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Ndege R, Rohacek M, Bani F, Ngome O, Okuma J, Sasamalo M, Mnzava D, Reither K, Vanobberghen F, Hella J, Paris DH, Weisser M. Diagnostic Yield of Urine Xpert MTB/RIF Ultra in Adults With Suspected Extrapulmonary Tuberculosis. Open Forum Infect Dis 2024; 11:ofae338. [PMID: 38957690 PMCID: PMC11218765 DOI: 10.1093/ofid/ofae338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024] Open
Abstract
We assessed the diagnostic yield of urine GeneXpert MTB/RIF Ultra and factors associated with a positive test among adult patients suspected to have extrapulmonary tuberculosis. Urine Ultra was positive in 14% of participants with definite or probable tuberculosis. Hospitalization, disseminated tuberculosis, and human immunodeficiency virus infection were associated with a positive result.
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Affiliation(s)
- Robert Ndege
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Internal Medicine Department, St Francis Regional Referral Hospital, Ifakara, Tanzania
| | - Martin Rohacek
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Internal Medicine Department, St Francis Regional Referral Hospital, Ifakara, Tanzania
| | - Farida Bani
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
- Internal Medicine Department, St Francis Regional Referral Hospital, Ifakara, Tanzania
| | - Omary Ngome
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
| | - James Okuma
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Mohamed Sasamalo
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Dorcas Mnzava
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Klaus Reither
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jerry Hella
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Daniel H Paris
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Maja Weisser
- Biomedical Research and Clinical Trials Department, Ifakara Health Institute, Ifakara, Tanzania
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Basel, Switzerland
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Möller K, Löwe A, Jenssen C, Chaubal N, Gottschall H, Misselwitz B, Kurapati MR, Puritipati AR, Dong Y, Faiss S, Dietrich CF. Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations. Diagnostics (Basel) 2024; 14:706. [PMID: 38611619 PMCID: PMC11011484 DOI: 10.3390/diagnostics14070706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
This review describes the appearance of extrapulmonary tuberculosis manifestations in comprehensive and multiparametric ultrasound imaging. The aim is to increase awareness of typical ultrasound findings regarding extrapulmonary tuberculosis, correlate those with pathological features, and facilitate differential diagnosis. Point of care ultrasound protocols can be used as a screening method in high-risk populations, although the negative findings do not exclude tuberculosis. Conversely, the diagnosis of extrapulmonary tuberculosis can never be made using ultrasound alone, as many ultrasound findings in extrapulmonary tuberculosis are non-specific. However, ultrasound-based sampling techniques can significantly facilitate the collection of samples for microbiological or molecular proof of tuberculosis, as well as facilitating the establishment of alternative diagnoses.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany; (K.M.); (H.G.); (S.F.)
| | - Axel Löwe
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland;
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany; (C.J.); (A.R.P.)
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Nitin Chaubal
- Thane Ultrasound Center, Thane 400601, India;
- Jaslok Hospital & Research Centre, Mumbai 400026, India
| | - Heike Gottschall
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany; (K.M.); (H.G.); (S.F.)
| | | | - Meghana Reddy Kurapati
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany; (C.J.); (A.R.P.)
| | - Anoop Reddy Puritipati
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany; (C.J.); (A.R.P.)
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany; (K.M.); (H.G.); (S.F.)
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland;
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Ndege R, Ngome O, Vanobberghen F, Bani F, Temba Y, Wilson H, Hella J, Gingo W, Sasamalo M, Mnzava D, Kimera N, Hiza H, Wigayi J, Mapesi H, Kato IB, Mhimbira F, Reither K, Battegay M, Paris DH, Weisser M, Rohacek M. Ultrasononography in Managing Extrapulmonary Tuberculosis: A Randomized, Controlled, Parallel, Superiority, Open-Label Trial. Clin Infect Dis 2023; 76:1013-1021. [PMID: 36331957 PMCID: PMC10029990 DOI: 10.1093/cid/ciac871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with suspected extrapulmonary tuberculosis are often treated empirically. We hypothesized that extended focused assessment with sonography for human immunodeficiency virus (HIV) and tuberculosis (eFASH), in combination with other tests, would increase the proportion of correctly managed patients with suspected extrapulmonary tuberculosis. METHODS This trial in adults with suspected extrapulmonary tuberculosis was performed in a rural and an urban hospital in Tanzania. Participants were randomized 1:1 to intervention or routine care, stratified by site and HIV status. All participants underwent clinical evaluation, chest radiography, and testing with sputum Xpert MTB/RIF and urine Xpert MTB/RIF Ultra assays. The intervention was a management algorithm based on results of eFASH plus microbiology, adenosine deaminase (ADA), and chest radiography. The primary outcome was the proportion of correctly managed patients. The presence of positive microbiological or ADA results defined definite tuberculosis. An independent end-point review committee determined diagnoses of probable or no tuberculosis. We evaluated outcomes using logistic regression models, adjusted for randomization stratification factors. RESULTS From September 2018 to October 2020, a total of 1036 patients were screened and 701 were randomized (350 to the intervention and 351 to the control group). Of participants in the intervention group, 251 (72%) had a positive eFASH outcome. In 258 (74%) of the intervention and 227 (65%) of the control participants antituberculosis was initiated treatment at baseline. More intervention participants had definite tuberculosis (n = 124 [35%]), compared with controls (n = 85 [24%]). There was no difference between groups for the primary outcome (intervention group, 266 of 286 [93%]; control group, 245 of 266 [92%]; odds ratio, 1.14 [95% confidence interval: .60-2.16]; P = .68). There were no procedure-associated adverse events. CONCLUSIONS eFASH did not change the proportion of correctly managed patients but increased the proportion of those with definite tuberculosis. CLINICAL TRIALS REGISTRATION Pan African Registry: PACTR201712002829221.
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Affiliation(s)
- Robert Ndege
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Saint Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Omary Ngome
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Mwananyamala Regional Referral Hospital, Dar es Salaam, United Republic of Tanzania
| | - Fiona Vanobberghen
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Farida Bani
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Saint Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Yvan Temba
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Mwananyamala Regional Referral Hospital, Dar es Salaam, United Republic of Tanzania
| | - Herieth Wilson
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Jerry Hella
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Winfrid Gingo
- Saint Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | | | - Dorcas Mnzava
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Namvua Kimera
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Hellen Hiza
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - John Wigayi
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Irene B Kato
- Mwananyamala Regional Referral Hospital, Dar es Salaam, United Republic of Tanzania
| | | | - Klaus Reither
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Daniel H Paris
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Maja Weisser
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Martin Rohacek
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Saint Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Swiss Tropical and Public Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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4
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Weisser M, Rohacek M, Ndege R, Luoga E, Katende A, Mollel GJ, Gingo W, Vanobberghen F, Paris DH, Hatz C, Battegay M. The Chronic Diseases Clinic of Ifakara (CDCI)—Establishing a Model Clinic for Chronic Care Delivery in Rural Sub-Saharan Africa. Diseases 2022; 10:diseases10040072. [PMID: 36278571 PMCID: PMC9590064 DOI: 10.3390/diseases10040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
The rollout of antiretroviral drugs in sub-Saharan Africa to address the huge health impact of the HIV pandemic has been one of the largest projects undertaken in medical history and is an unprecedented medical success story. However, the path has been and still is characterized by many far reaching implementational challenges. Here, we report on the building and maintaining of a role model clinic in Ifakara, rural Southwestern Tanzania, within a collaborative project to support HIV services within the national program, training for staff and integrated research to better understand local needs and improve patients’ outcomes.
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Affiliation(s)
- Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- Correspondence: (M.W.); (M.B.); Tel.: +41-328-67-42 (M.W.); +41-61-265-50-53 (M.B.)
| | - Martin Rohacek
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
| | - Robert Ndege
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Ezekiel Luoga
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Andrew Katende
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Getrud J. Mollel
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Winfrid Gingo
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Fiona Vanobberghen
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Daniel H. Paris
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Christoph Hatz
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland
- University of Basel, 4001 Basel, Switzerland
- Correspondence: (M.W.); (M.B.); Tel.: +41-328-67-42 (M.W.); +41-61-265-50-53 (M.B.)
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Zhou R, Qiu X, Ying J, Yue Y, Ruan T, Yu L, Liu Q, Sun X, Wang S, Qu Y, Li X, Mu D. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis. Front Public Health 2022; 10:938544. [PMID: 36211645 PMCID: PMC9533650 DOI: 10.3389/fpubh.2022.938544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background and aim Abdominal tuberculosis (TB) is a common type of extrapulmonary TB with an insidious onset and non-specific symptoms. Adenosine deaminase (ADA) levels increase rapidly in the early stages of abdominal TB. However, it remains unclear whether ADA serves as a diagnostic marker for abdominal TB. Methods We performed a systematic literature search for relevant articles published in PubMed, Web of Science, Cochrane Library, and Embase up to April 2022. First, we used the Quality Assessment of Diagnostic Accuracy Studies tool-2 (QUADAS-2), to evaluate the quality of the included articles. Bivariate and hierarchical summary receiver operating characteristic (HSROC) models were then utilized to analyze pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC). In addition, we explored a subgroup analysis for potential heterogeneity and publication bias among the included literature. Results Twenty-four articles (3,044 participants, 3,044 samples) which met the eligibility criteria were included in this study. The pooled sensitivity and specificity of ADA for abdominal TB detection were 93% [95% confidence interval (CI): 0.89-0.95] and 95% (95% CI: 0.93-0.96), respectively. PLR and NLR were 18.6 (95% CI: 14.0-24.6) and 0.08 (95% CI: 0.05-0.12), respectively. DOR and AUROC were 236 (95% CI: 134-415) and 0.98 (95% CI: 0.96-0.99), respectively. Furthermore, no heterogeneity or publication bias was found. Conclusions Our meta-analysis found ADA to be of excellent diagnostic value for abdominal TB and could be used as an auxiliary diagnostic tool. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022297931.
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Affiliation(s)
- Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,*Correspondence: Junjie Ying
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Tiechao Ruan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Luting Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qian Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xuemei Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Shaopu Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xihong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,Dezhi Mu
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Point-of-Care Ultrasound for Tuberculosis Management in Sub-Saharan Africa-A Balanced SWOT Analysis. Int J Infect Dis 2022; 123:46-51. [PMID: 35811083 DOI: 10.1016/j.ijid.2022.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/21/2022] Open
Abstract
Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to non-specialist healthcare workers to guide routine clinical decision making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Due to its high sensitivity to detect small consolidations, pleural effusions and sub pleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities & Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We idenitified numerous strengths and opportunities of POCUS for TB management e.g.; accessible, affordable, easy to use & maintain, expedited diagnosis, extra-pulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/PLHIV, targeted screening of TB contacts, monitoring TB sequelae, and creating AI decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from Sub-Saharan Africa must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice.
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7
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Pinto‐Carta R, Sierra‐Arango F, Vásquez‐Roldan M, Pérez‐Riveros ED. Peripancreatic lymph node tuberculosis diagnosed by endoscopic ultrasound. JGH Open 2021; 5:401-403. [PMID: 33732889 PMCID: PMC7936619 DOI: 10.1002/jgh3.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Renzo Pinto‐Carta
- Gastroenterology and Hepatology Department Fundación Santa Fe de Bogotá Bogotá Colombia
| | - Fernando Sierra‐Arango
- Gastroenterology and Hepatology Department Fundación Santa Fe de Bogotá Bogotá Colombia
- Clinical Studies and Clinical Epidemiology Division Fundación Santa Fe de Bogotá Bogotá Colombia
| | - Mariana Vásquez‐Roldan
- Clinical Studies and Clinical Epidemiology Division Fundación Santa Fe de Bogotá Bogotá Colombia
| | - Erika D Pérez‐Riveros
- Clinical Studies and Clinical Epidemiology Division Fundación Santa Fe de Bogotá Bogotá Colombia
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