Trastornos de la densidad mineral ósea en personas con VIH en tratamiento antirretroviral Pereira-Risaralda-Colombia / Disorders of bone mineral density in patients with HIV on antiretroviral treatment-Colombia Risaralda Pereira

Objetivo: La osteoporosis es común en las personas con el virus de inmunodeficiencia humana (VIH). La etiología es multifactorial, involucrando factores de riesgo tradicionales, efectos directos de la infección por el VIH y efectos de los medicamentos antiretrovirales (ARV). Las nuevas evidencias sugieren que el aumento de la prevalencia de la osteoporosis en las personas infectadas por el VIH se traduce en un mayor riesgo de fractura que puede conducir al aumento de morbilidad y mortalidad. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en 180 pacientes, que permitió conocer los trastornos de baja masa ósea que presentaban los pacientes estudiados que recibían terapia ARV. Para la medición se usó el método DXA (Dual Energy X Ray Absorptiometry) de columna lumbar y cuello femoral y para la clasificación los criterios de la OMS . Resultados: Se evaluaron 180 pacientes, 76,5% fueron hombres, con un promedio de edad de 41± 11,27 años. Resultaron normales 72,6%, Osteopenia 20,6% y osteoporosis en el 20,6% y osteoporosis en el 6,7%. El análisis multivariado mostró una asociación significativa importante de la Nevirapina frente a la disminución de la masa ósea (OR 0,10 IC95% 0,01 - 0,8). La combinación Tenofovir / Emtricitabina mostró una frecuencia más alta entre pacientes con disminución de la masa ósea (ORa 3.664 IC95% 1.2 - 11.0) . Conclusiones: Se hace necesario realizar tamizaje DXA a los pacientes que reciben TAR, para realizar un diagnóstico y tratamiento temprano y evitar complicaciones óseas que alteren la calidad de vida de las personas con VIH.

Objective: Osteoporosis is common in people with human immunodeficiency virus (HIV). The etiology is multifactorial, involving traditional risk factors, direct effects of HIV infection and effects of antiretroviral drugs (ARVs). New evidence suggests that the increased prevalence of osteoporosis in people with HIV results in an increased risk of fracture that can lead to increased morbidity and mortality. Materials and Methods: A descriptive cross-sectional study was undertaken of 180 patients, which allowed us to see the low bone mass disorders in patients of the study who were receiving ARV therapy. Measurements of lumber spine and femoral neck were made using the DXA (Dual Energy X-Ray Absorptiometry) method and for the classification, criteria of the WHO were used. Results: 180 patients were evaluated. 76.5% were men, with an average age of 41 +-11.27 years. 72.6% were normal, 20.6% had osteopenia and 6.7% osteoporosis. The multivariate analysis showed an important significant association of Nevirapine with the decreased bone mass (ORa 0.10 IC95% 0.01 - 0.8). The combination of Tenofovir / Emtricitabine showed a higher frequency among patients with low bone mass (ORa 3,664 IC95% 1.2 - 11.0). Conclusions: DXA screening is necessary for patients receiving TAR, in order to make a diagnosis, give early treatment and prevent bone complications that affect the quality of life of people with HIV.

Evaluación de los efectos del glifosato y otros plaguicidas en la salud humana en zonas objeto del programa de erradicación de cultivos ilícitos / Effects of aerial applications of the herbicide, glyphosate and insecticides on human health

Introducción. El Programa de Erradicación de Cultivos Ilícitos con Glifosato se ejecuta dando cumplimiento a lo establecido en el Plan de Manejo Ambiental. Objetivo. Explorar los posibles efectos del glifosato y otros plaguicidas sobre la salud humana como resultado de las aspersiones aéreas. Materiales y métodos. Se realizó un estudio descriptivo en 112 individuos procedentes de las áreas asperjadas de los departamentos de Huila, Tolima, Putumayo, Guaviare, Santander, Antioquia, Magdalena y La Guajira, durante 2005 y 2006. Se aplicó una encuesta y se recolectaron muestras de orina para la determinación de glifosato, y de sangre, para la determinación de acetilcolinesterasa y organoclorados. Se llevó a cabo un análisis simple y se exploraron las posibles asociaciones. Resultados. El 50,0% (56 individuos) de la población manifestó el uso de plaguicidas en su trabajo. El tiempo que llevaban utilizando los plaguicidas fue de 84,8 meses y refirieron aplicar plaguicidas 5,6 horas al día. El predominio de los plaguicidas usados fue extremadamente tóxico. De 39,6% de los individuos a quienes se les cuantificó glifosato, 64,3% reportaron su uso en actividades agrícolas. Se encontró una relación estadísticamente significativa entre el uso de glifosato terrestre (manual) y los niveles de este herbicida en orina (OR=2,54; IC95% 1,08-6,08). Conclusión. No hubo hallazgos concluyentes entre la exposición a glifosato empleado en la erradicación de cultivos ilícitos y los efectos en la salud, debido a que se halló exposición ocupacional concomitante por la misma sustancia y por otras de mayor toxicidad que el glifosato.

Introduction. The herbicide glyphosate is administered aerially by the Program to Eradicate Illicit Crops Program and is undertaken in rigorous compliance with the Environmental Management Plan. Objective. The effects of the glyphosate herbicide and other aerially applied insecticides were measured to determine possible impact on human health. Materials and methods. In 2005-2006, a survey was taken of 112 individuals living in herbicide-treated areas of the Colombian provinces of Huila, Tolima, Putumayo, Guaviare, Santander, Antioquia, Magdalena and La Guajira. Samples of blood were examined for presence of acetylcholinesterase and organochlorine insecticides; urine was analyzed for glyphosate and its metabolites. Results. Fifty percent (50%) of the individuals sampled acknowledged the use of control chemicals as part of their work. The mean exposure time to the chemicals was 84.4 months, with a mean daily exposure of 5.6 hours. The most commonly used pesticides were of category I--extremely hazardous. In individuals sampled for glyphosate (39.6% of the total), 64.3% indicated the use of this herbicide at ground level in agricultural work. A statistically significative relationship was found between the use of glyphosate at ground level, and the concentration levels of glyphosate in the urine samples (odds ratio=2.54, 95% CI: 1.08 to 6.8). Conclusion. These data did not show a relationship between the aerial sprayings of glyphosate for illicit crops eradication and an impact on human health, nor with occupational exposure to this and other chemicals (insecticides) with a high levels of toxicity.

Prácticas educativas familiares y desempeño académico en adolescentes escolarizados en el grado noveno de instituciones educativas oficiales del municipio de Envigado / Family educational practices and academic performance in schooled adolescents in the ninth grade in public educational institutions in the municipality of Envigado

En el presente artículo, se plantea la relación entre las prácticas educativas familiares y el desempeño académico de 451 adolescentes (hombres y mujeres) de noveno grado de Instituciones oficiales del Municipio de Envigado/Antioquia. Con una selección aleatoria simple y la aplicación de las escalas de afecto (EA-P) y de normas y exigencias (ENE-P) de Bersabé, Fuentes y Montrico (2001) con hijos y padres, se obtiene que los estilos de autoridad inductivos favorecen el desempeño académico, mientras que los rígidos propician un desempeño académico deficitario, siendo mas bajo en los permisivos. Además, los padres son percibidos más permisivos y rígidos que las madres, finalmente se observan divergencias entre las percepciones de los hijos y los padres, quienes tienden a evaluarse de manera positiva…

[Effects of aerial applications of the herbicide glyphosate and insecticides on human health]. / Evaluación de los efectos del glifosato y otros plaguicidas en la salud humana en zonas objeto del programa de erradicación de cultivos ilícitos.

INTRODUCTION: The herbicide glyphosate is administered aerially by the Program to Eradicate Illicit Crops Program and is undertaken in rigorous compliance with the Environmental Management Plan. OBJECTIVE: The effects of the glyphosate herbicide and other aerially applied insecticides were measured to determine possible impact on human health. MATERIALS AND METHODS: In 2006-2006, a survey was taken of 112 individuals living in herbicide-treated areas of the Colombian provinces of Huila, Tolima, Putumayo, Guaviare, Santander, Antioquia, Magdalena and La Guajira. Samples of blood were examined for presence of acetylcholinesterase and organochlorine insecticides; urine was analyzed for glyphosate and its metabolites. RESULTS: Fifty percent (50%) of the individuals sampled acknowledged the use of control chemicals as part of their work. The mean exposure time to the chemicals was 84.4 months, with a mean daily exposure of 5.6 hours. The most commonly used pesticides were of category I--extremely hazardous. In individuals sampled for glyphosate (39.6% of the total), 64.3% indicated the use of this herbicide at ground level in agricultural work. A statistically significative relationship was found between the use of glyphosate at ground level, and the concentration levels of glyphosate in the urine samples (odds ratio=2.54, 95% CI: 1.08 to 6.8). CONCLUSION: These data did not show a relationship between the aerial sprayings of glyphosate for illicit crops eradication and an impact on human health, nor with occupational exposure to this and other chemicals (insecticides) with a high levels of toxicity.

Factores de exposición a plaguicidas organofosforados y carbamatos en el departamento del Putumayo, 2006 / Organophosphorus and carbamate pesticide exposure in Putumayo Province, Colombia

Introducción. En 2005 el Sistema de Vigilancia en Salud Pública encontró que el departamento del Putumayo es la región con mayor incidencia de intoxicaciones por plaguicidas en Colombia. Objetivo. Establecer la exposición a plaguicidas organofosforados y carbamatos en la población agrícola mediante la determinación de los niveles de acetilcolinesterasa en el departamento de Putumayo, utilizando el método de Michel. Materiales y métodos. Se realizó un estudio transversal en 204 trabajadores ocupacionalmente expuestos, en cuatro municipios del departamento de Putumayo. Se aplicó una encuesta para recolectar información y se tomó una muestra de sangre para la determinación de la acetilcolinesterasa. Se llevó a cabo el análisis simple de las variables y se exploraron posibles asociaciones. Un grupo de trabajadores fueron capacitados con la metodología SARAR (una estrategia educacional participativa que significa: S: seguridad, A: asociación, R: reacción, A: actualización y R: responsabilidad) sobre el uso y el manejo de plaguicidas. Resultados. Se estableció que el tiempo promedio de exposición fue de nueve años. El 75,2 por ciento manifestó emplear plaguicidas extremadamente tóxicos y el 13,0 por ciento altamente tóxicos. En promedio refirieron aplicar plaguicidas 7,3 horas al día. El 9,8 por ciento usaban plaguicidas organoclorados. En cuanto a la actividad de la enzima acetilcolinesterasa, 17,6 por ciento presentaban inhibición. Conclusión. Este trabajo permitió tener una dimensión real del problema de los plaguicidas en el Putumayo y utilizarla para hacer una intervención educativa sobre los trabajadores y sus familias, con la metodología SARAR.

Introduction. In 2005, the Sistema de Vigilancia en Salud Pública, the governmental agency responsible for monitoring public health, found that Putumayo Province has the highest incidence of poisoning by pesticides in Colombia. Objective. Exposure to organophosphorus and carbamate pesticides and carbamates was established in the agricultural population of Putumayo by determining acetylcholinesterase levels. Materials and methods. A cross-sectional survey was made in 204 occupationally exposed workers in four municipalities of Putumayo. A questionnaire was administered to collect subject information; a blood sample was taken for acetylcholinesterase determination by Michel’s method. A straightforward analysis of the variables and possible associations were explored. A group of workers was enabled with SARAR (a participative educational strategy that means: S: safety, A: association, R: reaction, A: actualization and R: responsability)methodology for use and handling of pesticides. Results. The average time of exposure was nine years. Seventy-five percent declared using extremely toxic pesticides and 13% highly toxic. On average, they applied pesticides 7.3 hours/day. Nearly 10% used organochloride pesticides. Furthermore, 17.6% demonstrated inhibition of the enzyme acetylcholinesterase. Conclusion. A realistic scale of the pesticide use problem in humans was obtained; and the data effectively recommend an educatiional intervention for the workers and their families with SARAR methodology.

[Organophosphorus and carbamate pesticide exposure in Putumayo Province, Colombia]. / Factores de exposición a plaguicidas organofosforados y carbamatos en el departamento del Putumayo, 2006.

INTRODUCTION: In 2005, the Sistema de Vigilancia en Salud Pública, the governmental agency responsible for monitoring public health, found that Putumayo Province has the highest incidence of poisoning by pesticides in Colombia. OBJECTIVE: Exposure to organophosphorus and carbamate pesticides and carbamates was established in the agricultural population of Putumayo by determining acetylcholinesterase levels. MATERIALS AND METHODS: A cross-sectional survey was made in 204 occupationally exposed workers in four municipalities of Putumayo. A questionnaire was administered to collect subject information; a blood sample was taken for acetylcholinesterase determination by Michels method. A straightforward analysis of the variables and possible associations were explored. A group of workers was enabled with SARAR (a participative educational strategy that means: S: safety, A: association, R: reaction, A: actualization and R: responsability)methodology for use and handling of pesticides. RESULTS: The average time of exposure was nine years. Seventy-five percent declared using extremely toxic pesticides and 13% highly toxic. On average, they applied pesticides 7.3 hours/day. Nearly 10% used organochloride pesticides. Furthermore, 17.6% demonstrated inhibition of the enzyme acetylcholinesterase. CONCLUSION: A realistic scale of the pesticide use problem in humans was obtained; and the data effectively recommend an educatiional intervention for the workers and their families with SARAR methodology.

Attention-deficit/hyperactivity disorder and comorbidities in 18 Paisa Colombian multigenerational families.

OBJECTIVE: Eighteen extended multigenerational families were recruited from the genetically isolated Paisa community in Colombia to conduct genetic studies of attention-deficit/hyperactivity disorder (ADHD). This report describes the inclusion strategy and clinical features of participants to facilitate comparisons with other data sets. METHOD: Families were selected through a fixed-sampling scheme beginning with child probands referred for clinical evaluation for ADHD. Direct structured psychiatric interviews were conducted with 433 informative individuals, including 92 children aged 4 to 11, 57 adolescents aged 12 to 17, and 284 adults. Best estimate ADHD diagnoses were established for each informative pedigree member. RESULTS: These families contained a high proportion of individuals affected with ADHD (32.8%), which was highly comorbid with conduct disorder (50%; odds ratio 11.5, 95% confidence interval = 6.4-20.9), oppositional defiant disorder (25.4%; odds ratio 2.7, confidence interval = 1.5-4.8), and associated conditions including nicotine dependence and alcohol abuse and/or dependence. CONCLUSIONS: ADHD in these extended Paisa families is highly comorbid with conduct and oppositional defiant disorders. This pattern of comorbidity, as well as the large dense pedigrees of the sample, suggests that it will be particularly useful for molecular genetic studies that are currently under way.

Prevalence estimations of attention-deficit/hyperactivity disorder: differential diagnoses and comorbidities in a Colombian sample.

The aim of this article was to analyze the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) in Colombian "Paisa" children and adolescents. A randomized sample of 4- to 17-year-old children and adolescents--176 males and 154 females--was selected from schools in Manizales, Colombia. The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview, medical histories revision, and neurological or psychiatric evaluations. Several rating scales and a neuropsychological assessment were administered in order to confirm the diagnosis. Children with Full Scale Intelligence Quotient (FSIQ) between 71 and 84 were recorded as having Borderline Intellectual Functioning (BIF), and those with a history of mild motor retardation, and/or Performance Intelligence Quotient (PIQ) lower than 71, were recorded as having a Developmental Coordination disorder (DCD), after confirmation by neurological and neuropsychological examinations. BIF and DCD children were excluded from the ADHD group. Total prevalence of ADHD adjusted by sex was 16.4% (males 19.8% and females 12.3%). Prevalence of clean ADHD cases was 11.5%, distributed as follows: combined type, 6.4%; inattentive, 4.8%; and hyperactive-impulsive, 0.3%. Distribution by sex was as follows: males, 14.8%; and females, 7.7%; with an odds ratio of 2.1 (95% CI: 1-4.5, chi 2 = 4.0, p < .05). Clean prevalence of ADHD adjusted by equal sex distribution was 11.3%. Prevalence of BIF was 5.8%, DCD 3.0%, and mild mental retardation 3.9%. Prevalence of ADHD did not show differences by socioeconomic status (SES), in contrast to mild mental retardation in which BIF and DCD were significantly more frequent in the lower SES.

Trastorno por déficit de atención en una comunidad paisa: informe preliminar / Prevalence of attention deficit hyperactivity disorder in a paisa community: preliminary report

La prevalencia del trastorno por déficit de atención, cuando se utilizan instrumentos de diagnóstico epidemiológico y de aplicación a padres de niños paìsas, puede llegar al 16.1-18/100; estas cifras han sido criticadas por apoyarse en una sola fuente de información. El objetivo del estudio fue establecer la prevalencia del trastorno en una comunidad paisa usando multiples métodos para su diagnóstico. Se seleccionó de manera aleatoria una muestra de 341 niños y adolescentes de 4 a 17 años, 184 niños y 157 niñas de los colegios de la ciudad de Manizales. Se estratificaron en dos niveles socioeconómicos. Para el diagnóstico se utilizaron diversos cuestionarios, destinados a padres y maestros para la evaluación de la conducta de los niños y los adolescentes, previamente estandarizados en la población paisa. El diagnóstico se confirmó mediante una entrevista neurológica y psiquiátrica semiestructurada, se revisaron las historicas clínicas y se hizo una evaluación clínica neurológica y psiquiátrica cuando fue necesario. El análisis preliminar de los datos obtenidos, muestra que la prevalencia de la enfermedad y de acuerdo a los criterios de DSM IV, fue del 17.1/100. La distribución según tipos fue: combinado, inatento e hiperactivo-impulsivo. La prevalencia de la enfermedad en la comunidad paisa, según estos estudios es más alta que la informada en estudios de otras poblaciones