Usefulness of serum amylase and lipase as predictors of the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.

BACKGROUND: Post-ERCP pancreatitis (PEP) is the most common complication of Post-endoscopic retrograde cholangiopancreatography. OBJECTIVE: to demonstrate whether serum amylase and lipase values correlate with the presence and severity of PEP. METHOD: We conducted a retrospective, observational and analytical study of patients who underwent ERCP, those who developed pancreatitis were classified by severity according to the 2012 revised Atlanta criteria and their serum enzyme levels were analyzed. We used ROC (Receiver Operating Characteristics) curves to know the best enzyme cutoff points and analyzed their diagnostic yields. Chi-square, t-distribution and Mann-Whitney U test were used in the variable analysis and it was considered statistically significant when p < 0.05. RESULTS: A total 621 patients, 54 presented pancreatitis. For moderately severe and severe forms: lipase level of 1500 U/L had an area under the curve (AUC) = 0.827, 95% CI (0.67-0.98), sensitivity = 72.7%, specificity = 86%, negative predictive value = 92.5%, p < 0.05. Amylase level of 920 U/L presented AUC = 0.65, 95% CI (0.43-0.86), sensitivity = 63%, specificity = 67%, p > 0.05. CONCLUSIONS: Serum lipase shows correlation with the presence and severity of PEP. Amylase shows no significant correlation with PEP.

ANTECEDENTES: La pancreatitis poscolangiopancreatografía retrógrada endoscópica (PPCPRE) es la complicación más frecuente de este procedimiento. OBJETIVO: Demostrar si la amilasa y la lipasa séricas se correlacionan con la presencia y la gravedad de la PPCPRE. MÉTODO: Realizamos un estudio retrospectivo, observacional y analítico de pacientes a quienes se realizó CPRE. Los que desarrollaron pancreatitis se clasificaron por gravedad de acuerdo con la revisión de Atlanta de 2012 y se analizaron sus concentraciones séricas de enzimas. Empleamos curvas ROC (Receiver Operating Characteristics) para conocer los mejores puntos de corte enzimáticos y analizamos sus rendimientos diagnósticos. Usamos las pruebas de ji al cuadrado, t de Student y U de Mann Whitney para el análisis de las variables, y se consideró estadísticamente significativo un valor de p < 0.05. RESULTADOS: De un total de 621 pacientes, 54 presentaron pancreatitis. Para pancreatitis moderadamente grave y grave, unas cifras de lipasa de 1500 U/l presentaron un área bajo la curva (AUC) = 0.827 (intervalo de confianza del 95% [IC 95%]: 0.67-0.98), con una sensibilidad del 72.7%, una especificidad del 86% y un valor predictivo negativo del 92.5% (p < 0.05); y unas cifras de amilasa de 920 U/l presentaron un AUC = 0.65 (IC 95%: 0.43-0.86), con una sensibilidad del 63% y una especificidad del 67% (p > 0.05). CONCLUSIONES: La lipasa muestra correlación con la presencia y la gravedad de la PPCPRE. La amilasa muestra correlación no significativa con la PPCPRE.

Genome size determination in chagas disease transmitting bugs (hemiptera-triatominae) by flow cytometry.

Because information about genome size in triatomines is scarce and contradictory, we performed DNA quantification by flow cytometry in 13 species belonging to five genera (Dipetalogaster, Eratyrus, Panstrongylus, Rhodnius, and Triatoma) to infer overall tendencies and phylogenetic associations. The results show that the haploid DNA content of the subfamily Triatominae varies nearly 4-fold, from<0.7 pg in Rhodnius species (0.6x10(9) bp) to 2.7 pg in Triatoma delpontei (2.6x10(9) bp). Considering that triatomines present similar chromosome numbers, we suggest that genome size differences are the result of variation in the quantity of repetitive DNA sequences localized in hetero and euchromatin. Changes in heterochromatin are particularly important when considering populations or closely related species; in more distant taxa, euchromatic changes also play a role. Our analyses indicate that flow cytometry is a useful tool for population, taxonomic, and evolutionary studies in this subfamily.

[Using ELISA for identifying Triatominae feeding behaviour in Colombia]. / ELISA para la Identificación de los Patrones Alimentarios de Triatominae en Colombia.

OBJECTIVE: Standardising the ELISA technique for identifying triatomine insects' feeding behaviour. METHODS: The ELISA test was standardised by preparing 12 animal anti-specie polyclonal antisera by immunising rabbits with sera from domestic and wild animals; the sera were titred and absorbed to improve specificity. The intestinal content of fifth-instar Rhodnius prolixus (previously fed on each host) was used as positive control; negative controls were obtained from triatomines without feeding. The intestinal content from 60 intradomicile R. prolixus collected in the field was processed to determine the test's effectiveness. RESULTS: The high-reactivity ELISA technique was standardised in detecting every blood protein in the positive controls used here. Blood proteins from one or more domestic and wild hosts were detected in 70% of the intestinal content of triatomines collected in homes. Bird, human, pig and goat blood were the most frequent feeding sources; blood proteins from wild animals were identified in 9.5% of them. CONCLUSIONS: The technique was shown to be effective in detecting blood proteins from different hosts in the intestinal content of triatomines taken from the laboratory and the field. Even though domestic animals' blood was preferentially determined, the findings from wild animals' blood could indicate insect mobility probably from the wild to the domicile. This tool helps in understanding triatomines' behaviour regarding their hosts, thereby contributing to understanding Chagas' disease eco-epidemiology.

SASA: una escala sencilla de mortalidad postoperatoria explorada en un centro de atención de tercer nivel en México / SASA: a simple scale of postoperative mortality explored in a third-level care center in Mexico

Resumen: Introducción: Las complicaciones postquirúrgicas han sido causa importante de muerte. Por lo tanto, el uso de predictores sencillos de mortalidad con una nueva escala llamada SASA podría indicar un riesgo postoperatorio de mortalidad a los 30 días aplicado en una muestra en población mexicana. Material y métodos: Exploramos una asociación entre la clasificación de estado físico de la Sociedad Americana de Anestesiólogos (ASA-PS), el Apgar quirúrgico (sAs) y la puntuación de SASA con un análisis univariado en 371 pacientes estimando la relación de probabilidades (OR) y graficando las curvas de operación característica del receptor (receiver-operating-characteristic [ROC]) para cada escala. Resultados: Obtuvimos los valores de dos; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 40.56% (IC del 95%: 35.44-45.83)], 6; [sensibilidad; 81.82% (IC del 95 %: 48.2-97.72), especificidad; 77.5% (IC del 95%: 72.83-81.71)] y 10; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 83.6% (IC del 95%: 78.77-86.78)] como los mejores puntos de corte para el ASA-PS, sAs y SASA respectivamente. Conclusiones: el cálculo de SASA obtuvo la misma sensibilidad, pero mejor especificidad y área bajo la curva cuando se comparó con el ASA-PS y el sAs.

Abstract: Introduction: Post-surgical complications have been a significant cause of death. Therefore, the use of easy preoperative mortality predictors is recommended. A new SASA score could indicate a perioperative risk more globally at 30-days of the postoperative period applied in a Mexican sample. Material and methods: 371 patients were analyzed. We explore an association between the American Society of Anesthesiologists physical status classification (ASA-PS), the surgical Apgar score (sAs), and the new SASA score to assess 30-days mortality after surgery using univariate analysis to estimate the odds ratio (OR). Receiver-operating-characteristic (ROC) curves were plotted for each scale. Results: We obtained values of two; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 40.56% (95% CI: 35.44-45.83)] 6; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 77.5% (95% CI: 72.83-81.71)] and 10; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 83.6% (95% CI: 78.77-86.78)] as the best cut-off points for ASA-PS, sAs and SASA respectively. Conclusions: To predict postoperative 30-days mortality, SASA calculation as a new score obtained the same sensitivity but better specificity and area under the curve (AUC) for the ROC compared with the ASA-PS and the sAs.

On palms, bugs, and Chagas disease in the Americas.

Palms are ubiquitous across Neotropical landscapes, from pristine forests or savannahs to large cities. Although palms provide useful ecosystem services, they also offer suitable habitat for triatomines and for Trypanosoma cruzi mammalian hosts. Wild triatomines often invade houses by flying from nearby palms, potentially leading to new cases of human Chagas disease. Understanding and predicting triatomine-palm associations and palm infestation probabilities is important for enhancing Chagas disease prevention in areas where palm-associated vectors transmit T. cruzi. We present a comprehensive overview of palm infestation by triatomines in the Americas, combining a thorough reanalysis of our published and unpublished records with an in-depth review of the literature. We use site-occupancy modeling (SOM) to examine infestation in 3590 palms sampled with non-destructive methods, and standard statistics to describe and compare infestation in 2940 palms sampled by felling-and-dissection. Thirty-eight palm species (18 genera) have been reported to be infested by ∼39 triatomine species (10 genera) from the USA to Argentina. Overall infestation varied from 49.1-55.3% (SOM) to 62.6-66.1% (dissection), with important heterogeneities among sub-regions and particularly among palm species. Large palms with complex crowns (e.g., Attalea butyracea, Acrocomia aculeata) and some medium-crowned palms (e.g., Copernicia, Butia) are often infested; in slender, small-crowned palms (e.g., Euterpe) triatomines associate with vertebrate nests. Palm infestation tends to be higher in rural settings, but urban palms can also be infested. Most Rhodnius species are probably true palm specialists, whereas Psammolestes, Eratyrus, Cavernicola, Panstrongylus, Triatoma, Alberprosenia, and some Bolboderini seem to use palms opportunistically. Palms provide extensive habitat for enzootic T. cruzi cycles and a critical link between wild cycles and transmission to humans. Unless effective means to reduce contact between people and palm-living triatomines are devised, palms will contribute to maintaining long-term and widespread, albeit possibly low-intensity, transmission of human Chagas disease.

Triatoma dimidiata en Colombia; distribución, ecología e importancia epidemiológica / Triatoma dimidiata in Colombia: Distribution, ecology and epidemiological importance

RESUMEN Triatoma dimidiata es un importante vector de la enfermedad de Chagas en Centroamérica y en los países del norte de Suramérica. En Colombia, tiene una amplia distribución y su presencia se ha reportado en 14 departamentos de las regiones Andina, Caribe, de los Llanos Orientales y del Alto Magdalena, en las cuales ocupa diferentes ecótopos naturales y artificiales. La especie está clasificada como secundaria para la transmisión de Trypanosoma cruzi; sin embargo, su presencia en el ambiente silvestre, peridoméstico y doméstico en la región Andina, y su capacidad de movilizarse entre ellos, le han permitido escapar al control basado en la aspersión con piretroides y ello resalta su importancia en el mantenimiento de la transmisión del parásito debido a la potencial reinfestación de las viviendas. La comprensión de las relaciones de T. dimidiata con su hábitat, así como el empoderamiento de la comunidad, contribuyen al desarrollo de sistemas de control efectivos y perdurables. El propósito de esta revisión fue describir la distribución, los factores de riesgo, la ecología, las características entomológicas y los hábitats de las poblaciones de T. dimidiata en Colombia, y proponer alternativas de intervención acordes con las características particulares de esta especie.

ABSTRACT Triatoma dimidiata is an important vector of Chagas disease in Central America and countries of northern South America. In Colombia, it has a wide geographical distribution with reported presence in 14 departments in the Andean, Caribbean, Eastern plains and Upper Magdalena regions, where it occupies different natural and artificial ecotopes. The species is considered a secondary vector in the transmission of Trypanosoma cruzi. Its presence in wild, peridomestic and intradomiciliary habitats in the Andean region, coupled with its ability to move between them, has allowed it to escape the control based on pyrethroids spraying, highlighting its importance in maintaining transmission of the parasite through the potential reinfestation of homes. Understanding the relation of T. dimidiata and its habitats, as well as the empowerment of communities, will contribute to the development of effective and lasting control systems. The purpose of this review was to describe the distribution, risk factors, ecology, entomological features and habitats of T. dimidiata populations in Colombia, and to propose alternative interventions in agreement with the specific characteristics of the species.

ELISA para la Identificación de los Patrones Alimentarios de Triatominae en Colombia / Using ELISA for identifying Triatominae feeding behaviour in Colombia

Objetivo: Estandarizar la técnica de ELISA para la identificación de los patrones alimentarios de insectos triatominos. Métodos: Para estandarizar el ELISA se prepararon 12 antisueros policlonales anti-especie animal a partir de inmunizaciones en conejos con sueros de animales domésticos y silvestres, que fueron titulados y absorbidos para mejorar especificidad; como controles positivos se utilizaron contenidos intestinales de ninfas de V instar de Rhodnius prolixus previamente alimentadas sobre cada hospedero; los negativos se obtuvieron de triatominos sin alimentar. Se procesaron 60 contenidos intestinales de R. prolixus de intradomicilio colectados en campo para determinar la efectividad de la prueba. Resultados: Se estandarizó la técnica de ELISA con alta reactividad en la detección de cada proteína sanguínea de los controles positivos utilizados. En el 70 por ciento de los contenidos intestinales de los triatominos colectados en el domicilio se detectaron proteínas sanguíneas de uno o más hospederos domésticos y silvestres. Sangre de ave, humano, cerdo y cabra fueron las fuentes alimentarias más frecuentes; proteínas sanguíneas de animales silvestres fueron identificadas en 9,5 por ciento. Conclusiones: La técnica mostró ser efectiva en la detección de proteínas sanguíneas de diferentes hospederos en el contenido intestinal de triatominos de laboratorio y de campo. Si bien se determinó preferencialmente sangre de animales domésticos, el hallazgo de sangre de animales silvestres podría indicar movilidad de insectos probablemente de origen silvestre al domicilio. Esta herramienta ayuda a entender el comportamiento de los triatominos frente a sus hospederos, contribuyendo a la comprensión de la ecoepidemiología de la Enfermedad de Chagas.

Objective: Standardising the ELISA technique for identifying triatomine insects' feeding behaviour. Methods: The ELISA test was standardised by preparing 12 animal anti-specie polyclonal antisera by immunising rabbits with sera from domestic and wild animals; the sera were titred and absorbed to improve specificity. The intestinal content of fifth-instar Rhodnius prolixus (previously fed on each host) was used as positive control; negative controls were obtained from triatomines without feeding. The intestinal content from 60 intradomicile R. prolixus collected in the field was processed to determine the test's effectiveness. Results: The high-reactivity ELISA technique was standardised in detecting every blood protein in the positive controls used here. Blood proteins from one or more domestic and wild hosts were detected in 70 percent of the intestinal content of triatomines collected in homes. Bird, human, pig and goat blood were the most frequent feeding sources; blood proteins from wild animals were identified in 9.5 percent of them. Conclusions: The technique was shown to be effective in detecting blood proteins from different hosts in the intestinal content of triatomines taken from the laboratory and the field. Even though domestic animals' blood was preferentially determined, the findings from wild animals' blood could indicate insect mobility probably from the wild to the domicile. This tool helps in understanding triatomines' behaviour regarding their hosts, thereby contributing to understanding Chagas' disease eco-epidemiology.

Description and ontogenetic morphometrics of nymphs of Belminus herreri Lent & Wygodzinsky ( Hemiptera: Reduviidae, Triatominae )

Pela primeira vez todos estádios ninfais de uma espécie do gênero Belminus são descritos, baseados em espécimes da primeira geração obtida em laboratório a partir de adultos capturados em domicílios do Departamento de Cesar, Colômbia. A morfometria geométrica das cabeças sugere que as maiores mudanças no desenvolvimento pós-embrionário ocorrem entre o 1º e o 2º ínstares.

Especies de Lutzomyia (Diptera: Psychodidae) posibles vectores de leishmaniasis en la ciudad de Bucaramanga, Santander, Colombia / Lutzomyia species (Diptera: Psychodidae) possible leishmaniasis vector in the city of Bucaramanga, Santander, Colombia

Debido al registro, en los últimos cinco años, de ciento veinticinco casos urbanos de leishmaniasis cutánea en la ciudad de Bucaramanga, se desarrolló el presente estudio con el fin de determinar las especies del género Lutzomyia existentes en la ciudad y sus implicaciones en salud pública. La búsqueda de los flebotomíneos se hizo en ocho zonas de la ciudad en los meses de septiembre a diciembre de 1996, utilizando como técnicas de muestreo trampas de luz tipo CDC y aspiración directa en cebo humano protegido y en sitios de reposo. Los insectos fueron preservados en alcohol al 70 por ciento y aclarados con KOH y fenol. Se capturaron 212 especímenes pertenecientes a once especies del género Lutzomyia y una del género Brumptomyia. Entre las especies antropofílicas encontradas, L. ovallesi y L. gomezi se destacan por ser reconocidas como vectores de Leishmania braziliensis L. ovallesi fue la especie de mayor distribución en la ciudad, L. gomezi la más abundante en las capturas con cebo humano; las dos se encontraron en barrios donde se ha informado el mayor número de casos de la enfermedad. El hallazgo de estas especies en la ciudad sugiere la posibilidad de que los habitantes de Bucaramanga puedan infectarse en el área urbana y crea la necesidad de continuar estudios que contribuyan a interrumpir el ciclo de transmisión