Validación externa y reproducibilidad del cuestionario PUMA para el diagnóstico de EPOC en una población latinoamericana: validación externa del cuestionario PUMA / External validation and reproducibility of the PUMA questionnaire for the diagnosis of COPD in a Latin American population: external validation of the PUMA questionnaire

Resumen El uso de escalas de predicción clínica puede incrementar la detección temprana de enfermedad pulmonar obstructiva crónica (EPOC). Su rendimiento en población latinoamericana ha sido pobremente estudiado. Nuestro objetivo fue determinar la validez y reproducibilidad del cuestionario PUMA, como herramienta de tamización en atención primaria en población colombiana, mediante un estudio tipo corte transversal; donde se establecieron las características operativas del cuestionario, área bajo la curva de características operativas del receptor (ACOR) y el mejor punto de corte para esta población. 1.980 sujetos fueron incluidos en el análisis. La prevalencia de EPOC correspondió a 18,9%. La capacidad discriminatoria del cuestionario fue de 0,69 (IC95%: 0,66-0,72), para un punto de corte óptimo mayor de 5, con una sensibilidad del 60%, especificidad 66% y un valor predictivo negativo de 88%. La escala PUMA para tamizaje de pacientes en riesgo de EPOC tiene una capacidad discriminatoria moderada y una excelente reproducibilidad en la población estudiada.

The use of clinical prediction scales may increase the early detection of chronic obstructive pulmonary disease (COPD). The performance characteristics of these scales in the Latin American population is poorly studied. We aimed to evaluate validity and reproducibility of PUMA questionnaire as a screening tool in primary care in a Colombian population. A cross-sectional study was performed. Operational characteristics of the questionnaire, the area under the received operator curve (AUROC), and the best cut-off point of the score were calculated. 1,980 individuals were included in this analysis. Prevalence of COPD was 18.9%. AUROC of the questionary was 0.69 (CI95%: 0.66-0.72), with an optimal cut-off point greater than 5 (sensitivity 60%, specificity 66%); predictive negative value was 88%. PUMA's scale for the screening of patients at risk of COPD has a moderate accuracy and an excellent reproducibility in the studied population.

A case report of catheter-related bloodstream infection due to Trichosporon coremiiforme in a patient with secondary neutropenia to HIV.

Here, we describe an invasive infection due to Trichosporon coremiiforme in an HIV positive patient with neutropenia. The strain was first erroneously identified as Trichosporon asahii by conventional methods, but correctly identified by mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight technology (MALDI-TOF MS) and ribosomal DNA sequencing. The infection was successfully resolved after antifungal treatment with amphotericin B and fluconazole. This case report is a contribution to the study of T. coremiiforme infections and reinforces its relevance as a species capable of causing invasive human infection in immunocompromised patients and also contributes to the study of its susceptibility profile against antifungal drugs.

[Indirect immunofluorescence technique versus polymerase chain reaction for the diagnosis of respiratory viruses in children admitted to a hospital in the Metropolitan Region]. / Inmunofluorescencia indirecta versus reacción de polimerasa en cadena para el diagnóstico de virus respiratorios en niños ingresados en un hospital de la Región Metropolitana.

BACKGROUND: Early viral detection in acute respiratory infections (ARI) is essential to establish appropriate therapy and prevent nosocomial transmission. OBJECTIVE: To compare the efficacy of indirect immunofluorescence technique (IIF) with the polymerase chain reaction (PCR) to identify respiratory viruses in children hospitalized for ARI. METHODS: 47 nasopharyngeal aspirates of children ≤ 2 years with ARI were included. IFI included respiratory syncytial virus (RSV), adenovirus, influenza A and B and parainfluenza. PCR also included the detection of metapneumovirus, enterovirus/rhinovirus, bocavirus and coronavirus. Sensitivity, specificity, positive and negative predictive value (VPP/NPV) and kappa correlation for RSV were estimated by IIF compared to PCR. RESULTS: The IIF detected only RSV (29; 61.7%). PCR detected several viruses, including RSV in 26 cases (55.3%), followed by bocavirus (29.8%), rhinovirus/enterovirus (21.3%), adenovirus (14.9%) and parainfluenza (4,3%) among others, with 35.5% of coinfection. The IIF presented sensitivity: 85.7%, specificity: 73.6%, PPV: 82.7%, NPV: 77.7% and kappa: 0.5990 (95% CI, 0.3636-0.8346) for RSV. CONCLUSION: The IIF presents good sensitivity, but moderate specificity for RSV. However, IIF fails to detect other respiratory viruses. The introduction of PCR would improve the etiological diagnosis of ARI of viral origin.

Inmunofluorescencia indirecta versus reacción de polimerasa en cadena para el diagnóstico de virus respiratorios en niños ingresados en un hospital de la Región Metropolitana / Indirect immunofluorescence technique versus polymerase chain reaction for the diagnosis of respiratory viruses in children admitted to a hospital in the Metropolitan Region

Resumen Introducción: La temprana detección viral en infecciones respiratorias agudas (IRA) es esencial para establecer una terapia apropiada y prevenir el contagio intrahospitalario. Objetivo: Comparar la eficacia de la técnica de inmunofluorescencia indirecta (IFI) con la reacción de polimerasa en cadena (RPC) para identificar virus respiratorios en niños hospitalizados por IRA. Métodos: Se incluyeron 47 aspirados nasofaríngeos de niños ≤ 2 años con IRA. La IFI incluyó virus respiratorio sincicial (VRS), adenovirus, influenza A y B y parainfluenza. La RPC incluyó, además, la detección de metapneumovirus, enterovirus/rinovirus, bocavirus y coronavirus. Se estimó sensibilidad, especificidad, valor predictor positivo y negativo (VPP/VPN) y correlación kappa para VRS mediante IFI en comparación a la RPC. Resultados: La IFI detectó únicamente VRS (29; 61,7%). La RPC detectó diversos virus, entre ellos VRS en 26 casos (55,3%), seguido por bocavirus (29,8%), enterovirus/ rinovirus (21,3%), adenovirus (14,9%) y parainfluenza (4,3%) entre otros, con 35,5% de co-infección. La IFI presentó sensibilidad: 85,7%, especificidad: 73,6%, VPP: 82,7%, VPN: 77,7% y kappa: 0,5990 (IC 95%; 0,36360,8346) para VRS. Conclusión: La IFI presenta buena sensibilidad, pero moderada especificidad para VRS. Sin embargo, falla en la detección de otros virus respiratorios. La introducción de RPC permitiría mejorar el diagnóstico etiológico de las IRA de origen viral.

Background: Early viral detection in acute respiratory infections (ARI) is essential to establish appropriate therapy and prevent nosocomial transmission. Objective: To compare the efficacy of indirect immunofluorescence technique (IIF) with the polymerase chain reaction (PCR) to identify respiratory viruses in children hospitalized for ARI. Methods: 47 nasopharyngeal aspirates of children ≤ 2 years with ARI were included. IFI included respiratory syncytial virus (RSV), adenovirus, influenza A and B and parainfluenza. PCR also included the detection of metapneumovirus, enterovirus/rhinovirus, bocavirus and coronavirus. Sensitivity, specificity, positive and negative predictive value (VPP/NPV) and kappa correlation for RSV were estimated by IIF compared to PCR. Results: The IIF detected only RSV (29; 61.7%). PCR detected several viruses, including RSV in 26 cases (55.3%), followed by bocavirus (29.8%), rhinovirus/enterovirus (21.3%), adenovirus (14.9%) and parainfluenza (4,3%) among others, with 35.5% of coinfection. The IIF presented sensitivity: 85.7%, specificity: 73.6%, PPV: 82.7%, NPV: 77.7% and kappa: 0.5990 (95% CI, 0.3636-0.8346) for RSV. Conclusion: The IIF presents good sensitivity, but moderate specificity for RSV. However, IIF fails to detect other respiratory viruses. The introduction of PCR would improve the etiological diagnosis of ARI of viral origin.

Diversity and genetic structure analysis of three Amazonian Amerindian populations from Colombia / Análisis de la diversidad y la estructura genética de tres poblaciones indígenas amazónicas colombianas

Introduction: In the departments of the Vaupés and Guaviare, in southeastern Colombia, in a transitional area between Amazonia and the eastern plains, inhabit indigenous groups belonging to the Tukanoan (East) and Guahiban linguistic families. Although some studies have dealt with the culture and the cosmology description of these groups, little research has been done on the biological diversity and genetic relationships of such groups.Objective: To estimate the diversity, the structure, and the genetic relationships of one Guahiban and two Tukanoan groups of the Colombian Amazonian region.Methods: Samples were collected (n = 106) from unrelated individuals belonging to the Vaupés native indigenous communities. The DNA was extracted and nine autosomal microsatellites were typed. Several measures of diversity, FST, pairwise FST, and population differentiation between groups were calculated. Finally, it was estimated the genetic distances of the groups studied in relation with other Amazonian, Andean and Central American indigenous people.Results: 1. The genetic diversity found stands within the range of other Amazonian populations, whereas compared to the mestizo and afro-descendant Colombian populations, such diversity showed to be lower. 2. The structure and population differentiation tests showed two clusters; one consisting of the Vaupés Tukanoan and Guaviare Tukanoan groups, and a second one formed by the Guayabero. 3. Tukanoan groups are found to be closer related to the Brazilian Amazonian populations than to the Guayabero.Conclusion: The results of this study suggest that the Guayabero group from Guaviare, are genetically differentiated from those Tukanoan groups of the Vaupés and Guaviare

Diversity and genetic structure analysis of three Amazonian Amerindian populations of Colombia.

INTRODUCTION: In the departments of the Vaupés and Guaviare, in southeastern Colombia, in a transitional area between Amazonia and the eastern plains, inhabit indigenous groups belonging to the Tukanoan (East) and Guahiban linguistic families. Although some studies have dealt with the culture and the cosmology description of these groups, little research has been done on the biological diversity and genetic relationships of such groups. OBJECTIVE: To estimate the diversity, the structure, and the genetic relationships of one Guahiban and two Tukanoan groups of the Colombian Amazonian region. METHODS: Samples were collected (n = 106) from unrelated individuals belonging to the Vaupés native indigenous communities. The DNA was extracted and nine autosomal microsatellites were typed. Several measures of diversity, FST, pairwise FST, and population differentiation between groups were calculated. Finally, it was estimated the genetic distances of the groups studied in relation with other Amazonian, Andean and Central American indigenous people. RESULTS: 1. The genetic diversity found stands within the range of other Amazonian populations, whereas compared to the mestizo and afro-descendant Colombian populations, such diversity showed to be lower. 2. The structure and population differentiation tests showed two clusters; one consisting of the Vaupés Tukanoan and Guaviare Tukanoan groups, and a second one formed by the Guayabero. 3. Tukanoan groups are found to be closer related to the Brazilian Amazonian populations than to the Guayabero. CONCLUSION: The results of this study suggest that the Guayabero group from Guaviare, are genetically differentiated from those Tukanoan groups of the Vaupés and Guaviare.

INTRODUCCIÓN: En los departamentos del Vaupés y el Guaviare, al Suroriente de Colombia, en un área transicional entre la Amazonía y los Llanos Orientales, habitan pueblos indígenas de las familias lingüísticas Tucano (Oriental) y Guahibo. Se han hecho estudios sobre la cultura y la cosmología de dichos grupos, pero poco se ha investigado sobre su diversidad biológica y sus relaciones genéticas. OBJETIVO: Estimar la diversidad, la estructura y las relaciones genéticas de dos poblaciones Tucano Oriental y un grupo Guayabero (Guahibo) de la Amazonía colombiana. METODOS: Se recolectaron muestras de 106 individuos no emparentados, pertenecientes a comunidades indígenas del Vaupés y el Guaviare. Se tipificaron nueve microsatélites autosómicos. Se estimó la heterocigosidad, la diversidad génica, FST y FST pareados entre grupos. Se realizó una prueba de estructura espacial y se construyó un árbol de distancias genéticas con otras poblaciones indígenas amazónicas, Andinas y centroamericanas. RESULTADOS: La diversidad genética se encuentra en el rango estándar de otras poblaciones amazónicas, pero es más baja que en población mestiza y afrodescendiente de Colombia. Los Tucano Oriental del Vaupés y el Guaviare conforman una unidad genética que se diferencia significativamente de los Guayaberos. Los grupos Tucano están más cerca genéticamente de las poblaciones amazónicas brasileras que de los Guayabero. CONCLUSIÓN: Los resultados de este estudio sugieren que los Guayaberos en el Guaviare, están diferenciados genéticamente de los grupos Tucano del Vaupés y de los Tucano del Refugio en el Guaviare.

Diagnóstico de las enfermedades periodontales en un grupo de carnívoros nativos en cautiverio en el Zoológico Jaime Duque / Periodontal disease diagnosis in a group of captive native carnivores at Jaime Duque Zoo

Se realizó un diagnóstico de la Enfermedad Periodontal en 12 especies de carnívoros del Zoológico Jaime Duque. Se muestrearon 23 animales con diferentes protocolos de anestesia fija. Se diseñó e implementó un protocolo de examen de la cavidad oral, haciendo énfasis en la parte Periodontal. 16 de los 23 individuos presentaron enfermedad Periodontal. En 9 individuos se realizó cultivo microbiológico de la cavidad oral, donde los resultados en su mayoría indicaron flora bacteriana normal.

Reducción de dosis al paciente en TC: un estudio de resultados en la práctica clínica / Patient dose reduction in CT: results into clinical practice

Los estudios de tomografía computada corresponden al 10 por ciento del total de los estudios radiológicos pero superan el 40 por ciento de la dosis de radiación colectiva al paciente. Ello ha generado una gran presión internacional por reducir las dosis en tomografía computada. Se revisaron los protocolos vigentes en estudio de cefalea, abdomen, disfunción patelo-femoral y sinusitis. Ellos conforman aproximadamente el 60 por ciento de los estudios de tomografía computada en un centro hospitalario. Esta revisión, tanto bibliográfica como de series técnicas propias, permitieron reducir las dosis de radiación al paciente en un 30 por ciento a un 50 por ciento de sus valores originales. Ello sin disminuir su calidad diagnóstica y con obvio beneficio para el paciente.

Tipificación molecular del Vibrio cholerae 01 en el Perú / Molecular typification of Vibrio cholerae 01 from Peru

Este estudio de ribotipificación en 75 cepas de Vibrio cholerae 01 permitió identificar tres variantes ribotípicas, referidas como Per1, Per2 y Per3, aisladas durante el periodo 1991-1999 en el Perú. La variante Per1 fue reportada tanto en la etapa epidémica y endémica del cólera, mientras que Per2 y Per3 se relacionan sólo con la etapa endémica. Los resultados mostraron además una aparición constante y mayoritaria de la variante Per1, poniendo en evidencia la emergencia de un mismo grupo clonal en los brotes epidémicos del Perú. Las variantes ribotípicas encontradas fueron comparadas con los ribotipos de diferentes cepas referenciales de V. cholerae previamente caracterizadas. Se observó una identidad total del ribotipo Per1 con la variante ribotípica de aislamientos Asiáticos (Tailandia), encontrándose además altos índices de similitud entre los ribotipos Per1, Per2 y Per3, y evidenciándose una estrecha relación entre las cepas peuansa y los aislamientos asiáticos

Prevalence of attention-deficit/hyperactivity disorder symptoms in 4- to 17-year-old children in the general population.

The purposes of this study were (a) to estimate the prevalence of Attention-Deficit/Hyperactivity Disorder (AD/HD) symptoms in the general preschool and school population; and (b) to analyze the influence of gender, age, and socioeconomic status (SES) variables on AD/HD symptoms. Out of the 80,000 preschool and schoolchildren living in Manizales, Colombia, a random sample of 540 children was selected. Two gender, three age (4- to 5-year olds, 6- to 11-year olds, and 12- to 17-year olds), and three SES (low, middle, and high) groups were used. The 18 DSM-IV symptoms corresponding to AD/HD Criterion A were assessed on a scale of 0 (never) to 3 (almost always). All three demographic variables established statistically significant differences: AD/HD symptoms were more frequent in 6- to 11-year-old, low-SES, male participants. DSM-IV Criterion A for AD/HD was fulfilled by 19.8% of the boys and 12.3% of the girls. However, this difference was marginally significant only in the AD/HD Subtype I: Combined. It was concluded that demographic variables are significant correlates of the AD/HD diagnosis. The prevalence found in this study was higher than usually reported, even though only the symptomatic DSM-IV AD/HD criterion was analyzed. We failed to confirm the assumed AD/HD gender ratio.

Radiación dispersa en radiología de niños menores de 1 año / Backscatter radiation in radiology of infants under 1 year old

Es generalizado en nuestro medio radiológico el uso de grilla móvil (Bucky) en imágenes de niños menores de 1 año. Ello contradice las indicaciones teóricas y la experiencia internacional en radiología pediátrica. En el caso particular de imágenes de caderas en niños menores de 1 año, se evaluó la calidad radiológica de una muestra representativa de 30 casos consecutivos, en base a la lectura de los parámetros de Hilgenreiner. Ello permite medir objetivamente su calidad radiológica, independientemente de su relevancia en el diagnóstico clínico. El resultado técnico fue óptimo. Además, se estimó una reducción máxima del 400 por ciento en la dosis al paciente. Se estima mandatorio eliminar el uso de Bucky en todo tipo de imágenes para estos pacientes

Morbilidad y mortalidad perinatal hospitalaria/Crecimiento de niños de 2000g o menos de peso al nacer en el priemr año de vida / Morbidity and perinatal mortality hospitalaria/Crecimiento of children of 2000g or less of weight when being born in the first year of life

Presenta las tendencias y estado actual de la morbimortalidad hospitalaria en la Maternidad Isidro Ayora de la ciudad de Quito. Analiza las causas del suceso y los mecanismos de prevención que se adoptaron en la actualidad. Además, expone las étapas del crecimiento de los niños con bajo peso, sus necesidades y factores de riesgo principales...

[Taenia sp and other intestinal cestode infections in individuals from public outpatient clinics and hospitals from the northern section of Santiago, Chile (1985-1994)]. / Infecciones por Taenia sp. y otros cestodos intestinales en pacientes de consultorios y hospitales públicos del sector norte de Santiago, Chile. 1985-1994.

During 1985-1994 period, 70,642 parasitological stool examinations were performed. The exam was made to each patient which presenting gastrointestinal symptoms or nutritional problems, specially in children. 59,960 out of the 70,642 examinations corresponded to 1 month--15 years old children, 4,280 to 16-30 years old individuals and 6.402 to up to 30 years old adults. The infection rates (x 100,000) were: Taenia sp., 86; Hymenolepis nana, 1,165; Diphyllobotrium sp., 4 and Hymenolepis diminuta, 1. In this period, 11 cases of infection by Taenia saginata were detected, and none Taenia sodium infection. Although infections rates by intestinal cesdodes were higher in males than females, in the Taenia sp. infection the difference was not statistical significative. Médico-veterinary control of animals slaughtered in abbatoirs and the improvement of sanitary conditions in the last two decades have contributed to the control of most of human intestinal cestodiases.

[Blastocystis hominis: frequency of infection in ambulatory patients from the northern section of Santiago, Chile]. / Blastocystis hominis: frecuencia de infección en pacientes ambulatorios del sector norte de Santiago, Chile.

In July 1989-July 1990 period, a coproparasitological study of 6,162 ambulatory patients from the northern section of Santiago, was undertaken. Out of the total number of the studied individual, 88.6% were children, (51.4% females and 48.6% males). The global frequency of infection by B. hominis was 30.4%. In relation to age. Blastocystis hominis was found in: 13.1% of the group of children (1 month-2 years); 34.1% of the pre-school children, 45.4% in the school-children and 43.0% in the adults. B. hominis was frequently detected in association with other parasites and/or commensals, and observed alone in the 6.0% of the studied patients.

[Incidence of infection by intestinal parasites among school children in Santiago, Chile, 1988-1989]. / Frecuencia de infección por enteroparásitos en escolares de Santiago de Chile, 1988-1989.

In December 1988-February 1989 period, a survey on enteroparasitic infections in children (mean age 8.7 years; males 54.4% and females 45.6%) from five schools located in Santiago, Chile, was undertaken. To each of these individuals, three samples were obtained in order to perform in them the following examinations: co-proparasitological study, modified Ziehl-Neelsen staining for detecting Cryptosporidium sp. and cellulose adhesive test for Enterobius vermicularis. Parasitic elements were found in the following percentages: Blastocystis hominis 51.8, Enterobius vermicularis 39.9, Giardia lamblia 32.1, Entamoeba histolytica 7.8, Hymenolepis nana 2.1 and Ascaris lumbricoides 0.4, Cryptosporidium sp. were not observed. The present study would be demonstrating that enteroparasites maintain their endemic condition among school children from Santiago, including B. hominis which had not been searched previously.