Robinson Pacheco López

Background/Objectives: Normocalcemic primary hyperparathyroidism (NCPHP), characterized by elevated parathyroid hormone (PTH) and normal calcium, is considered an early phenotype of primary hyperparathyroidism (PHP), but community-based prevalence data are scarce and heterogeneous. The objectives of this study were to determine the prevalence of NCPHP and other phenotypes related to calcium and PTH metabolism, as well as to evaluate potential associated clinical and biochemical variables. Methods: We conducted a cross-sectional analysis of a community cohort of 1,747 adults from urban and rural areas of the Department of Cauca, Colombia, recruited by non-probabilistic sequential sampling. Participants with conditions or medications known to affect calcium-PTH metabolism were excluded. We measured PTH, ionized calcium, 25-hydroxyvitamin D (25OH Vit-D), phosphorus, alkaline phosphatase, and estimated glomerular filtration rate (eGFR), and defined nine phenotypes by cross-tabulating PTH and calcium categories. Predictors of NCPHP were identified with multivariable logistic regression. Results: The median age was 52 years, and 58.2% of participants were women. The prevalence of NCPHP was 9.8% [95% confidence interval (CI): 8.5–11.3], and classic PHP was found in 0.2% (95% CI: 0.1–0.6). In the multivariable model, only older age [adjusted odds ratio (OR): 1.02 per year; 95% CI: 1.01–1.03] and a 25OH Vit-D level Conclusions: In this large, community-based cohort, NCPHP was substantially more prevalent than previously reported, whereas classic PHP remained rare. Older age and vitamin D deficiency were the only independent correlates of the normocalcemic phenotype, findings that warrant confirmation in longitudinal studies.

Introducción. El distrito de Santiago de Cali es la segunda entidad territorial con mayor número de casos de tuberculosis en Colombia. Desde el 2016, la Secretaría de Salud Pública implementó el plan de control de infecciones en las instituciones prestadoras de servicios de salud con programas activos contra la tuberculosis, lo que hizo necesaria su evaluación.Objetivo. Contrastar los aspectos normativos y los elementos contextuales que influyen en la operación del plan de control de infecciones de tuberculosis, para documentar buenas prácticas y áreas de oportunidad en las instituciones prestadoras de servicios de salud.Materiales y métodos. Se llevó a cabo un estudio evaluativo con enfoque mixto para analizar las capacidades institucionales del plan de control de infecciones. El componente cuantitativo incluyó la revisión documental y la evaluación de las medidas administrativas, ambientales y de protección respiratoria. Con el componente cualitativo, mediante el estudio de caso, se analizaron la normatividad, la gobernanza, el financiamiento, los sistemas de información, la infraestructura y la formación del personal. La información se integró mediante triangulación.Resultados. El cumplimiento promedio del plan de control de infecciones fue del 70,8 % en las medidas administrativas, del 62,1 % en el control ambiental y del 90,5 % en de protección respiratoria. Se identificó la ausencia de normatividad nacional específica, frecuente rotación del personal, falta de capacitación, brechas en inversión y mantenimiento ambiental, e insuficiente monitoreo de la tuberculosis ocupacional. Entre las fortalezas, se destacaron la captación de pacientes sintomáticos respiratorios y la disponibilidad de elementos de protección respiratoria.Conclusiones. Se evidenciaron brechas estructurales asociadas con la falta de un marco normativo nacional, debilidades de gobernanza, limitaciones financieras y deficiencias en el seguimiento y en la formación. Se recomienda determinar responsabilidades, asignar recursos y establecer protocolos operativos en las instituciones prestadoras de servicios de salud. La sostenibilidad del plan de control de infecciones requiere indicadores de seguimiento, auditorías periódicas y capacitación continua.

Background/Objectives: Children with sickle cell disease (SCD) experience gastrointes-tinal symptoms; the contribution of disorders of gut–brain interaction (DGBIs) to this symptom burden remains underrecognized, particularly in low-middle-income coun-tries. This study aimed to determine the prevalence of DGBIs and associated factors in children with SCD. Methods: Descriptive cross-sectional study conducted in two pediatric centers in Cali, Colombia. Children aged 4-18 years with confirmed SCD were included. DGBIs were identified using the Questionnaire for Pediatric Gastrointestinal Symptoms–Rome IV. Sociodemographic/familial/clinical variables were obtained. Quality of Life was assessed using the Pediatric Quality of Life Inventory. Uni-bivariate, and multivariable logistic regression analyses were performed. Results A total of 103 patients were included. Prevalence of DGBIs was 11.7%. The most common functional constipation (7.8%), fol-lowed by functional dyspepsia (3.9%). Overlap was observed in 1.0%. Quality of life was impaired in 34.9%. This was reflected in 66.7% school absenteeism of patients with DGBIs compared of those without (38.5%) (OR=3.20; 95%CI=0.77-15.45; p=0.062). In the bivariate analysis, living with both parents, asthma, positive sickling test, and history of hema-tologic replacement therapy showed a trend toward association with DGBI. In the mul-tivariable analysis, asthma and history of transfusion also showed a trend toward asso-ciation, statistical significance was not reached. Conclusions: DGBIs are present in a clinically relevant proportion of children with SCD and represent a potentially under-diagnosed comorbidity. Quality of life was impaired. The incorporation of systematic screening using standardized Rome Criteria may improve the identification of DGBIs and strengthen the comprehensive management of these children.

Objectives: We aimed to determine the frequency and factors related to oropharyngeal dysphagia in adults in a health center in Colombia evaluated by videofluroscopy of swallowing. Methods: We reviewed the records of 144 patients evaluated through videofluroscopy of swallowing. In order to analyze the results, descriptive, bivariate statistical analysis, and multivariate regression were used. Results: This investigation revealed that 23.6% of adults had oropharyngeal dysphagia. Older adults had a higher percentage of occurrence, and the factors associated with this symptom were having a history of cerebral stroke and being medicated with anticholinergic drugs. Conclusions: These findings strongly suggest that older adults with other comorbidities have a high percentage of presenting oropharyngeal dysphagia. Further research is needed to characterize the entity in other populations.

A cross-sectional descriptive and analytical study evaluated years of potential life lost (YPLL) due to drug-susceptible pulmonary tuberculosis in Cali from 2009 to 2020, using death records from the Health Secretariat. Total YPLL and its annual rate were calculated by age at death, and median YPLL values were compared across subgroups. A total of 565 registers of death records were analyzed (71.5% men; median age 56 years, range 38–70), yielding 11,238 YPLL. The highest median YPLL were observed among persons living with HIV, those in socially vulnerable situations, the uninsured or those under subsidized or special coverage, in women, and in those who re-entered after previously discontinuing treatment or experiencing a tuberculosis relapse.

Introducción: Infecciones persistentes por VPH de alto riesgo se asocian con cáncer cervicouterino, primera causa de muerte oncológica en mujeres entre 30-59 años en Colombia. Este estudio describe resultados de tamizaje y distribución de genotipos de alto riesgo en mujeres atendidas por el programa Por Ti Mujer en Cali. Materiales y Métodos: Estudio observacional descriptivo de corte transversal de registros de mujeres adultas tamizadas con citología convencional, prueba de detección de ADN para VPH e inspección visual con ácido acético y lugol, realizado por el programa Por Ti Mujer en Cali, Colombia, entre enero-junio de 2023. Resultados: Se analizaron 15.130 registros, la positividad general independiente de la herramienta de tamizaje fue 10,2%; para ADN VPH fue 15,2% y para citología 5,4%. Mujeres entre 30-65 años y con régimen de salud contributivo presentaron mayor frecuencia de resultados con alteraciones. Los genotipos de VPH de alto riesgo más frecuentes fueron: 56-59-66 (21,2%), 33-39-68 (17,0%), 16 (13,8%), 33-58 (12,1%) y 52 (11,1%). Discusión: El índice de positividad para VPH en el programa Por Ti Mujer fue superior (15,2%) al reportado a nivel mundial (10,4%), pero menor al registrado en Latinoamérica (16,1%). Los genotipos de alto riesgo de mayor prevalencia fueron 56-59-66, seguido de 33-39-68.

Aumentar el conocimiento sobre los factores de riesgo de lesiones gástricas preneoplásicas y CG, enfocándose en H. pylori. Promover cambios de comportamiento relacionados con hábitos de higiene alimentaria y búsqueda activa de diagnóstico Fortalecer la participación comunitaria en actividades de detección temprana y prevención. Reducir la incidencia de lesiones gástricas preneoplásicas y condiciones precursoras de CG en diversas comunidades.

Type 2 diabetes mellitus (T2DM) impacts the development of cardiovascular disease. Prediabetes, called intermediate hyperglycemia, is diagnosed with glucose levels that do not meet the criteria for T2DM, but are elevated. Lifestyle changes achieve a reversal of up to 58%, structured within an adequate follow-up in cardiovascular risk programs. Longitudinal, descriptive study, with analytical scope, retrospective collection of information from a cohort of adults with a diagnosis of prediabetes; in quarterly follow-up by a cardiovascular risk program of a III level institution between 2019 - 2023. Univariate and bivariate analysis and logistic regression were performed to define the correlation between reversion to normoglycemia and associated factors. Mean age was 69.5 years (SD 10.1), 50.8% women, median follow-up 366 days (IQR 249 - 569). Performing physical activity > 150 minutes per week (validated by International Physical Activity Questionnaire - IPAQ), increases 4.15 times the chance of reversing prediabetes (p< 0.001); while decreasing the chance of reversal, having an HbA1c ≥ 6.0 to 86% (p= 0.014) and BMI ≥ 25 to 75% (p= 0.005). Follow-up in structured cardiovascular risk programs allows estimating factors related to prediabetes reversion and emphasizing strategies to reduce comorbidities. Population-based studies are required to expand the results.

Introducción: La identificación de áreas de alto riesgo de tuberculosis pulmonar (TBP) permite dirigir las intervenciones en salud pública a los grupos más vulnerables y a los lugares donde hay mayor transmisión. Objetivo: Determinar la distribución espaciotemporal de personas con edad ≥15 años afectadas por TBP en Cali, Colombia y describir sus características epidemiológicas. Métodos: Estudio observacional y ecológico. Se incluyeron sujetos con TBP activa confirmada entre el 2010 y 2017. Los análisis de información geográfica se realizaron en ArcGIS Desktop; con el análisis de Densidad de Kernel se presentaron mapas de calor. Se utilizó la herramienta Gi* Getis-Ord para el análisis de puntos calientes. Además, se describen sus características epidemiológicas. Resultados: La TBP afectó a personas de todas las comunas de Cali, pero se identificaron conglomerados de alto riesgo que permanecieron en el tiempo en las zonas centro y centro-oriente de la ciudad, donde también se orientaron la mayoría de casos de pérdida en el seguimiento y mortalidad. La incidencia promedio fue de 40,2 casos/100.000 habitantes y el 72% logró el éxito terapéutico. Los más afectados fueron los masculinos (63,3%) y el grupo etario 19 a 69 años (76%). El 16,5 % de pacientes se perdió en el seguimiento, el 1,9% presentó fracaso en el tratamiento y el 5,2% falleció. Conclusión: Se identificaron dos áreas críticas de concentración de casos de TBP (centro y centro-oriente de Cali), caracterizadas por la vulnerabilidad social. También, se observó una baja tasa de éxito en el tratamiento respecto a la meta del 85%. Esto subraya la necesidad de desarrollar estrategias integrales en toda la ciudad, con prioridad en áreas críticas.

Introduction: Immunization is a protective measure against SARS-CoV-2. This study assessed IgG anti-S antibodies levels and their association with clinical, demographic and vaccination-related factors in adults from Cali, Colombia (2021-2022). Objective: To analyze factors associated with binding antibodies levels in adults with a complete SARS-CoV-2 vaccination schedule in a middle-income country city. Methods: A cross-sectional study was conducted between December 2021 and February 2022 in Cali, Colombia. Eligible adults were identified from a local health database and recruited through random sampling and media outreach. A total of 394 participants were included. Data on demographics, vaccination, and COVID-19 history were collected via interviews and verified with official records. IgG antibodies against the SARS-CoV-2 Spike protein were measured using a standardized ELISA, and results were expressed in BAU/mL following WHO calibration. A cut-off of 1,000 BAU/mL defined high antibody response. Statistical analyses were performed with GraphPad Prism and Stata 14, using logistic regression to explore associations. The study was approved by the Universidad Libre Ethics Committee, and informed consent was obtained from all participants. Results: Seventy percent of participants showed specific antibodies titers ≥1000 BAU/mL (binding antibodies units). Associations were observed with: a) mRNA vaccines (aOR: 2.40; 95% CI: 0.99–5.84; p = 0.053); b) heterologous vaccination schemes (aOR: 2.39; 95% CI: 1.14–5.02; p < 0.021); and c) ≥21 days since the booster dose (aOR: 2.62; 95% CI: 1.29–5.30; p < 0.007). Women showed a stronger response with heterologous schemes (aOR: 3.27; 95% CI: 0.99–5.84; p = 0.008) and mRNA vaccines (aOR: 3.03; 95% CI: 0.99–5.84; p = 0.048). Among men, antibodies levels were higher when measured ≥21 days after the booster dose (aOR: 2.62; 95% CI: 1.29–5.30; p < 0.007). Conclusions: mRNA vaccines, heterologous vaccination schedules, and a longer interval since the booster dose were associated with higher anti-S IgG antibodies levels. These findings, relevant to middle-income countries, support the adaptation of vaccination strategies to specific population characteristics.