Instituto Nacional de Salud

Colombia has implemented a tiered tax on sugar-sweetened beverages (SSBs), reaching 20% for high-sugar products by 2025. To inform evaluations of this policy, we estimated taxed and untaxed beverage intake prior to implementation and examined differences across sociodemographic groups. We analyzed 24 h dietary recall data from the 2015 National Survey of the Nutritional Situation of Colombia (ENSIN; n = 11,877 adults aged 18-64), which uses a stratified, multistage cluster sampling design covering all regions of the country. Beverages were categorized by 2025 tax thresholds: untaxed (<5 g added sugar/100 mL), taxed (≥5 g), and high-sugar taxed (≥9 g). Intake (mL, kcal) was estimated per capita and per consumer using survey-weighted two-part models, adjusting for sociodemographic characteristics. Eighty-four percent of adults consumed taxed beverages, with per capita intake of 209 kcal (95% CI: 203-216) and 481 mL (95% CI: 464-497). Sixty-three percent consumed high-sugar taxed beverages, with intake of 134 kcal (95% CI: 130-139) and 292 mL (95% CI: 282-303) per capita. Untaxed beverages accounted for 109 kcal (95% CI: 106-112) and 837 mL (95% CI: 793-882) per capita. Across categories, the highest per capita kcal intakes were from untaxed dairy/milk substitutes (67 kcal, 95% CI: 64-69), any taxed fruit/vegetable juices (61 kcal, 95% CI: 55-66), and any taxed sodas/carbonated beverages (47 kcal, 95% CI: 44-50). Males consumed more taxed beverages of any type (255 kcal, 95% CI: 247-264) than females (174 kcal, 95% CI: 165-182). Prior to its SSB tax, Colombians had a high consumption of SSBs that would be subject to the tax. Future research should assess how consumption changed in response to the tax.

Introducción: La infección por VIH sigue siendo un desafío mundial con 39 millones de personas afectadas. En América Latina y Bolivia persisten altas tasas de diagnóstico tardío, baja adherencia terapéutica y escasez de información clínica sistematizada. Objetivo: Describir y analizar el perfil inmunológico y epidemiológico de nuevos casos de VIH en el Instituto Nacional de Laboratorios de Salud (INLASA) de La Paz, 2016–2020. Materiales y métodos: Estudio observacional retrospectivo analítico con 1.149 pacientes con diagnóstico confirmado en base al algoritmo de diagnóstico vigente. Se analizaron variables sociodemográficas, inmunológicas (CD4, CD8, índice CD4/CD8) y virológicas (carga viral), aplicando estadísticas descriptivas y bivariadas con p&lt;0,05. Resultados: La media de edad fue 32,16 años, 51,7% entre 15–29 años y 66,6% varones. La transmisión sexual representó 97,3% de los casos, predominando la vía heterosexual (70,9%). El 39,3% presentó CD4&lt;200 células/mL, 48% entre 200–499 y 10,6% ≥500. El 95,7% tuvo carga viral detectable. Hubo asociación significativa entre sexo y estado civil (χ²=91,5; p&lt;0,001) y entre sexo y categoría de CD4 (χ²=11,8; p=0,003). Los hombres tuvieron mayor proporción de CD4&lt;200 (45% vs. 30% en mujeres) y menor mediana de CD4 (198 vs. 279 células/mL; p&lt;0,001). No hubo diferencias significativas en carga viral por sexo (p=0,37). El índice CD4/CD8 estuvo invertido en la mayoría. Conclusiones: La mayoría de los pacientes fueron diagnosticados en fases avanzadas, especialmente varones jóvenes, lo que exige fortalecer el diagnóstico precoz focalizado y estrategias preventivas para alcanzar las metas 95-95-95 de ONUSIDA.

This study aims to evaluate nationwide diagnostic and treatment capacity for IFD across Colombia's diverse healthcare system. Between March and September 2024, a cross-sectional survey assessed institutional profiles, diagnostic access (microscopy, culture, antigen, polymerase chain reaction [PCR] testing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry [MALDI-TOF MS]), antifungal availability, and therapeutic drug monitoring (TDM) practices. Responses were collected from 133 institutions (113 hospitals, 20 research centers) across 26/33 departments. Among 179 complete responses (94 microbiologists, 85 physicians) Candida spp. (39%), Cryptococcus spp. (20%), Aspergillus spp. (18%), and Histoplasma spp. (14%), were the pathogens considered to be more worrisome. Conventional diagnostics showed broad availability (microscopy: 94%, culture: 74%), while advanced tools were limited (e.g. 12%). Antigen testing access varied by pathogen (Cryptococcus spp.: 54%, Aspergillus spp.: 52%, Histoplasma spp.: 44%), with metropolitan-rural disparities (P≤0.001). Antifungal susceptibility testing was available only in 56% of the surveyed institutions. Antifungal access revealed inequities: liposomal amphotericin B (68%), echinocandins (76%), and triazoles (97%) mainly accessible in metropolitan centers. HSCT/solid organ transplant (SOT) recipients had superior access to antifungals. TDM access was limited (voriconazole/itraconazole: 32%). Conventional mycological methods remain the cornerstone of fungal diagnosis in Colombia. Significant disparities in IFD management capacity persist, with metropolitan centers and transplant recipients disproportionately benefiting from advanced resources. Although Colombia has established clinical guidelines incorporating World Health Organization (WHO)-recommended diagnostics and treatments, urgent nationwide implementation efforts are required to translate these recommendations into routine clinical practice and address persistent geographic and socioeconomic inequities in patient care.

Urethral reconstruction remains a complex challenge in contemporary urology, particularly in patients with long-segment defects, recurrent strictures, or significant systemic comorbidities. Conventional techniques such as buccal mucosa graft urethroplasty provide reliable functional outcomes but are limited by donor-site morbidity and variable long-term durability. Advances in tissue engineering have introduced regenerative strategies aimed at restoring urethral structure while preserving physiological function, sexual health, and reproductive potential. This review synthesizes current experimental and clinical evidence on tissue-engineered urethral reconstruction, integrating a clinical urology perspective with considerations relevant to internal medicine. A structured narrative analysis of peer-reviewed studies was performed, focusing on scaffold design, cellularization strategies, functional urinary outcomes, complication profiles, reintervention burden, and patient-centered sexual and reproductive outcomes. The available evidence indicates that tissue-engineered urethral constructs are clinically feasible and capable of achieving sustained urethral patency in selected patients. Cell-seeded tubular scaffolds demonstrate favorable durability in carefully selected cohorts, while tissue-engineered buccal mucosa grafts reduce donor-site morbidity but show greater variability in long-term outcomes. Across all reconstructive strategies, reintervention rates increase with extended follow-up, reflecting the chronic nature of urethral stricture disease. Sexual and reproductive function is generally preserved, with trends favoring regenerative approaches, although these outcomes remain inconsistently reported. Overall, tissue-engineered urethral reconstruction represents a promising complementary strategy to conventional techniques, with its optimal application dependent on construct design, patient selection, and systemic health factors. Continued refinement and standardized outcome reporting are essential to support broader clinical adoption.

ABSTRACT Background Timely access to screening, diagnosis, and treatment services is essential to prevent complications among people with diabetes. We evaluated trends and factors associated with self-reported diabetes screening, diagnosis, and treatment among Peruvian adults aged 18 years and older from 2014 to 2024. Methods We analyzed data from the Health Questionnaire of the Demographic and Family Health Survey (ENDES). We used information on diabetes screening, diagnosis, and treatment, along with socio-demographic and clinical covariates. We fitted generalized linear models of the Poisson family with log link and robust variance, and performed Joinpoint regression to assess temporal trends. Results The prevalence of screening increased from 24% to 31% (APC: 1%; p=0.483). Higher screening was associated with being female, having higher educational attainment, not being single, belonging to higher wealth quintiles, being insured, and having hypertension. In contrast, smoking and living in rural areas or the Highlands were associated with lower screening. The prevalence of diagnosis increased from 3% to 5% (APC: 7%; p&lt;0.001). Higher diagnosis was associated with being female, not being single, higher wealth, being insured, and living in the Rainforest, while lower diagnosis was associated with higher education and living in rural areas or the Highlands. Among individuals with diabetes, treatment prevalence increased from 65% to 74% between 2014 and 2019 (APC: 2%; p=0.014), but decreased to 63% in 2024 (APC: −2%; p&lt;0.001). Higher treatment was associated with being married/widowed/divorced, being insured, higher wealth, and having hypertension. Lower treatment was associated with higher education and living in the Highlands. Conclusions Although the prevalences of diabetes screening and diagnosis have increased over the past 11 years, treatment has declined in the last five. Socio-demographic and clinical inequalities persist across all three indicators and should be considered in the planning of diabetes health services in Peru.

The Province of Lima, with over 10 million inhabitants, is the most populous in Peru and exhibits a significant disparity in solid waste production, a high percentage of which is recoverable (35% inorganic, 50% organic). Despite the advantages of waste valorization, its implementation faces considerable challenges. Given this diversity, this study aimed to group the districts according to similarities in their generation levels to provide a management tool. The methodology utilized official data (MINAM/INEI) from the 2014-2024 period. Through Hierarchical Clustering Analysis (HCA), validated with non-parametric tests, the districts were grouped, and the association with per capita income was evaluated using Spearman's correlation. The analysis defined three clusters for inorganic waste and two effective clusters for organic waste. A positive and significant correlation was found between waste generation and income, albeit moderate for inorganic (rho=0.49) and weak for organic waste (rho=0.31). A key finding is that districts with high organic waste generation are generally not the same as those with high inorganic waste generation. Socioeconomic and geographical patterns differ markedly between the two. The highest generation of inorganic waste is linked with high and upper-middle socioeconomic strata, concentrated in the central area of Lima. In contrast, the highest production of organic waste is linked to the middle stratum, with a dispersed geographical distribution and no significant socioeconomic differences among its groups. This disparity suggests that practices such as composting could influence the lower organic waste generation in higher strata. Finally, this segmentation provides a valuable empirical basis for designing and implementing focused and efficient waste management strategies.

Invasive non-typhoidal Salmonella disease is a leading cause of morbidity and mortality worldwide, primarily affecting children, the elderly, and immunocompromised adults, particularly those living with HIV. Salmonella meningitis is rare, except in sub-Saharan Africa. Salmonella arizonae is associated with reptiles and exceptionally causes meningitis in humans. We present the case of an adult man living with HIV who presented five episodes of bacterial meningitis due to S. arizonae within a period of 8 months. The patient improved after performing cholecystectomy and with optimization of antiretroviral treatment and prolonged antibiotic therapy. Genomic study confirmed that S. arizonae is sensitive to antibiotics. This case illustrates a rare form of S. arizonae meningitis. The identity of the etiological agent was confirmed by next-generation sequencing analysis.

Since 2016, Candida auris has been subject to mandatory reporting in Colombia due to its critical public health implications. In this context, a genomic characterization of clinical C. auris isolates collected between 2018 and 2024 through national surveillance led by the Instituto Nacional de Salud (INS) was conducted. Twenty-seven isolates from hospitalized patients across 14 departments were analyzed using next-generation sequencing (NGS) and bioinformatics tools (MycoSNP-nf v1.5, TheiaEuk BLAST, Python script, and MUSCLE, snp_phylogeny) to identify mutations associated with antifungal resistance. The patient group was predominantly male n = 18 (66.7%), with 48% (n = 13) for the older adult age group (>60 years of age). Antifungal susceptibility testing (anidulafungin, fluconazole, and amphotericin B) revealed that five isolates (18.5%) were resistant to a single antifungal, while 22 (81.5%) were resistant to two. All isolates belonged to clade IV (South America) and exhibited genetic divergence ranging from 5 to 127 single-nucleotide polymorphisms (SNPs). Mutations in the ERG11 gene were identified in 16 isolates, including Y132F (n = 11), G459S (n = 1), K143R (n = 2), and F444L (n = 1), along with a novel mutation, G445D (n = 1). Four of these 16 isolates also harbored mutations in the TAC1B gene (P595H, n = 3; S611P, n = 1), and one isolate carried a single TAC1B mutation (S195G). Additionally, three isolates presented the S639F mutation in the FKS1 gene. Notably, seven isolates showed phenotypic resistance without any known resistance mutations. These findings are concerning, as the antifungals involved are critical for treating invasive Candida infections. The study highlights the need for ongoing genomic surveillance to complement phenotypic testing and enhance strategies for antifungal resistance control, ultimately informing therapeutic decision-making and drug development.