Genetic damage among children living in agricultural areas in the North of Colombia.

In recent years, the use of pesticides has increased considerably for pest control and to improve agricultural production. The rural areas of several municipalities of department of Cordoba, north of Colombia, are highly dependent on agriculture. In this study, a questionnaire and field observations about pesticide use and genotoxic damage through the comet assay in peripheral blood lymphocytes of children who live near crop fields was evaluated. Damage Index for Comet Assay (DICA) of five children populations exposed to pesticides (mean of 94.73±53.95 for the municipality of Monteria, the higher damage in this study) were significantly Higher than control children population (mean of 7.56±7.39). Results showed the damage index in children exposed group was higher than in the control group. An inadequate management of pesticides, as well as incorrect disposal of toxic wastes was observed in the study zone.

Genotoxicity and mutagenicity in blood and drinking water induced by arsenic in an impacted gold mining region in Colombia.

Arsenic (As) is one of the most dangerous substances that can affect human health and long-term exposure to As in drinking water can even cause cancer. The objective of this study was to investigate the concentrations of total As in the blood of inhabitants of a Colombian region impacted by gold mining and to evaluate its genotoxic effect through DNA damage by means of the comet assay. Additionally, the concentration of As in the water consumed by the population as well as the mutagenic activity of drinking water (n = 34) in individuals were determined by hydride generator atomic absorption spectrometry and the Ames test, respectively. In the monitoring, the study population was made up of a group of 112 people, including inhabitants of four municipalities: Guaranda, Sucre, Majagual, and San Marcos from the Mojana region as the exposed group, and Montería as a control group. The results showed DNA damage related to the presence of As in blood (p < 0.05) in the exposed population, and blood As concentrations were above the maximum allowable limit of 1 µg/L established by the ATSDR. A mutagenic activity of the drinking water was observed, and regarding the concentrations of As in water, only one sample exceeded the maximum permissible value of 10 µg/L established by the WHO. The intake of water and/or food containing As is potentially generating DNA damage in the inhabitants of the Mojana region, which requires surveillance and control by health entities to mitigate these effects.

Progress towards the elimination of hepatitis B in children in Colombia: A novel two-phase study approach.

The World Health Organization (WHO) has established a target to eliminate mother-to-child-transmission (EMTCT) of hepatitis B virus (HBV), defined as a prevalence of hepatitis B surface antigen (HBsAg) of ≤0.1% among children, by 2030. Using nationally representative serosurveys to verify achievement of this target requires large sample sizes and significant resources. We assessed the feasibility of a potentially more efficient two-phase method to verify EMTCT of HBV in Colombia. In the first phase, we conducted a risk assessment to identify municipalities at the highest risk of ongoing HBV transmission. We ranked the 1122 municipalities of Colombia based on the reports of HBV infection in pregnant women per 1000 population. Municipalities with ≥0.3 reports per 1000 persons (equating to the top quartile) were further assessed based on health facility birth rates, coverage with three doses of hepatitis B vaccine (HepB3) and seroprevalence data. Hepatitis B risk was considered to be further increased for municipalities with HepB3 coverage or health facility birth rate <90%. In the second phase, we conducted a multistage household serosurvey of children aged 5-10 years in 36 municipalities with the highest assessed HBV risk. HBsAg was not detected in any of 3203 children tested, yielding a 90% upper confidence bound of <0.1% prevalence. Coverage with HepB3 and hepatitis B birth dose was high at 97.5% and 95.6%, respectively. These results support the conclusion that Colombia has likely achieved EMTCT of HBV.

Erythropoietin Receptor Signaling Supports Retinal Function after Vascular Injury.

The investigation of erythropoietin (EPO) has expanded to include potential nonhematopoietic roles in neural and retinal diseases, including diabetic retinopathy. However, it remains unclear how EPO functions to support the neural retina. Transgenic mice with hypoactive EPO receptor (EPOR) signaling (hWtEPOR) were compared with littermate control mice (WT) to test the role of EPOR signaling under normal conditions and after vascular injury and regrowth into the retina. Although retinal function tested with OptoMotry and electroretinography was comparable to adult (8-week-old) littermate WT mice, hWtEPOR mice had thinner inner and outer plexiform layers and a greater number of amacrine cells. Injury and repair caused by the oxygen-induced retinopathy model reduced visual acuity thresholds, reduced electroretinography amplitudes, and thinned the outer plexiform and inner nuclear layers of both WT and hWtEPOR 8-week-old mice. In hWtEPOR compared with WT mice, scotopic a-wave amplitudes were reduced by injury, despite no change in outer nuclear layer thickness; and peripheral rod, but not cone number, was reduced. Scotopic b-waves were reduced in injured hWtEPOR mice compared with WT, and rod bipolar cell ectopic neurites were increased in both genotypes after injury, suggesting a potential reparative process to preserve connectivity and the b-wave. Normal EPOR signaling appeared important because ectopic neurites and b-waves were lower in the hWtEPOR than WT injured mice.

Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995-2016.

OBJECTIVES: To estimate adult (15-49 years old) prevalence and incidence of active syphilis, gonorrhea, and chlamydia, and incidence of congenital syphilis (CS) and adverse birth outcomes (ABOs) in Colombia, over 1995-2016. METHODS: The Spectrum-STI epidemiological model tool estimated gonorrhea and chlamydia prevalences as moving averages across prevalences observed in representative general population surveys. For adult syphilis, Spectrum-STI applied segmented polynomial regression through prevalence data from antenatal care (ANC) surveys, routine ANC-based screening, and general population surveys. CS cases and ABOs were estimated from Spectrum's maternal syphilis estimates and proportions of women screened and treated for syphilis, applying World Health Organization case definitions and risk probabilities. RESULTS: The Spectrum model estimated prevalences in 2016 of 0.70% (95% confidence interval (CI): 0.15%-1.9%) in women and 0.60% (0.1%-1.9%) in men for gonorrhea and of 9.2% (4.4%-15.4%) in women and 7.4% (3.5%-14.7%) in men for chlamydia, without evidence for trends over 1995-2016. The prevalence of active syphilis in 2016 was 1.25% (1.22-1.29%) in women and 1.25% (1.1%-1.4%) in men, decreasing from 2.6% (2.1%-3.2%) in women in 1995. Corresponding CS cases in 2016 (including cases without clinical symptoms) totaled 3 851, of which 2 245 were ABOs. Annual CS and ABO estimates decreased over 2008-2016, reflecting decreasing maternal prevalence and increasing cases averted through ANC-based screening and treatment. CONCLUSIONS: The available surveillance and monitoring data synthesized in Spectrum-STI- and the resulting first-ever national STI estimates for Colombia-highlighted Colombia's persistently high STI burden. Adult syphilis and congenital syphilis are estimated to be falling, reflecting improving screening efforts. Strengthened surveillance, including with periodic screening in low-risk populations and future refined Spectrum estimations, should support planning and implementation of STI prevention and control, including CS elimination.

[Sexual and reproductive rights regarding contraception in a human rights framework in Bolivia, Colombia, and UruguayDireitos sexuais e reprodutivos de contracepção na Bolívia, Colômbia e Uruguai como parte dos princípios dos direitos humanos]. / Derechos sexuales y reproductivos para la anticoncepción en Bolivia, Colombia y Uruguay en el marco de los derechos humanos.

OBJECTIVE: Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed. METHODS: A systematic analysis was based on the WHO analytical framework "Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations" to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific references to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay. RESULTS: It was confirmed that each country's legislation complies with several WHO recommendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in availability, confidentiality, and participation. CONCLUSIONS: Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportunities to improve regulations.

OBJETIVO: Comparar as diretrizes da Organização Mundial da Saúde (OMS) para contracepção como parte dos princípios dos direitos humanos com os enquadramentos regulamentares existentes na Bolívia, Colômbia e Uruguai e avaliar os elementos destes enquadramentos que precisam ser melhorados. MÉTODOS: Realizou-se uma análise sistemática segundo a metodologia analítica descrita no documento da OMS ¨Respeito aos direitos humanos ao prestar informações e serviços sobre contracepção: orientação e recomendações com o propósito de verificar se as legislações da Bolívia, Colômbia e Uruguai fazem referências gerais à população, referências específicas aos adolescentes ou não fazem referências. Ao todo, 36 documentos sobre contracepção foram analisados: 9 provenientes da Bolívia, 15 da Colômbia e 12 do Uruguai. RESULTADOS: Verificou-se que as legislações dos três países cumprem com diversas recomendações da OMS. Não discriminação e oportunidade para decidir de forma esclarecida são os pontos fortes e acessibilidade, qualidade e prestação de contas são os pontos fracos. A aceitabilidade é um ponto forte na Colômbia e Bolívia e a confidencialidade, na Bolívia e Uruguai. Disponibilidade, confidencialidade e participação são os pontos fracos na Colômbia. CONCLUSÃO: A comparação das legislações nacionais com o guia da OMS possibilita identificar os pontos fortes e fracos no enquadramento regulamentar nacional e encontrar oportunidades para melhorar.

Unravelling arsenic bioavailability in floodplain soils impacted by mining activities.

Gold mining not only introduces mercury (Hg) contamination to soils but also facilitates the mobilization of other toxic substances, including arsenic (As). This study assessed the total content, chemical species, and bioavailable fraction of As in surface soils impacted by mining residues during frequent flooding. Analysis of 207 soil samples across the floodplain region of La Mojana, Colombia, screened to 2 mm with polyethylene mesh, revealed significant correlations (p < 0.05) between inorganic As, the residual phase, sulphur (S), iron (Fe), manganese (Mn), and aluminum (Al), indicating associations with sulfides and oxyhydroxides of Fe and Mn. The origin of toxicity was linked to suspended materials transported by rivers during flooding in areas with intense mining activity. Sites with better oxidizing conditions exhibited a higher presence of phases associated with amorphous and crystalline oxides in non-flooded areas. Although the bioavailable fraction was minimal in flooded sites, reducing conditions facilitated As mobility, resulting in higher concentrations in deeper soil layers, particularly as As(III). The contamination factor (CF) ranged from 1.3 to 11.1, and the geochemical index (Igeo) ranged from -0.2 to 2.9, indicating a moderate to high As contamination level in soils. This poses potential health risks, considering the agricultural use of these soils.

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador.

BACKGROUND: Urinary tract infections (UTI) are among the most common cause to prescribe antibiotics in primary care. Diagnosis is based on the presence of clinical symptoms in combination with the results of laboratory tests. Antibiotic therapy is the primary approach to the treatment of UTIs; however, some studies indicate that therapeutics in UTIs may be suboptimal, potentially leading to therapeutic failure and increased bacterial resistance. METHODS: This study aimed to analyze the antibiotic prescription patterns in adult patients with suspected UTIs and to evaluate the appropriateness of the antibiotic prescription. This is a cross-sectional study of patients treated in outpatient centers and in a second-level hospital of the Ministry of Public Health (MOPH) in a city in Ecuador during 2019. The International Classification of Disease Tenth Revision (ICD-10) was used for the selection of the acute UTI cases. The patients included in this study were those treated by family, emergency, and internal medicine physicians. RESULTS: We included a total of 507 patients in the analysis and 502 were prescribed antibiotics at first contact, constituting an immediate antibiotic prescription rate of 99.01%. Appropriate criteria for antibiotic prescription were met in 284 patients, representing an appropriate prescription rate of 56.02%. Less than 10% of patients with UTI had a urine culture. The most frequently prescribed antibiotics were alternative antibiotics (also known as second-line antibiotics), such as ciprofloxacin (50.39%) and cephalexin (23.55%). Factors associated with inappropriate antibiotic prescribing for UTIs were physician age over forty years, OR: 2.87 (95% CI, 1.65-5.12) p<0.0001, medical care by a general practitioner, OR: 1.89 (95% CI, 1.20-2.99) p = 0.006, not using point-of-care testing, OR: 1.96 (95% CI, 1.23-3.15) p = 0.005, and care at the first level of health, OR: 15.72 (95% CI, 8.57-30.88) p<0.0001. CONCLUSIONS: The results of our study indicate an appropriate prescription rate of 56.02%. Recommended antibiotics such as nitrofurantoin and fosfomycin for UTIs are underutilized. The odds for inappropriate antibiotic prescription were 15.72 times higher at the first level of care compared to the second. Effective strategies are needed to improve the diagnosis and treatment of UTIs.

Effect of Modified Peristaltic Phacoemulsification Device on Efficiency and Post-Occlusion Pressure Surge.

Purpose: To evaluate efficiency of grooving, nuclear fragment removal, and changes in pressure control in the Oertli Faros using traditional peristaltic and Speed and Precision (SPEEP) features. The SPEEP mode uses novel peristaltic technology permitting independent control of flow and vacuum. Methods: A porcine lens model was used with an enclosed chamber simulating the anterior segment. Grooving efficiency is evaluated with flow rates of 10, 30, and 50 mL/min using whole lenses. Lens cubes were emulsified at 20, 40, 60, 80, and 100% power with both SPEEP and non-SPEEP modes. Surge was evaluated with pressure gauges placed on the irrigation tubing and aspiration tubing. Pressure readings were recorded per the following: fluid and vacuum were initiated for 15 seconds, vacuum tubing was occluded for 5 seconds, tubing patency was then re-introduced for 15 seconds. Differences between sensors were recorded. Results: No significant increase in efficiency was seen with increasing flow rate from 30 to 50 mL/min using SPEEP. No significant differences were shown in lens fragment removal in SPEEP and non-SPEEP modes at any power tested. Pressure difference measurements were not significantly different with SPEEP and non-SPEEP modes. Conclusion: We showed that lower flow rates show comparable efficiency of grooving when using the SPEEP mode. The SPEEP function did not show increased efficiency in nuclear fragment removal when compared to traditional mode. Surge control was also comparable with both SPEEP and non-SPEEP modes. We suggest that the SPEEP function included in the Oertli Faros may have some advantages.

Efficiency of a polymer-coated phacoemulsification tip in cataract surgery.

PURPOSE: To determine whether there is a difference in efficiency during phacoemulsification when using the hybrid polymer tip compared with the metal balanced tip, as measured by cumulative dissipated energy (CDE) and total procedure time. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. DESIGN: Experimental study. METHODS: Phacoemulsification was performed with the Centurion Vision System and Infiniti OZil handpiece, with a 30-degree bevel metal balanced tip and hybrid polymer tip. The vacuum was set at 500 mm Hg and the aspiration flow rate at 50 mL/min. Power was changed for torsional and longitudinal ultrasound (US) at 20%, 40%, 60%, 80%, and 100%. Hardened porcine lenses were cut into 200 two mm cubes, 10 for each specified tip/power setting. They were placed into an artificial anterior chamber filled with a balanced salt solution, and phacoemulsification was performed. A second observer randomly assigned the US type and power. The same observer timed trials with a stopwatch, and CDE was recorded. RESULTS: There were no significant differences in time or CDE for any power levels or US modes when comparing the 2 tips. CONCLUSIONS: No significant difference in efficiency was observed when comparing the metal balanced tip with the hybrid polymer tip. Given the known improved safety profile and the overall equivalent efficiency of the hybrid tip, it could improve the performance of beginning and advanced surgeons in the future. Future study is needed to evaluate other setting combinations and to evaluate the hybrid tip in clinical settings.

Effect of simulated lenticular debris on corneal endothelial cells: experimental study in rabbit eyes.

PURPOSE: To evaluate mechanical damage of simulated lenticular debris on corneal endothelial cells during phacoemulsification. SETTING: University setting, Salt Lake City, Utah. DESIGN: Experimental study. METHODS: 12 New Zealand rabbits underwent bilateral surgery. After incision, 10 1.0 mm beads were injected into the anterior chamber of test eyes to simulate lenticular debris. A balanced salt solution was injected into the contralateral eyes with the same injector. The Intrepid Balanced Tip of the Centurion Ozil handpiece was inserted into the anterior chamber, and 60% torsional ultrasound was applied for 20 seconds with 50 mL/min flow, 70 mm Hg intraocular pressure, and 600 mm Hg vacuum. Cumulative dissipated energy (CDE) was noted. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (×400 photographs from 5 specific areas and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs. RESULTS: CDE was 4.64 ± 0.19 for test eyes with beads and 4.66 ± 0.17 for control eyes without beads ( P = .58). The percentage of intact cells was statistically higher in the control group ( P = .0005), whereas the percentages of damaged and lost cells were statistically higher in the test group ( P = .0010 and .0005, respectively). This was observed in the analysis of the ×400 photographs and overview photographs. CONCLUSIONS: This study suggests that lenticular debris swirling around the anterior chamber may cause significant damage to the corneal endothelium, providing further insight on mechanisms of damage during phacoemulsification.

Mercury Accumulation in Commercial Varieties of Oryza sativa L. Cultivated in Soils of La Mojana Region, Colombia.

The Hg accumulation in different commercial varieties of Oryzasativa L. was evaluated in the region of La Mojana, Colombia, where rice cultivation has become the staple food of the population living in this area. The varieties studied were Fedearroz-473 (FA473), Fedearroz-2000 (FA2000), and Fedearroz-Mocari (FAM). Soil spiked at different Hg levels was evaluated, (130, 800, and 1500 µg kg-1) using a 32 factorial design that consisted of 3 (rice varieties) × 3 (Hg contents). The biomass, 1000-grain weight, and the accumulation of Hg in the roots, grains, and husks were determined. The highest biomass was found in the FA473 (308.76 ± 108.26 g), and the lowest was found in FAM (144.04 ± 26.45 g) in the 1500 µg kg-1 Hg soil in both cases. The weight per 1000-grains decreased significantly in the soil containing 800 µg of Hg kg-1. Hg accumulation in the organs of the evaluated varieties was higher in the roots, followed by in the husks and grains. The Hg in the rice grains of the evaluated varieties presented levels close to the permissible limit of the Chinese standard (20 µg Hg kg-1) in the evaluated soils and were only exceeded by FA473. Although in natural soil concentrations, the non-cancer health risk (HQ) from rice consumption was lower for FA473 and FAM; Hg enrichment in the soil of La Mojana region may endanger the health of future populations due to their high consumption of rice.

Determination of arsenic chemical species in rice grains using high-performance liquid chromatography coupled to hydride generator with atomic fluorescence detector (HPLC-HG-AFS).

The objective of this work is the validation and implementation of an analytical method for the determination of arsenic chemical species in rice grain samples using High-performance liquid chromatography coupled to a hydride generator with atomic fluorescence detector (HPLC-HG-AFS). The extraction protocol developed was based on HNO3 0.28 M (90 °C, 2 h), microwave-assisted. The results showed recovery percentages of arsenite (As (III)) (99-101%), arsenate (As (V)) (91-96%), dimethylarsinic acid (DMA) (92-102%) and monomethylarsonic acid (MMA) (94-97%). The precision of the method presented coefficients of variation lower than 7% and 8% for repeatability and reproducibility respectively. The detection limits were 2.5, 3.75, 7.5 and 4.0 µg kg-1 for As (III), As (V), DMA and MMA respectively. The proposed methodology is reliable for the quantification of As species, because they are conserved during the extraction.•The extraction protocol developed was based on Microwave-assisted acid extraction.•This methodology offers good sensitivity, precision, accuracy, detection and quantification limits.•It was successfully applied to determination of arsenic chemical species in rice grains.

Assessment of Potential Health Risks Associated with the Intake of Heavy Metals in Fish Harvested from the Largest Estuary in Colombia.

This study assesses the potential human health risks posed by six heavy metals (Hg, As, Pb, Cd, Cu, and Zn) found in five of the most consumed fish species (Mugil incilis, Centropomus undecimalis, Cathorops mapale, Eugerres plumieri, and Elops smithi) collected by the riverine population living in Ciénaga Grande de Santa Marta (CGSM), the largest estuary in Colombia. Metal concentrations were low compared with those reported in other regions around the world and the maximum value established by international monitoring organizations. The estimation of the potential risk (HQ) indicated that Cu and Hg could generate negative effects in groups of women of childbearing age (WCA) and the remaining population (RP), because they exceeded their related reference doses, with HQ values > 1; however, Cu and Hg concentrations were not high in fish and EWI, MFW, or MeHgPSL values shows that there is no evidence of a potential health risk from MeHg exposure in the study population. Therefore, the recommendations are to establish continuous monitoring of heavy metals together with strategies that address the high fish consumption, as well as to implement mechanisms for the mitigation of contamination of the watershed, to ensure the safety of organisms in the ecosystem and human health, not only of populations who depend on aquatic resources in the area but also of those that market and consume these resources in the Colombian Caribbean.

Transfer and bioaccumulation of mercury from soil in cowpea in gold mining sites.

In this study, we evaluated the phytoremediation ability of three different genotypes of cowpea (Vigna unguiculata L. Walp) grown on mercury-contaminated soils from gold mining areas. In particular we compared a native genotype with two commercial lines L-019 and L-042. The plants were cultivated in soils amended at different concentrations of Hg (i.e. 0.2, 1, 2, 5 and 8 mg kg-1). After three months exposure, we determined plant growth, seed production, and Hg accumulation in different plant tissues (root, leaf, seed and stem). Indices of soil-plant metal transfer such as translocation, bioconcentration and bioaccumulation factors were calculated. Results showed that the native variety presented the highest seed production (3.8 g), however the highest plant biomass (7.9 g) was observed in line L-019, both on Hg-contaminated soil of 1 mg kg-1. The different plant tissues differed in terms of Hg concentration (root > leaf > stem). In the highest treated soil, the line L-042 accumulates higher Hg in both roots and leaves, while line L-019 accumulates more metal in stems. In line L-019, Hg concentrations in the fruit showed significant differences being higher in the valves than in the seeds. The transfer factors were generally lower than 1 and indicates the low accumulation of Hg by cowpeas. The estimated daily Hg intake through cowpea consumption showed values far below the threshold of 0.57 µg kg-1 dw day-1 recommended by the World Health Organization. Our results show cowpea V. unguiculata as a good protein-rich food substitute of Hg-contaminated fish for populations living near gold mining sites.

Mercury levels and genotoxic effect in caimans from tropical ecosystems impacted by gold mining.

One of the most representative predator species in tropical ecosystems is caiman that can provide relevant information about the impact of mercury (Hg) associated with artisanal and small-scale gold mining. To evaluate the degree to which adverse effects are likely to occur in Caiman crocodilus, total Hg (THg) concentrations in different tissues and DNA damage in erythrocytes were determined. Samples of claws, scutes, and blood were taken from 65 specimens in sites impacted by upstream gold mining, and in a crocodile breeding center as control site, located in a floodplain in northern Colombia. In all the sites, the highest THg among tissues was in the following order: claws >> scutes > blood. High concentrations of THg were found in the different tissues of the specimens captured in areas impacted by mining activities, with mean values in claws (1100 ng/g ww), caudal scutes (490 ng/g ww), and blood (65 ng/g ww), and statistically significant differences compared to those of the control site (p < 0.05). THg in scutes from impacted sites are 15-fold higher than in control, whereas for claws and blood are 8 times higher, and a high significant correlation with THg was found in all the tissues. The comet assay reveals significant differences in the DNA damage in the exposed reptiles compared to the controls (p < 0.01). In sum, C. crocodilus from La Mojana floodplain presents a high ecological risk given its genotypic susceptibility to Hg levels present in its habitat, which could possibly influence vital functions such as reproduction of the species and the ecological niche that it represents within the ecosystem.

Polycyclic aromatic hydrocarbons and heavy metals in the Cispata Bay, Colombia: A marine tropical ecosystem.

The concentrations of polycyclic aromatic hydrocarbons and heavy metals were evaluated in shallow sediments, water, fish and seabird samples from the Cispata Bay, Colombia. The heavy metals concentrations in the sediment was in the following order: Cu>Pb>Hg>Cd. The heavy metal concentration was different (p<0.05) in juvenile and adult birds. High concentrations of mercury were registered in the seabird (10.19±4.99mgkg-1) and fish (0.67µgg-1) samples. The total concentration of polycyclic aromatic hydrocarbons ranged from 7.0-41ngg-1 in sediment, 0.03-0.34ngmL-1 in water samples, 53.24ngg-1 in fish, and 66ngg-1 in seabirds. The high concentrations of heavy metals in seabirds may be explained by their feeding habits. The presence of polycyclic aromatic hydrocarbons in the Cispata Bay may be due to hydrocarbon spills during oil transport at the nearby oil port.

Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995-2016 / Estimaciones sobre la prevalencia y la incidencia de sífilis, clamidiasis, gonorrea y sífilis congénita en Colombia, 1995-2016 / Estimativas da incidência e prevalência de sífilis, clamídia, gonorreia e sífilis congênita na Colômbia, 1995-2016

ABSTRACT Objectives To estimate adult (15-49 years old) prevalence and incidence of active syphilis, gonorrhea, and chlamydia, and incidence of congenital syphilis (CS) and adverse birth outcomes (ABOs) in Colombia, over 1995-2016. Methods The Spectrum-STI epidemiological model tool estimated gonorrhea and chlamydia prevalences as moving averages across prevalences observed in representative general population surveys. For adult syphilis, Spectrum-STI applied segmented polynomial regression through prevalence data from antenatal care (ANC) surveys, routine ANC-based screening, and general population surveys. CS cases and ABOs were estimated from Spectrum's maternal syphilis estimates and proportions of women screened and treated for syphilis, applying World Health Organization case definitions and risk probabilities. Results The Spectrum model estimated prevalences in 2016 of 0.70% (95% confidence interval (CI): 0.15%-1.9%) in women and 0.60% (0.1%-1.9%) in men for gonorrhea and of 9.2% (4.4%-15.4%) in women and 7.4% (3.5%-14.7%) in men for chlamydia, without evidence for trends over 1995-2016. The prevalence of active syphilis in 2016 was 1.25% (1.22-1.29%) in women and 1.25% (1.1%-1.4%) in men, decreasing from 2.6% (2.1%-3.2%) in women in 1995. Corresponding CS cases in 2016 (including cases without clinical symptoms) totaled 3 851, of which 2 245 were ABOs. Annual CS and ABO estimates decreased over 2008-2016, reflecting decreasing maternal prevalence and increasing cases averted through ANC-based screening and treatment. Conclusions The available surveillance and monitoring data synthesized in Spectrum-STI— and the resulting first-ever national STI estimates for Colombia—highlighted Colombia's persistently high STI burden. Adult syphilis and congenital syphilis are estimated to be falling, reflecting improving screening efforts. Strengthened surveillance, including with periodic screening in low-risk populations and future refined Spectrum estimations, should support planning and implementation of STI prevention and control, including CS elimination.

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RESUMO Objetivos Estimar a incidência e a prevalência na população adulta (com idade de 15-49 anos) de sífilis ativa, gonorreia e clamídia e a incidência de sífilis congênita (SC) e desfechos adversos congênitos na Colômbia no período de 1995 a 2016. Métodos O modelo epidemiológico Spectrum-STI foi o instrumento usado para estimar a prevalência de gonorreia e clamídia como médias móveis nas prevalências observadas em pesquisas representativas da população geral. A sífilis em adultos foi estimada com a regressão polinomial segmentada aplicada ao modelo Spectrum-STI com dados de prevalência obtidos de pesquisas da atenção pré-natal, exames pré-natais de rotina de detecção precoce e pesquisas da população geral. Casos de SC e desfechos adversos congênitos foram estimados a partir das estimativas de sífilis materna do modelo Spectrum e percentuais de mulheres que fizeram testes de detecção e foram tratadas para sífilis, segundo as definições de casos da Organização Mundial da Saúde (OMS) e probabilidades de risco. Resultados O modelo Spectrum estimou, para 2016, uma prevalência de gonorreia de 0,70% (intervalo de confiança de 95% [IC 95%] 0,15%-1,9%) no sexo feminino e 0,60% (0,1%-1,9%) no sexo masculino e uma prevalência de clamídia de 9,2% (4,4%-15,4%) no sexo feminino e 7,4% (3,5%-14.7%) no sexo masculino, sem evidência de tendências no período 1995-2016. A prevalência de sífilis ativa em 2016 foi de 1,25% (1,22-1,29%) no sexo feminino e 1,25% (1,1%-1,4%) no sexo masculino, demonstrando um declínio da prevalência de 2,6% (2,1%-3,2%) observada em 1995 para o sexo feminino. Houve, ao todo, 3.851 casos correspondentes de SC em 2016 (incluindo casos assintomáticos), dos quais 2.245 foram desfechos adversos congênitos. Observou-se uma redução nas estimativas anuais de SC e desfechos adversos congênitos em 2008-2016, refletindo a diminuição da prevalência materna e o número crescente de casos evitados com exames pré-natais de detecção e tratamento. Conclusões Os dados disponíveis de vigilância e monitoramento condensados no modelo Spectrum-STI, e as resultantes estimativas nacionais de infeções sexualmente transmissíveis (IST) obtidas pela primeira vez na Colômbia, evidenciam a alta carga persistente de IST no país. Estima-se que a ocorrência de sífilis do adulto e sífilis congênita esteja diminuindo em decorrência da melhoria nos esforços de detecção precoce. A vigilância reforçada, consistindo também de exames periódicos de detecção precoce nas populações de baixo risco e estimavas futuras aprimoradas do instrumento Spectrum, deve sustentar o planejamento e a implementação de controle e prevenção de IST e a eliminação da SC.

Derechos sexuales y reproductivos para la anticoncepción en Bolivia, Colombia y Uruguay en el marco de los derechos humanos / Sexual and reproductive rights regarding contraception in a human rights framework in Bolivia, Colombia, and Uruguay / Direitos sexuais e reprodutivos de contracepção na Bolívia, Colômbia e Uruguai como parte dos princípios dos direitos humanos

RESUMEN Objetivo Realizar una comparación entre las Directrices de la Organización Mundial de la Salud (OMS) para la anticoncepción en el marco de los derechos humanos (DDHH) con el marco normativo existente en Bolivia, Colombia y Uruguay y evaluar los aspectos que son necesarios desarrollar en la normativa. Métodos Se realizó un análisis sistemático con base al marco analítico de la OMS ¨Respeto de los DDHH cuando se proporciona información y servicios de anticoncepción: orientación y recomendaciones¨ para determinar si la legislación de Bolivia, Colombia y Uruguay contienen referencias generales a la población, referencias específicas para los adolescentes o no hacen referencia. Para este fin, se analizó un total de 36 documentos relacionados con la anticoncepción: 9 de Bolivia, 15 de Colombia y 12 de Uruguay. Resultados Se verificó que la legislación de cada país cumple con varias recomendaciones de la OMS. Los tres países tienen fortalezas en la no discriminación y el espacio para las decisiones informadas; sus debilidades están en la accesibilidad, la calidad y la rendición de cuentas. La aceptabilidad es una fortaleza para Colombia y Bolivia; la confidencialidad es para Bolivia y Uruguay. Colombia tiene como debilidad la disponibilidad, la confidencialidad y la participación. Conclusiones La comparación de la legislación nacional con la guía de la OMS ayuda a ver las fortalezas y las debilidades en el marco normativo nacional y ver oportunidades para mejorar la normativa.

ABSTRACT Objective Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed. Methods A systematic analysis was based on the WHO analytical framework "Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations" to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific references to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay. Results It was confirmed that each country's legislation complies with several WHO recommendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in availability, confidentiality, and participation. Conclusions Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportunities to improve regulations.

RESUMO Objetivo Comparar as diretrizes da Organização Mundial da Saúde (OMS) para contracepção como parte dos princípios dos direitos humanos com os enquadramentos regulamentares existentes na Bolívia, Colômbia e Uruguai e avaliar os elementos destes enquadramentos que precisam ser melhorados. Métodos Realizou-se uma análise sistemática segundo a metodologia analítica descrita no documento da OMS ¨Respeito aos direitos humanos ao prestar informações e serviços sobre contracepção: orientação e recomendações com o propósito de verificar se as legislações da Bolívia, Colômbia e Uruguai fazem referências gerais à população, referências específicas aos adolescentes ou não fazem referências. Ao todo, 36 documentos sobre contracepção foram analisados: 9 provenientes da Bolívia, 15 da Colômbia e 12 do Uruguai. Resultados Verificou-se que as legislações dos três países cumprem com diversas recomendações da OMS. Não discriminação e oportunidade para decidir de forma esclarecida são os pontos fortes e acessibilidade, qualidade e prestação de contas são os pontos fracos. A aceitabilidade é um ponto forte na Colômbia e Bolívia e a confidencialidade, na Bolívia e Uruguai. Disponibilidade, confidencialidade e participação são os pontos fracos na Colômbia. Conclusão A comparação das legislações nacionais com o guia da OMS possibilita identificar os pontos fortes e fracos no enquadramento regulamentar nacional e encontrar oportunidades para melhorar.

Sarcoma sinovial: presentación de un caso / Sinovial sarcoma: report of a case

Estamos reportando nuestra experiencia en el tratamiento de un caso de Sarcoma Sinovial, cuyo diagnóstico generalmente suele ser difícil debido a la gran variedad de patrones histológicos. La separación de estos tumores de otros sarcomas pobremente diferenciados, como el Fibrosarcoma o el Schwanoma maligno crea problemas de tipo diagnóstico y por ende de tratamiento