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Background and Aims: Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide. There have been limited studies regarding ARF in high altitude settings. The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with ARF. Methods: The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric ARF. For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit (PICU) length of stay. Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at the time of admission. Patients who developed ARF were followed at the time of ARF, 48 h later, at the time of discharge, and at 30 and 60 days after discharge. It was conducted in the pediatric emergency, in-hospital, and critical-care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021. Results: Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, 90 patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00-11.5). Incidence of mortality was 6.1% (n = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay, the associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission. Conclusions: ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.
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Background and Aims: The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. Methods: This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. Results: Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. Conclusion: ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.
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Background and Aims: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. Methods: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. Results: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies.
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Introducción: El efecto deletéreo de material particulado fino exterior sobre la salud respiratoria de la población de niños y de adultos mayores, es de interés en salud pública. Objetivo: Establecer el efecto de la contaminación por Material Particulado de menos de 2,5 μm de diámetro (PM2,5), sobre la Enfermedad Respiratoria Aguda (ERA) en los menores de 5 y personas de mínimo 65 años, ajustado por variables meteorológicas y climáticas, en los municipios del Área Metropolitana del Valle de Aburrá (Colombia), 2008 a 2015. Materiales y métodos: Estudio ecológico con información de la red de vigilancia de calidad del aire y de registros de prestación de servicios de salud. Se construyeron Modelos Aditivos Generalizados con función de enlace Poisson y suavización spline. Para cada rezago distribuido se calculó la medida de la asociación e intervalo de confianza. Resultados: Los casos de ERA aumentaron significativamente en los menores de 5 años en Envigado y Caldas (43,3% vs 29,6%) y en los de 65 y más años, en Medellín (13,2%) por cada incremento de 10 µg/m3 en PM2,5 al día quince a partir de la exposición. Conclusiones: Los eventos diarios respiratorios tuvieron especial frecuencia en Medellín y en municipios de la zona sur.
Introduction: The harmful effect of fine particulate matter on the respiratory health of child and elderly populations is a concern for public health. Objective: To establish the effect of pollution by less than 2.5 μm in diameter (PM2.5) particulate matter on Acute Respiratory Disease (ARD) during 2008-2015 in children younger than 5 and adults older than 65 from the Metropolitan Area of the Aburrá Valley (Colombia), adjusting for meteorological and climate variables. Materials and methods: Ecological study with information from the air quality surveillance network and individual records of health providers. Generalized Additive Models were developed using smoothing spline Poisson models. The assessment of the association and confidence intervals were calculated for each distributed lag. Results: For each 10 µg/m3 increment in PM2,5 and the day 15 post-exposure, ARD cases increased significantly in populations who are younger than 5 and older than 65 in Envigado and Caldas (43.3% vs. 29.6%) and Medellín (13.2%), respectively. Conclusions: Daily respiratory events had a special frequency in Medellín and the municipalities of the southern region.
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Humanos , Preescolar , Anciano , Anciano de 80 o más Años , Salud , Ambiente , Enfermedades Respiratorias , Salud Pública , Enfermedad , Contaminación del Aire , Contaminación Ambiental , Material ParticuladoRESUMEN
Introduction: During the COVID-19 pandemic, women disproportionately assume more unpaid activities, affecting their employment. Objective: Describe the influence of COVID-19 on the employment of caregivers of children and adolescents from a gender perspective. Methods: Cross-sectional study in three high-complexity hospitals in Bogotá, Colombia from April 2020 to June 2021. A subsample of the FARA cohort was taken, including those patients with a positive test for SARS-COV2. We took as our analysis category children older than 8 years and younger than 18 years who had a positive SARS-COV2 test, as well as, caregivers of all children with a positive SARS-COV2 test. This subsample was drawn from the FARA cohort. A survey was applied to them. We carried out a descriptive and stratified analysis by age group, educational, and socioeconomic level. Results: We included 60 surveys of caregivers and 10 surveys of children. The main caregiver in 94.8% of the cases was a female. At the beginning of the pandemic, 63.3% of the caregivers were employed, and 78.9% of those lost their employment. The vast majority of these caregiver were women (96.6%, n = 29). A predominance of loss of work activity was documented in caregivers of children in early childhood 66.6% (n = 20), with lower education 66.6% (n = 20), and from lower strata 56.6% (n = 17). Conclusion: Caregivers of children with COVID-19 with low educational levels and lower socioeconomic conditions, as well as those with children under 5 years showed greater likelihood of employment loss between the interviewed subsample.
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Background: Acute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce. Objective: To determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic. Methods: A multicenter prospective cohort study called the FARA cohort was developed between April 2020 - December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included. Results: 685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-year CI 95%, (37.3-47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72â h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce. Conclusions: This multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.
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INTRODUCTION: Respiratory syncytial virus (RSV) is one of the most important childhood infections. OBJECTIVE: To evaluate the effectiveness and safety of palivizumab immunoprophylaxis in preterm infants at a high risk of severe respiratory syncytial virus infection during the RSV season in Colombia. METHODOLOGY: A prospective observational non-comparative multicenter study in six Colombian cities. At the beginning of the RSV infection season, palivizumab prophylaxis, up to five doses, was administered to infants born at ≤32 weeks of gestation, infants younger than six months, infants under one year of age with bronchopulmonary dysplasia (BPD), infants one year or less of age with hemodynamically significant acyanotic and non-acyanotic congenital heart disease (CHD), and with follow-up during the immunoprophylaxis until one month after the last dose. RESULTS: The study enrolled 600 patients, 91.8% of which were born at ≤ 32 weeks of gestation. BPD was observed in 54.9% of infants. 49% were born at < 32 weeks gestation and presented BPD. 6.9% had hemodynamically significant acyanotic and non-acyanotic CHD 53.3% received three or more doses of palivizumab. The mean interval between doses was 39.6 days. 1.8% of patients were hospitalized due to a confirmed RSV infection. Overall mortality was 1.2%, whereas the mortality by RSV in infants undergoing prophylaxis was 0.2%. CONCLUSIONS: Palivizumab was a clinically effective, well-tolerated treatment in the Colombian population. The safety profile of palivizumab reflects the findings from previous studies in developed countries.
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Antivirales/administración & dosificación , Palivizumab/administración & dosificación , Infecciones por Virus Sincitial Respiratorio/prevención & control , Colombia , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Profilaxis Posexposición/métodos , Estudios Prospectivos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Virus Sincitial Respiratorio Humano/inmunologíaRESUMEN
Talipes equinovarus, atrial septal defect, Robin sequence and persistent left superior vena cava (TARP) syndrome is a congenital disease caused by mutations in the RBBM10 gene. It has a low prevalence and a high rate of mortality in the neonatal stage. In this case report, we present a case of a 32-week gestational age preterm newborn with a prenatal diagnosis of intrauterine growth restriction, with a persistent left superior vena cava, interatrial communication and a horseshoe kidney. Additionally, postnatal optic nerve atrophy was diagnosed. By using exome sequencing, the pathogenic variant c.1877del; p.his626Lefus*78 was identified in the RMB10 gene. Due to a lack of reports in the medical literature, the phenotype has not fully been described. Here, we report on a patient with TARP syndrome and a previously unreported mutation, c.1877del; p.his627Leufs*78, which is predicted to generate a truncated and/or protein decay of the RBM10 transcript.
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Pie Equinovaro , Defectos del Tabique Interatrial , Síndrome de Pierre Robin , Atrofia , Cardiopatías Congénitas , Humanos , Recién Nacido , Nervio Óptico/diagnóstico por imagen , Proteínas de Unión al ARN , Vena Cava SuperiorRESUMEN
The datasets presented here were partially used in "Formulation and MIP-heuristics for the lot sizing and scheduling problem with temporal cleanings" (Toscano, A., Ferreira, D., Morabito, R., Computers & Chemical Engineering) [1], in "A decomposition heuristic to solve the two-stage lot sizing and scheduling problem with temporal cleaning" (Toscano, A., Ferreira, D., Morabito, R., Flexible Services and Manufacturing Journal) [2], and in "A heuristic approach to optimize the production scheduling of fruit-based beverages" (Toscano et al., Gestão & Produção, 2020) [3]. In fruit-based production processes, there are two production stages: preparation tanks and production lines. This production process has some process-specific characteristics, such as temporal cleanings and synchrony between the two production stages, which make optimized production planning and scheduling even more difficult. Thus, some papers in the literature have proposed different methods to solve this problem. To the best of our knowledge, there are no standard datasets used by researchers in the literature to verify the accuracy and performance of proposed methods or to be a benchmark for other researchers considering this problem. The authors have been using small data sets that do not satisfactorily represent different scenarios of production. Since the demand in the beverage sector is seasonal, a wide range of scenarios enables us to evaluate the effectiveness of the proposed methods in the scientific literature in solving real scenarios of the problem. The datasets presented here include data based on real data collected from five beverage companies. We presented four datasets that are specifically constructed assuming a scenario of restricted capacity and balanced costs.
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Ebstein anomaly is a congenital heart defect with a low prevalence and high mortality in the early stages of life. In medical literature, there is no reported association between Ebstein anomaly and cri du chat syndrome. Here, we report the case of a full-term newborn with a low weight for his age and who had a prenatal diagnosis of Ebstein anomaly and a postnatal diagnosis of cri du chat syndrome and 20q duplication detected on array CGH. The patient required medical treatment with inotropic support, high-frequency ventilation and nitric oxide, with an adequate response. Surgical intervention was not needed.
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Deleción Cromosómica , Duplicación Cromosómica , Cromosomas Humanos Par 20 , Síndrome del Maullido del Gato , Anomalía de Ebstein , Manejo de la Vía Aérea/métodos , Cardiotónicos/uso terapéutico , Cromosomas Humanos Par 20/genética , Síndrome del Maullido del Gato/complicaciones , Síndrome del Maullido del Gato/diagnóstico , Síndrome del Maullido del Gato/genética , Diagnóstico Diferencial , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/genética , Anomalía de Ebstein/fisiopatología , Anomalía de Ebstein/terapia , Pruebas Genéticas/métodos , Humanos , Recién Nacido , Masculino , Tamizaje Neonatal/métodos , Óxido Nítrico/uso terapéutico , Manejo de Atención al Paciente , Diagnóstico Prenatal/métodos , Enfermedades RarasRESUMEN
OBJETIVO: determinar a frequência, as complicações e a sazonalidade com que a infecção pelo vírus sincicial respiratório (VSR) do trato respiratório inferior causa hospitalização em neonatos com um ano de idade ou menos, em seis cidades da Colômbia. MÉTODOS: estudo observacional prospectivo multicêntrico de um ano que incluiu 717 pacientes, que compareceram ao serviço de emergência com sintomas respiratórios em seis cidades da Colômbia. As crianças hospitalizadas foram testadas para verificar a existência de VSR com teste de imunofluorescência das secreções nasofaríngeas. Foram realizadas análises descritivas e estatísticas da população. RESULTADOS: a população estudada incluiu 717 pacientes com uma idade média de 3,6 meses (DP 3,25), na proporção de 4:3 do sexo masculino para o sexo feminino e uma prevalência de ITRI por VSR de 30% (216 neonatos/cidade, faixa 26-49%). Os fatores de risco para ITRI por VSR foram encontrados em 8,2% da população, dos quais 28,8% foram positivos para VSR. Os grupos positivo e negativo para VSR foram comparados utilizando um teste t bicaudal com IC de 95%, p < 0,05. Não foram constatadas diferenças estatisticamente significativas. Todas as cidades apresentaram trimestres anuais específicos para ocorrência de ITRI por VSR. CONCLUSÕES: o VSR causou uma em três internações de ITRI na população, com uma incidência de 30%. Isso confirma uma circulação contínua do VSR na Colômbia, que varia pela localização geográfica.
OBJECTIVE: to determine the frequency, complications and seasonality at which respiratory syncytial virus (RSV) infection of the lower respiratory tract causes hospitalization in infants of age 1 year or less in 6 cities of Colombia. METHODS: one-year prospective multicentric observational study that included 717 patients presenting to the emergency department with respiratory symptoms in 6 cities of Colombia. Hospitalized children were tested for RSV with an immunofluorescence rapid test in nasopharyngeal secretions. Descriptive and statistical analyses of the population were conducted. RESULTS: the study population included 717 patients with a mean age of 3.6 months (SD 3.25), 4:3 male: female ratio and a positive RSV LRTI prevalence of 30.0% (216 infants/City, range 26.0 - 49.0%). Risk factors for RSV LRTI were found in 8.2% of the population, of which 28.8% were RSV positive. RSV positive and negative groups were compared using a two-tailed t test with 95.0%CI, p < 0.05. No statistically significant differences were found. All cities presented specific year trimesters in the occurrence of RSV LRTI. CONCLUSIONS: the RSV caused 1 in 3 LRTI hospitalizations in the population, with an incidence of 30.0%. This confirms a continuous circulation of RSV in Colombia varying by geographic location.
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Femenino , Humanos , Lactante , Recién Nacido , Masculino , Virus Sincitial Respiratorio Humano , Infecciones por Virus Sincitial Respiratorio/complicaciones , Secreciones Corporales , Comorbilidad , Colombia/epidemiología , Hospitalización , Nasofaringe/virología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Infecciones por Virus Sincitial Respiratorio/epidemiología , Estaciones del AñoRESUMEN
OBJECTIVE: to determine the frequency, complications and seasonality at which respiratory syncytial virus (RSV) infection of the lower respiratory tract causes hospitalization in infants of age 1 year or less in 6 cities of Colombia. METHODS: one-year prospective multicentric observational study that included 717 patients presenting to the emergency department with respiratory symptoms in 6 cities of Colombia. Hospitalized children were tested for RSV with an immunofluorescence rapid test in nasopharyngeal secretions. Descriptive and statistical analyses of the population were conducted. RESULTS: the study population included 717 patients with a mean age of 3.6 months (SD 3.25), 4:3 male: female ratio and a positive RSV LRTI prevalence of 30.0% (216 infants/City, range 26.0 - 49.0%). Risk factors for RSV LRTI were found in 8.2% of the population, of which 28.8% were RSV positive. RSV positive and negative groups were compared using a two-tailed t test with 95.0%CI, p < 0.05. No statistically significant differences were found. All cities presented specific year trimesters in the occurrence of RSV LRTI. CONCLUSIONS: the RSV caused 1 in 3 LRTI hospitalizations in the population, with an incidence of 30.0%. This confirms a continuous circulation of RSV in Colombia varying by geographic location.
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Infecciones por Virus Sincitial Respiratorio/complicaciones , Virus Sincitial Respiratorio Humano , Secreciones Corporales , Colombia/epidemiología , Comorbilidad , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Nasofaringe/virología , Prevalencia , Estudios Prospectivos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Factores de Riesgo , Estaciones del AñoRESUMEN
In malaria-endemic regions of Latin America, little is known about malaria in pregnancy. To characterize the clinical and laboratory findings of maternal infection, we evaluated 166 cases of pregnant women infected with Plasmodium spp. in a prospective study conducted in northwestern Colombia during 2005-2006. A total of 89.8% (149 of 166) had fever or a history of fever in the past 48 hours, 9.0% (15 of 166) had severe malaria, of which 66.7% was caused by Plasmodium vivax and 33.3% by P. falciparum. Hepatic dysfunction was the main complication (9 of 15) observed. The proportion of severe cases was similar for both species (P = 0.41). In malaria-endemic areas of Colombia, malaria in pregnancy has a broad clinical spectrum. In pregnant women, P. vivax infection frequently leads to organ-specific complications.
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Enfermedades Endémicas , Malaria Falciparum/epidemiología , Malaria Vivax/epidemiología , Complicaciones Parasitarias del Embarazo/epidemiología , Adolescente , Adulto , Alanina Transaminasa/sangre , Colombia/epidemiología , Creatinina/sangre , Femenino , Humanos , Malaria Falciparum/sangre , Malaria Vivax/sangre , Plasmodium falciparum/aislamiento & purificación , Plasmodium vivax/aislamiento & purificación , Embarazo , Estudios Prospectivos , Adulto JovenRESUMEN
Approximately 170 million inhabitants of the American continent live at risk of malaria transmission. Although the continent's contribution to the global malaria burden is small, at least 1-1.2 million malaria cases are reported annually. Sixty percent of the malaria cases occur in Brazil and the other 40% are distributed in 20 other countries of Central and South America. Plasmodium vivax is the predominant species (74.2%) followed by P. falciparum (25.7%) and P. malariae (0.1%), and no less than 10 Anopheles species have been identified as primary or secondary malaria vectors. Rapid deforestation and agricultural practices are directly related to increases in Anopheles species diversity and abundance, as well as in the number of malaria cases. Additionally, climate changes profoundly affect malaria transmission and are responsible for malaria epidemics in some regions of South America. Parasite drug resistance is increasing, but due to bio-geographic barriers there is extraordinary genetic differentiation of parasites with limited dispersion. Although the clinical spectrum ranges from uncomplicated to severe malaria cases, due to the generally low to middle transmission intensity, features such as severe anemia, cerebral malaria and other complications appear to be less frequent than in other endemic regions and asymptomatic infections are a common feature. Although the National Malaria Control Programs (NMCP) of different countries differ in their control activities these are all directed to reduce morbidity and mortality by using strategies like health promotion, vector control and impregnate bed nets among others. Recently, international initiatives such as the Malaria Control Program in Andean-country Border Regions (PAMAFRO) (implemented by the Andean Organism for Health (ORAS) and sponsored by The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)) and The Amazon Network for the Surveillance of Antimalarial Drug Resistance (RAVREDA) (sponsored by the Pan American Health Organization/World Health Organization (PAHO/WHO) and several other partners), have made great investments for malaria control in the region. We describe here the current status of malaria in a non-Amazonian region comprising several countries of South and Central America participating in the Centro Latino Americano de Investigación en Malaria (CLAIM), an International Center of Excellence for Malaria Research (ICEMR) sponsored by the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID).
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Erradicación de la Enfermedad/métodos , Malaria/epidemiología , Malaria/prevención & control , Programas Nacionales de Salud/organización & administración , Animales , Anopheles/efectos de los fármacos , Anopheles/parasitología , Anopheles/fisiología , Antimaláricos/farmacología , Erradicación de la Enfermedad/organización & administración , Resistencia a Medicamentos , Humanos , Insectos Vectores/efectos de los fármacos , Insectos Vectores/parasitología , Insectos Vectores/fisiología , Insecticidas/farmacología , Cooperación Internacional , América Latina/epidemiología , Malaria/parasitología , Malaria/patología , Control de Mosquitos/métodos , Plasmodium/patogenicidad , Evaluación de Programas y Proyectos de Salud/métodosRESUMEN
Traditionally, malaria research and study have followed the positivist scientific paradigm and its biomedical conception of disease. From this perspective, diverse control actions and strategies have been designed. However, despite a century of scientific experience and the depth and thoroughness achieved in the knowledge of malaria, this has not been translated into a constant and progressive decrease of its epidemiological burden. This essay argues for the need for a change in malaria conception, reconfiguring it as a process of biological and social character, where the geno-phenotypical possibilities of the host-parasite relationship and of the diseases clinical expression are articulated with the historic and social dynamics of the spaces in which they occur. In addition, it proposes rethinking the epidemiological research of this entity on the basis of the visualization of the dynamic, heterogeneous, dialectic and complex character of biosocial organizations that constitute the reality of malaria (from the social structure to the genetic and phenotypic level of parasite individuals, vectors and humans). To achieve this, it is suggested that: 1) the Latin American perspective on the social determinants of health be adopted; 2) new analytical categories (for instance, malaria social territory) and new investigation tools (matrices of critical processes of social determination) be incorporated, and 3) the conventional epidemiological categories of infectious diseases such as the transmission and infectiousness be reinterpreted.
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Malaria , Investigación Biomédica , Humanos , América Latina , Malaria/epidemiología , Malaria/prevención & control , Medicina SocialRESUMEN
Selecting suitable anti-malarial treatment represents one of the best tools for reducing morbidity and mortality caused by this disease. Sexual and asexual parasite dynamics were thus evaluated in patients involved in antimalarial drug efficacy studies by using combined treatment with and without artemisinin derivatives for treating uncomplicated acute Plasmodium falciparum malaria in Antioquia, Colombia. All treatment doses were supervised and administered according to patients' weight; sexual and asexual parasitemia were evaluated during 28- or 42-days follow-up in 468 patients. Artemisinin-based combination therapy showed greater parasiticidal ability, showing a mean asexual parasitemia survival rate of one day and mean gametocyte survival rate of 1-2 days. Sexual and asexual parasitemias were eliminated more quickly and effectively in the group receiving artemisinin-based combination therapy. Adding 45 mg of primaquine to treatment with artesunate and mefloquine reduced gametocyte and asexual parasite survival by one day.
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Antimaláricos/uso terapéutico , Quimioterapia Combinada/tendencias , Malaria Falciparum/tratamiento farmacológico , Malaria/tratamiento farmacológico , Parasitemia/tratamiento farmacológico , Administración Oral , Animales , Antimaláricos/administración & dosificación , Artemisininas/administración & dosificación , Artemisininas/uso terapéutico , Artesunato , Protocolos Clínicos , Colombia/epidemiología , Femenino , Humanos , Malaria Falciparum/parasitología , Masculino , Mefloquina/uso terapéutico , Cooperación del Paciente/psicología , Plasmodium falciparum/efectos de los fármacos , Primaquina/uso terapéutico , Resultado del TratamientoRESUMEN
Tradicionalmente, la investigación y el estudio de la malaria se han hecho bajo el paradigma positivista de la ciencia y su concepción biomédica de la enfermedad. Desde esta perspectiva se han diseñado las diversas acciones y estrategias para contrarrestarla. Sin embargo, a pesar de un siglo de experiencia científica, y de la profundidad y minuciosidad logradas en el campo de conocimiento de malaria, esto no se ha traducido en una disminución constante y progresiva de su carga epidemiológica. Este ensayo plantea la necesidad de un cambio en la concepción de la malaria, configurándola como un proceso de carácter biológico y social, en el cual las posibilidades genotípicas y fenotípicas de la relación entre huésped y parásito y de la expresión clínica de la enfermedad, se articulen a las dinámicas históricas y sociales de los espacios donde se presentan. Además, se propone replantear la investigación epidemiológica de esta entidad tomando como base la visualización del carácter dinámico, heterogéneo, dialéctico y complejo de las organizaciones biosociales que constituyen la realidad de la malaria, desde la estructura social hasta el nivel genético y fenotípico de los individuos parasitarios, vectoriales y humanos. Para esto se sugiere: 1) asumir el enfoque latinoamericano de factores determinantes sociales de la salud, 2) incorporar nuevas categorías analíticas (por ejemplo, territorio social de la malaria) y nuevas herramientas de investigación (matrices de procesos críticos de la determinación social), y 3) reinterpretar las categorías epidemiológicas convencionales de las enfermedades infecciosas, como la transmisión y la contagiosidad.
Traditionally, malaria research and study have followed the positivist scientific paradigm and its biomedical conception of disease. From this perspective, diverse control actions and strategies have been designed. However, despite a century of scientific experience and the depth and thoroughness achieved in the knowledge of malaria, this has not been translated into a constant and progressive decrease of its epidemiological burden.This essay argues for the need for a change in malaria conception, reconfiguring it as a process of biological and social character, where the geno-phenotypical possibilities of the host-parasite relationship and of the diseases clinical expression are articulated with the historic and social dynamics of the spaces in which they occur. In addition, it proposes rethinking the epidemiological research of this entity on the basis of the visualization of the dynamic, heterogeneous, dialectic and complex character of biosocial organizations that constitute the reality of malaria (from the social structure to the genetic and phenotypic level of parasite individuals, vectors and humans). To achieve this, it is suggested that: 1) the Latin American perspective on the social determinants of health be adopted; 2) new analytical categories (for instance, malaria social territory) and new investigation tools (matrices of critical processes of social determination) be incorporated, and 3) the conventional epidemiological categories of infectious diseases such as the transmission and infectiousness be reinterpreted.
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Epidemiología , Malaria , Medicina Social , Transmisión de Enfermedad Infecciosa , InvestigaciónRESUMEN
Candida infections represent a major threat in neonatal intensive care units. This is the first prospective study to obtain caspofungin plasma levels and safety data for neonates and very young infants. Patients of <3 months of age receiving intravenous amphotericin B for documented or highly suspected candidiasis were enrolled in a single-dose (n = 6) or subsequent multiple-dose (n = 12) panel; all received caspofungin at 25 mg/m(2) once daily as a 1-hour infusion. Caspofungin plasma levels were measured by high-performance liquid chromatography and compared to historical data from adults. Patient chronological ages ranged from 1 to 11 weeks, and weights ranged from 0.68 to 3.8 kg. Gestational ages ranged from 24 to 41 weeks. Geometric mean (GM) peak (C(1 h)) and trough (C(24 h)) caspofungin levels were 8.2 and 1.8 microg/ml, respectively, on day 1, and 11.1 and 2.4 microg/ml, respectively, on day 4. GM ratios for C(1 h) and C(24 h) for neonates/infants relative to adults receiving caspofungin at 50 mg/day were 1.07 and 1.36, respectively, on day 1, and 1.18 and 1.21, respectively, on day 4. Clinical and laboratory adverse events occurred in 17 (94%) and 8 (44%) patients, respectively. Five patients (28%) had serious adverse events, none of which were considered drug related. Caspofungin at 25 mg/m(2) once daily was well tolerated in this group of neonates/infants of <3 months of age and appears to provide relatively similar plasma exposure to that obtained in adults receiving 50 mg/day. However, the small number of patients studied precludes any definitive recommendations about caspofungin dosing for this group comprising a broad range of ages and weights.
Asunto(s)
Antifúngicos/farmacocinética , Equinocandinas/farmacocinética , Antifúngicos/administración & dosificación , Antifúngicos/efectos adversos , Antifúngicos/sangre , Superficie Corporal , Candidiasis/tratamiento farmacológico , Caspofungina , Ensayos Clínicos como Asunto , Esquema de Medicación , Equinocandinas/administración & dosificación , Equinocandinas/efectos adversos , Equinocandinas/sangre , Femenino , Fiebre/inducido químicamente , Humanos , Hipertensión/inducido químicamente , Hiperventilación/inducido químicamente , Lactante , Recién Nacido , Infusiones Intravenosas , Lipopéptidos , Masculino , Estudios Multicéntricos como Asunto , Estudios ProspectivosRESUMEN
Introducción: Actualmente existe un número limitado de antimaláricos eficaces, entre ellos amodiaquina; sin embargo, su uso se ha restringido por informes previos de toxicidad hepática y hemática a dosis superiores a 1,500 mg administradas como profiláctico para malaria. No obstante, en dosis terapéuticas antimaláricas los efectos adversos son de intensidad leve o moderada, e incluyen náuseas, vómito y prurito. Objetivo: Evaluar la toxicidad hepática y hemática de la amodiaquina en dosis y tiempo establecidos para tratar la malaria por Plasmodium falciparum no complicada. Metodología: Diseño longitudinal con determinación no ciega del efecto. Se captaron 57 pacientes, seguidos por 10 días (evaluación clínico-parasitológica). Resultados: Antes del tratamiento, las variables hemáticas y hepáticas mostraron alteración leve y se normalizaron postratamiento, que fue 100% eficaz. Los días 5 y 10 del tratamiento todas las variables estaban normales, lo que sugiere ausencia de efectos tóxicos imputables al medicamento. Los efectos adversos fueron pocos, leves y desaparecieron completamente el día 10. Conclusiones: Usada en la dosis (25 mg/kg peso) y el tiempo (3 días) definidos para el tratamiento de la malaria por P. falciparum sin complicaciones, la amodiaquina no mostró efectos adversos ni toxicidad hepática ni hemática.
Background: At present there are few effective antimalarial drugs, amodiaquine is one of them; however, its use has been restricted by previous information about hematic and hepatic toxicity when it is administered as prophylactic at doses greater than 1,500 mg. But at therapeutic doses, the side effects are either slight or of moderate intensity and include nausea, vomit and pruritus. Objective: To evaluate the hepatic and hematic toxicity of amodiaquine administered at doses and time recommended for treatment of uncomplicated Plasmodium falciparum malaria. Methods: Longitudinal design with no blind determination of the effect. A total of 57 patients were included and followed up for 10 days (clinical-parasitological evaluation). Results: Hematic and hepatic variables showed slight alteration previous treatment and were normal postreatment. Therapeutic efficacy of amodiaquine was 100%. All variables were normal at days 5 and 10, suggesting absence of toxic effects imputable to amodiaquine. The side effects were few, slight and disappeared completely at day 10. Conclusions: Amodiaquine administered at doses (25 mg/kg weight) and time (3 days) established for treatment of uncomplicated Plasmodium falciparum malaria is safe, it did not show neither hematic nor hepatic toxicity.
Asunto(s)
Amodiaquina , Antimaláricos , Malaria , Plasmodium falciparumRESUMEN
Plasmodium vivax malaria is an important cause of morbidity in Central and South America. In Colombia, this is the most prevalent malaria infection, representing 75% of the reported cases. To define the efficacy of the chloroquine and primaquine regimen to eliminate hypnozoites and prevent relapses, we conducted a random controlled clinical trial of three primaquine regimens in an open-label study. We evaluated the anti-relapse efficacy of total primaquine doses of 45, 105, and 210 mg administered at a dosage of 15 mg/day in 210 adults with P. vivax infection from the northwestern region of Colombia. Cure rates for blood-stage P. vivax malaria by day 28 of follow-up were 100% in all groups. Post-treatment reappearance of parasitemia during the six months of follow-up was 45%, 36.6% and 17.6%, respectively, for each group. When compared with other groups, administration of 210 mg was a significant protection factor for reappearance of parasitemia in a malaria-endemic area.