Confronting the Unseen: A Journey Through Primary Intra-orbital Squamous Cell Carcinoma.

Cases of squamous cell carcinoma (SCC) that are primary in origin occur even more infrequently due to the lack of squamous epithelium that is typically present in the orbital region. When SCC occurs in the orbit, it is more commonly due to invasion or metastasis from a local site. We report an uncommon case of intra-orbital SCC in a 74-year-old male, which is likely of primary origin. Brain, face, orbital, and neck magnetic resonance imaging proceeded to gather more information on the extent of the patient's orbital malignancy, which showed significant orbital burden and intracranial extension. The biopsy was performed with final pathology results showing moderately differentiated SCC. The patient was discharged with a follow-up with oncology for chemotherapy and a follow-up with oculoplastics for surgical intervention in nine months, after completing a course of chemotherapy with irradiation. We provide this case to shed insight into the difficulties associated with the extremely uncommon occurrence of primary SCC of the orbit.

Refractory Arrhythmias as a Potential Indicator of Underlying Cardiac Amyloidosis: A Case Report.

Primary (AL) amyloidosis is a rare multisystemic disorder that occurs approximately in 9.7-14.0 cases per million per year in the United States. A late diagnosis of amyloidosis can decrease the chance of survival to less than three years. With the intention to diagnose future cases of AL amyloidosis early in clinical presentation, we describe a case of a 64-year-old female who had presented to the hospital for a pre-liver transplant workup for presumed end-stage liver disease secondary to nonalcoholic steatohepatitis (NASH). Pre-transplant electrocardiogram (ECG) findings were significant for atrial fibrillation that was unable to resolve with synchronized cardioversion. Two previous cardioversions attempted in the preceding three years with amiodarone proved unsuccessful. Following her ECG, an endoscopy and colonoscopy were completed that demonstrated a lesion within the gastric mucosa along with two polyps in the transverse colon and ascending colon. Pathology for these lesions revealed amyloidosis in all biopsy sites, which was followed by a bone marrow biopsy also confirming AL amyloidosis and proliferative monoclonal B lymphocytes. A cardiac magnetic resonance imaging (MRI) proceeded to gather more information on the systemic extent of the patient's amyloidosis, which showed signs consistent with cardiac infiltration of amyloid. The patient was discharged with at-home hospice care and later decided to pursue chemotherapy, ultimately expiring from end organ failure. We conclude that failed cardioversion in a patient with persistent atrial fibrillation can be a clinical and diagnostic marker in suspecting a diagnosis of amyloidosis. Thus, we encourage clinicians to consider systemic amyloidosis in the assessment of unsuccessful cardioversion in these patient presentations for the initiation of treatment early on in the disease course.

Intraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia.

Mortality inequalities have been described across Latin American countries, but less is known about inequalities within cities, where most populations live. We aimed to identify geographic and socioeconomic inequalities in mortality within the urban areas of four main cities in Colombia. We analyzed mortality due to non-violent causes of diseases in adults between 2015 and 2019 using census sectors as unit of analysis in Barranquilla, Bogotá, Cali, and Medellín. We calculated smoothed Bayesian mortality rates as main health outcomes and used concentration indexes (CInd) for assessing inequalities using the multidimensional poverty index (MPI) as the socioeconomic measure. Moran eigenvector spatial filters were calculated to capture the spatial patterns of mortality and then used in multivariable models of the association between mortality rates and quintiles of MPI. Social inequalities were evident but not consistent across cities. The most disadvantaged groups showed the highest mortality rates in Cali. Geographic inequalities in mortality rates, regardless of the adults and poverty distribution, were identified in each city, suggesting that other social, environmental, or individual conditions are impacting the spatial distribution of mortality rates within the four cities.

Distribución espacial de la morbimortalidad atribuible a la contaminación del aire por PM2.5 en Medellín (Colombia), 2010-2016

Objetivo: Esta investigación buscó establecer la distribución espacial de la morbimortalidad atribuible a la contaminación del aire ambiental por materia particulada (particulate matter 2.5) (PM2.5) en Medellín entre 2010 y 2016. Metodología: Se planteó un estudio ecológico. Se estandarizaron las direcciones de residencia de los pacientes atendidos y las defunciones por eventos de interés. Se emplearon mapas de calor, mediante el análisis de densidad de Kernel, por núcleos domiciliarios para áreas de 10 000 m2. Resultados: Se encontraron 45 487 y 2743 casos y defunciones, respectivamente, atribuibles a la contaminación del aire ambiental por PM2.5 con datos de localización geográfica. La zona suroccidental de la ciudad presentó las mayores densidades de eventos atribuibles por todas las causas estudiadas y por grupo de eventos, con algunas áreas pequeñas en otros lugares. Por su parte, la zona suroriental, con las mejores condiciones socioeconómicas, manifestó la menor concentración de eventos atribuibles. Conclusión: La información geocodificada de la morbimortalidad por núcleos domiciliarios posibilitó establecer la distribución de casos y muertes atribuibles a la contaminación ambiental del aire por PM2.5 en Medellín, con mayor concentración al suroccidente de la ciudad, lo que permite evidenciar la presencia de disparidades territoriales de este fenómeno.

Objective: This research aimed to establish the spatial distribution of morbidity and mortality attributable to particulate matter (pm2.5) air pollution in Medellín between 2010 and 2016. Methodology: An ecological study was proposed. Addresses of patients treated and deceased due to events of interest were standardized. Heat maps were used, through Kernel density analysis per residential units for areas of 10,000 m2. Results: 45,487 cases and 2,743 deaths attributable to pm2.5 air pollution with geographic location data were found. The southwestern area of the city presented the highest event densities attributable to all causes studied and by group of events, with some small areas in other places. On the other hand, the southeastern area, with the best socio-economic conditions, showed the lowest concentration of attributable events. Conclusion: Geocoded information of morbidity and mortality by residential units made it possible to establish the distribution of cases and deaths attributable to pm2.5 air pollution in Medellín, with a greater concentration in the southwestern part of the city, which makes the presence of territorial disparities in this phenomenon observable.

Objetivo: Esta pesquisa procurou estabelecer a distribuição espacial da morbimortalidade atribuível à poluição do ar ambiental por matéria particulada (particulate matter 2.5) (PM2.5) em Medellín entre 2010 e 2016. Metodologia: Propôs-se uma abordagem ecológica. Padronizaram-se os endereços de residência dos pacientes atendidos e as mortes por eventos de interesse. Empregaram-se mapas de calor, por meio da análise de densidade de Kernel, por núcleos domiciliários para áreas de 10000 m2. Resultados: Acharam-se 45487 e 2743 casos e mortes, respectivamente, atribuíveis à poluição do ar ambiental por PM2.5 com dados de localização geográfica. A zona do sudoeste da cidade apresentou as maiores densidades de eventos atribuíveis por todas as causas estudadas e por grupo de eventos, com algumas áreas pequenas em outros lugares. Por sua parte, a zona do sudeste, com as melhores condições socioeconômicas, manifestou a menor concentração de eventos atribuíveis. Conclusão: A informação geocodificada da morbimortalidade por núcleos domiciliários possibilitou estabelecer a distribuição de casos e mortes atribuíveis à poluição ambiental do ar por PM2.5 em Medellín, com maior concentração no sudoeste da cidade, o que permite evidenciar a presença de disparidades territoriais deste fenômeno

Local attributable burden disease to PM 2.5 ambient air pollution in Medellín, Colombia, 2010-2016.

Background: Exposure to 2.5-micron diameter air pollutants (PM 2.5) has been associated with an increased risk of illness and death worldwide; however, in Latin American health impacts assessment of this risk factor is scarce. Medellín is one of the most polluted cities in the region, with a population growth rate that is twice as high as that of other Colombian cities, which implies a growing population at risk. Methods: A descriptive study of the disease burden was carried out using the city as the unit of observation. Health events were selected based on epidemiologic evidence and the availability of the population attributable fraction associated with PM 2.5. The mortality records were taken from the module of deceased of the Single Registry of Affiliates of the Health System; the morbidity records were taken from the Individual Health Services Registries. For the estimation of the burden of disease, the current Global Burden of Disease guidelines were followed. Results: Attributable disability-adjusted life years to exposure to ambient PM 2.5 pollution (DALYs PM2.5) constituted 13.8% of total burden of the city. Males showed the greatest loss of DALYs PM2.5 due to acute events, while in women the greatest loss was due to chronic events. Ischemic heart disease, chronic diseases of the lower respiratory tract, and influenza and pneumonia were the events that contributed the most to DALYs PM2.5. 71.4% of the DALYs PM2.5 corresponded to mortality, mainly in the population over 65 years of age. Regarding attributable morbidity, acute events were more prevalent in both sexes, especially due to respiratory diseases Conclusion: Premature death among the elderly population has the greatest weight on burden of disease attributable to ambient PM 2.5 pollution, mainly due to respiratory and cardiovascular diseases, without significant differences according to gender.

Enhancing food habits via sensitivity in rural low-SES mothers of children aged 1-3 living in Colombia: a randomized controlled trial using video-feedback intervention.

In a randomized controlled trial with 25 Colombian rural low-SES mothers and their children (aged 1-3 years), the effectiveness of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) in enhancing maternal sensitivity and food habits was tested pre-intervention, post-intervention, and at a 6-month follow-up. The study further verified whether maternal sensitivity represented a mechanism of change for food habits. Mixed models indicated that the VIPP-SD did promote higher maternal sensitivity and better food habits. Moreover, increased maternal sensitivity following the VIPP-SD predicted improved maternal food habits, both post-intervention and at the follow-up. The findings suggest that interventions aimed at preventing early inadequate parental food habits in low-SES communities should promote sensitive parenting during daily mother-child interactions, in addition to offering nutritional advice.

Air pollution, sociodemographic and health conditions effects on COVID-19 mortality in Colombia: An ecological study.

OBJECTIVE: The present study aimed to determine the association between chronic exposure to fine particulate matter (PM2.5), sociodemographic aspects, and health conditions with COVID-19 mortality in Colombia. METHODS: We performed an ecological study using data at the municipality level. We used COVID-19 data obtained from government public reports up to and including July 17th, 2020. We defined PM2.5 long-term exposure as the 2014-2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fitted a logit-negative binomial hurdle model for the mortality rate adjusting for sociodemographic and health conditions. RESULTS: Estimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in either of the two components of the hurdle model (i.e., the likelihood of reporting at least one death or the count of fatal cases). We found that having 10% or more of the population over 65 years of age (MRR = 3.91 95%CI 2.24-6.81), the poverty index (MRR = 1.03 95%CI 1.01-1.05), and the prevalence of hypertension over 6% (MRR = 1.32 95%CI1.03-1.68) are the main factors associated with death rate at the municipality level. Having higher hospital beds capacity is inversely correlated to mortality. CONCLUSIONS: There was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics, health system capacity, and social conditions did have evidence of an ecological effect on COVID-19 mortality. The use of model-based estimations of long-term PM2.5 exposure includes an undetermined level of uncertainty in the results, and therefore they should be interpreted as preliminary evidence.

Malaria in Pregnancy in Endemic Regions of Colombia: High Frequency of Asymptomatic and Peri-Urban Infections in Pregnant Women with Malaria.

Background: Malaria in pregnancy (MiP) has been associated with adverse pregnancy outcomes. There is limited information on MiP in low transmission regions as Colombia. This study aimed to describe the epidemiology of MiP through active surveillance of infections by microscopy and polymerase chain reaction (PCR). Methods: A cross-sectional study was conducted between May 2016 and January 2017 in five municipalities (Apartadó, Turbo, El Bagre, Quibdó, and Tumaco) in Colombia. Pregnant women self-presenting at health centers for antenatal care visits, seeking medical care for suspected malaria, or delivery, were enrolled. Diagnosis of Plasmodium spp was made in peripheral and placental blood samples by microscopy and PCR. Results: A total of 787 pregnant women were enrolled; plasmodial infection was diagnosed by microscopy in 4.2% (95% CI 2.8-5.6; 33/787) or by nPCR in 5.3% (95% CI 3.8-6.9; 42/787) in peripheral blood. Most of the infections were caused by P. falciparum (78.5%), and 46% were afebrile (asymptomatic). Women in the first and second trimester of pregnancy were more likely to be infected (aOR = 3.06, 95%CI = 1.6 - 5.8). To live in the urban/peri-urban area (aOR = 3.04, 95%CI = 1.4 - 6.56), to have a history of malaria during last year (aOR = 5.45, 95%IC = 2.16 - 13.75), and the infrequent bed net usage (aOR = 2.8, 95%CI = 1.31 - 5.97) were associated with the infection. Pregnant infected women had a higher risk of anaemia (aOR = 2.18, 95%CI = 1.15 - 4.12) and fever (aOR = 14.2, 95%CI = 6.89 - 29.8). Conclusion: The screening for malaria during antenatal care in endemic areas of Colombia is highly recommended due to the potential adverse effects of Plasmodium spp. infection in pregnancy and as an important activity for the surveillance of asymptomatic infections in the control of malaria.

[Knowledge of malaria and long-lasting insecticidal net use practices in two departments of colombia]. / Conocimientos sobre malaria y prácticas de uso de mosquiteros insecticidas de larga duración en dos departamentos de Colombia.

OBJECTIVES: To determine the knowledge about malaria and use practice of insecticide-treated mosquito nets in the departments of Antioquia and Chocó in Colombia, 2013. MATERIALS AND METHODS: Cross-sectional and descriptive study with probability sampling of clusters, stratified and two-staged. The head of household survey was developed using ten questions on knowledge, transmission, symptoms and preventive measures against malaria, used in the questionnaires of the 2007 National Health Survey in Colombia, as well as 13 questions on long-lasting insecticidal nets, tenure, use, reasons for non-use, short-term health side effects, washing and drying. RESULTS: 2078 residents responded to the survey. 89% (95% CI: 87.5-89.9) in Antioquia and 94% (95% CI: 93.0-94.0) in Chocó recognized the causes, symptoms, treatment and prevention methods. In Antioquia, 86% (95% CI: 84.9-87.3) had at least one mosquito net and 72% (95% CI: 70.0-73.4) used it daily; and for the department of Chocó, it was 93% (95% CI: 92.2-94.4) and 73% (95% CI: 72.0-74.4), respectively. CONCLUSIONS: There are high levels of knowledge about malaria; however, the care of the mosquito nets does not follow the recommendations to increase their useful life, therefore, specific social strategies are required for each department.

Objetivos. Determinar los conocimientos sobre malaria y prácticas del uso de mosquiteros tratados con insecticidas en los departamentos de Antioquia y Chocó en Colombia, 2013. Materiales y métodos. Estudio transversal y descriptivo con muestreo probabilístico de conglomerados, estratificado y bietápico. La encuesta dirigida a jefes de hogar se elaboró usando diez preguntas sobre conocimientos, transmisión, síntomas y medidas preventivas contra la malaria, utilizado en los cuestionarios de la Encuesta Nacional de Salud en Colombia 2007, e involucrando 13 preguntas sobre los mosquiteros insecticidas de larga duración (MILD), tenencia, uso, motivos de no uso, efectos secundarios sobre la salud a corto plazo, lavado y secado. Resultados. 2078 residentes respondieron la encuesta. El 89% (IC 95%: 87,5-89,9) en Antioquia y el 94% (IC 95%: 93,0-94,0) en Chocó reconoce las causas, síntomas, tratamiento y métodos de prevención. En Antioquia el 86% (IC 95%: 84,9-87,3) tuvo al menos un mosquitero y 72% (IC 95%: 70,0-73,4) lo usó diariamente, y para el departamento de Chocó fue de 93% (IC 95%: 92,2-94,4) y 73% (IC 95%: 72,0-74,4) respectivamente. Conclusiones. Hay altos niveles de conocimiento sobre malaria; sin embargo, el cuidado de los mosquiteros no está de acuerdo a lo recomendado para aumentar su vida útil, por lo tanto, se requieren estrategias sociales propias para cada departamento.

Conocimientos sobre malaria y prácticas de uso de mosquiteros insecticidas de larga duración en dos departamentos de Colombia / Knowledge of malaria and long-lasting insecticidal net use practices in two departments of colombia

RESUMEN Objetivos. Determinar los conocimientos sobre malaria y prácticas del uso de mosquiteros tratados con insecticidas en los departamentos de Antioquia y Chocó en Colombia, 2013. Materiales y métodos. Estudio transversal y descriptivo con muestreo probabilístico de conglomerados, estratificado y bietápico. La encuesta dirigida a jefes de hogar se elaboró usando diez preguntas sobre conocimientos, transmisión, síntomas y medidas preventivas contra la malaria, utilizado en los cuestionarios de la Encuesta Nacional de Salud en Colombia 2007, e involucrando 13 preguntas sobre los mosquiteros insecticidas de larga duración (MILD), tenencia, uso, motivos de no uso, efectos secundarios sobre la salud a corto plazo, lavado y secado. Resultados. 2078 residentes respondieron la encuesta. El 89% (IC 95%: 87,5-89,9) en Antioquia y el 94% (IC 95%: 93,0-94,0) en Chocó reconoce las causas, síntomas, tratamiento y métodos de prevención. En Antioquia el 86% (IC 95%: 84,9-87,3) tuvo al menos un mosquitero y 72% (IC 95%: 70,0-73,4) lo usó diariamente, y para el departamento de Chocó fue de 93% (IC 95%: 92,2-94,4) y 73% (IC 95%: 72,0-74,4) respectivamente. Conclusiones. Hay altos niveles de conocimiento sobre malaria; sin embargo, el cuidado de los mosquiteros no está de acuerdo a lo recomendado para aumentar su vida útil, por lo tanto, se requieren estrategias sociales propias para cada departamento.

ABSTRACT Objectives. To determine the knowledge about malaria and use practice of insecticide-treated mosquito nets in the departments of Antioquia and Chocó in Colombia, 2013. Materials and Methods. Cross-sectional and descriptive study with probability sampling of clusters, stratified and two-staged. The head of household survey was developed using ten questions on knowledge, transmission, symptoms and preventive measures against malaria, used in the questionnaires of the 2007 National Health Survey in Colombia, as well as 13 questions on long-lasting insecticidal nets, tenure, use, reasons for non-use, short-term health side effects, washing and drying. Results. 2078 residents responded to the survey. 89% (95% CI: 87.5-89.9) in Antioquia and 94% (95% CI: 93.0-94.0) in Chocó recognized the causes, symptoms, treatment and prevention methods. In Antioquia, 86% (95% CI: 84.9-87.3) had at least one mosquito net and 72% (95% CI: 70.0-73.4) used it daily; and for the department of Chocó, it was 93% (95% CI: 92.2-94.4) and 73% (95% CI: 72.0-74.4), respectively. Conclusions. There are high levels of knowledge about malaria; however, the care of the mosquito nets does not follow the recommendations to increase their useful life, therefore, specific social strategies are required for each department.

Monitoring and Predicting Net Longevity by Measuring Surface Levels of Insecticide: Implementing a Faster, Cost Effective, Nondestructive, and Field-Ready Alternative to the World Health Organization Cone Test Bioassay.

An important component of malaria control programs is the ability to assess the effectiveness of the insecticide in insecticide-treated nets (ITNs) during normal usage. The standard technique to measure insecticidal activity is the World Health Organization (WHO) cone test, which in many circumstances, may be difficult to implement. We have evaluated an alternative technique, the colorimetric field test (CFT) on a group of 24-month-old Permanet® 2.0 (Vestergaard-Frandsen, Denmark) nets collected in Colombia. The CFT, which measures surface levels (SL) of deltamethrin is compared with standard high-performance liquid chromatography (HPLC) and the WHO cone test. Effective concentrations of deltamethrin for 80% mortality (EC80) were determined from the CFT and HPLC results. Distribution of insecticide SL after 24 months of use reveal that sampling of the midsection best represents the condition of the entire net. We conclude that the CFT is a practical alternative to the WHO cone test for assessing ITN efficacy.

Epidemiología de la malaria durante el embarazo: [revisión] / Epidemiology of Malaria during pregnancy: [review]

La malaria durante el embarazo es un grave problema de salud materno-infantil. Anualmente, en el mundo se reportan alrededor de 24 millones de casos de malaria en embarazadas, quienes son reconocidas como un grupo de alta susceptibilidad y vulnerabilidad frente a esta infección, debido a las adaptaciones de tipo inmunológicas ocurridas durante la gestación y a la realidad social en que vive la gestante. Tradicionalmente, el estudio de la malaria durante el embarazo se ha centrado en dilucidar la presentación clínica en cada uno de los contextos epidemiológicos en donde esta se presenta y en los aspectos biomédicos con que se asocia. Algunos pocos han explorado la relación de la realidad social y cultural con este problema. La presente revisión tiene como fin, describir la epidemiología de la malaria durante el embarazo incluyendo los aspectos biomédicos y sociales asociados a ella, para permitir una reflexión más compleja de este problema de salud...

Malaria during pregnancy is a big problem for child and maternal health. Annually 24 millions of cases of malaria are reported in pregnant women in the world, who are recognized like a group with a high susceptibility and vulnerability for this infection, due to the immunological adaptations occurring in the pregnancy and social reality of the woman in malarial region. Typically, the study of malaria during pregnancy has been focused in its clinical presentation in any epidemiological context and biomedical aspects associated with it have been elucidated. Few studies have explored the relationship between this health problem and socio-cultural reality. This review pretends to describe the epidemiology of malaria during pregnancy taking to account its biomedical and social aspects, with the objective to facilitate a complex refl ection about it...

Reporte de cinco casos de malaria neonatal grave por Plasmodium vivax en Urabá, Colombia / Report of five cases of severe neonatal Plasmodium vivax malaria in Urabá, Colombia

Introducción. La malaria neonatal es aquélla que ocurre durante el primer mes de vida. Durante más de medio siglo se reporta la presencia de parásitos de malaria en neonatos, generalmente asociada a transmisión congénita, cuya frecuencia se ha incrementado desde hace algunosaños, especialmente en África. En Latinoamérica su situación es desconocida y sólo hay reportes aislados de casos. Objetivos. Describir los casos de paludismo neonatal diagnosticado en los hospitales de la región del Urabá antioqueño entre marzo de 2002 y marzo de 2004. Materiales y métodos. Se hizo una búsqueda de casos en los hospitales de Turbo y Apartadó que cumplieran los criterios de malaria neonatal. Se buscaron y tabularon datos sobre algunas características: maternas, demográficas de los neonatos, clínicas de la enfermedad y hallazgos de laboratorio. Resultados. Se encontraron cinco casos de malaria neonatal, todos por Plasmodium vivax, de los cuales, sólo uno cumplió los criterios de infección congénita. Aunque tres de los pacientes tuvieron parto institucional y dos antecedentes maternos de malaria gestacional, ninguno fue tamizado para malaria; 25 por ciento (1 de 4) de las madres eran primíparas y la mitad eran menores de 20 años. Todos los neonatos tuvieron fiebre, algún signo de enfermedad grave al examen físico de ingreso y cifras de hemoglobina compatibles con anemia neonatal grave. Ninguno recibió el esquema antipalúdico recomendado.Conclusión. Se trata de un reporte de cinco casos de malaria neonatal grave por P. vivax, especie que habitualmente no se relaciona con complicaciones, sin que existiera en ningún caso la sospecha clínica y con tratamiento inadecuado.

[Report of five cases of severe neonatal Plasmodium vivax malaria in Urabá, Colombia]. / Reporte de cinco casos de malaria neonatal grave por Plasmodium vivax en Urabá, Colombia.

INTRODUCTION: Neonatal malaria is a type of malaria that occurs during the first month of life. In the last half century, the reports of malaria parasites in neonates generally have been associated with congenital transmission. However, in recent years, cases have appeared with increasing frequency, especially in Africa. In Latin America, the incidence of neonatal malaria is unknown, with only isolated cases reported. OBJECTIVE: Cases of neonatal malaria were identified and characterized to better recognize the frequency and symptoms of cases as they occur in Colombia. MATERIALS AND METHODS: Between March 2002-March 2004, a search for cases of neonatal malaria was made in the hospitals of the Turbo and Apartadó counties (Urabá, Antioquia Province). The following date were compiled: (1) characteristics of the mother, (2) demographic characteristics of the neonates, (3) clinical characteristics of the disease, and (4) laboratory results. RESULTS: Five cases were discovered of neonatal vivax malaria; however, only one met the criteria for congenital infection. Three patients had institutional delivery and two had a maternal history of gestational malaria, but none underwent a screening test for malaria. One of the four mothers were primaparous and half of them were younger than 20 years. All neonates had fever and presented some sign of severe disease during the first medical examination; each had hemoglobin levels compatible with severe neonatal anemia. No neonate had received the recommended treatment for this type of malaria. CONCLUSION: Five cases of severe neonatal malaria were reported, caused by infections of P. vivax, which normally does not produce severe disease. Since none of the malaria cases were recognized or treated at the local hospitals, advisories to medical professionals are recommended concerning neonatal malaria, particularly in endemic regions.

Eficacia de tres esquemas con cloroquina – primaquina para el tratamiento de la malaria por Plasmodium vivax en Colombia / Efficacy of three chloroquine-primaquine regimens for treatment of Plasmodium vivax malaria in Colombia

La malaria por Plasmodiun vivax es una de las principales causas de morbilidad en centro y sur América. En Colombia es la más prevalente y representa el 75 por ciento de los casos reportados. La primaquina (PQ) es la única droga disponible de uso clínico para eliminar los hipnozoitos y prevenir recaídas en la malaria por P. vivax. Se hizo un ensayo clínico aleatorio controlado sin placebo y no ciego. Se estudió la eficacia antirrecaída de tres esquemas de tratamiento con dosis total de PQ (45, 105 y 210 mg) suministrados en dosis de 15 mg/día, en 210 adultos con diagnóstico de P. vivax en dos municipios de Antioquia (Colombia). Todos los pacientes recibieron una dosis total de 1.500 mg de cloroquina [CQ] en tres días (600 mg el día 1 y 450 mg los días 2 y 3). Los pacientes tuvieron una respuesta clínica adecuada del 100 por ciento al tratamiento CQ+PQ hasta el día 28, en los tres grupos. El porcentaje de recurrencias durante los seis meses de seguimiento fue de 45 por ciento, 36,6 por ciento y 17,6 por ciento para los grupos con 45, 105 y 210 mg de PQ respectivamente. El tratamiento convencional (210 mg) fue un factor de protección para las recurrencias cuando se comparó con los esquemas de 45 y 105 mg respectivamente. El tratamiento convencional sigue siendo el tratamiento más eficaz para prevenir las recaídas en la malaria por P. vivax en una zona endémica...

Plasmodium vivax malaria is an important cause of morbility in Central and South America. In Colombia this is the most prevalent malaria infection representing75 % of the reported cases. To define the efficacy of the chloroquine and primaquine regimen to eliminatehypnozoites and prevent relapses, we a conducted a random controlled clinical trial of three primaquine regimens in an open-label study. We evaluated the anti-relapse efficacy of a total primaquine dose of 45, 105 and 210 mg administered at 15mg/day in 210 adults with P. vivaxinfection from the Northwestern region of Colombia. Cure rates for blood stage vivax malaria by day 28 of followupwere 100 % in all groups. Post-treatment reappearance of parasitaemia during the 6 months of following up was 45 %, 36,6 % and 17,6 % respectively, for each group. When compared to other groups, administration of 210 mg was a significant protection factor for reappearance of parasitaemia in an endemic area.