Mortalidad infantil en Antioquia durante el año 2021: hacia un enfoque sindemico / Infant mortality in Antioquia during 2021: towards a syndemic approach / Mortalidade infantil em Antioquia durante o ano de 2021: rumo a uma abor-dagem sindêmica

En Colombia, la mortalidad infantil ha seguido una tendencia marcada al descenso en los últimos años. Sin embargo, tras la llegada del coronavirus se ha identificado un discreto au-mento en los casos de mortalidad infantil. El objetivo es describir los factores relacionados con la mortalidad infantil y las estrategias implementadas durante el 2021. Materiales y métodos: estudio descriptivo retrospectivo, sobre casos confirmados de mortalidad infantil en Antioquia durante el 2021, las fuentes información fueron los reportes de notificación epidemiológica y las transcripciones de las entrevistas de campo de análisis de los eventos. Para el análisis de las fichas epidemiológicas se utilizaron estadísticos descriptivos y para las entrevistas análisis de contenido cualitativo. Resultados: En Antioquia, para el año 2021, se presentaron 43 muertes en menores de 5 años por Insuficiencia Respiratoria Aguda (IRA), Enfermedad Diarreica Aguda (EDA) y Desnutrición (DNT), de los cuales la mayor inciden-cia la aportó la mortalidad por IRA con 24 casos, le sigue la mortalidad por desnutrición con 10 casos y por último, la mortalidad por enfermedad diarreica aguda presentó 9 casos. Se analizaron 10 entrevistas a madres y familiares de los menores fallecidos se identificaron las siguientes categorías de análisis sindemia y mortalidad; salud mental materna y mortalidad infantil; y calidad de la atención en salud. Con base en los problemas identificados se desarr-ollaron dos eventos educativos con enfoque de AIEPI comunitario. Conclusión: Un enfoque de sindemia, posibilita comprender el impacto de la pandemia en la mortalidad infantil, en-tender es el primer paso para intervenir. El aumento de las cifras de mortalidad infantil es solo la punta del iceberg, es necesario considerar otros efectos a largo plazo en la salud infantil

In Colombia, infant mortality has followed a marked downward trend in recent years. How-ever, after the arrival of the coronavirus, a discrete increase in infant mortality cases has been identified. The objective is to describe the factors related to infant mortality and the strategies implemented during 2021. Materials and methods: retrospective descriptive study on confirmed cases of infant mortality in Antioquia during 2021, the sources of in-formation were epidemiological notification reports and transcripts of field interviews for event analysis. Descriptive statistics were used for the analysis of the epidemiological records and qualitative content analysis was used for the interviews. Results: In Antioquia, for the year 2021, there were 43 deaths in children under 5 years of age due to Acute Respiratory Insufficiency (ARI), Acute Diarrheal Disease (ADE) and Malnutrition (DNT), of which the highest incidence was contributed by mortality due to ARI with 24 cases, followed by mor-tality due to malnutrition with 10 cases and finally, mortality due to acute diarrheal disease had 9 cases. Ten interviews with mothers and relatives of deceased children were analyzed and the following categories of analysis were identified: syndemic and mortality; maternal mental health and infant mortality; and quality of health care. Based on the problems iden-tified, two educational events were developed with a community IMCI approach. Conclu-sion: A syndemic approach makes it possible to understand the impact of the pandemic on infant mortality, which is the first step to intervene. The increase in infant mortality figures is only the tip of the iceberg; it is necessary to consider other long-term effects on child health.

Na Colômbia, a mortalidade infantil tem seguido uma tendência de queda acentuada nos últimos anos. No entanto, após a chegada do coronavírus, foi identificado um aumento modesto nos casos de mortalidade infantil. O objetivo é descrever os fatores relacionados à mortalidade infantil e as estratégias implementadas durante 2021. Materiais e métodos: estudo descritivo retrospectivo de casos confirmados de mortalidade infantil em Antioquia durante 2021. As fontes de informação foram relatórios de notificação epidemiológica e tran-scrições de entrevistas de campo para análise de eventos. A estatística descritiva foi usada para analisar os registros epidemiológicos e a análise qualitativa de conteúdo foi usada para as entrevistas. Resultados: em Antioquia, para o ano de 2021, houve 43 mortes em crianças menores de 5 anos de idade por Insuficiência Respiratória Aguda (IRA), Doença Diarreica Aguda (DDA) e Desnutrição (DNT), das quais a maior incidência foi contribuída pela mor-talidade por IRA com 24 casos, seguida pela mortalidade por desnutrição com 10 casos e, finalmente, a mortalidade por doença diarreica aguda teve 9 casos. Dez entrevistas com mães e parentes de crianças falecidas foram analisadas e as seguintes categorias de análise foram identificadas: sindemia e mortalidade; saúde mental materna e mortalidade infantil; e quali-dade da assistência médica. Com base nos problemas identificados, foram desenvolvidos dois eventos educacionais com uma abordagem IMCI comunitária. Conclusão: Uma abordagem sindêmica permite compreender o impacto da pandemia na mortalidade infantil, o que é o primeiro passo para a intervenção. O aumento nos números da mortalidade infantil é apenas a ponta do iceberg, outros efeitos de longo prazo na saúde infantil precisam ser considerados.

Validación de una prueba serológica para detectar la infección por Helicobacter pylori en Costa Rica

Introduction: Helicobacter pylori is a Gram-negative bacterium capable to survive and multiply in the gastric mucosa. It is the most prominent factor in the development of chronic atrophic gastritis, peptic ulcer, adenocarcinoma and MALT lymphoma. It is estimated that half the world population is infected. The economic cost and impact on the quality of life caused by H. pylori are important. There are several methods to detect the bacteria, but some are invasive, expensive, or both. Objective: We compare an inexpensive serological test based on ELISA for the detection of IgG, using the urea breath test (PYtest) as the reference method. Methods: The area under the ROC curve, sensitivity, specificity and predictive values were calculated. A subset of 45 samples was used for validation of the ELISA test, while the assay was evaluated with 185 additional samples. Results: The cut-off point to discriminate between positive and negative infection status by H. pylori was 0.75, using the optical density ratio of each serum and a positive control. With a higher value of the ratio, the probability of being infected increased. Using this criterion, the test showed a sensitivity of 91.4 % and specificity of 93.7 %. All diagnostic values improved when a gray zone was considered. Conclusion: The serological test developed here is equivalent to the urea breath test. However, the serological test is more accessible to the general population because of its lower cost. This serological test could be used in large-scale clinical research.

Introducción: Helicobacter pylori es una bacteria Gram negativa capaz de sobrevivir y multiplicarse en la mucosa gástrica humana. Es el factor más importante en el desarrollo de gastritis atrófica crónica, úlcera péptica, linfoma MALT y adenocarcinoma. Se estima que la mitad de la población mundial está infectada con esta bacteria. La baja en calidad de vida y el costo económico causados por la infección por H. pylori son importantes. Existen varios métodos para su diagnóstico, pero algunos son invasivos, de alto costo o ambos. Objetivo: Comparar una prueba serológica de bajo costo basada en la técnica de ELISA para detección de IgG, usando la prueba de urea en aliento (PYtest) como método de referencia. Métodos: Se calculó el área bajo la curva ROC, sensibilidad, especificidad y valores predictivos. Se utilizaron 45 muestras de suero para validar la prueba de ELISA, mientras que para su evaluación se usaron otras 185 muestras de suero. Resultados: El punto de corte para discriminar entre positivos y negativos para la infección por H. pylori fue de 0.75 en la razón de densidad óptica entre los sueros de las muestras y el control positivo. A mayor valor de la razón, más probabilidad de ser positivo para la infección. Usando este criterio, la prueba tuvo una sensibilidad del 91.4 % y una especificidad del 93.7 %. Todos los valores diagnósticos mejoran al considerar una zona gris. Conclusiones: En la población estudiada, la prueba serológica se comporta de forma equivalente a la prueba de urea en aliento. Tiene la ventaja de que es más asequible a la población general por su bajo costo. La prueba podría ser usada en investigación clínica a gran escala.

Polimorfismos en los genes de desintoxicación CYP1A1, CYP2E1, GSTT1 y GSTM1 en la susceptibilidad al cáncer gástrico / Polymorphisms in detoxification genes CYP1A1, CYP2E1, GSTT1 and GSTM1 in gastric cancer susceptibility

Cytochrome P450 (CYP) and glutathione S-transferase (GST) enzymes are involved in activation and detoxification of many potential carcinogens. Genetic polymorphisms in those enzymes have been found to influence the interindividual susceptibility to cancer. Some polymorphisms of those enzymes have been associated specifically with susceptibility to gastric cancer. We conducted a study in a Costa Rican population, where gastric cancer incidence and mortality rates are among the highest in the world. We investigated whether such variations affected the risk of developing gastric cancer. Subjects included 31 with gastric cancer, 58 controls with gastric injures others than cancer and 51 normal controls confirmed by X-rays (double-contrast) or endoscopic diagnostic. DNA from peripheral white blood cell was obtained from all subjects. Deletion of GSTT1 and GSTM1 was assessed by multiplex PCR and genotyping of CYP2E1 was performed using a PCR-based restriction fragment length polymorphism assay with the restriction enzyme PstI and the gene CYP1A1 using the restriction enzyme MspI The prevalence of CYP1A1 Msp1 polymorphism, GSTT1 and GSTM1 null genotype was similar in the three groups of individuals (p = 0.73, p = 0.88 y p = 0.89 respectively). Our findings suggest that the polymorphism CYP2E1 PstI could be associated with a reduced risk of having gastric cancer (OR = 0.09, IC95%:0.01 - 0.83).

Mutagénesis ambiental y el uso de biomarcadores para predecir el riesgo de cáncer: [revisión] / Environmental mutagenesis and use of biomarkers in cancer risk prediction: [review]

The field of environmental mutagenesis or toxicology genetics aims to study the genetic damage that leads to mutations produced by physical, chemical and biological agents, to identify these agents and analyze their interactions and ways of action. There are enough experimental and epidemiological evidences implicating mutations in oncogenes, tumor suppressor genes and DNA repair genes as determinants in the onset and progression of the neoplastic process. A valuable tool in public and occupational health is the monitoring of populations exposed to potentially hazardous agents. The objective is to protect the health and quality of life of high risk groups on account of the nature of the agents of exposure. Monitoring of genotoxic effects in exposed populations as well as the analysis of susceptibility polymorphism are visualized as key tools in the realm of future public and occupational health in order to prevent the occurrence of environmental and specially occupational origin of tumors. This paper reviews the main concepts concerning this issue and refers to studies on the subject in Costa Rica.

Genotoxicidad de tres plaguicidas utilizados en la actividad bananera de Costa Rica / Genotoxicity of three pesticides used in Costa Rican banana plantations

The in vitro genotoxicity of imazalil and thiabendazole fungicides and the insecticide chlorpyrifos, compounds used in Costa Rican banana plantations, was evaluated with the single-cell gel electrophoresis technique (comet assay). The comet assay is a simple, rapid and low cost technique for quantification of DNA damage. This assay detects DNA single-strand breaks and alkali-labile sites in individual cells. The effects were analyzed by using human lymphocytes exposed to doses of 0, 25, 50, 75 and 100 microg/ml of each pesticide for 30 min at 37 degrees C. The cells were embedded in agarose, lysed, subjected to alkaline electrophoresis (pH >13) for 20 min at 25V, neutralized and dehydrated to be stained with a fluorescent dye and later comets visualization with the epifluorescence microscope. Chlorpyrifos and imazalil induced significant DNA damage in a dose-dependent manner. Chlorpyrifos was the major inductor of DNA breaks. These results indicate that both are genotoxic compounds in vitro. Thiabendazole fungicide did not induced DNA damage using the comet assay for all concentrations tested.

Micronúcleos y otras anormalidades nucleares en el epitelio oral de mujeres expuestas ocupacionalmente a plaguicidas / Micronuclei and other nuclear abnormalities in the oral epithelium of female workers exposed to pesticides

In order to study if banana fields labour exposure to pesticides produces some kind of DNA damage, we determine the presence of micronuclei in epithelial oral cells in working women in Guapiles and Siquirres, Costa Rica, as an effect biomarker. We also analyzed other abnormalities in the nucleus of those cells such as broken-egg, karyolysis or kariorrhexis, to see if there was some kind of genotoxicity or citotoxicity. The women group exposed to pesticides worked in packing bananas plant from different independent farms. The control group of women had never done any farming tasks; they did not live in the banana fields, neither their husband. We got information about the life style, medical and familial history of the participants through an interview. We did not found any significant increment in the frequency of micronuclei form the exposed group compared with the controls. The other nuclei abnormalities showed signs of citotoxicity or genotoxicity in the controls, associated with the intake of coffee and dental x-rays. These results do not rule out at that pesticides used in packing bananas are agents capable of producing damage to the DNA, but it seems that micronuclei from the oral epithelium is not the most adequate marker to measure it.

Aberraciones cromosómicas en trabajadoras expuestas a plaguicidas / Chromosomic aberrations in female workers exposed to pesticides

The purpose of this work was to determine if the occupational exposure to those pesticides used at banana plantations' packaging plants produces genetic damage to somatic cells of female workers. Chromosomal aberrations were scored in lymphocytes of 20 women, 10 female exposed workers and 10 female controls. Workers were recruited from independent farms from two locations in Costa Rica, during January through June in 1996 and 1997. These females had a minimum of three months of work, had never received chemotherapy or radiotherapy and did some of these labors: sealing, spraying or weighting of bananas. Control unexposed females lived in the same area, were of similar age and neither them nor their husbands/mates had ever worked in pesticide related labors. For each female, 100 mitotic figures were scored. The kind of aberrations detected were acentric fragments, dicentric chromosomes, rings, gaps and breaks. Among workers, 16% of cells (n=1000) had one or more abnormalities, whereas control unexposed females had 6% of cells (n=1000) with comparable anomalies (p < 0.05). In conclusion, the pesticide exposure is a risk factor for chromosome aberrations in female somatic cells.

Pepsinógenos séricos para detectar cáncer gástrico en Costa Rica / Serum pepsinogen in screening for gastric cancer in Costa Rica

Las concentraciones de pepsinógenos (PG) I y II en suero, reflejan el estado funcional y morfológico de la mucosa gástrica. En este estudio se determinaron los puntos de corte óptimos de los niveles séricos de PGI, PGII y de la razón PGI/PGII, para identificar a las personas con alto riesgo de cáncer gástrico en una población de alto riesgo en Costa Rica. La población en estudio estaba formada por 338 personas sin cáncer gástrico y por 20 pacientes con cáncer gástrico. Los niveles de PGI y el valor de PGI/PGII fueron significativamente más bajos en las personas con cáncer gástrico que en los controles. Los puntos de corte óptimos para la detección de cáncer gástrico fueron de PGI ¾ 2,5. Usando estos puntos de corte la sensibilidad y especificidad fueron de 90 y 64 por ciento. Las concentraciones bajas de PGI y valores bajos de PGI/PGII indican alto riesgo de presentar un cáncer gástrico. El tamizaje por medio de pepsinógenos es simple y relativamente barato, sin embargo el beneficio real de esta prueba debe determinarse en el impacto sobre las tasas de mortalidad por cáncer gástrico

Erradicación de Helicobacter pylori mediante triple terapia (amoxicilina, claritromicina y omeprazole), en pacientes del Hospital Rafael Ángel Calderón Guardia / Eradication of Helicobactr Pylori by means of triple therappy (amoxicilin, claroitromicina and omeprazole), in patients of the Hospital Rafael Calderón Guardia

Justificación y objetivo: H. pylori es un factor importante en el desarrollo de diversos tipos de patologías gástricas como: gastritis crónica, úlcera péptica, adenocarcinoma tipo intestinal y linfoma. Erradicar la infección es una importante posibilidad en la terapia de los pacientes con esas patologías. En el estudios se analizó la utilidad de la triple terapia para erradicar de la infección por H. pylori en pacientes con gastritis crónica y úlcera péptica. Métodos: Se incluyeron 267 pacientes que atendieron el Servicio de gastroenterología del HCG, entre enero y mayo de 2000. La presencia de H. pylori fue dterminada por ureasa rápida, cultivo y antígenos fecales específicos. Se determinó la CIM de algunos aislamientos mediante la prueba de E-test. Los pacientes recibieron triple terapia con amoxicilina (1000 mg bid vo), claritromicina (500 mg bid vo - Claritrobac,) y omeprazole (20 mg bid vo - Proton,), por 10 días. La erradicación de la infección se definió como presencia de H. pylori al principio del tratamiento y un resultado negativo en la prueba de antígenos fecales específicos, entre 30 y 45 días después de finalizado el tratamiento. Resultados: De los 267 pacientes que recibieron la triple terapia, 189 (70.8 por ciento) la completaron. La erradicación de la bacteria se confirmó en 127 (84,7 por ciento) de los pacientes que completaron el tratamiento. Treinta y siete (94,9 por ciento) de los 39 pacientes con diagnóstico endoscópico de úlcera péptica erradicaron la bacteria. La erradicación fue exitosa incluso en pacientes portadores de cepas que mostraron resistencia in vitro a amoxicilina o a claritromicina, aunque en este estudio la presencia de cepas sensibles no predice el éxito del tratamiento en todos los casos. Conclusión: La triple terapia basada en amoxicilina (1000 mg bid vo), claritromicina (500 mg bid vo - Claritrobac,) y omeprazole (20 mg bid vo - Proton,), por 10 días, erradicó la infección por H. pylori en el 84,7 por ciento de los pacientes que cumplieron el tratamiento, incluyeron a 37 de 39 pacientes (94,9 por ciento) con enfermedad úlcero-péptica. La triple terapia por 10 días constituye una opción exitosa para erradicar de la infección por H. pylori. Descriptores: Helicobacter pylori, triple terapia, resistencia a antibióticos, amoxicilina, claritromicina, omeprazole.

Daño del ADN en trabajadoras bananeras expuestas a plaguicidas en Limón, Costa Rica / DNA damage in female workers exposed to pesticides in banana plantations at Limón, Costa Rica

Pesticide use in Costa Rica is very high and all year round. A high percentage of what is sprayed remains in the environment and in the living organisms around. This situation brings contamination and health problems to people in contact with them. The onset of adverse effects may be in the short or the long term, and symptoms vary widely, from headaches to cancer. Much research in this area has been devoted to acute or chronic effects, and not until recently to the genotoxic effect of pesticides. This study evaluated the genotoxic effect of pesticides used in banana packing activities, using the comet assay (single cell electrophoresis) as the biological marker in lymphocytes. This was a case-control double blind study of 30 exposed women from 15 banana farms and 28 women not occupationally exposed to pesticides from the same geographic area. Results show damage to single stranded DNA after working from 5 to 15 years (R2 = 0.12). In Costa Rica we do not have an historical record of the kind of pesticides used in banana farms, the period of time and for how long were they used. This prevented further analysis concerning dose, frequency of exposure and use of new or old kind of pesticides in the farms in relation to DNA damage. The comet assay is of value in the genetic monitoring of pesticide exposed populations.

Micronuclei frequency in lymphocytes of individuals occupationally exposed to pesticides

Pesticides have been widely used in developing countries over the years. A large amount of these remains in the environment and organisms. Pesticide pollution is detrimental to human health. The effects can be seen on a short or a long-term basis and the symptoms can vary from headache to cancer. Only a minority of studies focuses on their genotoxic effect. This study assesses the genotoxic effect of the pesticides used at banana-packaging plants with binucleate micronuclei assay using cultured lymphocytes. The studied population included 32 exposed and 37 unexposed women from Costa Rica. There is no significant difference between the two groups. However, women who worked at the packaging plant and had stillbirths or spontaneous abortions were 1.45 times more (alpha = 0.06) likely to have an increased micronuclei frequency than their coworkers who lacked those disorders; this may indicate genetic susceptibility. In vitro pesticides studies and susceptibility biomarkers are needed to identify subgroups with higher risks.