Luis Gabriel Parra-Lara

Introducción: Los efectos adversos asociados al uso de fármacos (EAF) ocurren como consecuencia del uso tanto apropiado como inapropiado de medicamentos. El objetivo de este estudio fue caracterizar las reacciones adversas asociadas al uso de antimicrobianos y anticonvulsivantes en pacientes adultos hospitalizados en una unidad de cuidado intensivo en un hospital de referencia en Colombia. Materiales y métodos: Estudio descriptivo realizado durante 16 meses antes de la pandemia por COVID-19. Se evaluó la frecuencia y tipo de reacciones en términos de causalidad y severidad según algoritmo de Naranjo y la clasificación Common Terminology Criteria For Adverse Events. Resultados: Se encontraron reacciones adversas asociadas a medicamentos de tipo hematológico y renales, todas de severidad moderada. Las más frecuentes fueron eosinofilia, aumento de creatinina y trombocitopenia. El mayor número de reacciones adversas asociadas a medicamentos estuvo relacionado con las prescripciones de meropenem y fenitoína en eventos hematológicos y vancomicina en los renales. Discusión: Casi el 20% de pacientes del estudio presentaron reacciones adversas asociadas a medicamentos, recalcando la necesidad de monitorización de los medicamentos que puedan empeorar el estado de los pacientes en la unidad de cuidado intensivo.

Background: Allogeneic peripheral blood stem cell transplantation (PBSCT) has been increasing for the last years in Latin America. The objective of this study was to describe clinical outcomes in acute myeloid leukemia (AML) receiving allogeneic PBSCT between 2013 and 2019 in a single center of Cali, Colombia. Methods: A retrospective cohort study was conducted in Fundacion Valle del Lili. Patients diagnosed with AML who received an allogeneic PBSCT between 2013 and 2019 using human leukocyte antigen (HLA)-matched sibling donors (MSDs) or haploidentical related donors (HRDs) with myeloablative conditioning regimen were included. Cases with diagnosis of promyelocytic leukemia, myelodysplastic syndrome-related AML and therapy-related AML were excluded. Data were obtained directly from the hospital PBSCT database and clinical records. Results: A total of 50 patients were included (HRD, n = 32; MSD, n = 18). Sixty-two percent was in the first complete remission (CR1) at the time of the transplant, of which 26% were MSD and 74% were HRD. The European Group for Blood and Marrow Transplantation (EBMT) risk score was: 44% vs. 50% low, 28% vs. 28% intermediate and 28% vs. 22% high for MSD vs. HRD, respectively. Overall survival at 5 years for MSD was 62% (95% confidence interval (CI): 3183%) and 43% (95% CI: 25-60%) for HRD. Event-free survival was 56% (95% CI: 26-78%) and 35.6% (95% CI: 18-53%), respectively. Non-relapse mortality at day-100 was 6% (95% CI: 0.8-35%) and 20% (95% CI: 9-39%). Relapse at5 years was 18% (95% CI: 4-58%) and 25% (95% CI: 10-52%). Overall mortality rate was 46%. The grade II-IV, III-IV acute graft-versus-host disease and severe chronic graft-versus-host disease was 44%, 11% and 12% for MSD, and 43%, 9% and 0% for HRD. Conclusion: These results underline that MSD remains the first donor choice for AML patients in CR1 when available. HRDs are still our next option among alternative donors. It is necessary to find strategies that have a positive impact on those outcomes that markedly affect the quality of allogeneic PBSCT and the prognosis of patients. Comparative, randomized, prospective studies with longer follow-up of haploidentical allogeneic PBSCT with other donor types are required to definitely establish its role among alternative donors.

Background:People living with HIV have an increased risk of cancer compared to the general population. However, with the increase in life expectancy and advances in antiretroviral therapy, the survival of patients with cancer and HIV has changed. Objective:To determine the survival of patients living with HIV and cancer in Cali, Colombia. Methods:A retrospective cohort study was conducted at the Fundacion Valle del Lili, Cali, Colombia. Data from the HIV database was crossed with data from the hospital and population-based cancer registries between 2011-2019. Patients <18 years, limited available clinical information on the diagnosis and treatment of HIV and cancer, and non-oncological tumor diagnosis were excluded. Results:A total of 173 patients were included. The frequencies of AIDS-defining neoplasms were: Non-Hodgkin lymphoma (42.8%), Kaposi sarcoma (27.8%), and cervical cancer (4.6%). Overall survival was 76.4% (95% CI 68.9-82.3) at five years. Poorer survival was found in patients with AIDS-defining infections (56.9% vs. 77.8%, p=0.027) and non-AIDS-defining infections (57.8% vs. 84.2%, p=0.013), while there was better survival in patients who received antiretroviral therapy (65.9% vs. 17.9%, p=0.021) and oncological treatment (66.7% vs. 35.4%, p<0.001). The presence of non-AIDS-defining infections increases the risk of dying (HR = 2.39, 95% CI 1.05-5.46, p=0.038), while oncological treatment decreases it (HR = 0.33, 95% CI 0.14-0.80, p=0.014). Conclusions:In people living with HIV, Non-Hodgkin lymphoma and Kaposi sarcoma are the most common neoplasms. Factors such as AIDS-associated and non-AIDS-associated infections have been identified as determinants of survival. Cancer treatment seems to improve survival.

: The co-occurrence of COVID-19 with endemic diseases is a public health concern that may affect patient prognosis and outcomes. The objective of this study was to describe the clinical characteristics of patients with dengue virus (DENV) and SARS-CoV-2 co-infections and compare their outcomes against those of COVID-19 patients without dengue. A cross-sectional study was conducted in patients with SARS-CoV-2 infection who attended a single center in Cali, Colombia, from March 2020 to March 2021. All patients who were tested by both real-time polymerase chain reaction for SARS-CoV-2 and IgM/NS1 for DENV were included. Dengue was diagnosed as having either an IgM- or an NS1- positive test. A total of 90 patients were included (72 with COVID-19 only and 18 with co-infection). Patients with co-infection had more dyspnea (61.1% versus 22.2%; P = 0.003) as well as higher oxygen desaturation (53.3% versus 13.4%; P = 0.002) and neutrophil-to-lymphocyte ratio (5.59 versus 3.84; P = 0.038) than patients with COVID-19 alone. The proportion of patients classified with moderate to severe COVID-19 was higher in the co-infection group (88.3% versus 47.8%; P = 0.002). Also, co-infection was associated with an increased need for mechanical ventilation (P = 0.06), intensive care unit (ICU) initial management (P = 0.02), and ICU admission during hospitalization (P = 0.04) compared with COVID-19 only. The ICU mortality rate was 66.6% in patients with co-infection versus 29.4% in patients infected with only SARS-CoV-2 (P < 0.05). The possibility of DENV and SARS-CoV2 co-infection occurred in the convergence of both epidemic waves. Co-infection was associated with worse clinical outcomes and higher mortality in ICU-admitted patients than in patients with the COVID-19 only.

Objetivos: determinar los factores asociados a la supervivencia de pacientes con cáncer y VIH en Cali, Colombia. Métodos: se realizó un estudio de cohorte retrospectivo en la Fundación Valle del Lili, Cali, Colombia. Se cruzaron datos de la base de datos de VIH con datos del Registro Poblacional de Cáncer de Cali (PCRC) entre 2011 y 2019. Se excluyeron pacientes menores de 18 años y aquellos con información limitada en la historia clínica. Se realizó un análisis de supervivencia mediante el método de Kaplan-Meier y se ajustó un modelo de regresión de Cox.

Objetivo: describir la oportunidad de diagnóstico y tratamiento del cáncer antes y después de la pandemia por COVID-19 en Cali, Colombia. Materiales y métodos: se realizó un estudio observacional retrospectivo. Se incluyeron pacientes con edad= 18 años diagnosticados con cáncer que fueron atendidos en la Fundación Valle del Lili, Cali, Colombia, en el periodo 2018 a 2021. Los datos se obtuvieron de la base de datos de la Cuenta de Alto Costo del hospital. La fecha de rango para el inicio de la pandemia por COVID-19 en Colombia fue de marzo a mayo de 2020. Se estimaron los indicadores de gestión del riesgo de cáncer para cada localización del cáncer establecidos previamente por el panel de expertos de la Cuenta de Alto Costo (mama, próstata, cuello uterino, colon y recto y estómago). Se utilizaron gráficos acíclicos dirigidos para identificar variables que podrían ser elegibles como factores de confusión. Todos los análisis estadísticos se realizaron con R-Studio.

El sarcoma de Ewing es una neoplasia de hueso y tejidos blandos, cuyo manejo se relaciona con toxicidad hematológica. Este aspecto representa un desafío médico y ético en los pacientes testigos de Jehová quienes, por sus creencias religiosas, rechazan la aplicación de hemoderivados, con riesgo de que se descontinúe la quimioterapia o de que se utilicen dosis subóptimas.Se presenta el caso de una mujer colombiana de 34 años, testigo de Jehová, con diagnóstico de sarcoma de Ewing con estadificación clínica IIB (T1N0M0) en las regiones maxilar y mandibular izquierdas, tratada con quimioterapia, quien presentó un valor mínimo de hemoglobina de hasta 4,5 g/dl y tuvo indicación quirúrgica como parte del tratamiento.En estos pacientes, la decisión de practicar una transfusión comprende implicaciones éticas que requieren alternativas terapéuticas y un abordaje multidisciplinario.

Background: Acute myeloid leukemia (AML) is a hematological ne-oplasm that is more frequent in elderly patients. The objective of this study was to evaluate elderly patients' survival with de novo AML and acute myeloid leukemia myelodysplasia-related (AML-MR), treated with intensive and less-intensive chemotherapy and supportive care. Methods: A retrospective cohort study was conducted in Fundacion Valle del Lili (Cali, Colombia), between 2013 and 2019. We included patients >= 60 years old diagnosed with AML. The statistical analy-sis considered the leukemia type (de novo vs. myelodysplasia-relat-ed) and treatment (intensive chemotherapy regimen, less-intensive chemotherapy regimen, and without chemotherapy). Survival analy-sis was performed using Kaplan-Meier method and Cox regression models. Results: A total of 53 patients were included (31 de novo and 22 AML-MR). Intensive chemotherapy regimens were more frequent in patients with de novo leukemia (54.8%), and 77.3% of patients with AML-MR received less-intensive regimens. Survival was higher in the chemotherapy group (P = 0.006), but with no differ-ence between chemotherapy modalities. Additionally, patients with-out chemotherapy were 10 times more likely to die than those who received any regimen, independent of age, sex, Eastern Coopera-tive Oncology performance status, and Charlson comorbidity index (adjusted hazard ratio (HR) = 11.6, 95% confidence interval (CI) 3.47 -38.8). Conclusions: Elderly patients with AML had longer survival time when receiving chemotherapy, regardless of the type of regimen.

Background: Thrombocytopenia is a marker of severity in dengue, and its resolution predicts clinical improvement. The objective was to evaluate mean platelet volume (MPV) trajectories as a predictor of platelet count (PC) recovery in dengue patients. Methods: An observational, longitudinal and analytical study was conducted at Fundación Valle del Lili (Cali, Colombia). Patients diagnosed with dengue during 2016–2020 were included. The association between PC and the covariates was evaluated using simple linear, quadratic and non-parametric spline smoothing regression models. A longitudinal linear mixed model was adjusted and then validated for PC measurements. Results: A total of 71 patients were included. The median age was 27 y, 38.5% were women and half had dengue with warning signs. A statistically significant PC decrease was observed when MPV was 13.87 fL and 4.46 d from the onset of symptoms, while PC displayed a significant constant increase with neutrophils count. Then, PC recovery was achieved with an MPV of 13.58 fL, 4.5 d from the onset of symptoms and a minimum neutrophils count of 150 μL. Conclusion: MPV may be a predictor of PC recovery in dengue patients. PC recovery is expected when a patient has an MPV of 13.58 fL, an onset time of 4.5 d and a neutrophils count of 150 μL.

Purpose To describe our experience upon developing and implementing a hospital-based cancer registry (HBCR) in a quaternary-level of care private non-profit academic medical center in Cali, Colombia. Methods HBCRs capture, in a given institution, every single patient with a confirmed malignancy. In this study, all cases evaluated between 2014 and 2018 were included in the HBCR. In compliance with the International Agency for Research on Cancer recommendations, cases were classified as analytic or non-analytic. Data derived from an exhaustive selection of patients was stored in a computing platform owned by the institution, meeting the 2016 Facility Oncology Registry Data Standards recommendations. Quality control was performed by evaluating comparability, timeliness, validity, and completeness. Results A total of 24,405 new cases were registered between 2014 and 2018, from which 4253 (17.4%) died. Among all cases, based on the anatomic location, most common malignancies were breast (n = 1554), thyroid (n = 1346), hematolymphoid (n = 1251), prostatic (n = 805), and colorectal (n = 624). The behavior of the new cases was consistent with an incremental trend. Conclusion Upon implementing the HBCR, major challenges were identified (i.e., a precise definition of cases, the development of processes for capturing new cases, a standardized data collection strategy, and carrying-out an appropriate patient follow-up). Based on our experience, the success of an HBCR largely relies on the interest from the institution, the engagement of stakeholders and financial support, that is, it depends on the adequate access over time to funding, technological, and staffing resources.