Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas.

The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.

Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia.

INTRODUCTION: Chronic Inflammatory Rheumatism (CIR) is one of the recognized and increasingly reported consequence post-chikungunya infection (pCHIK) in Colombia and Latin America. METHODS: Retrospective cohort study of 128 patients with CHIK that persisted with pCHIK-CIR after 59-68 weeks (1.13-1.31 years). This information was evaluated by means of a telephone survey and according to validated criteria (WHO 2015) previously (patients with >12 weeks post-CHIK with ≥1 manifestations [continuous/recurrent]: chronic polyarthralgia [pCHIK-CPA], stiffness and/or joint edema). RESULTS: Of the total CHIK-infected subjects finally included (n = 65), 28 (43.1%) reported pCHIK-CPA; and 38 patients (58.5%) at least one persistent rheumatological symptoms over the last year (pCHIK-CIR); 38.5% of them, morning stiffness, 18.5% joint edema, and 3.1% joint redness. No significant sex differences were found; 60% of patients with pCHIK-CPA aged> 40 years (RR = 3.75; 95%CI 1.47-9.53). The 29.2% of patients required medical attention because of symptoms. CONCLUSIONS: Nearly half of patients with CHIK had at least one rheumatologic symptom persistent over a year, and the third of them, pCHIK-CPA. These results are comparable with previous estimates obtained in other cohorts in the country (Risaralda and Sucre) and are consistent with results from other studies in France and India.

Physical activity in a rural community in Colombia / Actividad física en una comunidad rural de Colombia

ABSTRACT Objective To characterize physical activity profiles in a rural community in the southwest of Colombia and to identify knowledge gaps on this issue in the country. Methods Cross-sectional study conducted in a rural area in Puerto Caldas, Pereira, Risaralda. The population of the study was obtained by convenience sampling from people participating in the activities of the Second Multidisciplinary Camp for Research and Services (CUMIS, for its acronym in Spanish), which was organized by the Colombian Association of Medical Students' Scientific Societies (ASCEMCOL, for its acronym in Spanish). The International Physical Activity Questionnaire (IPAQ) was used in order to measure and classify the physical activity behaviors of this population. Results Data from 100 subjects with a mean age of 43±18 years were collected. 6 % of the population did not perform any kind of physical activity, while 61 % performed vigorous physical activity. Men spent more time in doing vigorous and moderate physical activity than women did (p<0.05). The World Health Organization (WHO) recommendations on physical activity were followed by 72.29 % (n=60) and 82.35 % (n=14) of the people with an age of 18 to64 and ≥65 years, respectively. Conclusion It is necessary to build up evidence regarding physical activity in rural areas in order to implement public policies that promote its practice in communities where socioeconomic and health inequities exist. Part of the population living in the community where the study was carried out does not follow the WHO recommendations on physical activity; therefore, the lack of public health interventions is highlighted. A better coherence between international resolutions, national public policies and their implementation could lead to an increase in practice levels of physical activity.(AU)

RESUMEN Objetivo Caracterizar la actividad física en una comunidad rural del suroeste de Colombia e identificar los vacíos de conocimiento alrededor del tema en el país. Métodos Estudio de corte transversal en una zona rural de Puerto Caldas, Pereira, Risaralda. La población fue seleccionada, mediante muestreo por conveniencia, entre las personas que participaron en las actividades del II Campamento Multidisciplinar de Investigación y Servicios (CUMIS), dirigido por la Asociación Colombiana de Sociedades Científicas de Estudiantes de Medicina (ASCEMCOL). Se utilizó el International Physical Activity Questionnaire (IPAQ) para medir y clasificar los comportamientos de esta población en términos de actividad física. Resultados Se recogieron datos de 100 sujetos con edad promedio de 43±18 años. El 6 % de la población no realizó ningún tipo de actividad física, mientras que el 61 % realizó actividad física vigorosa. Los hombres dedicaron más tiempo a la práctica de actividad física vigorosa y moderada que las mujeres (p<0,05). Las recomendaciones sobre actividad física de la Organización Mundial de la Salud (OMS) fueron seguidas por el 72,3 % (n=60) y el 82,4 % (n=14) de las personas en los grupos de edad de 18 a 64 y ≥65 años, respectivamente Conclusión Es necesario construir evidencia en torno a la actividad física en el área rural, a fin de implementar políticas públicas que promuevan su práctica en comunidades que presenten desigualdades socioeconómicas y en salud. Parte de la población de la comunidad donde se llevó a cabo el estudio no sigue las recomendaciones de la OMS para actividad física, en consecuencia, la falta de intervenciones en salud pública se pone en evidencia. Una mayor coherencia entre las resoluciones internacionales, las políticas públicas nacionales y su aplicación podría conducir a un aumento en los niveles de actividad física.(AU)

Mapping Zika virus infection using geographical information systems in Tolima, Colombia, 2015-2016.

OBJECTIVE: Geographical information systems (GIS) have been extensively used for the development of epidemiological maps of tropical diseases, however not yet specifically for Zika virus (ZIKV) infection. METHODS: Surveillance case data of the ongoing epidemics of ZIKV in the Tolima department, Colombia (2015-2016) were used to estimate cumulative incidence rates (cases/100,000 pop.) to develop the first maps in the department and its municipalities, including detail for the capital, Ibagué. The GIS software used was Kosmo Desktop 3.0RC1®. Two thematic maps were developed according to municipality and communes incidence rates. RESULTS: Up to March 5, 2016, 4,094 cases of ZIKV were reported in Tolima, for cumulated rates of 289.9 cases/100,000 pop. (7.95% of the country). Burden of ZIKV infection has been concentrated in its east area, where municipalities have reported >500 cases/100,000 pop. These municipalities are bordered by two other departments, Cundinamarca (3,778 cases) and Huila (5,338 cases), which also have high incidences of ZIKV infection. Seven municipalities of Tolima ranged from 250-499.99 cases/100,000 pop., of this group five border with high incidence municipalities (>250), including the capital, where almost half of the reported cases of ZIKV in Tolima are concentrated. CONCLUSIONS: Use of GIS-based epidemiological maps helps to  guide decisions for the prevention and control of diseases that represent significant issues in the region and the country, but also in emerging conditions such as ZIKV.

Physical activity in a rural community in Colombia.

OBJECTIVE: To characterize physical activity profiles in a rural community in the southwest of Colombia and to identify knowledge gaps on this issue in the country. METHODS: Cross-sectional study conducted in a rural area in Puerto Caldas, Pereira, Risaralda. The population of the study was obtained by convenience sampling from people participating in the activities of the Second Multidisciplinary Camp for Research and Services (CUMIS, for its acronym in Spanish), which was organized by the Colombian Association of Medical Students' Scientific Societies (ASCEMCOL, for its acronym in Spanish). The International Physical Activity Questionnaire (IPAQ) was used in order to measure and classify the physical activity behaviors of this population. RESULTS: Data from 100 subjects with a mean age of 43±18 years were collected. 6 % of the population did not perform any kind of physical activity, while 61 % performed vigorous physical activity. Men spent more time in doing vigorous and moderate physical activity than women did (p<0.05). The World Health Organization (WHO) recommendations on physical activity were followed by 72.29 % (n=60) and 82.35 % (n=14) of the people with an age of 18 to64 and ≥65 years, respectively. CONCLUSION: It is necessary to build up evidence regarding physical activity in rural areas in order to implement public policies that promote its practice in communities where socioeconomic and health inequities exist. Part of the population living in the community where the study was carried out does not follow the WHO recommendations on physical activity; therefore, the lack of public health interventions is highlighted. A better coherence between international resolutions, national public policies and their implementation could lead to an increase in practice levels of physical activity.

Estimating the burden of disease and the economic cost attributable to chikungunya, Colombia, 2014.

BACKGROUND: Chikungunya (CHIK) virus disease is expected to be a considerable cause of disability and economic burden in Latin America given its chronic sequelae, particularly its chronic inflammatory rheumatism. There have been no previous studies assessing CHIK costs and disability in Latin America. METHODS: We calculated incidence rates for CHIK during the 2014 outbreak in Colombia using epidemiological data provided by the Colombian National Institute of Health, using demographic data from the National Administrative Department of Statistics. The burden of disease was estimated through disability adjusted life years (DALYs) lost and the costs were estimated based on the national recommendations for CHIK acute and chronic phase attention. RESULTS: There were a total of 106 592 cases, with incidence rates ranging from 0 to 1837.3 cases/100 000 population in different departments. An estimate was made of total DALYs lost of 40.44 to 45.14 lost/100 000 population. The 2014 outbreak estimated costs were at least US$73.6 million. CONCLUSIONS: Our estimates raise concerns about the effects of continued CHIK spread in Colombia and other Latin-American countries. The lack of transmission control for this disease and potential for spread means that there will be significant acute and chronic disability and related costs in the short and long term for Latin American health care systems.

Impacto de una actividad formativa en los conocimientos, actitudes y percepciones sobre tuberculosis de estudiantes de medicina de una universidad de Risaralda Colombia / Impact of one formative activity in the students`knowledge, attitudes and perceptions on tuberculosis from one university in Risaralda Colombia

La tuberculosis continúa siendo una de las principales enfermedades tropicales en términos de morbimortalidad. De allí la importancia de mejorar su prevención, a través de diferentes estrategias, incluida la educación médica continua. En el marco del Día Mundial de la lucha contra la tuberculosis se realizó un simposio eduactivo incluyendo charlas y una obra de teatro sobre diferentes aspectos de la enfermedad (duración 280 minutos). Antes de iniciar se aplicó una encuesta para evaluar conocimientos, actitudes y percepciones sobre tuberculosis, basada en guía para encuestas ACMS, de STOP Tuberculosis Partnership de la OMS. Al finalizar esta fue aplicada de nuevo. Se comparan las diferecias entre los resultados antes u después con la prueba X², confianza 95%. Se evaluó un total de 109 universitarios antes de iniciar (pre) y 103 después (pos) (total, 211 encuestas). Sobre las preguntas realizadas, la primera de ella fue "¿Cuán serio percibe usted el problema de la tuberculosis en su comunidad?". En la encuesta pre solo 50,9% lo consideró un problema muy serio. En la pos se incrementó a 94,1% (X²= 49,602; P<0,001). En la encuesta pre, 31,5% lo consideró como algo serio, 2,8% no tan serio, 8,3% no sabía y 6,5% no contestó. En la pos, el restante 5,9% correspondió solo a considerarlo como algo serio. En general se observó mejoría significativa sobre los conocimientos, actitudes y percepciones en síntomas, trasmisión, prevención, curación, que sentiría al ser diagnosticado y otros aspectos evaluados (P<0,05). Este tipo de abordajes, especialmente a nivel comunitario, debe ser replicado, con el fin de mejorar los conocimientos, actitudes y percepciones de la población no solo universitaria, sino también general, sobre la tuberculosis. Se requiere dar mayor información en las poblaciones afectadas y sus familiares sobre las formas de transmisión, para mitigar los mitos y el estigma, que es también prevalente

Tuberculosis continues to be one of the most principal tropical diseases in terms of its morbidity and mortality. Since there the importance to improve its prevention, through different strategies, included the continuing medical eduaction. In the context of the World Tuberculosis Day an educative symposium, including conferences and a theater play about different disease aspects (lasting 280 minutes), was done. Before start them, a questionnaire to assess knowledges, attitudes and perceptions about tuberculosis, based on the guide for surveys ACMS, of STOP Tuberculosis Partnership from the who, was applied. Finishing them this questionnaire was applied again. Differences between before and after results, using the X²-test, 95% confidence level, were compared. A total 109 universitary students (before) and 102 (after) were evaluated. About the applied questions, first of them was "How serious do you perceive the tuberculosis problem in your community?" In the pre-test survey only 50.9% considered it as a very serious problem. In the post-test it increased to 94.1% (X²=49.602; P<0.001). In the pre-test, 31.5% considered as something serious, 2.8% not so serious, 8.3% did not knew and 6.5% did not answered. In the post-test, resting 5.9% corresponded just no considered it as something serious. In genral a significant improvement about the knowledges, attitudes and perceptions in symptoms, transmission, prevention, cure, how feel about been diagnosed and other evaluated aspect was observed (P<0.05). This type of approach, especially at community level, should be replicated, with the goal to improve the knowledges, attitudes and perceptions of the population not just universitary, but also general, about tuberculosis. It is requerid to give more information in the affected populations and their families about the transmission, in order to mitigate the myths and stigma, which is also prevalent