Out-of-pocket expenses and parent reported quality of life in children with cow's milk protein allergy in Bogotá, Colombia.

OBJECTIVE: To identify the out-of-pocket expenses and parent-reported quality of life (QoL) of children with a diagnosis of cow's milk protein allergy (CMPA) between the ages of 0 and 5 using the Food Allergy Quality of Life Questionnaire - Parent Form. METHODS: A cross-sectional study was conducted in two tertiary care centers in Bogotá. Demographic, medical information, and QoL scores were collected by parental interview. We carried out a cost-of-illness analysis based on self-reported out-of-pocket expenses attributed to the treatment as a whole and the family's monthly income. Exploratory analyses used the QoL scores and the percentage of out-of-pocket expenses attributable to treatment as outcomes. RESULTS: 122 families were analyzed. Median subject age was 17 months (Q1-Q3: 11-26.75 months) and female subjects made up 71% of the sample. The median QoL score was 3.21 points (Q1-Q3: 2.43-4.34) and only differed by age groups and personal history of other food allergies. The median out-of-pocket treatment related costs was 300,000 Colombian pesos (COP) (Q1-Q3: 280,000-340,000 COP). About 17% of the families had to pay over 15% of their monthly income to purchase food and dietary products. Out-of-pocket treatment related costs differed depending on whether the treatment included formulas (Mann-Whitney test p < 0.001). Out-of-pocket treatment expenses were uncorrelated with the QoL scores. CONCLUSION: Food allergy related QoL scores were not associated with out-of-pocket expenses as a whole or as a fraction of monthly income but were higher in children with additional food allergies and in older age groups, suggesting a lower QoL.

Usefulness of Ultrasonography and Radiography in the Evaluation of Distal Forearm Fractures in Children: A Narrative Review / Utilidad de la ecografía y la radiografía en la evaluación de las fracturas distales del antebrazo en niños: una revisión narrativa

Pediatric fractures, especially distal forearm fractures, represent a significant global medical concern, affecting up to 50% of pediatric fracture cases. This narrative review aims to compare diagnostic modalities to determine which offers higher accuracy, minimizes radiation exposure, and is adaptable to diverse clinical settings. In the choice between ultrasound and X-ray for diagnosing distal forearm fractures in children, each modality has its merits. X-ray provides accuracy and value in wellequipped facilities, while ultrasound, being radiation-free, is effective in resourcelimited areas and is essential for pediatric patients to avoid radiation exposure. Professional training and continual updates are crucial. Moreover, it underscores that alongside diagnostic imaging, comprehensive clinical assessment remains pivotal for making informed medical decisions. The choice of method should consider individual case factors and prioritize patient safety. (AU)

Las fracturas pediátricas, especialmente las fracturas distales del antebrazo, representan una importante preocupación médica mundial y afectan hasta el 50% de los casos de fracturas pediátricas. Esta revisión narrativa tiene como objetivo comparar modalidades de diagnóstico para determinar cuál ofrece mayor precisión, minimiza la exposición a la radiación y es adaptable a diversos entornos clínicos. A la hora de elegir entre ecografía y rayos X para diagnosticar fracturas distales del antebrazo en niños, cada modalidad tiene sus ventajas. Los rayos X proporcionan precisión y valor en instalaciones bien equipadas, mientras que el ultrasonido, al no tener radiación, es eficaz en áreas con recursos limitados y es esencial para que los pacientes pediátricos eviten la exposición a la radiación. La formación profesional y la actualización continua son cruciales. Además, subraya que, junto con el diagnóstico por imágenes, la evaluación clínica integral sigue siendo fundamental para tomar decisiones médicas informadas. La elección del método debe considerar factores de cada caso individual y priorizar la seguridad del paciente. (AU)

Anti-Inflammatory Effect of Izalpinin Derived from Chromolaena leivensis: λ-Carrageenan-Induced Paw Edema and In Silico Model.

The flavonoid izalpinin was isolated from the aerial parts of Chromolaena leivensis. Its structural determination was carried out using MS and NMR spectroscopic techniques (1H, 13C). This compound was evaluated for its anti-inflammatory effect in a rat model on λ-carrageenan-induced plantar edema. Paw inflammation was measured at one-hour intervals for seven hours following the administration of λ-carrageenan. Serum creatine kinase (CK) levels were evaluated, obtaining statistically significant results with the treatments at doses of 10 mg/kg (* p < 0.01) and 20 mg/kg (** p < 0.005). The anti-inflammatory effect of the compound was evaluated by using plethysmography, and the results showed significant differences at the three concentrations (10 mg/kg, 20 mg/kg, 40 mg/kg) in the first and third hours after treatment. * p < 0.05; ** p < 0.001; **** p < 0.0001 vs. the negative control group treated with vehicle (DMSO). Lastly, molecular docking analyses reveal that izalpinin has a strong binding affinity with five target proteins involved in the inflammatory process. The analysis using molecular dynamics allowed demonstrating that the ligand-protein complexes present acceptable stability, with RMSD values within the allowed range.

Sanitary and environmental conditions related to food poisoning among informal street vendors in downtown Medellín, Colombia, 2016.

Introduction: Although studies with informal workers have been conducted in Latin America and the Caribbean, there is still scarce evidence on the prevalence of food poisoning among workers with subsistence jobs on the streets and sidewalks of cities and on the factors that influence its presentation. Objectives: To determine sociodemographic, labor, sanitary, and environmental conditions that influence the prevalence of food poisoning in informal workers in downtown Medellín, Colombia. Methods: This is a cross-sectional study using a workers' survey as the primary source. A total of 686 workers aged ≥18 years who had been working for ≥ 5 years were surveyed. An assisted survey was initially applied as a pilot test for training purposes and to obtain informed consent. Results: We identified several associations and explanatory factors of food poisoning using chi-square tests and prevalence ratios, with unadjusted and adjusted 95% confidence intervals (95%CI). A higher prevalence of food poisoning (p < 0.05) was observed in workers with lower frequency of waste collection (PR = 2.09; 95%CI = 1.04-4.19), who left cooked food (PR = 6.40; 95%CI = 2.34-17.8), beverages or chopped fruits uncovered at their workplace (PR = 3.92; 95%CI = 1.40-10.48), with inadequate waste management (PR = 4.84; 95%CI = 2.12-11.06), exposure to polluted water (PR = 3.00; 95%CI = 1.20-7.50) and acceptable water supply (PR = 5.40; 95%CI = 1.60-17.8). The factors that explained higher rates of food poisoning were not having a waste collection service (PRadjusted = 5.58; 95%CI = 3.38-13.10), inadequate waste management (PRadjusted = 6.61; 95%CI = 1.25-34.84), and having sanitary services next to worker's stall (PRadjusted = 14.44; 95%CI = 1.26-165.11). Conclusions: The conditions that are associated with and explain the higher prevalence of food poisoning in this working population can be addressed with health promotion and disease prevention interventions.

Introducción: Aunque se han realizado estudios con trabajadores informales en América Latina y el Caribe, aun es escasa la evidencia con respecto a la prevalencia de intoxicaciones alimentarias en trabajadores con empleos de subsistencia en las calles y aceras de las ciudades y a los factores que influyen en su presentación. Objetivos: Determinar las condiciones sociodemográficas, laborales, sanitarias y ambientales que influyen en la prevalencia de intoxicación alimentaria en trabajadores informales del centro de Medellín. Métodos: Estudio transversal con fuente primaria de información en un censo de 686 trabajadores, ≥18 años y con ≥5 años en su oficio. Se aplicó encuesta asistida previa realización de prueba piloto, estandarización de encuestadores y toma de consentimiento. Resultados: Se identificaron asociaciones y factores explicativos de intoxicación alimentaria, con pruebas del chi-cuadrado y razones de prevalencia (RP), con intervalos de confianza del 95% (IC95%) crudos y ajustados. Mayor prevalencia de intoxicación alimentaria (p < 0,05) en trabajadores con menor frecuencia de recolección de residuos (RP = 2,09; IC95% = 1,04-4,19), en quienes dejaban alimentos preparados (RP = 6,40; IC95% = 2,34-17,8), bebidas o fruta picada descubiertos en el puesto de trabajo (RP = 3,92; IC95% = 1,40-10,48), con inadecuado manejo de residuos (RP = 4,84; IC95% = 2,12-11,06), exposición a agua contaminada (RP = 3,00; IC95% = 1,20-7,50) y de aceptable calidad (RP = 5,40; IC95% = 1,60-17,8). Explicaron mayor intoxicación alimentaria no tener servicio de recolección de residuos (RPajustada = 5,58; IC95% = 3,38-13,10), inadecuado manejo de residuos (RPajustada = 6,61; IC95% = 1,25-34,84), y tener servicios sanitarios al lado del puesto de trabajo (RPajustada = 14,44; IC95% = 1,26-165,11). Conclusiones: Las condiciones que se asocian y explican mayor prevalencia de intoxicación alimentaria en esta población trabajadora, pueden ser revertidas con acciones de promoción de la salud y prevención de la enfermedad.

The impact of city-wide deployment of Wolbachia-carrying mosquitoes on arboviral disease incidence in Medellín and Bello, Colombia: study protocol for an interrupted time-series analysis and a test-negative design study.

Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia-exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018.

Effects of additional agitation process on the spectrophotometric profiles of homeopathic high dilutions

INTRODUCTION: Conventional homeopathy advocates giving 10 strokes (agitation/succussions) to a prescription bottle containing liquid dilution, before taking it. To scientifically support such activity, it must be based on studies on the physicochemical aspects of the memory of water and agitated water chains, supplemented with spectrometry. OBJECTIVE: To analyze spectrometric profiles of homeopathic high dilutions, comparing additionally agitated and non-agitated dilutions, and to define differences according to each dilution´s kingdom. METHODOLOGY: Homeopathic dilutions were prepared using a ratio of 1:100 obtaining dilutions from 1cH to 15cH. Measurements of absorbance of 15cH dilutions were performed at 340 nm and 200 nm, with and without additional agitation. RESULTS: Statistically significant differences were found between agitated and non-agitated dilutions (p <0.05) for Apis mellifica, Bufo rana, and Calcium iodatum, with a decrease in the mean value of absorbance (340 nm) in agitated solutions. For A nica montana, Matricaria chamomilla, Coffea arabica, Pulsatilla nigricans, Calcium iodatum and Natrum muriaticum, the absorbance values increased; these values decreased for Apis and Bufo. In addition, measurements were performed with a shorter wavelength (200 nm); it was observed that there are significant differences for all homeopathic dilutions studied. Additionally, when comparing the mean values of the absorbance for each kingdom, and observing the agitation factor, a statistically significant difference was found in the animal kingdom (p<0.05), having lower absorbance for agitated dilutions. CONCLUSION: Comparisons of the spectrometric profiles of agitated and non-agitated solutions allow to observe that there is a difference of the absorbance when comparing a previously agitated solution and a solution with no agitation before taking it.

Effects of additional agitation process on the spectrophotometric profiles of homeopathic high dilutions

Introduction: Conventional homeopathy advocates giving 10 strokes (agitation/succussions) to a prescription bottle containing liquid dilution, before taking it. To scientifically support such activity, it must be based on studies on the physicochemical aspects of the memory of water and agitated water chains, supplemented with spectrometry. Objective: To analyze spectrometric profiles of homeopathic high dilutions, comparing additionally agitated and non-agitated dilutions, and to define differences according to each dilution´s kingdom. Methodology: Homeopathic dilutions were prepared using a ratio of 1:100 obtaining dilutions from 1cH to 15cH. Measurements of absorbance of 15cH dilutions were performed at 340 nm and 200 nm, with and without additional agitation. Results: Statistically significant differences were found between agitated and non-agitated dilutions (p <0.05) for Apis mellifica, Bufo rana, and Calcium iodatum, with a decrease in the mean value of absorbance (340 nm) in agitated solutions. For A nica montana, Matricaria chamomilla, Coffea arabica, Pulsatilla nigricans, Calcium iodatum and Natrum muriaticum, the absorbance values increased; these values decreased for Apis and Bufo. In addition, measurements were performed with a shorter wavelength (200 nm); it was observed that there are significant differences for all homeopathic dilutions studied. Additionally, when comparing the mean values of the absorbance for each kingdom, and observing the agitation factor, a statistically significant difference was found in the animal kingdom (p<0.05), having lower absorbance for agitated dilutions. Conclusion: Comparisons of the spectrometric profiles of agitated and non-agitated solutions allow to observe that there is a difference of the absorbance when comparing a previously agitated solution and a solution with no agitation before taking it. (AU)