Early Diagnosis and Treatment of COPD and Asthma - A Randomized, Controlled Trial.

BACKGROUND: Many persons with chronic obstructive pulmonary disease (COPD) or asthma have not received a diagnosis, so their respiratory symptoms remain largely untreated. METHODS: We used a case-finding method to identify adults in the community with respiratory symptoms without diagnosed lung disease. Participants who were found to have undiagnosed COPD or asthma on spirometry were enrolled in a multicenter, randomized, controlled trial to determine whether early diagnosis and treatment reduces health care utilization for respiratory illness and improves health outcomes. Participants were assigned to receive the intervention (evaluation by a pulmonologist and an asthma-COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. Secondary outcomes included changes from baseline to 1 year in disease-specific quality of life, as assessed with the St. George Respiratory Questionnaire (SGRQ; scores range from 0 to 100, with lower scores indicating better health status); symptom burden, as assessed with the COPD Assessment Test (CAT; scores range from 0 to 40, with lower scores indicating better health status); and forced expiratory volume in 1 second (FEV1). RESULTS: Of 38,353 persons interviewed, 595 were found to have undiagnosed COPD or asthma and 508 underwent randomization: 253 were assigned to the intervention group and 255 to the usual-care group. The annualized rate of a primary-outcome event was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). At 12 months, the SGRQ score was lower than the baseline score by 10.2 points in the intervention group and by 6.8 points in the usual-care group (difference, -3.5 points; 95% CI, -6.0 to -0.9), and the CAT score was lower than the baseline score by 3.8 points and 2.6 points, respectively (difference, -1.3 points; 95% CI, -2.4 to -0.1). The FEV1 increased by 119 ml in the intervention group and by 22 ml in the usual-care group (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in the trial groups. CONCLUSIONS: In this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. (Funded by Canadian Institutes of Health Research; UCAP ClinicalTrials.gov number, NCT03148210.).

Self-Interacting Dark Matter Solves the Final Parsec Problem of Supermassive Black Hole Mergers.

Evidence for a stochastic gravitational wave (GW) background, plausibly originating from the merger of supermassive black holes (SMBHs), is accumulating with observations from pulsar timing arrays. An outstanding question is how inspiraling SMBHs get past the "final parsec" of separation, where they have a tendency to stall before GW emission alone can make the binary coalesce. We argue that dynamical friction from the dark matter (DM) spike surrounding the black holes is sufficient to resolve this puzzle, if the DM has a self-interaction cross section of order cm^{2}/g. The same effect leads to a softening of the GW spectrum at low frequencies as suggested by the current data. For collisionless cold DM, the friction deposits so much energy that the spike is disrupted and cannot bridge the final parsec, while for self-interacting DM, the isothermal core of the halo can act as a reservoir for the energy liberated from the SMBH orbits. A realistic velocity dependence, such as generated by the exchange of a massive mediator like a dark photon, is favored to give a good fit to the GW spectrum while providing a large enough core. A similar velocity dependence has been advocated for solving the small-scale structure problems of cold DM.

The first limit on invisible decays of Bs mesons comes from LEP.

Motivated by the recent evidence for B+→K+ν¯ν decays at Belle II, we point out that fully invisible Bd and Bs meson decays are strongly constrained by LEP. A reinterpretation of an old inclusive ALEPH search for b-hadron decays with large missing energy allows us to place the limits Br(Bd→invisible)<1.4×10-4 and Br(Bs→invisible)<5.6×10-4, both at 90% CL. The Bd limit is only a factor of 6 looser than the world-leading one provided by the BaBar collaboration, while the Bs one is the first limit in the literature on this decay mode. These results are relevant in the context of new light states coupled to quarks and exemplify the power of a future Tera-Z factory at FCC-ee to look for B meson decays containing missing energy.

Modeling the dynamics of harmful algal bloom events in two bays from the northern Chilean upwelling system.

The bays of Tongoy and Guanaqueros are located in the Humboldt Current system, where Argopecten purpuratus has been the subject of intense aquaculture development. These bays lie in one of the most productive marine ecosystems on Earth and are dominated by permanent coastal upwelling at Lengua de Vaca Point and Choros Point, one of the three upwelling centers on the Chilean coast. Significantly, this productive system experiences a high recurrence of harmful algal bloom (HAB) events. This paper examines 9-year (2010-2018) samples of three toxic microalgal species collected in different monitoring programs and research projects. During this period, nine HAB events were detected in Guanaqueros Bay and 14 in Tongoy Bay. Among these, three HAB events were produced simultaneously in both bays by Pseudo-nitzschia australis, and two events produced simultaneously were detected in one bay by Alexandrium spp. and the other by Dinophysis acuminata. Before El Niño 2015-16, there were more HAB events of longer duration by the three species. Since El Niño, the number and duration of events were reduced and only produced by P. australis. HAB events were simulated with the FVCOM model and a virtual particle tracker model to evaluate the dynamics of bays and their relationship with HAB events. The results showed retention in bays during the relaxation conditions of upwelling and low connectivity between bays, which explains why almost no simultaneous events were recorded.

An Unprecedented Bloom of Oceanic Dinoflagellates (Karenia spp.) Inside a Fjord within a Highly Dynamic Multifrontal Ecosystem in Chilean Patagonia.

At the end of summer 2020, a moderate (~105 cells L-1) bloom of potential fish-killing Karenia spp. was detected in samples from a 24 h study focused on Dinophysis spp. in the outer reaches of the Pitipalena-Añihue Marine Protected Area. Previous Karenia events with devastating effects on caged salmon and the wild fauna of Chilean Patagonia had been restricted to offshore waters, eventually reaching the southern coasts of Chiloé Island through the channel connecting the Chiloé Inland Sea to the Pacific Ocean. This event occurred at the onset of the COVID-19 lockdown when monitoring activities were slackened. A few salmon mortalities were related to other fish-killing species (e.g., Margalefidinium polykrikoides). As in the major Karenia event in 1999, the austral summer of 2020 was characterised by negative anomalies in rainfall and river outflow and a severe drought in March. Karenia spp. appeared to have been advected in a warm (14-15 °C) surface layer of estuarine saline water (S > 21). A lack of daily vertical migration patterns and cells dispersed through the whole water column suggested a declining population. Satellite images confirmed the decline, but gave evidence of dynamic multifrontal patterns of temperature and chl a distribution. A conceptual circulation model is proposed to explain the hypothetical retention of the Karenia bloom by a coastally generated eddy coupled with the semidiurnal tides at the mouth of Pitipalena Fjord. Thermal fronts generated by (topographically induced) upwelling around the Tic Toc Seamount are proposed as hot spots for the accumulation of swimming dinoflagellates in summer in the southern Chiloé Inland Sea. The results here provide helpful information on the environmental conditions and water column structure favouring Karenia occurrence. Thermohaline properties in the surface layer in summer can be used to develop a risk index (positive if the EFW layer is thin or absent).

Effects of the toxic dinoflagellate Protoceratium reticulatum and its yessotoxins on the survival and feed ingestion of Argopecten purpuratus veliger larvae.

The effects of yessotoxins (YTXs) produced by the dinoflagellate Protoceratium reticulatum in the early stages of bivalves have not been studied in detail. The present study evaluates the effects of P. reticulatum and YTXs on the survival and feed ingestion of veliger larvae of Argopecten purpuratus. Larvae were 96 h-exposed to 500, 1000 and 2000 P. reticulatum cells mL-1, and their equivalent YTX extract was prepared in methanol. Results show a survival mean of 82 % at the highest density of dinoflagellate, and 38 % for larvae with the highest amount of YTX extract. Feed ingestion is reduced in the dinoflagellate exposure treatments as a function of cell density. Therefore, the effect of YTXs on A. purpuratus represents a new and important area of study for investigations into the deleterious effects of these toxins in the early stages of the life cycle of this and, potentially, other bivalves.

Synchronic distribution of the dinoflagellate Protoceratium reticulatum and yessotoxins in a high stratified fjord system: Tidal or light modulation?

Protoceratium reticulatum is the main yessotoxin-producer along the Chilean coast. Thus far, the yessotoxin levels recorded in this region have not posed a serious threat to human health. However, a bloom of P. reticulatum during the austral summer of 2022 caused the first ban of shellfish collection, due to the high toxin levels. A bloom of P. reticulatum during the austral summer of 2020 allowed an evaluation of the fine-scale distribution of the dinoflagellate during a tidal cycle. High-resolution measurements of biophysical properties were carried out in mid-summer (February 18-19) at a fixed sampling station in Puyuhuapi Fjord, Chilean Patagonia, as part of an intensive 24-h biophysical experiment to monitor the circadian distributions of P. reticulatum vegetative cells and yessotoxins. High P. reticulatum cell densities (>20 × 103 cells L-1) were found in association with a warmer (14.5-15 °C) and estuarine (23.5-24.5 g kg-1) sub-surface water layer (6-8 m). P. reticulatum cell numbers and yessotoxins followed a synchronic distribution pattern consistent with the excursions of the pycnocline. Nevertheless, the surface aggregation of the cells was modulated by the light cycle, suggesting daily vertical migration. The yessotoxin content per P. reticulatum cell ranged from 9.4 to 52.2 pg. This study demonstrates both the value of fine-scale resolution measurements of biophysical properties in a highly stratified system and the potential ecosystem impact of P. reticulatum strains producing high levels of yessotoxins.

Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally.

Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.

Effect of strength training on knee proprioception in patients with knee osteoarthritis: A systematic review and meta-analysis.

Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g â€‹= â€‹-1.33 [-2.33, -0.32], g = â€‹-2.29 [-2.82, -1.75] and g â€‹= â€‹-2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g â€‹= â€‹-0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

Scientometric indicators for Brazilian research on High Energy Physics, 1983-2013

ABSTRACT This article presents an analysis of Brazilian research on High Energy Physics (HEP) indexed by Web of Science (WoS) from 1983 to 2013. Scientometric indicators for output, collaboration and impact were used to characterize the field under study. The results show that the Brazilian articles account for 3% of total HEP research worldwide and that the sharp rise in the scientific activity between 2009 and 2013 may have resulted from the consolidation of graduate programs, the increase of the funding and of the international collaboration as well as the implementation of the Rede Nacional de Física de Altas Energias (RENAFAE) in 2008. Our results also indicate that the collaboration patterns in terms of the authors, the institutions and the countries confirm the presence of Brazil in multinational Big Science experiments, which may also explain the prevalence of foreign citing documents (all types), emphasizing the international prestige and visibility of the output of Brazilian scientists. We concluded that the scientometric indicators suggested scientific maturity in the Brazilian HEP community due to its long history of experimental research.

Prevalencia de manchas blancas antes y después del tratamiento de ortodoncia / Prevalence of white spot lesions before and after orthodontic treatment

Resumen Introducción y objetivo: La aparatología de ortodoncia correctiva es un factor de riesgo para caries dental, facilitar su diagnóstico, prevención y control debe ser parte de la formación en esta especialidad. El propósito de este estudio fue evaluar la prevalencia de manchas blancas antes y después del tratamiento de ortodoncia en pacientes entre 10 y 22 años mediante fotografías digitales. Materiales y métodos: Se evaluaron fotografías iniciales y finales de 87 pacientes seleccionados, y modelos finales de 59 pacientes. La información recolectada fue: edad, sexo, tamaño de corona clínica, y presencia de manchas blancas en los 12 dientes anteriores; se utilizaron los criterios ICDAS para determinar la prevalencia de lesiones de mancha blanca (d2) y microcavidad en el esmalte (d3). Resultados: El 26,4% de los pacientes desarrolló lesiones de mancha blanca durante el tratamiento de ortodoncia, no hubo diferencias significativas en la distribución por cuadrantes ni por género, la prevalencia de manchas blancas fue mayor en el tercio gingival, en el canino superior derecho y en los dientes con tamaño de corona clínica más grande. Conclusión: La prevalencia de mancha blanca tuvo un aumento importante durante el tratamiento de ortodoncia con una distribución homogénea según sexo. El ortodoncista debe estar atento y orientar estrategias preventivas en sus pacientes.

Abstract Introduction and objective: Orthodontic fixed appliances are a risk factor for dental caries, and thus the understanding its prevention, diagnosis and treatment should be an integral part of specialty training in orthodontics. The purpose of this study was to evaluate the prevalence of white spot lesions before and after orthodontic treatment in patients between 10 and 22 years of age using digital photographs. Materials and methods: Initial and final photographs of 87 patients and final casts of 59 patients were evaluated. Chart information included: Age, sex, clinical crown size, and presence of white spot lesions in all 12 anterior teeth; ICDAS criteria was used to determine the prevalence of white spot lesions (d2) and enamel micro cavity (d3). Results: 26.4% of patients developed white spot lesions during orthodontic treatment; there was no significant difference in the distribution by quadrants or gender; the prevalence of white spot lesions was higher in gingival third, upper right canine and teeth with greater clinical crown size. Conclusion: Prevalence of white spot lesions increased during the orthodontic treatment with a homogenous distribution by sex. Orthodontists must to be alert and develop preventive strategies in these patients.

Diez años de eficacia terapéutica de la cloroquina en malaria no complicada por Plasmodium vivax , Turbo, Antioquia, años 2002 y 2011 / Ten years of chloroquine efficacy for uncomplicated Plasmodium vivax malaria treatment, Turbo, Antioquia, 2002 and 2011

Introducción. La eficacia terapéutica de los antipalúdicos debe ser vigilada permanentemente debido al problema de resistencia. En Colombia existen pocos estudios que evalúen la eficacia de la cloroquina en la malaria no complicada por Plasmodium vivax . Objetivo. Evaluar la respuesta terapéutica de la cloroquina en el tratamiento del paludismo no complicado por P. vivax en el año 2011 en Turbo, Antioquia, y comparar estos resultados con los del estudio realizado en el año 2002 en el mismo municipio. Materiales y métodos. Se llevaron a cabo dos estudios en los que se incluyeron 152 participantes (50 en el año 2002 y 102 en el año 2011), todos mayores de cinco años, con malaria no complicada e infección simple por P. vivax , según los criterios de la Organización Mundial de la Salud (OMS). Se evaluó la eficacia terapéutica de la cloroquina, según los protocolos vigentes de la Organización Panamericana de la Salud (1998) y la OMS (2009); se dio tratamiento estándar supervisado con 1.500 mg de cloroquina en tres días y se hizo seguimiento clínico y parasitológico los días 0, 1, 2, 3, 7, 14 y 21 en el año 2002 y, además, el día 28 en el año 2011. Al finalizar el seguimiento se suministró primaquina a una dosis diaria de 0,25 mg/kg durante 14 días en todos los participantes. Resultados. Los resultados clínico y parasitológicos fueron adecuados en el 100 % de los participantes de ambos estudios. Conclusiones. La cloroquina continúa siendo eficaz para el tratamiento de la malaria no complicada por P. vivax en Turbo, Antioquia.

Introduction: The therapeutic efficacy of antimalarial drugs should be monitored continuously because of the emergence of drug resistance. In Colombia, there are few studies evaluating the efficacy of chloroquine in uncomplicated malaria by Plasmodium vivax . This study evaluated the therapeutic efficacy of chloroquine at two different times, with an interval of ten years, in the same municipality. Objective: To evaluate the therapeutic response to chloroquine for the treatment of uncomplicated P. vivax malaria in Turbo, Antioquia, in 2002, and to compare these results with those observed in 2011 in the same municipality. Materials and methods: Two studies included 152 volunteers (50 in 2002 and 102 in 2011), older than 5 years old, with uncomplicated malaria according to the World Health Organization (WHO) criteria and simple infection with P. vivax. The efficacy of chloroquine, according to the current standard treatment of the Pan American Health Organization (PAHO) (1998) and WHO (2009), was monitored with 1,500 mg of chloroquine in 3 days and was followed clinically and parasitologically on days 0, 1, 2, 3, 7, 14 and 21 in 2002, and also on day 28 in 2011. At the end of the follow-up a dose of 0.25 mg/kg/day of primaquine was administered to each patient for 14 days. Results: A hundred percent of the volunteers had adequate clinical and parasitological response in both studies. Conclusions: Chloroquine continues to be highly effective for the treatment of uncomplicated P. vivax malaria in Turbo, Antioquia, Colombia.

Actividad sérica de la acetilhidrolasa del factor activador de plaquetas en pacientes afrodescendientes y mestizos con dengue, Colombia / Serum platelet-activating factor acetylhydrolase activity in dengue patients of African or mestizo descendency

Introducción. El dengue grave se caracteriza por el aumento de la permeabilidad vascular inducida por citocinas y mediadores químicos; uno de estos es el factor activador de plaquetas. La acetilhidrolasa del factor activador de plaquetas es la enzima responsable de su degradación, y su deficiencia o aumento se ha relacionado con varias enfermedades. Sin embargo, su papel en la infección por dengue es poco conocido, como tampoco se sabe si existe diferente actividad según el grupo étnico. Objetivo. Comparar la actividad en suero de la acetilhidrolasa del factor activador de plaquetas en dos grupos étnicos con infección por el virus del dengue. Materiales y métodos. Se llevó a cabo un estudio descriptivo, longitudinal, prospectivo, en dos departamentos de Colombia, Antioquia y Chocó. A 43 pacientes mestizos y a 33 pacientes afrodescendientes con diagnóstico de dengue, se les tomó una muestra de suero por cinco días consecutivos en la fase aguda y una muestra en la de convalecencia. Resultados. Se observó mayor frecuencia de casos de dengue hemorrágico en los pacientes mestizos que en los afrodescendientes (23,3 % Vs. 12,1 %, p=0,248). La actividad sérica de la acetilhidrolasa del factor activador de plaquetas (mediana, percentil 25 y percentil 75) fue más elevada en afrodescendientes que en mestizos (0,89 (0,72-1,10) Vs. 0,76 (0-1,03), p=0,000). Este comportamiento se conserva en el dengue clásico (0,89 (0,73-1,10) Vs. 0,73 (0-1,05), p=0,000) y en el hemorrágico (0,88 (0,69-1,12) Vs. 0,83 (0,71-1,08), p=0,893). Conclusiones. Se encontró mayor producción de acetilhidrolasa del factor activador de plaquetas en los pacientes afrodescendientes. Sin embargo, es necesario hacer estudios de polimorfismos de esta enzima que permitan obtener resultados concluyentes.

Análisis del cumplimiento de la Guía Clínica del AUGE en pacientes con accidente cerebrovascular isquémico: la utilización de tecnología sanitaria de diagnóstico para prevención secundaria en un hospital público / Compliance with Chilean diagnostic guidelines among patients with ischemic stroke admitted to a public hospital

Background: Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform. Aim: To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital. Patients and Methods: The study included a review of the medical records of 101 patients aged 70 ±13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained ob-servers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated. Results: Ten patients died before discharge, 38 percent were discharged with and 52 percent were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87 percent of patients with a score of 3 to 5 (moderate to severe disability). In 27 percent of the patients, there was an overuse of diagnostic tests. No association between the diagnostic test use adequacy and year of discharge was observed. Conclusions: There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke.

Deficiencia de glucosa 6-fostato deshidrogenasa en hombres sanos y en pacientes maláricos; Turbo (Antioquia, Colombia) / Deficiency of glucose-6-phosphate dehydrogenase in healthy men and malaria patients; Turbo (Antioquia, Colombia)

INTRODUCCIÓN: En América Latina la deficiencia de glucosa 6-fosfato deshidrogenasa (d-G6PD) ha sido poco estudiada y en Colombia solo conocemos tres publicaciones antiguas. Urge conocer más la prevalencia de d-G6PD, sobre todo ahora que el tratamiento de la malaria vivax plantea aumentar la dosis diaria o total de primaquina. OBJETIVO: Medir la prevalencia de d-G6PD en poblaciones masculina sana y de enfermos con malaria por Plasmodium vivax, en Turbo (Urabá, departamento de Antioquia, Colombia). METODOLOGÍA: Encuestas de prevalencia, para evaluar la G6PD en dos poblaciones de Turbo (Antioquia): hombres sanos; hombres y mujeres con malaria vivax. Se trabajó con muestras diseñadas con criterios estadístico-epidemiológicos. La actividad enzimática se midió con el método normalizado de Beutler para valorar la G6PD en hemolizados. RESULTADOS: Entre los hombres sanos (n = 508), el intervalo de confianza 95 por ciento para el promedio (IC95 por ciento) estuvo entre 4,15 y 4,51 UI/g hemoglobina y 14,8 por ciento presentaron valores por debajo del "límite normal" de < 2,29 UI/g hemoglobina (prevalencia de d-G6PD). Entre los hombres con malaria (n = 206) el IC95 por ciento fue 3,81 a 4,16 UI/g hemoglobina y entre las mujeres palúdicas fue 3,86 a 4,20 UI/g hemoglobina. Los promedios masculinos (sanos vs. maláricos) fueron estadísticamente diferentes (p = 0,028). Únicamente 9,5 por ciento (13/137) de los enfermos con paludismo, todos de sexo masculino, presentaron d-G6PD. CONCLUSIONES: la d-G6PD es relativamente alta (14,8 por ciento) en la población masculina sana de Turbo y en los enfermos maláricos por P. vivax (9,5 por ciento, todos hombres).

Transmisión vertical y transferencia placentaria de anticuerpos contra el dengue / Vertical transmission and transplacental antibody transfer in dengue infection

La expansión del dengue puede afectar a las mujeres durante el embarazo, por lo tanto es importante conocer sus consecuencias. Los objetivos de este estudio fueron determinar los efectos del dengue en el binomio madre-hijo, describir la presentación clínica e inmunológica de la enfermedad y la transferencia placentaria de anticuerpos IgG. En el departamento de Antioquia, Colombia, se realizó un estudio descriptivo longitudinal comparativo, en el cual fueron estudiadas 39 gestantes con dengue y 39 gestantes sin dengue y los recién nacidos. En las gestantes con dengue, se presentó mayor frecuencia de sangrado vaginal (p = 0.005), aborto, preeclampsia y sufrimiento fetal agudo (p = 0.02). En 26 recién nacidos de gestantes con dengue, se observó la presencia de anticuerpos IgG, los cuales declinaron a los 9 meses, y en dos se observaron anticuerpos IgM. El análisis cromosómico de estos recién nacidos fue normal y su desarrollo psicomotor fue adecuado durante el primer año. Los niveles séricos de INF-gamma, TNF-alfa eIL-6 fueron más elevados en las gestantes con dengue. En conclusión, la infección por el virus del dengue durante el embarazo puede tener efectos adversos en la evolución del embarazo y en el recién nacido, no presenta efectos teratogénicos y la respuesta clínica e inmunológica es semejante a la de otras poblaciones...

Apolipoproteína A1 para evaluar el estado nutricional en niños con y sin malaria / Apolipoprotein A1 to evaluate nutritional status in children with and without malaria

ANTECEDENTES: la apolipoproteína A1 (apoA1) se ha propuesto como indicador del estado nutricional, pero existe controversia al respecto.OBJETIVO: comparar la apoA1 sérica con la evaluación antropométrica como prueba diagnóstica del estado nutricional de niños (4-11 años) con malaria y sin ella.METODOLOGÍA: diseño descriptivo, prospectivo y transversal, con uso ciego y simultáneo de las dos pruebas diagnósticas. ApoA1 sérica se midió con métodonefelométrico (APOA, Laboratorio Beckman®).RESULTADOS: fueron evaluados 262 niños. La frecuencia de algún riesgo antropométrico de desnutrición fue 72 por ciento en niños maláricos y 70 por ciento en niños sin malaria. Dos de cada tres niños presentaron menos de 0,94 g/L (límite inferior normal) de apoA1. No hubo correlación significativa entre apoA1 y cada indicador antropométrico y los coeficientes rho de Spearman fueron siempre menores de 0,1. Entre niños sin malaria, apoA1 tuvo sensibilidad de 31 por ciento y especificidad de 83 por ciento, comparada con la clasificación nutricional antropométrica. Entre niños con malaria, la sensibilidad de apoA1 subió a 83 por ciento y la especificidad cayó a 27 por ciento.CONCLUSIONES: la apoA1 no es una herramienta útil para el diagnóstico del estado nutricional, tanto en niños con malaria como en aquellos sin esta enfermedad.

Malaria por Plasmodium vivax: curación del ataque agudo con tres dosis diferentes de primaquina y dosis fija de cloroquina. Antioquia, Colombia, 2003-2004 / Plasmodium vivax malaria: treatment of primary attacks with primaquine, in three different doses, and a fixed dose of chloroquine, Antioquia, Colombia, 2003-2004

Introducción. Cloroquina (CQ) y primaquina (PQ) se usan en Colombia para tratar la malaria vivax no complicada, pero son escasas las evaluaciones de su eficacia. Objetivos. a) investigar la clínica de la malaria vivax en dos zonas con muy diferente nivel endémico; b) evaluar la respuesta terapéutica antimalárica obtenida con el tratamiento estándar CQ-PQ tomadas simultáneamente; c) comparar la eficacia del tratamiento estándar y la de otros dos esquemas que conservan la dosis total de CQ pero varían la de PQ; d) identificar los efectos adversos ocurridos durante el tratamiento CQ-PQ. Materiales y métodos. Diseño aleatorio, controlado, no ciego; tres grupos definidos según dosis total de PQ: 45, 105 y 210 mg. Todos recibieron CQ (1500 mg, en 48 horas) y simultáneamente PQ. Pacientes captados consecutivamente, en Turbo y El Bagre. Seguimiento durante 28 días. La respuesta terapéutica antimalárica clasificada en falla precoz, falla tardía y respuesta adecuada. Resultados. Se trataron 228 pacientes y la respuesta terapéutica antimalárica se evaluó en 210. El cuadro clínico encontrado es similar al descrito por otros autores. En todos los tres grupos, la parasitemia se eliminó en 24 horas de tratamiento con CQ en 11 por ciento de los pacientes, en 48 horas en 66 por ciento y en 72 horas en 97 por ciento. Todos los 210 pacientes respondieron adecuadamente al tratamiento CQ-PQ. La dosis variable de PQ no afectó esta respuesta.Conclusiones. CQ-PQ debe conservarse como la primera opción terapéutica y debe evaluarse en otras áreas. Se propone la administración concomitante de CQ y PQ.

Introduction. Chloroquine (CQ) and primaquine (PQ) are used in Colombia for treatment of uncomplicated vivax malaria but there are few efficacy studies of this scheme. Objectives. a) to investigate the clinical picture of vivax malaria in adult patients; b) to evaluate the antimalarial treatment response to the standard scheme CQ-PQ; c) to compare the efficacy of the standard scheme and two alternative schemes with equal dose of CQ and different PQ dose; d) to identify the adverse effects of CQ-PQ treatment.Materials and methods. Randomized, nonblind design; three groups, defined according to total dose of PQ: 45, 105 and 210 mg. All patients received CQ (1500 mg, in 48 hours), which was followed by PQ. Patients were recruited in Turbo and El Bagre. The follow-up period was 28 days. Antimalarial treatment response was classified according to the WHO-2001 protocol (early failure, late failure, adequate response). Results. In total 228 patients were recruited, 18 were lost between days 4 and 27; the antimalarial treatment response was evaluated in 210. The clinical findings were similar to those described by other authors. Parasitaemia clearance was confirmed during the first 24 hours of CQ treatment in 11% of patients. At 48 hours 66% and at 72 hours 97% of patients were negative. All patients (210) displayed adequate treatment response to the CQ-PQ treatment. The different doses of PQ did not affect this response. Conclusions. CQ-PQ should be conserved as the first treatment choice and should be evaluated in other areas. Simultaneous administration of CQ and PQ is proposed.

Apiñamiento antero-inferior durante el desarrollo del arco dental con presencia de terceros molares. Estudio longitudinal en niños entre los 6 y 15 años / Antero-inferior crowding during development of the dental arch with presence of third molars. Longitudinal study in children between the 6 and 15 years

El objetivo del estudio fue explorar la relación que existe entre el grado de apiñamiento de los dientes antero-inferiores con las dimensiones de los arcos y el patrón de crecimiento esquelético en individuos entre los 6 y 15 años de edad con presencia de terceros molares inferiores y con un seguimiento a 8 años. Se evaluaron 13 pacientes del corregimiento de Damasco en el municipio de Santa Bárbara Antioquia, a quienes se les tomaron radiografías cefálicas laterales, panorámicas y modelos de estudio. Se obtuvieron medidas sobre la posición del incisivo central, primer molar y tercer molar inferior; medidas relacionadas con el patrón de crecimiento esquelético, longitud mandibular, rotación mandibular, distancia intercanina, intermolar, longitud y perímetro de arco. El análisis multivariado mostró que el apiñamiento anteroinferior se pudo explicar en un 6,.1 por ciento por la distancia intermolar, la inclinación del incisivo central inferior y la longitud del arco dental. En conclusión se encontró que el apiñamiento anteroinferior es una característica que se presenta por la combinación de diferentes factores, los cuales no han sido determinados en su totalidad por lo que se sugiere realizar otros estudios con el fin de determinar otros factores que expliquen el apiñamiento anteroinferior...

Variables cefalométricas asociadas con el desarrollo de maloclusión esquelética clase I y II / Cephalometric variables associated with the development of class I and II malocclusions

A través del tiempo se han realizado estudios cefalométricos que muestran una alta prevalencia de desórdenes dentales y esqueléticos en diferentes grupos poblacionales. Sin embargo los reportes no mencionan que ocurrió con las maloclusiones durante el proceso de crecimiento y desarrollo en cada uno de los individuos examinados. Se hizo un estudio cefalométrico descriptivo longitudinal retrospectivo a 10 años, con 24 individuos (16 hombres y 8 mujeres) del corregimiento de Damasco. El objetivo fue evaluar el peso de las variables que podrían contribuir al desarrollo de una maloclusión esquelética clase I o II a través del tiempo. Se tuvieron en cuenta mediciones cefalométricas angulares y lineales que determinaron el componente esquelético de los maxilares y base de cráneo. También se describieron los tipos de maloclusión desarrollada por sexo, edad. El análisis de regresión logística generó un modelo matemático que determinó que variables tuvieron más peso en el desarrollo de la maloclusión. Los resultados mostraron que la maloclusión se mantuvo estable en un 95 por ciento durante los 10 años de seguimiento, la mayoría de los individuos iniciaron con una maloclusión clase I y solo un 5 por ciento cambiaron a clase II o III. Las mediciones de SNA, Co-A, Co-GN y ANB fueron las variables que tuvieron más peso para el desarrollo de la maloclusión con un 99 por ciento de predicción para la maloclusión clase I y con un 71 por ciento para la maloclusión clase II. Palabras clave: Maloclusión, Análisis Multivariados, Análisis de Regresión Logística...