La trazabilidad en las mediciones del laboratorio clínico: impacto en la calidad y seguridad del paciente / Traceability in clinical laboratory measurements: impact on quality and patient safety

Las mediciones confiables, trazables metrológicamente y comparables proporcionan la base racional para la evaluación de la calidad de un resultado y el fortalecimiento de las redes de laboratorios clínicos, lo cual permite mejorar la calidad de atención y la seguridad del paciente. En este documento se revisan los principios básicos que deben seguirse para garantizar la trazabilidad de las mediciones del laboratorio clínico, las ventajas de utilizar métodos trazables, el impacto de no hacerlo, y se discuten las principales limitaciones para relacionar las mediciones con los estándares de medición de referencia apropiados

Reliable, metrologically traceable, and comparable measurements provide the rationale for evaluating the quality of a result and strengthening clinical laboratory networks, thereby improving quality of care and patient safety. This document reviews the basic principles that must be followed to ensure the traceability of clinical laboratory results, the advantages of using traceable methods, the impact of not doing so, and the main limitations in relating measurements to appropriate reference standards

Evaluación del desempeño de un analizador POCT con relación a los resultados de los métodos convencionales rutinarios del laboratorio clínico en un hogar de ancianos. Cali. 2014 / Performance evaluation of a POCT analyzer in relation to the results of routine conventional clinical laboratory methods in a nursing home. Cali. 2014

RESUMEN Introducción: Los análisis en el sitio de atención (POCT, por sus siglas en ingles Point-of-care testing) son pruebas de diagnóstico clínico llevadas a cabo fuera de los espacios específicamente diseñados para los análisis clínicos, que proporcionan resultados rápidos que mejoran la oportunidad en la toma de decisiones médicas. En Colombia no hay información sobre su uso y desempeño en grupos etarios específicos como los de los hogares de ancianos en Colombia. Objetivo: Evaluar el desempeño de un analizador POCT para perfil lipídico (CT, LDL-c, HDL-c, TG) y glicemia con relación a los resultados de los métodos convencionales rutinarios del laboratorio clínico en un hogar de ancianos. Materiales y métodos: Estudio descriptivo de corte transversal. Se tomaron 52 residentes a quienes se les tomaron muestras pareadas (punción venosa y digital). Se usó un instrumento estandarizado para la descripción de las características deseadas del POCT. Se aplicó estadística univariada y bivariada. Resultados: La edad promedio de los participantes fue de 78, rango 64-91 años. El POCT mostró un desempeño aceptable frente a los métodos convencionales del laboratorio clínico, especialmente TG y HDL-c. Sin embargo, se observaron diferencias estadísticamente significativas en los resultados de glicemia, CT y LDL-c entregados por el POCT en comparación con los del laboratorio clínico. Conclusiones: La POCT puede ser una opción importante para tamizaje y control de enfermedades crónicas en hogares de ancianos. Sin embargo, es necesario una estructura organizacional que garantice la calidad de las mediciones del POCT. MÉD.UIS.2021;34(2): 9-18.

ABSTRACT Introduction: Point-of-care testing (POCT) are clinical diagnostic tests carried out than laboratory analysts, outside of spaces specifically designed for clinical analysis, and they provide quick results that improve the timeliness of medical decision making. In Colombia there is no information on its use and performance in specific age groups such as those in nursing homes. Objective: To evaluate the performance of a POCT analyzer for lipid profile (CT, LDL-c, HDL-c, TG) and glycemia in relation to the results of routine conventional methods of the clinical laboratory in a nursing home. Materials and methods: Descriptive cross-sectional. 52 residents were taken to whom paired samples were applied. Glucose and lipid levels were determined. Samples collected by fingerstick were analyzed by POCT and venipuncture by conventional methods certified by the CDC in the laboratory. A standardized instrument was used to describe the desired characteristics of the POCT. Univariate and bivariate statistics were applied. The results issued by the clinical reference laboratory were compared with those of the POCT through the ICC. Results: The average age of the participants was 78, range 64-91 years. The POCT showed an acceptable performance compared to conventional clinical laboratory methods, especially TG and HDL-c. However, statistically significant differences were observed in the results of glycemia, CT and LDL-c delivered by the POCT compared to those of the clinical laboratory. Conclusions: POCT can be an important option for chronic disease screening and management in nursing homes. However, an organizational structure is necessary to ensure the quality of the POCT measurements. MÉD.UIS.2021;34(2): 9-18.

Correlación entre deficiencias de hierro y enteroparasitismo en menores de 14 años de seis cabildos indígenas urbanizados de Colombia / Correlation between iron deficiencies and enteroparasitism in children under 14 years of age from six urbanized indigenous councils in Colombia

INTRODUCCIÓN: las comorbilidades de anemia y enteroparasitismo siguen siendo un importante problema de salud pública en muchos países en desarrollo y en especial en comunidades con mayores desventajas económicas. OBJETIVO: evaluar la correlación entre enteroparasitismo y deficiencias de hierro en menores de 14 años de los cabildos indígenas urbanizados de la ciudad de Santiago de Cali. MÉTODO: estudio observacional y analítico que involucró una muestra probabilística de indígenas menores de 14 años. Se analizaron tres muestras seriadas de materia fecal y sangre para establecer las proporciones de menores parasitados y no parasitados; anemia/ferropenia y depleción de las reservas de hierro. Se usó estadística descriptiva, univariada y bivariada, finalizando con los análisis multivariados de componentes principales y clúster jerárquico. RESULTADOS: el 80% de los menores estaban parasitados, el 17% con áscaris y tricocéfalo. No se halló asociación estadísticamente significativa entre parasitismo y género; cinco menores de entre 5-7 años presentaron anemia. Tres grupos se identificaron con el análisis multivariado. CONCLUSIONES: elevada prevalencia de parasitismo intestinal global y en particular una infestación significativa leve-moderada por helmintos; en términos generales, la anemia no predominó en la población de estudio y no se encontraron asociaciones significantes entre esta y parásitos patógenos

INTRODUCTION: the comorbidities of anaemia and enteroparasitism remain a major public health problem in many developing countries, especially in communities with economically disadvantages. OBJECTIVE: to assess the correlation between enteroparasitism and iron deficiency in children under aged 14 from the urbanized indigenous councils of the city of Santiago de Cali. METHOD: observational and analytical study that involved a probabilistic sample of indigenous people under 14 years old. Three serial samples of fecal matter and blood were analyzed to establish the proportions of parasitized and non-parasitized minors; anemia and depletion of iron reserves. Descriptive, univariate and bivariate statistics were used, ending with multivariate analysis of main components and hierarchical cluster. RESULTS: 80% of the minors were parasitized, 17% had parascaris and trichocephalon. No statistically significant association was found between parasitism and gender; 5 minors between 5-7 years presented anemia. Three groups were identified with the multivariate analysis. CONCLUSIONS: there is a high prevalence of global intestinal parasitism, particularly, there is a significant mild-moderate infestation caused by helminths; in general terms, anemia did not predominate in the study population and no significant associations were found between this and pathogenic parasites

Conventional biomarkers for cardiovascular risks and their correlation with the Castelli Risk Index-Indices and TG/HDL-C / Biomarcadores convencionales de riesgo cardiovascular y su correlación con los índices de CASTELLI Y TG/CHDL

Objective: to evaluate the correlation between a group of conventional biomarkers of cardiovascular risk with the Castelli-I and Castelli-II indices, and TG/HDL-C ratio in patients assigned to a program of cardiovascular risk for users of the clinical laboratory service of an institution that provides health services in the southwest of the Colombia.Materials and Methods: retrospective, descriptive multivariate exploratory study, carried out in 2 126 patients. Some sociodemographic variables were analyzed, as well as glucose and lipid profile. The Castelli-I and Castelli-II indices, and TG/HDL-C ratio were calculated. The correlation among the variables was evaluated through a matrix of correlations, the correlation index and the Bartlett's Test of Sphericity. The analysis ended with a study of main components, which allowed to identify how the variables studied were grouped into components that characterized the population. Results: the average age was 56 ± 11 years; 68.7% were women; 48% hypercholesterolemic and 49% hypertriglyceridemic; 22% with alterations in glucose. Total cholesterol correlated positively with LDL-C and triglycerides negatively with HDL-C. Two components characterized the population, one related to cardiovascular risk and the other to lipid alterations. Conclusions: conventional biomarkers reveal high prevalences in dyslipidemias, in contrast to atherogenic indices. The results highlight the importance of considering the evaluation of these indices in primary care and the need to strengthen the measurement systems of clinical laboratories for the reliability of the data on which decisions are made for the management of these patients..(AU)

Objetivo: evaluar la correlación entre un grupo de biomarcadores convencionales de riesgo cardiovascular con los índices de Castelli-I, Castelli-II y TG/cHDL en pacientes de riesgo cardiovascular usuarios del servicio de laboratorio clínico de una institución prestadora de servicios de salud del suroccidente de Colombia. Materiales y Métodos: estudio retrospectivo, descriptivo multivariado exploratorio, llevado a cabo en 2 126 pacientes. Se analizaron algunas variables sociodemográficas, glucosa y perfil lipídico. Se calcularon los índices de Castelli I/II y el índice de TG/cHDL. La correlación entre las variables se evaluó a través de una matriz de correlaciones, el índice de correlación y el Test de Esfericidad de Bartlet. El análisis finalizó con un estudio de componentes principales que permitió identificar como se agrupaban las variables estudiadas en componentes que caracterizaban a la población. Resultados: la edad promedio fue de 56±11 años, 68,7% fueron mujeres; 48% ipercolesterolemicos y 49% hipertrigliceridemicos; 22% con alteraciones en la glucosa. El colesterol total correlacionó positivamente con cLDL y los triglicéridos negativamente con cHDL. Dos componentes caracterizaron la población, uno relacionado con el riesgo cardiovascular y otro con las alteraciones lipídicas. Conclusiones: los biomarcadores convencionales develan altas prevalencias en las dislipidemias en contraste con los índices aterogénicos. Los resultados resaltan la importancia de considerar la evaluación de estos índices en atención primaria y la necesidad de fortalecer los sistemas de medición de los laboratorios clínicos para la confiabilidad de los datos sobre los cuales se toman decisiones en el manejo de estos pacientes.

Cumplimiento de una estrategia de higiene de las manos en ambientes asistenciales / Compliance with a hand hygiene strategy in healthcare settings / Observância da estratégia de higiene das mãos em ambientes assistenciais

Introducción: Si bien la higiene de las manos es la medida más importante en la mitigación del riesgo biológico en ambientes hospitalarios, evidencia científica muestra un escaso cumplimiento de las recomendaciones entre los trabajadores asistenciales. Objetivo: Evaluar el cumplimiento de cinco dimensiones que fortalecen la estrategia de higiene de las manos para la prevención del riesgo biológico en ambientes asistenciales. Método: Estudio observacional, de corte transversal, en cinco instituciones prestadoras de servicios de salud. Se aplicó estadística descriptiva. Con el Test de Medianas se evaluó si había diferencias significativas entre el grupo de profesionales por institución de salud, considerando significante una .p ≤ 0,05. El análisis finalizó con un análisis discriminante. Resultados: La representatividad estuvo en las instituciones hospitalarias de primer nivel en las cuales el personal de enfermería, seguido por los médicos, tuvo un mejor cumplimiento del protocolo de lavado de manos. Este porcentaje se vio impactado por el menor cumplimiento de suministro de insumos e infraestructura. Hay una perfecta diferenciación entre los resultados del municipio de Cali con relación al de Caicedonia, en contraste con los de Popayán, Buga y Buenaventura. Conclusión: Se encontró un incumplimiento del protocolo de higiene de las manos, con una calificación inaceptable para los factores de insumos/infraestructura y técnica de higiene de las manos, respectivamente.

Introduction: Although hand hygiene is the most important measure for biological risk mitigation in hospital settings, there is scientific evidence of low compliance among healthcare workers with the established recommendations. Objective: To assess compliance with five dimensions that strengthen the hand hygiene strategy for biological risk prevention in healthcare settings. Method: Observational, cross-sectional study in five institutions providing healthcare services with the application of descriptive statistics. The Median Test evaluated whether there were significant differences among groups of professionals per health institution, considering a p ≤ 0.05 to be significant. The analysis was completed with a discriminant analysis. Results: First-level hospital institutions showed representative results where the nursing staff, followed by physicians, had a better compliance with the handwashing protocol. This percentage was impacted by the lower compliance with the provisioning of supplies and infrastructure. There is a perfect differentiation between the results of the municipality of Cali compared those of Caicedonia, and in contrast with the results of Popayán, Buga, and Buenaventura. Conclusion: Compliance with the hand hygiene protocol was seen, with an assessment rated as unacceptable for the factors related to supplies and infrastructure and hand hygiene technique.

Introdução: Embora a higiene das mãos seja a medida mais importante na mitigação do risco biológico em ambientes hospitalares, tem evidência científica que mostra baixo cumprimento das recomendações entre trabalhadores assistenciais. Objetivo: Avaliar o cumprimento de cinco dimensões que fortalecem a estratégia de higiene das mãos para a prevenção do risco biológico em ambientes assistenciais. Método: Estudo observacional, de corte transversal, em cinco instituições prestadoras de serviços de saúde. Foi aplicada estatística descritiva. Com o Teste da Mediana avaliou-se se havia diferenças significativas entre o grupo de profissionais por instituição de saúde, considerando significante uma p ≤ 0,05. Finalizou-se com análise discriminante. Resultados: A representatividade ocorreu nas instituições hospitalares de primeiro nível onde a equipe de enfermagem, seguido pelos médicos, apresentou melhor cumprimento do protocolo de lavagem de mãos. Esse porcentual foi impactado pelo menor cumprimento do fornecimento de suprimentos e infraestrutura. Há uma perfeita diferenciação entre os resultados do município de Cali em relação aos de Caicedonia, em contraste com os de Popayán, Buga e Buenaventura. Conclusão: Encontrou-se não inobservância do protocolo de higiene das mãos, com qualificação inaceitável para os fatores de suprimentos/infraestrutura e técnica de higiene das mãos.

Variables pre-analíticas en los análisis de gasometría sanguínea en una institución hospitalaria de tercer nivel, Cali-Colombia / Pre-analytical variables in blood arterial analysis in a third-level hospital institution in Cali, Colombia

Resumen Introducción: Varios factores pre-analíticos afectan los resultados de gases sanguíneos. Objetivo: Evaluar la calidad del proceso pre-analítico de los análisis de gasometría sanguínea solicitados en las unidades de cuidados críticos e intermedios de una institución hospitalaria de tercer nivel de la ciudad de Santiago de Cali. Materiales y métodos: Estudio analítico de corte transversal. Se evaluaron las solicitudes y muestras tomadas a pacientes hospitalizados en las unidades de cuidados críticos. Se calculó medidas de tendencia central, desviación estándar y distribución de proporciones. Los test de Medianas y Kruskal-Wallis permitieron evaluar diferencias estadísticamente significativas en el manejo de la muestra por unidad de servicio/turno/mes/semana de estudio. El análisis se realizó en STATA 15®. Resultados: La muestra efectiva fue de 414 tomadas a 125 pacientes. En promedio se tomaron 4 muestras/día para estudios de gasometría. El 100% de las solicitudes y muestras no cumplieron con los criterios de calidad y seguridad para la identificación del paciente y 3% cumplieron con los criterios técnicos de temperatura y tiempos. Conclusiones: Las directrices del Ministerio de Salud para la seguridad del paciente y las normas técnicas de calidad pre-analítica en gasometría no se cumplen.

Abstract Introduction: Several pre-analytical factors affect the results of blood gases. Objective: To evaluate the quality of the pre-analytical process of the blood arterial analyses requested in the critical and intermediate care units of a third-level hospital institution in the city of Santiago de Cali, Colombia. Materials and methods: A transverse analytical study was conducted. Applications and samples taken to hospitalized patients in critical care units were assessed. Measures of central tendency, standard deviation and distribution of proportions were calculated. The medians and Kruskal-Wallis tests allowed to evaluate statistically significant differences in the management of the sample per unit of service, shift, month, week of study. The analysis was performed in Stata 15®. Results: The effective sample was 414, which were taken to 125 patients. On average, 4 samples a day were taken for arterial studies. 100% of applications and samples did not meet the quality and safety criteria for patient identification and 3% met the technical criteria of temperature and time. Conclusions: The guidelines of the Ministry of Health for patient safety and the technical standards of pre-analytical quality in arterial are not fulfilled.

Uso que se le dio a las pruebas periciales en los casos de delito sexual con menores de 14 años, sentenciados entre el 2012-2014 en San Juan de Pasto / Use given to expert evidences and witnesses in legal proceedings on offense cases involving minors under 14 sentenced in 2012-2014 in San Juan de Pasto / Uso dado aos testes periciais nos casos do crime sexual com os menores de 14 anos, sentenciados entre 2012-2014 em San Juan de Pasto

Resumen La prueba pericial es muy frecuente en los procesos judiciales de delito sexual. El presente trabajo tuvo como objetivo analizar el uso que se le dio a las pruebas periciales en los casos de delito sexual con menor de 14 años, sentenciados entre el 2012-2014 en San Juan de Pasto; en el método se llevó a cabo un estudio descriptivo/retrospectivo, que revisó 21 sentencias. Se evaluaron variables sociodemográficas de la víctima/agresor, contexto del hecho, médico-legales/científico-forenses usadas en el proceso judicial. En los análisis realizados en SPSS, se calcularon medidas de tendencia central en las variables cuantitativas, y en las cualitativas, proporciones. Se usó la prueba Z, y un valor de p ≤ 0,05 fue considerado como significante. Los resultados mostraron a los menores entre 4 y 10 años como los más afectados; los conocidos y familiares fueron sus principales agresores. El informe de psicología forense, en el 81% de las sentencias, fue seguido por el médico legal. Se concluyó que los jueces usan frecuentemente el informe de psicología forense para la toma de decisiones; sin embargo, es la prueba que más controvierte la defensa.

Abstract Expert evidence is very frequent in judicial proceedings on sexual offenses. The objective of this paper was to analyze the use of expert evidence in cases dealing with this type of crimes against minors under the age of 14, sentenced in 2012-2014 in San Juan de Pasto. With the use of this method, a descriptive/retrospective study was carried out in the revision of 21 sentences. Socio-demographic variables of the victim/aggressor and the fact's context were assessed, as well as those of medical-legal/scientific forensic nature used in the legal proceeding. In the SPSS analyses carried out, central trend measures were calculated on the quantitative variables and proportions on the qualitative ones. The Z test was used, and a p≤0.05 value was deemed to be significant. Results showed that minors under 4 and 10 years of age were the most affected victims while their main aggressors were used as a proof found among acquaintances and family members. In 81% of the sentences, the forensic psychology report was followed-up by the legal doctor. The conclusion was that judges do often use the forensic psychology report in decision making; but, nevertheless, this is the evidence most controverted by the defense.

Resumo O teste pericial é muito frequente nos processos judiciais do crime sexual. O trabalho atual teve como objetivo analisar o uso conferido aos testes periciais nos casos do crime sexual com o menor de 14 anos, sentenciados entre 2012-2014 em San Juan de Pasto; no método realizou-se um estudo descritivo/retrospectivo, que revisou 21 sentenças. As variáveis sociais e demográficas da vítima/agressor foram avaliadas, contexto do fato, médico-legal/cientista-forenses usadas no processo judicial. Nas análises feitas no SPSS, calcularam-se medidas da tendência central nas variáveis quantitativas, e nas qualitativas, proporções. O teste Z foi usado, e um valor de p≤0,05 foi considerado como significativo. Os resultados mostraram aos menores entre 4 e 10 anos como os mais afetados; os conhecidos e familiares foram seus agressores principais. O relatório de psicologia forense, em 81% das sentenças, foi seguido pelo médico legal. Conclui-se que os juízes usam frequentemente o relatório de psicologia forense para a tomada de decisões; não obstante, é o teste que controverte a defesa de mais.

Caracterización de los casos de violencia sexual atendidos en dos instituciones prestadoras de servicios de salud del municipio de Palmira-Valle Del Cauca, Colombia / Characterization of sexual violence treated at two provider of health care institutions of the municipality of Palmira-Valle Del Cauca, Colombia

Introducción: la violencia sexual es un problema de salud pública que afecta especialmente a menores, adolescentes y mujeres. Muchos de estos casos son atendidos en servicios de salud y no son conocidos por los operadores de justicia. Objetivo: caracterizar los casos de presuntas víctimas de delito sexual atendidas en los servicios de urgencias de dos instituciones prestadoras de servicios de salud de mediana y alta complejidad del municipio de Palmira-Valle del Cauca entre el 2012 y el 2015. Materiales y Métodos: estudio descriptivo, realizado con el total de los casos atendidos en dos instituciones de salud durante el periodo de estudio. A las variables cuantitativas se les calcularon medidas de tendencia central y dispersión; a las variables cualitativas, se les calcularon proporciones y razones. Se uso la prueba chi2 para explorar diferencias estadísticamente significativas (p<0,05) entre las variables. Resultados: un total de 40 casos fueron identificados durante el periodo de estudio, el 95% fueron mujeres, 65% menores de edad. En el 70% de los casos la víctima conocía a su agresor; 50% se consumaron en la residencia de la víctima o el agresor. El uso de la fuerza, la amenaza, el chantaje y el engaño, fueron las principales formas de abordaje e inducción al silencio empleadas por el agresor. Conclusiones: las características de los eventos contra la libertad, integridad y formación sexual en las dos instituciones, son persistentes y comparables con estudios en otros países. La mayoría de las víctimas son mujeres y adolescentes de bajos estratos socioeconómicos, usuarias del sistema de salud subsidiado, cuyo agresor era alguien conocido.

Introduction: sexual violence is a public health problem that affects especially to children, adolescents and women. Many of these cases are treated in health services and are not known by justice office. Objective: to characterize the alleged victims of sexual crime treated in the emergency department of two institutions providing health services in medium and high complexity in the municipality of Palmira-Valle del Cauca in 2012-2015. Materials and Methods: we conducted a prevalence, retrospective study performed in the total of the cases attended in two institutions that provide health services during the study period. Quantitative variables were measured with central tendency and dispersion, for qualitative variables proportions and reasons were calculated as well. The chi2 test was used to explore differences between variables. Results: 40 cases were included, 95% were women and 65% children. In 70% of cases the perpetrator was known by the victim and 72.5% of cases occurred at victim's residence. The use of physical force, threats, tricks and persuasion were the main ways used by the aggressor. Conclusions: the characteristics of the events against liberty, integrity and sexual education are persistent and comparable with studies in other countries. Most of victims were, women and adolescents low socioeconomic status women and adolescents attended by subsidized health system centers, who knew the perpetrator

Accidentes con material biológico en trabajadores de la salud. Palmira-Valle del Cauca. 2014-2016 / Accidents with biological material in health workers. Palmira-Valle del Cauca. 2014-2016 / Acidentes com material biológico em trabalhadores da saúde, Palmira,Valle del Cauca (2014-2016)

Introducción: Los profesionales sanitarios están expuestos diariamente a diferentes riesgos biológicos generados por su ambiente laboral. Objetivo: Describir el perfi l de los accidentes laborales por riesgo biológico en una institución de salud de segundo nivel de complejidad. Palmira-Valle del Cauca. 2014-2016. Materiales y métodos: Estudio descriptivo, retrospectivo, realizado con 37 reportes. A las variables cuantitativas se les calcularon medidas de tendencia central y dispersión y a las cualitativas proporciones y razones. Para analizar la relación entre variables se usaron los Test del Chi cuadrado, Fisher o Medianas de acuerdo a la distribución de los datos, considerando un valor de p≤0,05 como signifi cante. Resultados: La mayoría de los trabajadores accidentados fueron mujeres jóvenes, principalmente enfermeras auxiliares las cuales fueron lesionadas por elementos punzantes (agujas) durante los turnos matutinos y en los servicios de mayor demanda (urgencias y hospitalización). El 89 % de los trabajadores expuestos al riesgo biológico no utilizaron materiales o equipos de seguridad al momento del accidente. Las causas frecuentes fueron la manipulación de agujas y los movimientos del paciente al realizar procedimientos asistenciales. Las manos fueron el área más afectada. Conclusiones: El elemento vulnerante, el sitio de la lesión, el servicio, la edad del trabajador, el turno y el cargo en la institución prestadora de servicios de salud, determinaron el perfi l de los accidentes de trabajo, que registraron el mayor número de accidentes laborales con exposición a riesgo biológico; las causas más frecuentes se asociaron con la manipulación de elementos punzantes cuando la asistente atiende al paciente.

Introduction: Sanitary professionals are exposed daily to different biological risks generated by their work environment Objective: Describe the profile of work accidents caused by biological risks in a secondary level health care institution. Palmira-Valle del Cauca. 2014-2016. Materials and methods: Descriptive, retrospective study performed with 37 reports. For the quantitative variables, central tendency and dispersion were calculated, and for the qualitative variables, proportions and ratios. To analyze the relation between variables the Pearson's chi-squared test, fisher or the median were used according to the distribution of data, considering a value of p≤0,05 as significant. Results: Most of the workers injured were young women, mainly auxiliary nurses which were injured by sharps (needles) during morning shifts and in services of greater demand (emergencies and hospitalization). 89% of the workers exposed to biological risk did not use safety materials or equipment at the moment of the accident. The frequent causes were needle manipulation and movements of the patient when performing assistant procedures. Hands were the most affected area. Conclusions: The object that caused the accident, the place of the injury, the service, the age of the worker, the shift and the charge in the health care service institution, determined the profile of the work accidents which registered the greatest number of work accidents with exposure to biological risks; the most frequent causes were associated to the manipulation of sharp objects when the assistant or nurse attends the patient.

Introdução: Os professionais sanitários estão expostos diariamente a diferentes riscos biológicos gerados por seu ambiente de trabalho. Objetivo: Descrever o perfil dos acidentes no trabalho por risco biológico numa instituição de saúde de segundo nível de complexidade, na cidade de Palmira, Valle del Cauca, Colômbia (2014-2016). Materiais e Métodos: Estudo descritivo, retrospectivo, realizado com 37 relatórios. Às variáveis quantitativas se lhes calcularam medidas de tendência central e dispersão e às qualitativas proporções e razões. Para analisar a relação entre variáveis se usaram os Teste do Qui-quadrado, Fisher ou Medianas de acordo à distribuição dos dados, considerando um valor de p≤0,05 como significativo. Resultados: A maioria dos trabalhadores acidentados foram mulheres jovens, principalmente auxiliares de enfermagem as quais foram lesionadas por elementos perfurocortantes (agulhas) durante os turnos da manhã e nos serviços de maior demanda (emergências e hospitalização). O 89 % dos trabalhadores expostos ao risco biológico não utilizaram materiais ou equipamentos de segurança ao momento do acidente. As causas frequentes foram a manipulação de agulhas e os movimentos do paciente ao realizar procedimentos de cuidados de saúde. As mãos foram a área mais afeitada. Conclusões: O elemento vulnerável, o local da lesão, o serviço, a idade do trabalhador, o turno e o cargo na instituição fornecedora de serviços de saúde; determinaram o perfil dos acidentes no trabalho que registraram o maior número de acidentes com exposição a risco biológico; as causas mais frequentes se associaram com a manipulação de elementos pontiagudos quando a auxiliar de enfermagem cuidava do paciente

Caracterización de los casos de abuso sexual valorados en los servicios de urgencias y consulta externa de una institución hospitalaria de primer nivel en el Departamento del Cauca, 2007 - 2015 / Characterization of sexual abuse cases valued in the emergency services and outpatient consultation of a first-level hospital institution in the department of Cauca, 2007 - 2015

Resumen Introducción: El abuso sexual afecta a millones de niños, niñas y adolescentes e impacta en su salud física y mental. Objetivo: Caracterizar los casos de abuso sexual valorados en los servicios de urgencias y consulta externa de una institución hospitalaria de primer nivel del Departamento del Cauca entre 2007 al 2015. Materiales y métodos: Estudio descriptivo, retrospectivo de víctimas de abuso sexual atendidas en consulta externa/urgencias. Se seleccionaron variables temporales, sociodemográficas de la víctima/agresor y del contexto donde ocurrió el hecho. El análisis se realizó en Epi Info. Se calcularon medidas de tendencia central, dispersión, proporciones y razones. Con el test de Fischer se evaluó la relación entre variables. Resultados: El 77% de las víctimas fueron mujeres, 23% hombres, en edades entre los 2-16 años, el 100% eran estudiantes. El acto fue cometido por un solo agresor; en el 93,0% fue perpetrado por conocidos, de los cuales 42,9% eran familiares. Conclusiones: A pesar de las medidas de control y regulación, los resultados sugieren que el abuso sexual tiene lugar a edades muy tempranas, el agresor es casi siempre un conocido frecuentemente con vínculo consanguíneo, lo cual le facilita la perpetuación del hecho hacia el interior del núcleo familiar a través del engaño, el chantaje o la amenaza.

Abstract Introduction: Sexual abuse affects millions of children and adolescents and it impacts on their physical and mental health. Objective: To characterize the cases of sexual abuse valued in the emergency services and external consultation of a hospital institution of first level in the department of Cauca between 2007 and 2015. Materials and methods: A descriptive, retrospective study of victims of sexual abuse attended in external consultation/emergencies was made. Temporal and sociodemographic variables of the victim/aggressor and the context where the event occurred were selected. The analysis was done in Epi Info. Measures of central tendency, dispersion, proportions and reasons were calculated. The relationship between variables was assessed by using the Fischer test. Results: 77% of the victims were women, 23% men, at ages between 2 to 16 years and 100% were students. The act was committed by a single aggressor. Besides, in 93.0% of the cases, the act was perpetrated by acquaintances, of whom 42.9% were family members. Conclusions: Despite the control and regulation measures, the results suggest that sexual abuse takes place at very early ages. The aggressor is almost always a commonly known person with consanguineous bond, which facilitates the perpetuation of the act towards the family nucleus through deceit, blackmail or threat.

Identificación de criterios de orden legal y científico en el derecho probatorio del sistema penal que incidieron en el proferimiento de sentencias de los enjuiciados por delitos sexuales entre el 2009-2010 en dos municipios del Valle del Cauca / Identification of criteria of legal and scientific nature in the probative law of the criminal system having influenced the delivery of judgments and the passing of sentences for those having been prosecuted or tried for sexual crimes during 2009-2010 in two Valle del Cauca municipalities / Identificação de critérios para a ordem jurídica e científica no direito probatório do sistema de justiça criminal que afetaram o proferimento das sentenças dos processados por ofensas sexuais entre 2009-2010 em dois municípios de Valle del Cauca

El objetivo fue identificar los criterios de orden legal y científico en el derecho probatorio del sistema penal que incidieron en el proferimiento de sentencias de los enjuiciados por delitos sexuales entre el 2009-2010 en dos municipios del Valle del Cauca. El método utilizado consistió en el estudio de casos en 21 fallos entre el 2009-2010, con aplicación de variables sociodemográficas, médicolegales/ científico-forenses utilizadas para la descripción de los casos. En los análisis realizados en SPSS, se calcularon medidas de tendencia central, posición y dispersión a los datos cuantitativos, y a los cualitativos se les calcularon proporciones y razones. Se usó el test de chi cuadrado y un valor de p ≤=0,05 fue considerado como significante. Los resultados obtenidos evidenciaron que las mujeres entre 5-14 años fueron las más afectadas, y sus agresores, prevalentes familiares. La mayoría de los casos fueron actos sexuales abusivos, dos de acto sexual agravado en concurso homogéneo y heterogéneo. El informe médico-legal estuvo en todas las sentencias, y le siguió, en orden de frecuencia, el de psicología forense. Los ausentes en su mayor proporción fueron los de biología o genética forense. La investigación realizada permitió concluir que es tarea de los jueces garantizar la integridad de los menores víctimas de abuso sexual; no obstante, para ello cuentan con poco acervo probatorio científico-forense.

The objective was to identify criteria of legal and scientific nature in the probative law of the criminal system having influenced the delivery of judgments and the passing of sentences for those having been prosecuted or tried for sexual crimes over 2009-2010 in two Valle del Cauca municipalities. The method used involved case studies in 21 court decisions taking place from 2009 through 2010 with the application of socio-demographic, medical-legal/scientific forensic variables used in the respective descriptions. In analyses conducted with SPSS, central trend measures, position and dispersion were calculated for quantitative data, and proportions and rations for those of qualitative nature. The Chi-square test was used, and a p ≤=0.05 value was deemed significant. The results obtained evidenced that females between the ages of 5 through 14 were the most aff ected, aggressors being often family members. Most cases referred to abusive sexual acts, two of them aggravated, in multiple and concomitant combination. In order of frequency, in all judgments there were medicallegal and forensic psychology reports. In a larger proportion, reports concerning biology or forensic-genetics were not available. Research carried out helped conclude that judges should be in charge of ensuring the integrity of minors having been victims of any form of sexual abuse; notwithstanding this responsibility, their probatory material and scientific-forensic evidence on hand are very poor.

O objetivo foi identificar os critérios de ordem legal e científica no dereito probatório do sistema de justiça criminal que afetaram a proferimento das sentenças dos processados por crimes sexuais entre 2009-2010 em dois municípios de Valle del Cauca. O método utilizado foi o estudo de casos em 21 senteças entre 2009-2010, com aplicação de variáveis sociodemográficas médico-legais / científico-forenses, utilizadas na descrição dos casos. Nas análises realizadas no SPSS, as medidas de tendência central, posição e dispersão foram calculadas aos dados quantitativos e proporções e razões foram calculadas aos qualitativos. O teste de qui-quadrado e um valor p ≤=0,05 foi usado e foi considerado como significativo. Os resultados mostraram que as mulheres com idade entre 5-14 anos foram as mais afetadas, e seus agressores, prevalentes parentes. A maioria dos casos foram atos sexuais abusivos, dois de ato sexual agravado em concurso homogêneo e heterogêneo. O relatório médico-legal estave em todas as senteças, e seguido, em ordem de freqüência, um de psicologia forense. Os ausentes em maior proporção foram os de biologia ou genética forense. A pesquisa levou à conclusão de que é a tarefa dos juízes garantir a integridade das crianças vítimas de abuso sexual; no entanto, para isso têm pouca evidência forense científica.

Evaluación de la persistencia deespermatozoides humanos en la vagina / Evaluation of persistence of human spermatozoa in the vagina

Introducción: la determinación del tiempo de persistencia de los espermatozoides en el frotis vaginal poscoital tiene especial importancia en la investigación de los delitos sexuales. Objetivo: evaluar la persistencia de espermatozoides en muestras de frotis vaginales poscoitales a diferentes tiempos durante cinco días en mujeres voluntarias. Materiales y métodos: se realizó un estudio experimental, descriptivo en muestras de frotis vaginal poscoital tomadas cada ocho horas durante 128 horas. Las muestras se sometieron a un proceso de extracción, sedimentación y coloración supravital. Se realizó el análisis estadístico utilizando el software Minitab 16. A las variables cuantitativas se les calculó las medidas de tendencia central y de dispersión y a las cualitativas las proporciones. Además, se evaluó si existían diferencias estadísticamente significativas entre las muestras recolectadas en el mismo intervalo de tiempo aplicando un test de ANOVA unidireccional para un nivel de significancia del 0,05. Resultados: de 18 muestras de mujeres voluntarias en el 60% se observaron, en las primeras 72 horas, más de 10 espermatozoides por campo, 10% de estas muestras llegaron a las 128 horas con más de cinco espermatozoides y 2% con uno por campo. Se observó una disminución marcada del número de espermatozoides en dos muestras con abundante reacción leucocitaria y alta densidad de levaduras, hifas, seudohifas y bacterias...

Introduction: determination of persistence of spermatozoa in postcoital vaginal smears is especially important in sexual assault investigation. Objective: To evaluate the persistence of spermatozoa in postcoital vaginal smears samples at different times during 128 hours in female volunteers. Materials and methods: Experimental, descriptive study was made in postcoital vaginal smears samples collected every eight hours during five days. The samples were subjected to an extraction process, sedimentation and supra-vital staining. Statistical analysis was performed using Minitab 16 software. Measures of central tendency and dispersion were calculated for quantitative variables; and proportions for qualitative variables. In addition, we assessed whether there were statistically significant differences between the samples collected at the same time interval through an ANOVA (unidirectional) test, to a significance level of 0.05. Results: From 18 samples of female volunteers in 60% were obtained within the first 72 hours over 10 spermatozoon per field; 10% of those samples reached 128 hours with over five sperm; and 2% with 1 spermatozoon per field. In two samples with abundant leukocyte reaction and with high density of yeasts, hyphae, pseudohyphae and bacteria, a marked decrease in sperm count was observed...

Estado nutricional del hierro en niños de comunidades indígenas de Cali, Colombia / Iron nutritional state in children from aboriginal communities, Cali, Colombia

Introducción: Los escolares son susceptibles a padecer anemia y deficiencia de micronutrientes. No hay reportes del estado del hierro en indígenas del sector urbano. Objetivo: Establecer el estado del hierro en niños de 5 a 14 años de edad de seis comunidades indígenas residentes en la ciudad de Cali-Colombia. Sujetos y métodos: Se estudiaron 62 niños indígenas de 5 a 14 años de edad, sin antecedentes febriles. Se les midió hemoglobina, hematocrito, volumen corpuscular medio, ferritina y transferrina. Los datos fueron analizados con STATA versión 10.0. Se calcularon promedios y desviación estándar para las variables cuantitativas y para las cualitativas proporciones y distribución de frecuencia simple. Las comparaciones entre comunidades se realizaron con el Test de Mediana y t de Student. Resultados: Las variables bioquímicas no mostraron distribución normal frente a las variables hematológicas. Se presentaron diferencias estadísticamente significantes en la hemoglobina y hematocrito entre dos cabildos indígenas. La transferrina fue semejante en todos los cabildos; la ferritina mostró diferencias estadísticamente significantes. La prevalencia de anemia por deficiencia de hierro fue de 25,8%, siendo los Inga y Yanacona los más afectados. Conclusiones: Los niños indígenas presentaron deficiencia de hierro, y riesgo para el buen desarrollo físico y cognitivo. Se debe considerar la intervención, para establecer las causas y tomar medidas correctivas.

Introduction: The School children are susceptible for anemia and deficiency of micronutrients. No reports of the iron status in urban indigenous. Objective: To establish the iron status in children between 5 and 14 years old from six indigenous communities living in Cali-Colombia. Methods: Were studied 62 indigenous children, between 5 and 14 years old without antecedents of febrile illness. The hemoglobin, hematocrit, mean corpuscular volume, ferritin and transferrin were measured. Data were analyzed with the STATA program version 10.0. Averages and standard deviation were calculated for quantitative variables and proportions and simple frequency distribution were calculated for qualitative variables. Comparisons among communities were carried out via the Median test and Student t-test. Results: Biochemical variables did not show normal distribution in contrast to hematological variables. Statistically significant differences were found in hemoglobin and hematocrit between two indigenous councils. Transferrin levels were similar in all councils, while ferritin levels showed statically significant differences. Low iron supply anemia prevalence was 25.8% and Inga and Yanacona were the most affected. Conclusions: The indigenous children have iron deficiency, which may affect their physical and cognitive development. This guides in considering an opportune intervention to establish the causes and to take corrective measures.

Utilidad diagnóstica del anticuerpo antipéptidocíclico citrulinado como prueba diagnóstica enpacientes con artritis reumatoide / Diagnostic utility of antibody to cyclic citrullinated peptide as a diagnostic test for rheumatoid arthritis patients

Introducción: La artritis reumatoide es una enfermedad autoinmune sistémica, inflamatoria y crónica. En el diagnóstico confirmatorio la presencia del anticuerpo contra el péptido cíclico citrulinado parece tener mejor especificidad que el factor reumatoide. Objetivo: Evaluar las características operativas de los anticuerpos contra el péptido cíclico citrulinado y factor reumatoide en pacientes con artritis reumatoide. Métodos: Estudio retrospectivo convencional de pruebas diagnósticas, en 68 pacientes con artritis reumatoide, y 68 con patologías ortopédicas. El diagnóstico de la artritis se hizo a través de los criterios del Colegio Americano de Reumatología. La determinación del anticuerpo contra el péptido cíclico citrulinado se realizó por electroquimioluminiscencia y factor reumatoide por inmunoturbidimetría. Para el análisis de datos se usó el software R. A través de tabulaciones cruzadas se determinaron las características operacionales del método. Se construyó la gráfica de Receiver Operating Curve. Resultados: La sensibilidad, especificidad, valor predictivo positivo y negativo del anticuerpo contra el péptido cíclico citrulinado fueron 81%, 92%, 90% y 82%, respectivamente. Para el factor reumatoide los resultados fueron similares, excepto en la especificidad (90%). Con cualquiera de las dos pruebas positivas la sensibilidad alcanza 89% y la especificidad 86%, con razón de verosimilitud positiva de 6,35. La positividad simultánea de ambas pruebas disminuye la sensibilidad a 67% y la especificidad aumenta 100% con razón de verosimilitud negativa de 0,33. Conclusión: Por la sensibilidad y especificidad del anticuerpo contra el péptido cíclico citrulinado es considerado como una prueba útil para el diagnóstico temprano. El uso combinado de las dos pruebas aumenta significativamente la sensibilidad, especificidad y razón de verosimilitud positiva.

Introduction: Rheumatoid arthritis is a systemic autoimmune, inflammatory and chronic disease. In the confirmatory diagnosis, the presence of anti-cyclic citrullinated peptide antibody seems to have better specificity than rheumatoid factor. Objective: To evaluate the operating characteristics of anti cyclic citrullinated peptide antibody and rheumatoid factor in patients with rheumatoid arthritis. Methods: Retrospective conventional diagnostic test study in 68 patients with rheumatoid arthritis and 68 with orthopedic conditions.The diagnostic was made using the American College of Rheumatology criteria. Serum levels of antibody to cyclic citrullinated peptide were determined by electrochemiluminescence and rheumatoid factor by inmunoturbidimetry. Data analysis was used software R. Through cross tabulations, operational characteristics of the method where determined. Receiver Operating Curve grahp was constructed. Results: The sensitivity, specificity, positive and negative predictive value of antibody to cyclic citrullinated peptide were 81%, 92%, 90% and 82% respectively. Similar results for rheumatoid factor except in specificity (90%). With either of the two positive tests the sensitivity reached 89 and specificity 86% and the positive likelihood ratio for these data was 6.3. The simultaneous positivity of both tests decreases the sensitivity to 67% and specificity increases to 100%, and negative likelihood ratio of 0.33. Conclusion: For the sensitivity and specificity of the antibody against cyclic citrullinated peptide test is considered useful for early diagnosis. The combined use of both tests significantly increases the sensitivity, specificity and positive likelihood ratio.

Enteroparasitismo, higiene y saneamiento ambiental en menores de seis comunidades indígenas. Cali-Colombia / Enteroparasitism, hygiene and environmental sanitation in under-aged from six indigenous communities. Cali-Colombia

Objetivo Determinar la prevalencia de enteroparasitismo y los factores asociados en menores indígenas entre 5 y 14 años residentes en la ciudad de Cali-Colombia. Metodología Se incluyeron 63 menores entre 5 y 14 años. Se recolectaron mínimo dos muestras de materia fecal a las cuales se les practicó un examen directo, otro por concentración, tinción de Ziehl-Neelsen modificada y KatoKatz. Se les aplicó una encuesta para la recolección de datos sociodemográficos y de interés epidemiológico. Los resultados de la encuesta fueron contrastados mediante un proceso de observación en el 50,0 % de los hogares de los menores. Se calcularon proporciones y razones en las variables cualitativas, en las cuantitativas medidas de tendencia central y la asociación entre variables con el usó el Test χ² y Prueba Exacta de Fischer, considerando un valor de p≤0,05 como significante estadísticamente. Resultados 84,0 % de los menores se encontraron parasitados, predominando los protozoarios (71,0 %). Más del 50,0 % de las muestras estaban poliparasitadas. El parasito patógeno prevalente fue E. histolytica/dispar (25,0 %) y el comensal Endolimax nana (60,0 %). Se observó asociación estadísticamente significativa entre parasitismo, dolor abdominal (Test χ², p≤0,05) y la no desparasitación de los animales domésticos (Test Fisher's, p≤0,05). Conclusiones La prevalencia de enteroparasitosis fue alta así como la de sus factores de riesgo asociados. Se evidenció asociación con algunos factores de riesgo estudiados.

Objective Determine the prevalence of intestinal parasitism and associated factors in indigenous children between 5 and 14 years, living in the city of Cali, Colombia. Methodology 63 children aged 5 to 14 were included. At least two fecal samples were taken to which two different tests were applied, first one directly and the other one forconcentration: Ziehl-Neelsen modified and Kato Katz. In order to collect socio-demographic and epidemiological interest data, a survey was done. The results of the survey were compared through a process of observation at 50.0 % of the minors´ homes. Proportions and ratios were calculated for qualitative variables, χ² and Fischer Exact Test (considering a value of p ≤ 0.05 as statistically significant) was used for quantitative measures of the main trend and the relation between variables. Results 84.0 % of the minors were infected, predominantly by protozoa 71.0 %. Over 50.0 % of those samples were considered as multiple parasitism; the predominant parasites were E histolytica/dispar (25.0 %) and the guest was Endolimax nana (60.0 %). Statistically significant association was observed between parasitism, abdominal pain (Test χ², p≤0.05) and non-deworming of domestic animals (Test Fisher's p ≤0.05). Conclusions The prevalence of intestinal parasitism was high, as well as the risk factors associated with this. Association with studied factors was evidenced.

[Enteroparasitism, hygiene and environmental sanitation in under-aged from six indigenous communities. Cali-Colombia]. / Enteroparasitismo, higiene y saneamiento ambiental en menores de seis comunidades indígenas. Cali-Colombia.

OBJECTIVE: Determine the prevalence of intestinal parasitism and associated factors in indigenous children between 5 and 14 years, living in the city of Cali, Colombia. METHODOLOGY: 63 children aged 5 to 14 were included. At least two fecal samples were taken to which two different tests were applied, first one directly and the other one for concentration: Ziehl-Neelsen modified and Kato Katz. In order to collect socio-demographic and epidemiological interest data, a survey was done. The results of the survey were compared through a process of observation at 50.0 % of the minors' homes. Proportions and ratios were calculated for qualitative variables, χ(2) and Fischer Exact Test (considering a value of p ≤ 0.05 as statistically significant) was used for quantitative measures of the main trend and the relation between variables. RESULTS: 84.0 % of the minors were infected, predominantly by protozoa 71.0 %. Over 50.0 % of those samples were considered as multiple parasitism; the predominant parasites were E histolytica/dispar (25.0 %) and the guest was Endolimax nana (60.0 %). Statistically significant association was observed between parasitism, abdominal pain (Test χ(2), p ≤ 0.05) and non-deworming of domestic animals (Test Fisher's p ≤ 0.05). CONCLUSIONS: The prevalence of intestinal parasitism was high, as well as the risk factors associated with this. Association with studied factors was evidenced.

Intestinal parasitism prevalence amongst children from six indigenous communities residing in Cali, Colombia.

OBJECTIVE: Establishing the prevalence of intestinal parasitism in children aged 5 to 14 years of age from six indigenous communities residing in the city of Cali. METHODOLOGY: A cross-sectional, descriptive epidemiological study was carried out in six indigenous communities residing in the city of Cali; it consisted of making a direct serial and concentration coproparasitological examination of a randomly selected sample of fifty-seven 5 to 14 year-old children. RESULTS: Of the 57 samples obtained, 84 % of the children were infected with parasites; protozoa (98 %) predominated over helminths (16.7 %) and mixed parasitemia was found in 14.6 % of the samples. Monoparasitism appeared in children over 10 years of age and biparasitism (10.4 %) and polyparasitism (52.1 %) in children under 10 years of age. Regarding occult blood determination, 6 % were observed to be positive in all the samples analysed; 4 % of these results were associated with E. histolyticaldispar. The simple parasitism index (SPI) reflected a high degree of infestation amongst the children included in the study. CONCLUSIONS: The prevalence of intestinal parasitism in indigenous infants was higher than that reported nationally in the overall adolescent and school-aged children population in the same age group. Mono- and polyparasitism prevailed in the positive samples. The infestation load was not randomly distributed amongst the communities.

Intestinal parasitism prevalence amongst children from six indigenous communities residing in Cali, Colombia / Prevalencia de parasitismo intestinal en menores de seis comunidades indígenas residentes en Cali, Colombia

Objective Establishing the prevalence of intestinal parasitism in children aged 5 to 14 years of age from six indigenous communities residing in the city of Cali. Methodology A cross-sectional, descriptive epidemiological study was carried out in six indigenous communities residing in the city of Cali; it consisted of making a direct serial and concentration coproparasitological examination of a randomly selected sample of fifty-seven 5 to 14 year-old children. Results Of the 57 samples obtained, 84 % of the children were infected with parasites; protozoa (98 %) predominated over helminths (16.7 %) and mixed parasitemia was found in 14.6 % of the samples. Monoparasitism appeared in children over 10 years of age and biparasitism (10.4 %) and polyparasitism (52.1 %) in children under 10 years of age. Regarding occult blood determination, 6 % were observed to be positive in all the samples analysed; 4 % of these results were associated with E. histolyticaldispar. The simple parasitism index (SPI) reflected a high degree of infestation amongst the children included in the study. Conclusions The prevalence of intestinal parasitism in indigenous infants was higher than that reported nationally in the overall adolescent and school-aged children population in the same age group. Mono- and polyparasitism prevailed in the positive samples. The infestation load was not randomly distributed amongst the communities.

Objetivo Establecer la prevalencia de parasitismo intestinal en menores de 5 a 14 años de seis comunidades indígenas residentes en la ciudad de Cali. Metodología Se llevó a cabo un estudio epidemiológico transversal en seis comunidades indígenas residentes en la ciudad de Cali, que consistió en realizar un examen seriado coproparasitológico a una muestra de menores entre 5 y 14 años elegida al azar. Resultados De las 57 muestras, un total de 84 % estaban infectados con parásitos; en los cuales predominaron los protozoarios (98 %) sobre los helmintos (16,7 %) y la presencia de enfermedades parasitarias intestinales mixtas fue del 14,6 %. El monoparasitismo se observe en los mayores de 10 años; en niños por debajo de los 10 años se observó el biparasitismo (10,4 %) y poliparasitismo (52,1 %). Con relación a la determinación de sangre oculta, un 6 % de las muestras fueron positivas, 4 % de esos resultados estaban asociados con E. histolyticaldispar. El índice de parasitismo simple refleja un alto grado de infestación en los menores incluidos en este estudio. Conclusiones La prevalencia de parasitismo intestinal en menores de ascendencia indígena es mayor a la reportada en el orden nacional en menores escolares y adolescentes. Sobresalieron el mono y poliparasitismo en las muestras positivas. La carga de infestación no se distribuyó al azar entre las comunidades.

Epidemiología genómica y paraparesia espástica tropical asociada a la infección por el virus linfotrópico humano de células T tipo 1 / Genome epidemiology and tropical spastic paraparesis associated with human T-cell lymphotropic virus type 1

OBJETIVO: Caracterizar el ambiente genómico de las secuencias adyacentes al virus linfotrópico humano de células T tipo 1 (HTLV-1) en pacientes con paraparesia espßstica tropical y mielopatía asociada a la infección con HTLV-1 (PET/MAH) de diferentes regiones de Colombia y del Japón. MÉTODOS: Se enfrentaron 71 clones recombinantes con secuencias del genoma humano adyacentes al 5'-LTR de pacientes con PET/MAH, a las bases de datos del Genome Browser y del Gen-Bank. Se identificaron y analizaron estadísticamente 16 variables genómicas estructurales y composicionales mediante el programa informßtico R, versión 2.8.1, en una ventana de 0,5 Mb. RESULTADOS: El 43,0 por ciento de los provirus se localizaron en los cromosomas del grupo C; 74 por ciento de las secuencias se ubicaron en regiones teloméricas y subteloméricas (P < 0,05). Un anßlisis de conglomerados permitió establecer las relaciones jerßrquicas entre las características genómicas incluidas en el estudio; el anßlisis de componentes principales identificó las componentes que definieron los ambientes genómicos preferidos para la integración proviral en casos de PET/MAH. CONCLUSIONES: El HTLV-1 se integró con mayor frecuencia en regiones de la cromatina ricas en islas de citocina fosfato guanina (CpG), de alta densidad de genes y de repeticiones tipo LINE (elemento disperso largo [long interspersed element]) y transposones de ADN que, en conjunto, conformarían los ambientes genómicos blanco de integración. Este nuevo escenario promoverß cambios sustanciales en el campo de la salud pública y en el manejo epidemiológico de las enfermedades infecciosas, y permitirß desarrollar potentes herramientas para incrementar la eficiencia de la vigilancia epidemiológica.

OBJECTIVE: Characterize the genomic environment of the sequences adjacent to human T-cell lymphotropic virus type 1 (HTLV-1) in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in different regions of Colombia and Japan. METHODS: A total of 71 recombinant clones with human genome sequences adjacent to 5' LTR in patients with HAM/TSP were compared to the Genome Browser and GenBank databases. Sixteen structural and compositional genome variables were identified, and statistical analysis was conducted in the R computer program, version 2.8.1, in a 0.5 Mb window. RESULTS: A total of 43.0 percent of the proviruses were located in the group C chromosomes; 74 percent of the sequences were located in the telomeric and subtelomeric regions (P < 0.05). A cluster analysis was used to establish the hierarchical relations between the genome characteristics included in the study. The analysis of principal components identified the components that defined the preferred genome environments for proviral integration in cases of HAM/TSP. CONCLUSIONS: HTLV-1 was integrated more often in chromatin regions rich in CpG islands with a high density of genes and LINE type repetitions, and DNA transposons which, overall, would form the genomic environments targeted for integration. This new scenario will promote substantial changes in the field of public health and in epidemiological management of infectious diseases. It will also foster the development of powerful tools for increasing the efficiency of epidemiological surveillance.

[Using epidemiology and bioinformatics for studying HTLV-1 infection-associated adult T-cell leukemia]. / Epidemiología y bioinformática en el estudio de la Leucemia Linfoma de Células T del Adulto asociada a la infección con VLHT-1.

OBJECTIVES: Establishing a correlation between the number of HTLV-1 provirus and the characteristics of the genomic environment in ATL cases. METHODOLOGY: A systematic search was made of publications as well as a meta-analysis of the pertinent literature considering proviruses per chromosome and structural and functional characteristics of flanking chromatin regions as variables. The concordance of experts' study was evaluated by Spearman Rho correlation. Publication bias was analysed by funnel plot and the Egger statisgrapher. A fixed effects model was applied according to heterogeneity evaluation to combine the results of integration occurring in coding sequences as well as coding sequences according to their molecular function. RESULTS: The expert concepts' Kappa index was 0.7 and no publication bias was observed. The meta-analysis result was homogeneous (p>0.05). HTLV-1 integration was directed towards several chromosomes' telomeric and subtelomeric regions. The combination of published results in the articles which were analysed supported the hypothesis of integration events being site-directed towards coding regions of the human genome (p<0.05). Moreover, the groups of genes having enzymatic and receptor functions was statistically significant. CONCLUSION: The results led to concluding that HTLV-I integration in the ATLL cases analysed here was not random but was directed towards regulatory regions. Such results could help to explain the role of some processes involved in leukemogenesis.