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1. Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Author

Carlos J. Pérez Rivera, Nicolás Lozano-Suárez, Alejandro Velandia-Sánchez, Maria Paula Vargas-Cuellar, Luisa Fernanda Rojas-Serrano, Camilo A. Polanía-Sandoval, Daniela Lara-Espinosa, Laura García-Zambrano, Maria Paz Bohórquez-Tarazona, Silvia Valentina Agudelo-Mendoza, Paulo A. Cabrera-Rivera, Leonardo Briceno-Ayala, Camilo Andres Polania-Sandoval, María Paula Vargas-Cuéllar, Paulo Andrés Cabrera-Rivera, Danna Cruz-Reyes, Juan Guillermo Barrera Carvajal, Luis Felipe Cabrera-Vargas, Oscar Guevara, Laura Cristina Arce Polania, Laura Natalia Buendía Barrios, María Isabel Cristina Camargo Areyanes, Felipe Casas, Valeria Cormane Alfaro, Juan P. García-Méndez, Bayron Guerra, Sharon V. Idarraga-Ayala, Akram Kadamani Abiyomaa, Christopher Montoya, Manuel Santiago Mosquera Paz, María Alejandra Pineda, Juliana Pinzón-Luna, Isabella Roa Bastidas, Carlos Fernando Roman Ortega, Juan D. Saavedra Henao, Laura Carolina SanJuan-Arias, Vanessa Barreto, Julian Corso, Mariana Maksoud-Garcia, Eliana Pineda Mateus, Alejandra Vega Zabaraín, Fabien Mantilla-Sylvain, Nicolas Perez, Sergio Alzate-Ricaurte, Monica Bejarano, Isabella Caicedo Holguin, Alberto Federico García, Stefania Rodriguez Sanchez, Felipe Bernal Santos, Carlos Luna Jaspe, Maria Camila Luna-Jaspe Roa, Maria Paula OLIVERA Bolívar, MariaFernanda Valdivieso Diaz, Yuli Agudelo, Maria Paula Castillo-Aristizábal, Juan Pablo Hoyos Burgos, Maria Clara Maria Clara Mendoza Arango, Gabriel Arroyave, Felipe Buitrago Preciado, Lina María Cardona González, Juan Camilo Correa-Cote, Karen Lorena Franco Arias, Juan Felipe Llano Sierra, Gustavo López, Cesar Mancero, Sebastian Parra, Beatriz Ramirez Gonzalez, Daniela Sierra, Maria Camila Amaya Muñoz, Ashley Blanco-Ramírez, Paul Anthony Camacho, Jorge Campillo, Andrea Ximena Carvajal Mejia, María Alejandra González Yamil, Juan Carlos Osorno Villegas, Eduardo Rubio, Santiago Sánchez Herrera, Sebastian Sanchez Herrera, Tatiana Agudelo, Valentina Andrade, Laura Arango Pérez, Anibal Ariza-Gutiérrez, Jacobo Berrio, Natalia Cantillo Torres, Maria Valeria Chamorro-Rodríguez, Lucia Conde, Oscar Hernando Feo Lee, María Camila González Nieto, Laura Cecilia Ibañez-Pintor, Catalina Ochoa, Juan Ospina, Juan José Pérez-Ocampo, Esteban Portilla Rojas, Daniela Saaibi Rey, Eduardo Serrano, Sharon Michelle Solorza Velásquez, Angélica María Toro Cubides, Raúl Aguiar, Diego Armando Beltrán Rincón, Juan Sebastian Figueroa, Rafael Figueroa-Casanova, Maria Fernanda Gonzalez Mosos, Marcia Gabriela Gómez, Susana Osorno, Laura Laura Palacio, Jose Venegas, Liliana Marcela Caicedo Ramírez, Diana Catalina Cardona Gomez, Daniel Alejandro Fernandez Bolaños, Adriana Fernández-Diago, Victor David Olave Montaño, César Pastás, Silvia Marcela Amorocho, Jorge Barbosa-Santibañez, Vladimir Baron, Alejandra Cartagena-Alvarado, Maria Castillo, Maria Carolina Castillo-Florez, Omar David Dimian Mayorga, Elena Leonor Delgado-Nieto, Ernesto Fajardo, Omar Leonardo Gomez Polania, Tania Gonzalez, Daniel Felipe Guzman Mesa, Andres Isaza-Restrepo, Jaime A. Leal, Camilo Medina, Jorge Navarro-Alean, Maria Antonia Ocampo, Guillermo Oliveros, Maria Ortiz, Jorge I. Ortiz-Mahecha, Katherine Parra Abaunza, Felipe Antonio Pulido Reyes, Natalia Rivera-Rincón, Carlos Alfonso Rodriguez Pinedo, Lizeth Rodriguez Sanchez, Juan Javier Romero, Juan Carlos Sabogal Olarte, Javier Mauricio Salgado Tovar, Guillermo Andrés Torres, Linda Vallejo, Felipe Vargas-Barato, Ana María Vargas Patiño, Juan Pablo Villate León, Miguel Angel Montañez Aldana, Chiara Norato, Hugo Rojas Borda, Miguel Á Romero Núñez, Alejandro Sánchez, Jose Támara López, Jose Támara P, Wilmer Fernando Botache Capera, Rolando Medina Rojas, Juan Torres, Gina Catalina Trujillo, Gabriela Estefanía Cubillos Saavedra, Francisco García-Laverde, Jussef Camilo Naffah Enciso, Julian Arango Betancur, Adriana Cortés-Coronado, Susana Sepúlveda Tamayo, Valentina Arboleda Cardenas, Luis Guillermo García-Barrero, Jhonatan Enrique Garzón-Galindo, Lina Fernanda Torres Parada, Alejandro Arias Quintero, David Cano, Kevin Fernando Montoya Quintero, Santiago Nieto Muñoz, Paula Saza Mejía, Jesus David Gomez Barrios, María Angélica Jimeno, Ghandi Ignacio Restrepo Hernandez, Adrian Rodríguez-Sequea, Juan Carlos Varón Cotes, Hanner Enrique Acevedo Reyes, Claudia Marcela Barandica Bolaño, Maria Camila Sierra-Cote, Laura Daniela Angarita Vargas, Alix Yurany Báez Ramírez, Jose Armando Rodriguez Suarez, David Leonardo Sánchez, Silvia Natalia Sandoval Rangel, Edwin Ulloa Hurtado, Olga Esther Hernández Almanza, Rosalba Inmaculada Martínez Zubiria, Angel Alexis Muegues Salas, Diego Alexander Becerra Cardona, Fabio Hernán Cárdenas Santamaría, Juan Daniel Echeverri Castaño, Juan Sebastián Echeverri Uribe, María Helena Gaitán Buitrago, Luis Felipe Galvis Valencia, Andrea Henao Sabogal, David Felipe López Atehortúa, Juan Manuel Molina Uribe, Edwin Enrique Peñate Suárez, Heiller Torres Valencia, Marcela Velásquez Salazar, Catalina Correa, Hans García, Juan Hernández Leal, Paula Tatiana Muñoz Vargas, Dínimo José Bolívar Sáenz, Camilo Andrés Caicedo Medina, Camilo Andres Garcia Riaño, Stephanye Carrillo Gonzalez, Jaime Lorduy Gómez, Carlos Torres Madrid, Walter Torres Villa, Juan Sebastian Luengas Orozco, Camilo Avendaño Capriles, Carolina Diaz Blanco, Maria Lucía Brieva Hoyos, Paola Andrea Cantillo Moreno, Sofía Carolina Granados Mendoza, José Dario Vizcaino Lara, Karla Lizeth Babativa Peñuela, Paula Andrea Jiménez Bahamón, Jhonier Estiven Maldonado Rico, Duvan Ernesto Martínez Cortes, José Alfredo Orjuela Aragón, Lizeth Daniela Castro Roa, Julieth Sarmiento Gallego, Marta Maria Herazo Meza, Anlly Caterin Hernández Castillo, Rosa Gabriela Rojas Moncada, Lucia Fernanda Casanova Bermeo, Oscar Fernando Cortés Otero, Nicolás Diaz Pinilla, Harrison Rene Herrera Delgado, Simon Alberto Macías Segura, David Ramiro Muñoz Castrillón, Luis Ramiro Nuñez Romero, Cesar Andrés Polania Andrade, Hector Alejandro Valdez Toro, Ana María Cardozo Parrado, Jose Gonzalo Moros, Paula Andrea Nieto, Jorge Mario Patarroyo, Jose Luis Perilla Martínez, María del Pilar Torres Gutierrez, Erika Johana Benito Flórez, Mariana Vergel Gómez, Diana Ximena Robayo Rodriguez, Diego Fernando Salcedo Miranda, Maria Alejandra Triviño Cortés, William Baquero Sastre, Juan Sebastian Bonett, Eliana Cortes, Pedro Fernando Duque, Carlos Enrique Gutierrez, Piedad Echeverry, Andrés Felipe Motta Amar, Lorena Torres, Jeremias Carvajal Bautista, David Mauricio Figueroa Bohórquez, Manuel Latorre Quintana, Diego Fernando Olivera Briñez, Marcel Leonardo Quintero Contreras, Raúl Vera Gamboa, Mariana Arias Zapata, Cristhian Daniel Benavides Caipe, Luisa Fernanda Betancur Acevedo, Valentina Botero Zuluaga, Vanessa Figueroa-Espinoza, Arbey Leandro Londoño-Patiño, Santiago Moncayo-Gonzalez, Laura Sofia Puerta Suárez, Paula Camila Vargas-Arboleda, Lisbet Sofia Gonzalez Cera, Katerine Henao Toro, Leobardo de Jesus Ortiz Pino, Sergio Andrés Vasquez Vargas, Lency Naranjo Zuluaga, Jaime Chamorro Garzón, Adriana Paola Franco Rodriguez, Nataly Johana Acosta Alape, Andrés Felipe Arbelaez Mariño, Juan José Mora Herrera, Javier Felipe Ayala Muñoz, Yeiny Carina Camacho Pinzon, José Francisco Cárdenas Chacón, Liliana Andrea Peña Arenas, Gustavo Adolfo Rodriguez Camargo, Carlos Alberto Sánchez Arango, Daniel Mauricio Bolaños Ñañez, Diana Sofía Garcés-Palacios, María Alejandra Ñañez Pantoja, Omar Alejandro Ortega-Valencia, María Paula Gamboa Bernal, Juan David Lotero Gómez, Juan Sebastián Martínez-Gutiérrez, Daniel Morales-Gómez, Lina Pardo-Jiménez, Leon Miguel Fonseca Galindo, Angélica Maria Garcia Ramirez, Juan David Saurith Ramirez, Ivan Ricardo Barrero Montoya, Santiago Cadena Espitia, Salomé Pallares Rojas, Laura Camila Zapata Berrio, Diana Andrea Benavides Rodríguez, Juan Carlos Gonzalez, Sharon Valentina Idarraga, Óscar Eduardo Márquez Rodríguez, Ivi Yohana Marrugo Prieto, Laura Vanessa Soledad Machado, Rubén Luna, Nicolás Navarro Pulido, Federico Javier Nuñez Ricardo, Andrea Elena García López, Fernando Girón Luque, Nasly Patiño Jaramillo, Néstor Fabian Pedraza Alonso, Javier Yecid Acuña Acuña Rivera JY, Oscar Alexander Guevara Cruz, Juan Sebastián Martínez Buitrago, Nathalia Montoya Oviedo, Marcia Roxana Santafe Guerrero, Juanita Carolina Chaves Cortés, Francisco Mauricio Rincón Tello, Diana Fernanda Bejarano Ramirez, Nicolas Andres Cortes Mejia, Camilo Ernesto Garzon Mesa, Alejandra Moncada Pabon, Diego Rymel Triviño Alvarez, Alonso Vera Torres, Maria Alejandra Cote Martinez, Juan Manuel Machado Rodriguez, Gonzalo Nuñez Martinez, Laura Naranjo Osuna, Andres Felipe Roldan Garay, Daniel Amado, Jaime Camacho-Mackenzie, Maria Ceballos Mora, Sara Cifuentes-Navarrete, Andrea Donoso-Samper, Manuel A. Ferro, Juan C. Gómez-Cáceres, Sebastián Gómez-Galán, Ana G. Leiva, Juan Lisarazo, Maria G. López-Castaño, Sofía Martínez-Gil, M.J. Montoya, Santiago Niño-Basto, Sergio Andrés Ortigoza-Espitia, Gustavo Páez, Jesús William Ramos-Anaya, María J. Rozo, Juan P. Umana, Andres Motta Amar, Andrés Felipe Barrera Vargas, Javier Dario Maldonado Escalante, German Ricardo Molina Marroquin, and Silvia Alejandra Prada Lievano

Subjects
Global health, Public health, Surgery, Health policy, Hospital mortality, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Published
2024
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2. Colombian ocular inflammatory diseases epidemiology study (COIDES): prevalence, incidence and sociodemographic characterisation of Scleritis in Colombia, 2015–2020

Author

William Rojas-Carabali, Alejandra de-la-Torre, Carlos Cifuentes-González, Germán Mejia-Salgado, Juan Sebastián Pineda-Sierra, Paula Tatiana Muñoz-Vargas, Laura Boada-Robayo, and Danna Lesley Cruz

Subjects
Ophthalmology, RE1-994
Abstract

Objective To describe the epidemiological and demographic characteristics of scleritis in Colombia.Methods and analysis Population-based study using the national database from the Colombian Ministry of Health, using the International Classification of Diseases-10 code for Scleritis (H150) to estimate the prevalence and incidence from 2015 to 2019. Additionally, we evaluated the impact of the COVID-19 pandemic lockdown on the epidemiology of the disease during 2020, using the Gaussian Random Markov Field model (conditional autoregressive; CAR model). Finally, a standardised morbidity rate map was made to assess the geographic distribution of scleritis in the country.Results The 5-year average prevalence and incidence of scleritis in Colombia were 0.6 (95% CI 0.59 to 0.6) and 0.65 (95% CI 0.64 to 0.64) cases per 100 000 inhabitants, respectively. We found 1429 registers of scleritis throughout the country between 2015 and 2019. Women represented 64.3%. The age groups with most cases were between 40 and 69 years in both sexes. However, women between 30 and 39 years and men between 20 and 29 years presented the highest number of new cases. In 2020, the pandemic reduced approximately 0.23 points the incidence of scleritis. Bogotá, Valle del Cauca and Antioquia had most of the cases, the latter two with an increased risk over time.Conclusion Colombia has a lower incidence of scleritis than the reported in other latitudes, with a pattern of presentation at younger ages. Furthermore, the lockdown derived from the CODIV-19 pandemic affected the follow-up and diagnosis of patients with scleritis. This is the first epidemiological description of scleritis in a developing country and South America.

Published
2022
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4. Necrotizing Anterior Scleritis in a Woman with Terrien’s Marginal Degeneration: A Case Report

Author

Juliana Reyes-Guanes, William Rojas-Carabali, Miguel Cuevas, Alejandra De-la-Torre, Paula Tatiana Muñoz-Vargas, and MARIA ALEJANDRA FONSECA MORA

Subjects
Ophthalmology
Abstract

Purpose: The aim of the study was to report the first case of a patient with Terrien’s Marginal Degeneration (TMD) who developed necrotizing anterior scleritis without systemic disease association, requiring systemic immunosuppressive treatment. Case Report: A 32-year-old female consulted for bilateral ocular burning and hyperemia. Initially, she was diagnosed with conjunctivitis and treated with topical antibiotics and corticosteroids, with mild transitory improvement but the progression of the disease. Years later, she attended the ocular immunology consultation for a second opinion where TMD with ocular inflammatory component OU was diagnosed. Seven months later, she presented with severe pain, decreased visual acuity, and photophobia in OS. At the slit-lamp examination, necrotizing anterior scleritis with a high risk of perforation in OS was observed. The patient was referred to the rheumatologist and started treatment with systemic corticosteroids and cyclophosphamide, exhibiting a clinical improvement. The patient did not meet the criteria for any systemic illness associated with scleritis, such as autoimmune diseases or vasculitis. Thus, scleritis was related to the adjacent inflammatory process associated with TMD, as an atypical presentation of this disease. Conclusion: Although an inflammatory type of TMD has been proposed, it is essential to follow up closely these patients and consider necrotizing anterior scleritis, a severe ocular disease that requires prompt immunosuppressive management, as a possible atypical associated presentation of this disease.

Published
2021

5. Ocular Manifestations Related to Antibodies Positivity and Inflammatory Biomarkers in a Rheumatological Cohort

Author

Carlos Cifuentes-González, Pilar Uribe-Reina, Juliana Reyes-Guanes, Juliana Muñoz-Ortiz, Paula Tatiana Muñoz-Vargas, William Rojas-Carabali, Dora Victoria Nova-Florián, Ana Sofía De-Los-Ríos, Rubén Dario Mantilla-Hernández, and Alejandra de-la-Torre

Subjects
Ophthalmology, Clinical Ophthalmology
Abstract

Carlos Cifuentes-González,1 Pilar Uribe-Reina,1 Juliana Reyes-Guanes,1 Juliana Muñoz-Ortiz,1 Paula Tatiana Muñoz-Vargas,1 William Rojas-Carabali,1 Dora Victoria Nova-Florián,1 Ana Sofía De-Los-Ríos,1 Rubén Dario Mantilla-Hernández,2 Alejandra de-la-Torre1 1Neuroscience Research Group (NEUROS), Neurovitae Center, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; 2Fundación Para la Investigación En Dermatología y Reumatología (FUNINDERMA), Bogotá, ColombiaCorrespondence: Alejandra de-la-Torre, Neuroscience Research Group (NEUROS), Neurovitae Center, School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia, Tel +2970200 ext. 3320, Email alejadelatorre@yahoo.comPurpose: Ocular involvement is frequent in autoimmune diseases and even can be the first manifestation. There are multiple descriptions in the literature around the world regarding this topic. However, we evidenced a lack of studies analyzing the relationship between the ocular manifestations and systemic biomarkers, especially in Latinamerica. Therefore, this study aimed to examine the relationship between the positivity of inflammatory biomarkers and the ocular manifestations in a Colombian cohort of rheumatological patients.Patients and Methods: We conducted an observational, descriptive, non-comparative cross-sectional study in a rheumatology center, in Bogotá, Colombia, from 2013 to 2019. We calculated a sample size of 797 patients to assess the prevalence of ocular manifestations and inflammatory biomarkers. We performed univariate analyses for categorical and continuous variables and bivariate analyses using the Chi-square and Fisher’s exact test for categorical variables.Results: Women represented 84% of the population, and the mean age was 54.61± 15.64 years. Of 797 patients, 21.45% reported one or more ophthalmological diagnoses, being keratoconjunctivitis sicca (KCS) the most common (15.93%), followed by uveitis, and cataract (1.38%, each one). Regarding ophthalmological symptoms, 35% presented at least one, being dry eye sensation (DE) the most common (30.86%), followed by ocular pain (2.76%), red eye, and decreased visual acuity (2.63%, each one). The antibodies or inflammatory biomarkers most frequently found were antinuclear antibodies (ANAs) (35.3%), C-reactive protein (28.7%), and rheumatoid factor (27.9%). We found statistical associations between consumption of complement 3, anti-CCP, anti-RO, and anti-LA antibodies with ocular manifestations such as photophobia, DE, conjunctivitis, KCS, uveitis, retinal vasculitis, and maculopathy.Conclusion: Ocular manifestations are frequently found in patients with positive antibodies and inflammatory biomarkers. Our results suggest antibodies and inflammatory molecules could be biomarkers for ocular manifestations in patients with rheumatological diseases. This study provides the basis for future longitudinal studies.Keywords: antibodies, inflammatory biomarker, rheumatological disease, ocular manifestations, ophthalmology, autoimmune diseases

Published
2022

6. Colombian ocular inflammatory diseases epidemiology study (COIDES): prevalence, incidence and sociodemographic characterisation of Scleritis in Colombia, 2015–2020

Author

Carlos Cifuentes-González, William Rojas-Carabali, Germán Mejia-Salgado, Juan Sebastián Pineda-Sierra, Paula Tatiana Muñoz-Vargas, Laura Boada-Robayo, Danna Lesley Cruz, and Alejandra de-la-Torre

Subjects
Ophthalmology
Abstract

ObjectiveTo describe the epidemiological and demographic characteristics of scleritis in Colombia.Methods and AnalysisPopulation-based study using the national database from the Colombian Ministry of Health, using the ICD-10 code for Scleritis (H150) to estimate the prevalence and incidence from 2015 to 2019. Additionally, we evaluated the impact of the COVID-19 pandemic lockdown on the epidemiology of the disease during 2020, using the Gaussian Random Markov Field model (CAR model). Finally, a standardized morbidity rate map was made to assess the geographic distribution of scleritis in the country.ResultsThe five-year average incidence and prevalence of scleritis in Colombia were 0.6 (95% CI 0.59-0.6) and 0.65 (95% CI 0.64-0.64) cases per 100,000 inhabitants, respectively. We found 1,429 registers of scleritis throughout the country between 2015 and 2019. Women represented 64.3%. The age groups with most cases were between 40 and 69 years in both sexes. However, women between 30-39 years and men between 20-29 years presented the highest number of new cases. In 2020, the pandemic reduced approximately 0.23 points the incidence of scleritis. Bogotá, Valle del Cauca, and Antioquia had most of the cases, the latter two with an increased risk over time.ConclusionColombia has a lower incidence of scleritis than the reported in other latitudes, with a pattern of presentation at younger ages. Furthermore, the lockdown derived from the CODIV-19 pandemic affected the follow-up and diagnosis of patients with scleritis. This is the first epidemiological description of scleritis in a developing country and South America.Key messagesWhat is already known about this subject?Scleritis epidemiology has been described in developed countries. Its prevalence has been calculated between 1.7 and 93.62 cases per 100,000 inhabitants, and its incidence between 1.0 and 5.54 cases per 100,000 inhabitants per year.What are the new findings?This study describes the epidemiological characteristics of scleritis in a developing country in South America for the first time, finding that the incidence and prevalence of scleritis in Colombia are 0.6 (95% CI: 0.59-0.6) and 0.65 (95% CI: 0.64-0.64) cases per 100,000 inhabitants, respectively. With a high number of new cases in the young population. Also, the pandemic’s negative impact on the diagnosis and follow-up of patients with scleritis was evidenced.How might these results change the focus of research or clinical practice?This article will promote the generation of new research questions in a population that did not have previous studies on this topic. Also, the data highlight that younger people present more new cases and may need more attention from ophthalmologists. This might be due to a lower incidence of scleritis in the elderly population with autoimmune diseases owing to the treatment with immunomodulatory medications.

Published
2022

7. Clinical characterization of patients with HLA-B27-associated uveitis and evaluation of the impact of systemic treatment on the recurrence rate: a cross-sectional study

Author

Juan Sebastián Pineda-Sierra, Carlos Cifuentes-González, William Rojas-Carabali, Paula Tatiana Muñoz-Vargas, Alejandro Henao-Posada, and Alejandra de-la-Torre

Subjects
Biologic therapy, Complications, HLA-B27-associated uveitis, Ocular inflammation, Recurrences, Ophthalmology, RE1-994
Abstract

Abstract Introduction Despite HLA-B27-associated uveitis is one of the most frequent etiologies of uveitis worldwide, there are scarce studies on the clinical spectrum of this disease and the implications of therapeutic strategies used in the Latin-American population, with none conducted in Colombia. Thus, this study aimed to describe the clinical characteristics of a cohort of patients with positive HLA-B27-associated uveitis in Colombia and evaluate the impact of systemic treatment on the recurrence rate. Methods We retrospectively reviewed 490 clinical charts of patients with uveitis, searching for those with positive HLA-B27-associated uveitis over eight years in a referral center in Bogotá, Colombia. We used descriptive statistics to summarize demographic and clinical characteristics and conducted a Chi-square test, Fisher Exact test, Spearman correlation, and Mann–Whitney test to assess associations between treatment strategies and the recurrences rate. Results We analyzed 39 patients (59% females) with positive HLA-B27-associated uveitis, with a median age at the first consultation of 44.5 years (Range: 2–80) and a mean follow-up time of 86.4 weeks (1.65 years). Most patients had unilateral uveitis (53.8%) and an anterior anatomical diagnosis (76.6%); two had anterior chamber fibrinous reaction, and only one had hypopyon. Most patients did not show associated systemic symptoms (66.7%). Topical corticosteroids, NSAIDs, methotrexate, mydriatics, and adalimumab were the most used treatments. The most common complications included cataracts, posterior synechiae, and macular edema. We identified that the rate of recurrences decreases over time (r = -0.6361, P = 0.002571), and this decrease seems to be associated with the initiation of disease-modifying antirheumatic drugs (DMARDs) in chronic and recurrent cases. Conclusion The clinical spectrum of HLA-B27-associated uveitis in Colombian patients is distinct from other latitudes. Notably, we found a female predominance, older age at presentation, higher frequency of bilateral and vitreous involvement, and lower frequency of concomitant systemic diseases. Additionally, our results suggest that DMARDs such as methotrexate and biologic agents are good therapeutic options to avoid recurrences in chronic and recurrent cases.

Published
2023
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8. Quantitative changes in the corneal endothelium and central corneal thickness during anterior chamber inflammation: A systematic review and meta-analysis.

Author

Germán Mejía-Salgado, Paula Tatiana Muñoz-Vargas, Carlos Cifuentes-González, Gabriela Flórez-Esparza, Rebeca Paquentín-Jiménez, Miguel Ángel Castro-Monreal, Naomi Medina-Galindo, Gilma Norella Hernández-Herrera, Luz Elena Concha-Del-Río, and Alejandra de-la-Torre

Subjects
Medicine, Science
Abstract

PurposeTo establish the effects of anterior chamber inflammation (ACI) on the corneal endothelium parameters and central corneal thickness (CCT).MethodsWe conducted a comprehensive literature review using medical databases (PubMed, EMBASE, VHL, and medRxiv) on March 8, 2023, for studies that included patients with ACI who had undergone specular microscopy or pachymetry. Case series with >10 patients, cross-sectional, case-control, and cohort studies were included. The risk of bias was assessed using CLARITY tools and validated scales such as those by Hassan Murad et al. and Hoy et al. A narrative synthesis and a quantitative standardized mean difference meta-analysis, I2 heterogeneity assessment, and publication bias tests were conducted. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethical committee (DVO005 2277- CV1712).ResultsThirty-four studies, encompassing 1,388 eyes with ACI, were included. Compared with healthy controls, overall, ACI eyes show significant mean differences in endothelial parameters (endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX)) (P < 0.05). In the subgroup analysis compared with healthy controls, both active and chronic-recurrent ACI demonstrated a reduced ECD. An increased CV was observed in active, inactive, and chronic-recurrent ACI. Lower HEX was evident in inactive, acute, and chronic-recurrent ACI, while both active and acute ACI exhibited high CCT.ConclusionACI leads to significant alterations in endothelial parameters and CCT. The primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Further studies are needed to explore the impact of ACI etiology on the endothelium, potential biases in IOP measurements during acute ACI episodes, and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI.

Published
2024
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