.1% were 50 years or older, 69.96% had at least one comorbidity. The most frequent comorbidities were dislipidemia(15.06%), hypertension(5.67%), risk factors were tobacco use(15.33%), alcohol intake(24.36%) and drugs abuse (14.66%).Discussion: These findings are consistent with previous reports showing the underlying processes of patients, producing multiple comorbidities.Conclusions: Significant proportion of patients have comorbidities that may increase risk of other complications or reduced comorbidity-free years. Poly-pharmacy among HIV+ adults need to be addressed to ensure adherence and minimize drug-drug interactions.

Acute Myeloid Leukemia: Experience of a Single Center in Colombia

Acute Myeloid Leukemia: Experience of a Single Center in Colombia

Survival of Acute Lymphoblastic Leukemia: Experience of a Single Center in Colombia

Survival of Acute Lymphoblastic Leukemia: Experience of a Single Center in Colombia

Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

Capsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC. The authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach. In June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients. Pearson's chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed. CHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.

Characterization of skin cancer in a dermatologic center in Colombia

Characterization of skin cancer in a dermatologic center in Colombia

Indications and techniques of corneal transplantation in a referral center in Colombia, South America (2012-2016).

To describe the indications and techniques of corneal grafting in a tertiary institution in a middle-sized city in Colombia. A retrospective review of surgical reports and medical records of patients undergoing keratoplasty from January 2012 to December of 2016. A total of 346 eyes from 316 patients were included. The first three indications for keratoplasty were: bullous keratopathy (BK) with 46.2% of the cases, active infectious keratitis (22.3%) and the group of corneal dystrophies and degenerations, including Fuchs' endothelial dystrophy (9%). Keratoconus was in the sixth place (4.9%). 73.3% of the procedures were penetrating keratoplasties (n = 255), 21.7% posterior lamellar (n = 75) and 3.5% anterior lamellar (n = 12). While in 2012, 25 cases of endothelial grafts were performed, only 13 were done in 2016. BK was the first cause of keratoplasty with almost half of the cases, and keratoconus was relegated to sixth place with less than 5%. In comparison, in a study from eye banks from the US, BK was the second and keratoconus was the third indication for corneal grafts. The frequency of endothelial lamellar techniques in our institution decreased from 2012 to 2016. This could have been related to both the long time that the patients had to be on a waiting list, which made them unsuitable candidates for this technique, due to stromal fibrosis, and to the fact that surgeons of our institution had less experience with posterior endothelial grafting than with penetrating keratoplasties.

Colorectal cancer survival at an oncologic center in Colombia. A historic cohort study

Introduction and aimsIn Colombia, cancer of the colon is the third most frequent cancer in relation to incidence and mortality. Five-year survival depends on stage at diagnosis, albeit that rate is not known for the country. The aim of the present study was to characterize the overall survival and disease-free survival rates in an adult population with colorectal cancer treated at an oncology center in Medellín, Colombia. Materials and methodsA retrospective cohort study was conducted. The case records of patients with a histologic diagnosis of colorectal cancer, seen within the time frame of 2011 and 2015, were reviewed. The overall survival and disease-free survival curves were calculated using the Kaplan-Meier method. ResultsA total of 824 (54.9%) patients with cancer of the colon and 676 (45.1%) with cancer of the rectum were treated. Mean patient age was 63.3 years, female sex predominated (56.3%), and 98.1% of the tumors were adenocarcinomas. The majority of the lesions were stage iii (31.9% in the colon and 35.5% in the rectum) at the time of diagnosis. Surgery was the most frequent treatment in the colon (85.2%) and radiotherapy was the most frequent in the rectum (75.4%). Overall survival at the median follow-up (27.3 months) was 66.7% for cancer of the colon and 63.9% for cancer of the rectum. Disease-free survival at the median follow-up (18.6 months in colon and 14.9 in rectum) was 72.5 and 68.9%, respectively. ConclusionsThe clinical characteristics and treatment of patients were similar to those found in other studies. Two-year survival was higher than in other Colombian reports and 5-year survival was lower than that observed in developed countries.

Agency Loss and the Strategic Redesign of the Presidential Office in Colombia

AbstractPresidents rely on their trusted advisers to collect, analyze, coordinate, and present information in a timely fashion. However, Latin American presidents often fail to form majority governments and must use cabinet appointments to secure legislative coalitions to pursue their policies. This article suggests that presidents strategically redesign their executive offices to address the ministry drift. Presidents who can transform the organizations attached to their executive office have additional tools to monitor their ministers’ flexibility. The article argues that the greater the number of ministers in the cabinet from parties different from the president’s, the greater the transformations to the presidential office. Using time-series analysis, hypotheses are tested with an original dataset of organizational changes to the presidential center in Colombia, 1967–2015. The findings indicate that the percentage of ministers from other parties is a good predictor of the transformations undertaken in the executive office of the president.

Niche Modeling of Dengue Fever Using Remotely Sensed Environmental Factors and BRT

Niche Modeling of Dengue Fever Using Remotely Sensed Environmental Factors and BRT

Perspectiva de los centros de escritura en Colombia

En este artículo se describen 19 centros de escritura (CE) de Colombia, a partir de la información que aparece en sus páginas web y de publicaciones que se han generado sobre las experiencias de estos espacios dentro de las instituciones en que se instauran. La metodología utilizada fue la investigación documental. Para comenzar, se presenta una introducción sobre la lectura y escritura en Colombia; luego, el texto se centra en la descripción de los centros de escritura en la educación superior en el contexto de Colombia, sin embargo se aborda un CE dentro de la educación básica y media, que se ha identificado. Al final, se plantea la perspectiva general de los centros de escritura en el contexto colombiano. Como conclusión, se afirma que los centros de escritura en Colombia son una estrategia reciente, que se ha venido pensando con el propósito de fortalecer los procesos de escritura académica en los estudiantes.

Epidemiological profile of primary cutaneous melanoma over a 15-year period at a private skin cancer center in Colombia.

To describe clinical, histopathological and treatment characteristics of melanoma in a private institution of Bogotá, Colombia, and to identify differences regarding sex and age. Observational, retrospective study. 415 medical records between January 1999 and May 2014 were analyzed. Out of 415 patients, 244 (58.8%) were females and 171 (41.2%) were males with a mean age of 56.1 ±16.2 SD. Superficial spreading melanoma (SSMM) was the main subtype (n=175, 42.7%). Breslow's thickness ≤1mm was predominant, while phototypes II and III were more frequent (n=87, 69.6%). Melanoma was predominantly localized on the head in men (n=83, 50.3%) and in the lower limbs in women (n=89, 36.8%), with a higher frequency of SSMM pattern among patients aged ≤65. Lentigo maligna (LM) was more frequent in patients aged >65 (p<0.001), with a higher number of ulcerated melanomas (p=0.046). A predominance of thin SSMM and fair skin phototypes were found, unlike previous reports that showed acral lentiginous melanoma (ALM) as predominant, which may be caused by local variations related to mixed ethnicity.

Early Experience with Endoscopic Endonasal Techniques for Skull Base Pathologies at a Referral Center in Colombia: Multidisciplinary Team Approach Implementation

Early Experience with Endoscopic Endonasal Techniques for Skull Base Pathologies at a Referral Center in Colombia: Multidisciplinary Team Approach Implementation

Estimation of Design and Construction Costs of Third Level Health Centers in Colombia

This article states the average cost per square meter in Colombia for the design and construction of third level complexity hospitals by comparing the design and construction square meter cost obtained in other countries and national projects. Due to the Colombian population and the number of beds there is a deficit of 42.3%, having 1.5 beds per thousand habitants. As recommended by the World Health Organization (WHO) which is 2.6 beds per thousand inhabitants. Therefore, more hospital design and construction projects are required in years to come.

PMS36 - Patterns of Biological Therapy Use in Patients with Rheumatoid Artrhitis in a Real-Life Setting in Colombia

Rheumatoid arthritis (RA) is a chronic, inflammatory and systemic disease of with a prevalence between 0.5 and 1.3%; biological therapy for RA has proven efficacy and represent promising advances for individuals with the disease, and have been associated with significant improvement in outcomes including reduction in pain, joint swelling, serologic inflammatory indices, and rates of radiologic damage. The objective of this study was to describe the patterns of usage of biological therapy and resulting disease activity during a 12 month period in a RA specialized center in Colombia. We used data from the clinical charts in a specialized RA center, containing demographic characteristics, medical prescription and disease activity during 2016. Descriptive epidemiology was performed. Two-group comparisons were performed using Student-t test (p values with a significance level of 0.05. During a 12 month period 895 patients were under biological treatment. 83% were woman and 17% were men, mean age was 59 ± 12 years. The majority of patients (95%) were between 40 and 92 years old. Regarding usage of biological therapy 25% of patients received Certolizumab, 18% Etanercept, 12% Rituximab, 11% Adalimumab, 9% tocilizumab, 11% Abatacept, 7% infliximab, 4% Golimumab , 3% Tofacitninib. Mean DAS28 at 3 months was 2.99 ±1.13, at 6 months 2.99 ±1.05 and at 12 month 2.98 ±1.02. The comparison between disease activity and biological therapy were statistical significant. Biological therapy is effective for the management of RA in a real life setting. Also, as other studies had shown the most used biologics are Certolizumab and Etanercept.

PMS14 - Cost-Savings Due to The Withdrawing of Biological Therapy for Treatment of Rheumathoid Artritis in A Specialized Center in Colombia

Rheumatoid arthritis (RA) is the prevalent autoimmune inflammatory arthritis found in adults, with a worldwide prevalence ranging from 0.4% to 1.3%. The biological therapy for the treatment of RA can cost more than ten times the cost of conventional disease modifying RA drugs (DMARDs). Moreover, the increasing use of biologics is the greatest source of direct costs of patients with RA impacting health systems. The aim of this study was to describe the cost savings regarding the discontinuation of biological therapy in patients with RA during five years in a specialized RA medical center. A descriptive study was performed. We reviewed the records from patients that were receiving biological therapy and after some time had a withdrawing of the therapy; the criteria for discontinuation of medications were: diagnostic mistake, therapy failure, comorbidities, adverse events or very extended remission. Between 2011 and 2016, 140 patients were withdrawn from biological therapy; 23% of patients stopped therapy due to adverse events, 16% due to complex comorbidities, 15% for obtaining remission, 15% due to serious infections, 13% diagnostic mistake and 7% for therapy failure. The correct discontinuation of biological therapy saved per patient 9.800 USD/year and for the 140 patients 1.372.000 USD/million The biological therapy for the treatment of RA brings high costs in several countries from the perspective of the health system and the society. These results suggest that adequate discontinuation of biological therapy can reduce the health care system expenses.

Profile of gastrointestinal diseases in a pediatric gastroenterology center in Colombia: 15 years of follow-up

The profile of gastrointestinal diseases is constantly changing globally and locally affecting suspected diagnosis and medical methods. To establish the main diagnoses in a gastroenterology, hepatology, and pediatric nutrition unit in Bogota between 2009 and 2013, and to compare with findings from the same unit during the two prior five-year periods (1997 to 2006). We conducted a retrospective descriptive study. Medical records were reviewed to extract diagnoses. Data from the two previous five-year periods were taken from institutional records. A univariate analysis was performed, along with calculation of absolute and relative frequencies for qualitative variables, and central tendency and dispersion measures for quantitative variables. The study collected the diagnoses of 1,171 patients, 51.8% (607) of whom were male, and 64% (753/1171), under five years of age. The main diagnoses were: constipation (33.9%), food allergy (23.5%), eating disorders (5.5%), gastroesophageal reflux disease (4.1%), peptic ulcer disease (4.1%), persistent diarrhea (3.8%) and cystic fibrosis (3.4%). Upon comparing this period with the two previous ones, we observed that peptic ulcer disease decreased while constipation, which was in the second position, rose to the first place. Food allergy, not registered within the first ten diagnoses in previous periods, appeared during this last period. During the last five years, constipation was the first gastrointestinal diagnosis followed by food allergy, in agreement with the global trend. It is essential, therefore, to apply diagnostic algorithms, timely treatment, and prevention.