Zika emergence, persistence, and transmission rate in Colombia: a nationwide application of a space-time Markov switching model.

Zika, a viral disease transmitted to humans by Aedes mosquitoes, emerged in the Americas in 2015, causing large-scale epidemics. Colombia alone reported over 72,000 Zika cases between 2015 and 2016. Using national surveillance data from 1121 municipalities over 70 weeks, we identified sociodemographic and environmental factors associated with Zika's emergence, re-emergence, persistence, and transmission intensity in Colombia. We fitted a zero-state Markov-switching model under the Bayesian framework, assuming Zika switched between periods of presence and absence according to spatially and temporally varying probabilities of emergence/re-emergence (from absence to presence) and persistence (from presence to presence). These probabilities were assumed to follow a series of mixed multiple logistic regressions. When Zika was present, assuming that the cases follow a negative binomial distribution, we estimated the transmission intensity rate. Our results indicate that Zika emerged/re-emerged sooner and that transmission was intensified in municipalities that were more densely populated, at lower altitudes and/or with less vegetation cover. Warmer temperatures and less weekly-accumulated rain were also associated with Zika emergence. Zika cases persisted for longer in more densely populated areas with more cases reported in the previous week. Overall, population density, elevation, and temperature were identified as the main contributors to the first Zika epidemic in Colombia. We also estimated the probability of Zika presence by municipality and week, and the results suggest that the disease circulated undetected by the surveillance system on many occasions. Our results offer insights into priority areas for public health interventions against emerging and re-emerging Aedes-borne diseases.

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study.

Background: Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective: To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods: Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ([Formula: see text]), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results: Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion: The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.

Clinical Manifestations of Dengue in Children and Adults in a Hyperendemic Region of Colombia.

Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.

Risk Factors Associated With Bullying in Context of a Territory Exposed to Armed Conflict: A Cross-sectional Study.

School violence and bullying are current and problematic events during adolescence. They are likely to have a marked presence in places highly exposed to armed conflict and violent environments, representing a double public health problem. The study aims to estimate the prevalence of different types of school violence perpetrated and experienced by school adolescents in a community with a history of exposure to armed conflict. Two thousand one hundred eighty-five school adolescents from a municipality in Colombia (males = 54.1%, 14-16 years = 38.6%) participated in the study. Nine educational institutions were included. A systematic random sampling was designed, with a proportional allocation of 35% within each school year from sixth to eleventh grade. The School Coexistence and Circumstances Affecting it-ECECA survey was applied. The prevalence and risks of bully and bullying were estimated. RRa were calculated with the 95% confidence interval adjusted for the other confounding variables. Analyses were constructed from generalized linear models, under the Poisson family and a logarithmic link function. We found a 9.3% of bullying victimization and a 3.5% prevalence of bully. A higher risk of bully was found among males, persons between 10 and 14 years of age, residents of rural or urban dispersed areas, residents of violent neighborhoods, alcohol consumers at school, and victims of aggression in childhood (RRa > 1.0, p-values <.05). The risk of victimization of bullying was higher in students younger than 15 years old, as residents of urban areas, having a history of childhood aggression, suffering abuse by a close person, and as alcohol users at school. This study provides evidence of risk factors for aggression and bullying that have implications for possible prevention measures in multiple social domains, including the individual, the family, and the school environment.

Immune system gene polymorphisms associated with severe dengue in Latin America: a systematic review.

One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.

Burden of undiagnosed hypertension and its associated factors: A challenge for primary health care in urban Colombia.

BACKGROUND: Arterial hypertension is one of the most prevalent chronic, non-communicable diseases and the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide. Although its primary causes and consequences are preventable, it often remains undiagnosed. Consequently, this study aims to determine the prevalence and factors associated with normotensive, diagnosed, and undiagnosed hypertension in adults. METHODS: A cross-sectional, population-based study was conducted in Sabaneta, Colombia, between 2021 and 2022, with 286 adults aged 18 and older. Stratified and systematic random sampling methods were employed. The World Health Organization STEP survey and the Perez Rojas test were utilized to assess behavioral risk factors and sedentary lifestyles. Body mass index, waist circumference, and arterial tension were measured using standardized instruments. The prevalence of hypertension was then estimated. Risk factors influencing normotensive, diagnosed, and undiagnosed hypertension were analyzed using multinomial regression. The outcome variable comprised three categories: normotensive (reference category), diagnosed hypertension, and undiagnosed hypertension. The multinomial regression coefficients were exponentiated and are presented as relative risk ratios (RRR) with 95% confidence intervals (CI). The model was adjusted for sex and sample weight per neighborhood. RESULTS: The study revealed a hypertension prevalence of 38.5% and an undiagnosed hypertension rate of 50.9%. Those with undiagnosed hypertension were predominantly adults over 60 years (RRR = 0.68; 95% CI: 0.53-0.86), individuals with an elementary school education (RRR = 1.75; 95% CI: 1.27-2.42), those physically active (RRR = 1.52; 95% CI: 1.22-1.89), without prior diagnoses of chronic comorbidities (RRR = 1.42; 95% CI: 1.12-1.82), and with obesity (RRR = 2.25; 95% CI: 1.63-3.11) or overweight conditions (RRR = 1.70; 95% CI: 1.334-2.15). CONCLUSIONS: Undiagnosed hypertension was significant among populations without risk conditions. There is an urgent need for community-based early detection and education strategies to mitigate this issue.

Immune system gene polymorphisms associated with severe dengue in Latin America: a systematic review

ABSTRACT One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.

Predicción fisicomatemática de la dinámica semestral de la malaria en Antioquia, Colombia / Physico-mathematical prediction of the biannual dynamics of malaria in Antioquia, Colombia

Introducción: La malaria es una enfermedad endémica en Colombia, cuyas características biológicas, fisiopatológicas y el impacto socioeconómico que genera la han posicionado como una enfermedad de interés en salud pública. Objetivo: Predecir el número de casos notificados de malaria para el segundo semestre del año 2020 en el departamento de Antioquia, a través de la aplicación de la teoría de la probabilidad y la caminata al azar. Métodos: Se realizó un estudio observacional longitudinal retrospectivo. Se analizó la dinámica geométrica del comportamiento semestral de la epidemia de malaria en el departamento de Antioquia durante los años 2008-2020 con los datos del Sistema Nacional de Vigilancia en Salud Pública, como una caminata al azar probabilística. En relación con los aumentos y disminuciones consecutivas semestrales, se determinó el número de infectados más probable para el segundo semestre del año 2020. Resultados: El valor de la predicción fue de 3433. Al ser comparado con los valores reportados por el Sistema Nacional de Vigilancia en Salud Pública, se obtuvo un porcentaje de acierto del 95,4 %. Conclusiones: Al predecir con alta precisión el número de infectados para el segundo semestre del año 2020 en el departamento de Antioquia, se evidencia la potencialidad de la metodología para implementarse como una herramienta de vigilancia en salud pública y como un medio que sirva para apoyar la toma de decisiones en materia de políticas públicas.

Introduction: Malaria is an endemic disease in Colombia. Due to its biological and pathophysiological characteristics and socioeconomic impact, it is positioned as a disease of public health interest. Objective: To predict the number of reported cases of malaria for the second semester of 2020 in Antioquia department using the theory of probability and probabilistic random walk. Methods: A retrospective, longitudinal, observational study was conducted. The geometric dynamics of the biannual development of malaria epidemic in Antioquia department from 2008 to 2020 was analyzed using the data from the National Surveillance System in Public Health as a probabilistic random walk. Regarding the consecutive biannual reductions and increments, the most probable number of infected individuals was determined for the second semester of 2020. Results: The predictive value was 3433. When it was compared to the values reported by the National Surveillance System in Public Health, a 95.4% accuracy rate was obtained. Conclusions: By predicting with high accuracy the number of infected individuals for the second semester of 2020 in Antioquia department, it is evident the methodology potential as a public health surveillance tool and as a means to support public policy decision making.

Síndrome metabólico postrasplante hepático en pacientes del Centro Especializado San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017 / Metabolic syndrome after liver transplant in patients at the Specialized Center San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017

Se revisaron las historias clínicas de todos los pacientes con trasplante hepático atendidos en el Centro Especializado San Vicente Fundación entre enero de 2013 y junio de 2017, para determinar la frecuencia de síndrome metabólico (SM) postrasplante. En instrumento validado se registraron datos sociodemográficos, antecedentes patológicos, antecedentes toxicológicos, complicaciones y criterios ATP III. Se utilizó OpenEpi 3,01 para análisis estadístico; se consideró significancia estadística con p<0,05. De 102 historias clínicas revisadas, se analizaron 73 que cumplieron criterios de inclusión (sin diagnóstico de SM pretrasplante y con información completa para el instrumento). La mayoría de los pacientes eran hombres (59%), adultos mayores (64%) y casados (62%). La frecuencia de SM postrasplante fue 66%; hubo asociación significativa entre SM y antecedentes de hipertensión arterial y diabetes. Se confirma que el SM es una complicación frecuente de los trasplantados hepáticos y los antecedentes de hipertensión y diabetes son los factores asociados más frecuentes.

The medical records of all liver transplant patients attended at the Centro Especializado San Vicente Fundación between January 2013 and June 2017 were reviewed in order to determine the frequency of post-transplant metabolic syndrome (MS). We collected sociodemographic data, pathological history, toxicological history, complications, and ATP III criteria in a validated instrument. The statistical analysis was carried out with OpenEpi 3.01; p<0.05 was considered as statistically significant. Of the 102 reviewed medical records, 73 met the inclusion criteria (no MS diagnosis prior to transplant and complete information for the instru­ment) and were analyzed. Most patients were male (59%), older adults (64%) and married (62%). The frequency of MS after liver transplant was 66%. The association between MS and history of hypertension and diabetes was significant. We confirmed that MS is a frequent complication in liver transplant recipients and that history of hypertension and diabetes are the most frequent associated factors.

Metabolic syndrome after liver transplant in patients at the specialized Center San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017. / Síndrome metabólico postrasplante hepático en pacientes del Centro Especializado San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017.

OBJECTIVES.: Motivation for the study: there is a lack of studies in Latin America on the frequency of metabolic syndrome in patients who receive liver transplants. Main findings: two-thirds (66%) of patients who received liver transplantation between 2013 and 2017 at the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, subsequently presented metabolic syndrome. Implications: this study confirms that liver transplant recipients very frequently develop metabolic syndrome; however, the frequency found by this study (66%) was almost double that reported in other regions of the world, suggesting that patients from the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, may present some additional condition. The medical records of all liver transplant patients attended at the Centro Especializado San Vicente Fundación between January 2013 and June 2017 were reviewed in order to determine the frequency of post-transplant metabolic syndrome (MS). We collected sociodemographic data, pathological history, toxicological history, complications, and ATP III criteria in a validated instrument. The statistical analysis was carried out with OpenEpi 3.01; p<0.05 was considered as statistically significant. Of the 102 reviewed medical records, 73 met the inclusion criteria (no MS diagnosis prior to transplant and complete information for the instru-ment) and were analyzed. Most patients were male (59%), older adults (64%) and married (62%). The frequency of MS after liver transplant was 66%. The association between MS and history of hypertension and diabetes was significant. We confirmed that MS is a frequent complication in liver transplant recipients and that history of hypertension and diabetes are the most frequent associated factors.

OBJETIVOS.: Motivation for the study: there is a lack of studies in Latin America on the frequency of metabolic syndrome in patients who receive liver transplants. Main findings: two-thirds (66%) of patients who received liver transplantation between 2013 and 2017 at the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, subsequently presented metabolic syndrome. Implications: this study confirms that liver transplant recipients very frequently develop metabolic syndrome; however, the frequency found by this study (66%) was almost double that reported in other regions of the world, suggesting that patients from the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, may present some additional condition. Se revisaron las historias clínicas de todos los pacientes con trasplante hepático atendidos en el Centro Especializado San Vicente Fundación entre enero de 2013 y junio de 2017, para determinar la frecuencia de síndrome metabólico (SM) postrasplante. En instrumento validado se registraron datos sociodemográficos, antecedentes patológicos, antecedentes toxicológicos, complicaciones y criterios ATP III. Se utilizó OpenEpi 3,01 para análisis estadístico; se consideró significancia estadística con p<0,05. De 102 historias clínicas revisadas, se analizaron 73 que cumplieron criterios de inclusión (sin diagnóstico de SM pretrasplante y con información completa para el instrumento). La mayoría de los pacientes eran hombres (59%), adultos mayores (64%) y casados (62%). La frecuencia de SM postrasplante fue 66%; hubo asociación significativa entre SM y antecedentes de hipertensión arterial y diabetes. Se confirma que el SM es una complicación frecuente de los trasplantados hepáticos y los antecedentes de hipertensión y diabetes son los factores asociados más frecuentes.