Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique - A systematic review.

BACKGROUND/OBJECTIVES: Prenatal myelomeningocele (MMC) repair has been shown to improve neurological outcomes. It has been suggested that decreases in the hysterotomy diameter during surgery can improve perinatal outcomes without altering neurologic outcomes. The objective of this study is to describe and compare the main maternal and fetal outcomes of fetuses undergoing open surgery for MMC repair, through the different modifications (standard-classical, mini-hysterotomy, and microneurosurgery). DATA SOURCE: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, SciELO, LILACS, PROSPERO. RESULTS: From a total of 112 studies, seven case series were selected including 399 fetuses with open fetal surgery, five studies using the classical technique (n = 181), one with mini-hysterotomy (n = 176), and one with the microneurosurgery technique (n = 42). The mini-hysterotomy and microneurosurgery techniques presented a lower risk of preterm delivery (21.4% and 30%, respectively) compared to the classic technique (47.3%), premature rupture of membranes (78%, 62%, and 72.5 %, respectively), oligohydramnios (0% and 72.5%, respectively), dehiscence of hysterotomy, maintaining the same frequency of Chiari reversion (78%, 62%, and 72.5%, respectively), postnatal correction requirement (0%, 4.8%, and 5.8%, respectively), and lower frequency of requirement for a ventriculoperitoneal shunt placement (13.0%, 7.5%, and 29.1%, respectively). CONCLUSION: The least invasive techniques (minihysterotomy-microneurosurgery) are possible and reproduceable, as they are associated with better maternal and perinatal outcomes.

Consecuencias y complicaciones de la amniocentesis. Experiencia de dos centros latinoamericanos de medicina materno fetal / Results and complications of amniocentesis. Experience of two centers of Latin American fetal maternal medicine

Resumen Objetivo Describir las indicaciones, complicaciones y repercusiones de la amniocentesis. Materiales y métodos Estudio descriptivo, observacional y transversal de las amniocentesis efectuadas de 2009 a 2015 en dos unidades de medicina materno fetal de Bogotá, Colombia. Se evaluaron las características de las pacientes, indicación de los procedimientos y las complicaciones. Además, los hallazgos se compararon con reportes de diferentes estudios de la bibliografía internacional. Resultados Se incluyeron 748 amniocentesis. La mediana de edad de las pacientes fue de 29 años (límites 23 y 37). La indicación más común fue el estudio genético en 508 casos (67.9%). Se reportaron 89 (17.5%) casos de cromosomopatías, y de éstas la de mayor frecuencia fue la trisomía 21 en 41 pacientes (46%). La mayor parte de las complicaciones se registró en embarazos que superaron las 20 semanas. La pérdida del embarazo y la amenaza de parto pretérmino atribuibles a la amniocentesis fueron de 0.9 y 2.5%, respectivamente. Conclusión Las características de la amniocentesis permitieron conocer sus repercusiones, complicaciones, tasa de pérdida real o factores asociados, con miras a explorar los factores maternos y fe tales en embarazos únicos y múltiples en dos unidades de Medicina Materno Fetal latinoamericanas.

Abstract Objective The purpose of this paper is to describe the indications, complications and results of amniocentesis performed in two fetal maternal medicine units in Bogota Colombia between 2009 and 2015. Materials and methods Cross-sectional observational descriptive study; 770 amniocentesis performed during 6 years (2009 - 2015) with evaluation of the characteristics of the patients, procedures and complications observed were evaluated. In addition, the findings were compared with reports from different studies of the world literature. Results 748 amniocentesis data were included, statistically analyzing the clinical characteristics of the patients and the results, indications and complications of the procedure. The median age was 29 years (RIQ: 23-37). The most common indication was genetic in 508 cases (67.9%). 89 (17.5%) cases of chromosomopathies were reported, with trisomy 21 being more frequently observed in 41 patients (46%). The loss of pregnancy and the threat of preterm labor attributable to amniocentesis were 0.94% and 2.54%, respectively. Conclusion The characteristics of amniocentesis allow us to know statistics of outcomes, complications, actual loss rate or associated factors, with a view to exploring both maternal and fetal factors in single and multiple pregnancies in two units of Latin American Fetal Maternal Medicine.

Anthropophilic biting behaviour of Anopheles (Kerteszia) neivai Howard, Dyar & Knab associated with Fishermen’s activities in a malaria-endemic area in the Colombian Pacific

On the southwest Pacific Coast of Colombia, a field study was initiated to determine the human-vector association between Anopheles (Kerteszia) neivai and fishermen, including their nearby houses. Mosquitoes were collected over 24-h periods from mangrove swamps, marshlands and fishing vessels in three locations, as well as in and around the houses of fishermen. A total of 6,382 mosquitoes were collected. An. neivai was most abundant in mangroves and fishing canoes (90.8%), while Anopheles albimanus was found indoors (82%) and outdoors (73%). One An. neivai and one An. albimanus collected during fishing activities in canoes were positive for Plasmodium vivax , whereas one female An. neivai collected in a mangrove was positive for P. vivax . In the mangroves and fishing canoes, An. neivai demonstrated biting activity throughout the day, peaking between 06:00 pm-07:00 pm and there were two minor peaks at dusk and dawn. These peaks coincided with fishing activities in the marshlands and mangroves, a situation that places the fishermen at risk of contracting malaria when they are performing their daily activities. It is recommended that protective measures be implemented to reduce the risk that fishermen will contract malaria.

Anthropophilic biting behaviour of Anopheles (Kerteszia) neivai Howard, Dyar & Knab associated with Fishermen's activities in a malaria-endemic area in the Colombian Pacific.

On the southwest Pacific Coast of Colombia, a field study was initiated to determine the human-vector association between Anopheles (Kerteszia) neivai and fishermen, including their nearby houses. Mosquitoes were collected over 24-h periods from mangrove swamps, marshlands and fishing vessels in three locations, as well as in and around the houses of fishermen. A total of 6,382 mosquitoes were collected. An. neivai was most abundant in mangroves and fishing canoes (90.8%), while Anopheles albimanus was found indoors (82%) and outdoors (73%). One An. neivai and one An. albimanus collected during fishing activities in canoes were positive for Plasmodium vivax , whereas one female An. neivai collected in a mangrove was positive for P. vivax . In the mangroves and fishing canoes, An. neivai demonstrated biting activity throughout the day, peaking between 06:00 pm-07:00 pm and there were two minor peaks at dusk and dawn. These peaks coincided with fishing activities in the marshlands and mangroves, a situation that places the fishermen at risk of contracting malaria when they are performing their daily activities. It is recommended that protective measures be implemented to reduce the risk that fishermen will contract malaria.

Malaria in selected non-Amazonian countries of Latin America.

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).

Prospects for malaria elimination in non-Amazonian regions of Latin America.

Latin America contributes 1-1.2 million clinical malaria cases to the global malaria burden of about 300 million per year. In 21 malaria endemic countries, the population at risk in this region represents less than 10% of the total population exposed worldwide. Factors such as rapid deforestation, inadequate agricultural practices, climate change, political instability, and both increasing parasite drug resistance and vector resistance to insecticides contribute to malaria transmission. Recently, several malaria endemic countries have experienced a significant reduction in numbers of malaria cases. This is most likely due to actions taken by National Malaria Control Programs (NMCP) with the support from international funding agencies. We describe here the research strategies and activities to be undertaken by the Centro Latino Americano de Investigación en Malaria (CLAIM), a new research center established for the non-Amazonian region of Latin America by the National Institute of Allergy and Infectious Diseases (NIAID). Throughout a network of countries in the region, initially including Colombia, Guatemala, Panama, and Peru, CLAIM will address major gaps in our understanding of changing malaria epidemiology, vector biology and control, and clinical malaria mainly due to Plasmodium vivax. In close partnership with NMCPs, CLAIM seeks to conduct research on how and why malaria is decreasing in many countries of the region as a basis for developing and implementing new strategies that will accelerate malaria elimination.

Relationship between coffee cultivation practices in Colombia and exposure to infection with Leishmania.

The inhabitants of coffee-growing municipalities consistently report the highest annual rates of cutaneous leishmaniasis in Colombia. During the last two decades most Colombian coffee growers have changed from the traditional system of cultivation, where the crop is grown under different species of shade trees, to an intensified system where it is grown at high densities in full sunlight. This change may affect transmission of Leishmania spp. to humans in several ways, probably resulting from reduced human-vector contact. The responses of residents of traditional and intensified coffee plantations to the leishmanin skin test were compared to ascertain whether intensification has indeed affected Leishmania transmission. Although prevalence of infection was significantly higher (P< or =0.01) among residents of traditional plantations (26.8%) than among those of intensified ones (13.2%), no significant difference could be demonstrated with respect to incidence of infection at the time of the study. Similar rates of infection were found for men and women, although the incidence of infection was significantly higher among the latter in intensified plantations. Changes to the type of data collected and the data collection process will facilitate the evaluation of the long-term effects of intensification of coffee plantations on Leishmania transmission.

[Differentiation by geometric morphometrics among 11 Anopheles (Nyssorhynchus) in Colombia]. / Discriminación por morfometría geométrica de once especies de Anopheles (Nyssorhynchus) presentes en Colombia.

INTRODUCTION: The correct identification of the Anopheles species of the subgenus Nyssorhynchus is important because this subgenus includes the main malaria vectors in Colombia. This information is necessary for focusing a malaria control program. OBJECTIVE: Geometric morphometrics were used to evaluate morphometric variation of 11 species of subgenus Nyssorhynchus present in Colombia and to distinguish females of each species. Materials and methods. The specimens were obtained from series and family broods from females collected with protected human hosts as attractants. The field collected specimens and their progeny were identified at each of the associated stages by conventional keys. For some species, wild females were used. Landmarks were selected on wings from digital pictures from 336 individuals, and digitized with coordinates. The coordinate matrix was processed by generalized Procrustes analysis which generated size and shape variables, free of non-biological variation. Size and shape variables were analyzed by univariate and multivariate statistics. RESULTS: The subdivision of subgenus Nyssorhynchus in sections is not correlated with wing shape. Discriminant analyses correctly classified 97% of females in the section Albimanus and 86% in the section Argyritarsis. In addition, these methodologies allowed the correct identification of 3 sympatric species from Putumayo which have been difficult to identify in the adult female stage. CONCLUSION: The geometric morphometrics were demonstrated to be a very useful tool as an adjunct to taxonomy of females the use of this method is recommended in studies of the subgenus Nyssorhynchus in Colombia.

Discriminación por morfometría geométrica de once especies de Anopheles (Nyssorhynchus) presentes en Colombia / Differentiation by geometric morphometrics among 11 Anopheles (Nyssorhynchus) in Colombia

Introducción. Es importante determinar las especies de Anopheles pertenecientes al subgénero Nyssorhynchus, dado que allí se encuentran los vectores principales de malaria en Colombia. Objetivo. Utilizar la morfometría geométrica para evaluar la variación morfométrica de once especies del subgénero Nyssorhynchus, presentes en Colombia y la capacidad de diferenciar las hembras. Materiales y métodos. Los especímenes fueron obtenidos de mosquitos silvestres, series e isofamilias de hembras recolectadas en cebos humanos protegidos y fueron identificados en todos sus estadios asociados usando las claves convencionales. A partir de fotografías digitales del ala derecha de 336 ejemplares de las 11 especies se seleccionaron 12 puntos anatómicos. Los puntos se convirtieron en coordenadas, las cuales se procesaron mediante el análisis generalizado de Procrustes. Se obtuvieron variables de tamaño y conformación, las cuales fueron analizadas mediante estadísticas univariadas y multivariadas. Resultados. Las técnicas de morfometría geométrica demuestran que la división en secciones del subgénero Nyssorrhynchus no se correlaciona con la conformación de las alas y demostraron que sólo con 12 puntos anatómicos se logra diferenciar en sus respectivas especies el 97 por ciento de los especímenes de la sección Argyritarsis y el 86 por ciento de la sección Albimanus del subgénero Nyssorhynchus, de forma cuantitativa y sin ambigüedades. Además, se separaron los individuos de tres especies que habitan en simpatría en el Putumayo, difíciles de discriminar en el estadio de adulto hembra. Conclusión. La mayoría de especies de Anopheles (Nyssorhynchus) presentes en Colombia se pueden diferenciar al utilizar la morfometría geométrica como herramienta de apoyo a las claves convencionales.