Social gradient and rural-urban disparities in cancer mortality in Costa Rica.

INTRODUCTION: Data on social inequalities in cancer mortality are sparse, especially in low- and middle-income countries. We aimed to analyze the socioeconomic inequalities in cancer mortality in Costa Rica between 2010 and 2018. METHODS: We linked 9-years of data from the National Electoral Rolls, National Birth Index and National Death Index to classify deaths due to cancer and socioeconomic characteristics of the district of residence, as measured by levels of urbanicity and wealth. We analyzed the fifteen most frequent cancer sites in Costa Rica among the 2.7 million inhabitants aged 20 years and older. We used a parametric survival model based on a Gompertz distribution. RESULTS: Compared to urban areas, mixed and rural area residents had lower mortality from pancreas, lung, breast, prostate, kidney, and bladder cancers, and higher mortality from stomach cancer. Mortality from stomach, lung and cervical cancer was higher, and mortality from colorectal cancer, non-Hodgkin lymphoma and leukemia was lower in the most disadvantaged districts, compared to the wealthiest ones. CONCLUSION: We observed marked disparities in cancer mortality in Costa Rica in particular from infection- and lifestyle- related cancers. There are important opportunities to reduce disparities in cancer mortality by targeting cancer prevention, early detection and opportune treatment, mainly in urban and disadvantaged districts.

Prevalencia y determinantes de la infección por virus de papiloma humano en mujeres jóvenes de Guanacaste y Puntarenas, Costa Rica, 2004-2005.

OBJETIVO: Estimar la prevalencia e identificar determinantes de la infección por el virus del papiloma humano (VPH) en mujeres jóvenes (18-25 años). Material y métodos. Se analizaron datos de 5 871 mujeres sexualmente activas a quienes se les realizó una entrevista y toma de muestras cervicouterinas para detección de VPH y citología durante la visita de reclutamiento del Ensayo de Vacunación contra VPH16/18 en Costa Rica. Se calculó la prevalencia total para cualquier tipo de VPH y tipos oncogénicos, no oncogénicos y específicos, con intervalos de confianza al 95% (IC95%). Se utilizó regresión logística múltiple paso-a-paso para identificar determinantes asociados con la infección. RESULTADOS: La prevalencia total de VPH fue 50.0% (IC95% 48.8,51.3) y por tipos oncogénicos fue 33.8% (IC95% 32.6,35.0). El VPH-16 fue el tipo más prevalente (8.3%, IC95% 7.6,9.0). Los determinantes asociados con un alto riesgo de infección prevalente por VPH oncogénicos fueron no estar casada/unión libre, >1 compañero sexual, infección concomitante por Chlamydia trachomatis, y entre aquéllas con un único compañero sexual en su vida, un compañero con antecedente de múltiples compañeras sexuales. Conclusión. Se confirma la asociación de las infecciones por VPH oncogénicos con el comportamiento sexual de la mujer y se destacan los comportamientos del compañero sexual.

Trends in incidence rates of head and neck squamous cell carcinomas overall and by potential relatedness to human papillomavirus, Costa Rica 2006 to 2015.

In Costa Rica (CR), only one report on head and neck cancer (HNC) incidence trends (1985-2007) has been published and no investigations on the epidemiology of potentially human papillomavirus (HPV)-related and HPV-unrelated HNCs have been done. We examined the age-standardized incidence rates (IRs) and trends of head and neck squamous cell carcinomas (HNSCC) and compared incidence trends of potentially HPV-related and HPV-unrelated HNSCCs. We obtained all available HNC cases for the period 2006-2015 from the Costa Rican National Cancer Registry of Tumors and the population estimates from the Costa Rican National Institute of Statistics and Census. The analysis was restricted to invasive HNSCCs (n = 1577). IRs and incidence rate ratios were calculated using SEER*Stat software and were age-standardized for the 2010 Costa Rican population. Joinpoint regression analysis program was used to calculate trends and annual percent changes (APCs) in rates. For all HNSCCs, the age-standardized IR was 34.0/million person-years; 95% CI 32.4, 35.8. There was a significant decline in the incidence of nasopharyngeal cancer (APC: -5.9% per year; 95% CI -10.8, -0.7) and laryngeal cancer (APC: -5.4% per year; -9.2, 1.5). The incidence trends for hypopharyngeal, oropharyngeal and oral cavity cancers each remained stable over time. HNSCCs were categorized by their potential relatedness to HPV infection. Though the APCs were not statistically significant, IRs of potentially HPV-related HNSCCs trended upward, while HPV-unrelated HNSCCs trended downward. HNSCCs are uncommon in CR and decreased over time. We observed a divergent pattern of decreasing HPV-unrelated with increasing HPV-related HNSCCs that should be further informed by HPV genotyping tumor samples.

Analysis of cervical HPV infections among unvaccinated young adult women to inform vaccine strategies in this age group: the Costa Rica HPV Vaccine Trial.

INTRODUCTION: Human papillomavirus (HPV) vaccines protect against incident HPV infections, which cause cervical cancer. OBJECTIVES: We estimated the prevalence and incidence of HPV infections in young adult women to understand the impact of an HPV vaccination programme in this population. METHODS: We collected cervical specimens from 6322 unvaccinated women, aged 18-37 years, who participated in the Costa Rica Vaccine Trial and its long-term follow-up. Women were followed for (median) 4.8 years and had (median) 4.0 study visits. Cervical specimens were tested for the presence/absence of 25 HPV genotypes. For each age band, we estimated the percentage of women with 1+ prevalent or 1+ incident HPV infections using generalised estimating equations. We also estimated the prevalence and incidence of HPV as a function of time since first sexual intercourse (FSI). RESULTS: The model estimated HPV incident infections peaked at 28.0% (95% CI 25.3% to 30.9%) at age 20 years then steadily declined to 11.8% (95% CI 7.6% to 17.8%) at age 37 years. Incident oncogenic HPV infections (HPV16/18/31/33/35/39/45/51/52/56/58/59) peaked and then declined from 20.3% (95% CI 17.9% to 22.9%) to 7.7% (95% CI 4.4% to 13.1%); HPV16/18 declined from 6.4% (95% CI 5.1% to 8.1%) to 1.1% (95% CI 0.33% to 3.6%) and HPV31/33/45/52/58 declined from 11.0% (95% CI 9.3% to 13.1%) to 4.5% (95% CI 2.2% to 8.9%) over the same ages. The percentage of women with 1+ incident HPV of any, oncogenic, non-oncogenic and vaccine-preventable (HPV16/18, HPV31/33/45, HPV31/33/45/52/58, and HPV6/11) types peaked <1 year after FSI and steadily declined with increasing time since FSI (p for trends <0.001). We observed similar patterns for model estimated HPV prevalences. CONCLUSION: Young adult women may benefit from HPV vaccination if newly acquired vaccine-preventable oncogenic infections lead to cervical precancer and cancer. HPV vaccination targeting this population may provide additional opportunities for primary prevention. TRIAL REGISTRATION NUMBER: NCT00128661.

Precancerous cervical lesions caused by non-vaccine-preventable HPV types after vaccination with the bivalent AS04-adjuvanted HPV vaccine: an analysis of the long-term follow-up study from the randomised Costa Rica HPV Vaccine Trial.

BACKGROUND: In women vaccinated against human papillomavirus (HPV), reductions in cervical disease and related procedures results in more women having intact transformation zones, potentially increasing the risk of cervical lesions caused by non-vaccine-preventable HPV types, a phenomenon termed clinical unmasking. We aimed to evaluate HPV vaccine efficacy against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) attributed to non-preventable HPV types in the long-term follow-up phase of the Costa Rica HPV Vaccine Trial (CVT). METHODS: CVT was a randomised, double-blind, community-based trial done in Costa Rica. Eligible participants were women aged 18-25 years who were in general good health. Participants were randomly assigned (1:1) to receive an HPV 16 and 18 AS04-adjuvanted vaccine or control hepatitis A vaccine, using a blocked randomisation method (permuted block sizes of 14, 16, and 18). Vaccines in both groups were administered intramuscularly with 0·5 mL doses at 0, 1, and 6 months. Masking of vaccine allocation was maintained throughout the 4-year randomised trial phase, after which participants in the hepatitis A virus vaccine control group were provided the HPV vaccine and exited the study; a screening-only, unvaccinated control group was enrolled. The unvaccinated control group and HPV vaccine group were followed up for 7 years, during which treatment allocation was not masked. One of the prespecified primary endpoints for the long-term follow-up phase was precancers associated with HPV types not prevented by the vaccine, defined as histologically confirmed incident CIN2+ events or CIN3+ events attributed to any HPV type except HPV 16, 18, 31, 33, and 45. Our primary analytical period was years 7-11. Primary analyses were in all participants with at least one follow-up visit and excluded participants with a previous endpoint (ie, modified intention-to-treat cohort). Safety endpoints have been reported elsewhere. This trial is registered with ClinicalTrials.gov, NCT00128661 and NCT00867464. The randomised, masked trial phase is completed; an unmasked subset of women in the HPV-vaccinated group is under active investigation. FINDINGS: Between June 28, 2004, and Dec 21, 2005, 7466 participants were enrolled (HPV vaccine group n=3727 and hepatitis A virus vaccine control group n=3739). Between March 30, 2009, and July 5, 2012, 2836 women enrolled in the new unvaccinated control group. The primary analytical cohort (years 7 to 11) included 2767 participants in the HPV vaccine group and 2563 in the unvaccinated group for the CIN2+ events endpoint assessment and 2826 participants in the HPV vaccine group and 2592 in the unvaccinated control group for the CIN3+ events endpoint assessment. Median follow-up during years 7 to 11 for women included for the CIN2+ events analysis was 52·8 months (IQR 44·0 to 60·7) for the HPV vaccine group and 49·8 months (42·0 to 56·9) for the unvaccinated control group. During years 7 to 11, clinical unmasking was observed with a negative vaccine efficacy against CIN2+ events attributed to non-preventable HPV types (-71·2% [95% CI -164·0 to -12·5]), with 9·2 (95% CI 2·1 to 15·6) additional CIN2+ events attributed to non-preventable HPV types per 1000 HPV-vaccinated participants versus HPV-unvaccinated participants. 27·0 (95% CI 14·2 to 39·9) fewer CIN2+ events irrespective of HPV type per 1000 vaccinated participants were observed during 11 years of follow-up. Vaccine efficacy against CIN3+ events attributed to non-preventable HPV types during years 7 to 11 was -135·0% (95% CI -329·8 to -33·5), with 8·3 (3·0 to 12·8) additional CIN3+ events attributed to non-preventable HPV types per 1000 vaccinated participants versus unvaccinated participants. INTERPRETATION: Higher rates of CIN2+ events and CIN3+ events due to non-preventable HPV types in vaccinated versus unvaccinated participants suggests clinical unmasking could attenuate long-term reductions in high-grade disease following successful implementation of HPV vaccination programmes in screened populations. Importantly, the net benefit of vaccination remains considerable; therefore, HPV vaccination should still be prioritised as primary prevention for cervical cancer. FUNDING: National Cancer Institute and National Institutes of Health Office of Research on Women's Health. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Rationale and design of a double-blind randomized non-inferiority clinical trial to evaluate one or two doses of vaccine against human papillomavirus including an epidemiologic survey to estimate vaccine efficacy: The Costa Rica ESCUDDO trial.

HPV vaccination of adolescent girls is the most effective measure to prevent cervical cancer. The World Health Organization recommends that adolescent girls receive two doses of vaccine but only a small proportion of girls from regions with the highest disease burden are vaccinated because of cost and logistical considerations. Our Costa Rica HPV Vaccine trial suggested that one dose of the bivalent HPV vaccine provides robust and lasting protection against persistent HPV infections for over a decade. Data from a post-licensure trial of the quadrivalent vaccine in India also suggested that a single dose may be effective in reducing cervical cancer risk. To formally compare one versus two doses of the bivalent and nonavalent HPV vaccines, we implemented a large, randomized, double-blind trial to investigate the non-inferiority of one compared to two vaccine doses in the prevention of new HPV16/18 infections that persist 6 or more months. Bivalent and nonavalent vaccines will be evaluated separately. The trial enrolled and randomized (1:1:1:1 to 1- and 2-dose arms of the bivalent and nonavalent vaccines) 20,330 girls 12 to 16 years old residing in Costa Rica. Trial participants are followed every 6 months for up to 5 years. We also aim to estimate vaccine efficacy by comparing the rates of 6 month persistent infection in unvaccinated women with the rates in the follow-up visits of trial participants. We included one survey of unvaccinated women at the start of the study (N = 4452) and will include another survey concomitant with follow up visits of trial participants at year 4.5 (planned N = 3000). Survey participants attend two visits 6 months appart. Herein, we present the rationale, design, and enrolled study population of the ESCUDDO trial. ClinicalTrials.gov Identifier: NCT03180034.

Risk Factors for Non-Human Papillomavirus (HPV) Type 16/18 Cervical Infections and Associated Lesions Among HPV DNA-Negative Women Vaccinated Against HPV-16/18 in the Costa Rica Vaccine Trial.

BACKGROUND: Factors that lead human papillomavirus (HPV) infections to persist and progress to cancer are not fully understood. We evaluated co-factors for acquisition, persistence, and progression of non-HPV-16/18 infections among HPV-vaccinated women. METHODS: We analyzed 2153 women aged 18-25 years randomized to the HPV-vaccine arm of the Costa Rica HPV Vaccine Trial. Women were HPV DNA negative for all types at baseline and followed for approximately 11 years. Generalized estimating equation methods were used to account for correlated observations. Time-dependent factors evaluated were age, sexual behavior, marital status, hormonally related factors, number of full-term pregnancies (FTPs), smoking behavior, and baseline body mass index. RESULTS: A total of 1777 incident oncogenic non-HPV-16/18 infections were detected in 12 292 visits (average, 0.14 infections/visit). Age and sexual behavior-related variables were associated with oncogenic non-HPV-16/18 acquisition. Twenty-six percent of incident infections persisted for ≥1 year. None of the factors evaluated were statistically associated with persistence of oncogenic non-HPV-16/18 infections. Risk of progression to Cervical Intraepithelial Neoplasia grade 2 or worst (CIN2+) increased with increasing age (P for trend = .001), injectable contraceptive use (relative risk, 2.61 [95% confidence interval, 1.19-5.73] ever vs never), and increasing FTPs (P for trend = .034). CONCLUSIONS: In a cohort of HPV-16/18-vaccinated women, age and sexual behavior variables are associated with acquisition of oncogenic non-HPV-16/18 infections; no notable factors are associated with persistence of acquired infections; and age, parity, and hormonally related exposures are associated with progression to CIN2+.

Evaluation of Durability of a Single Dose of the Bivalent HPV Vaccine: The CVT Trial.

BACKGROUND: The authors investigated the durability of vaccine efficacy (VE) against human papillomavirus (HPV)16 or 18 infections and antibody response among nonrandomly assigned women who received a single dose of the bivalent HPV vaccine compared with women who received multiple doses and unvaccinated women. METHODS: HPV infections were compared between HPV16 or 18-vaccinated women aged 18 to 25 years who received one (N = 112), two (N = 62), or three (N = 1365) doses, and age- and geography-matched unvaccinated women (N = 1783) in the long-term follow-up of the Costa Rica HPV Vaccine Trial. Cervical HPV infections were measured at two study visits, approximately 9 and 11 years after initial HPV vaccination, using National Cancer Institute next-generation sequencing TypeSeq1 assay. VE and 95% confidence intervals (CIs) were estimated. HPV16 or 18 antibody levels were measured in all one- and two-dose women, and a subset of three-dose women, using a virus-like particle-based enzyme-linked immunosorbent assay (n = 448). RESULTS: Median follow-up for the HPV-vaccinated group was 11.3 years (interquartile range = 10.9-11.7 years) and did not vary by dose group. VE against prevalent HPV16 or 18 infection was 80.2% (95% CI = 70.7% to 87.0%) among three-dose, 83.8% (95% CI = 19.5% to 99.2%) among two-dose, and 82.1% (95% CI = 40.2% to 97.0%) among single-dose women. HPV16 or 18 antibody levels did not qualitatively decline between years four and 11 regardless of the number of doses given, although one-dose titers continue to be statistically significantly lower compared with two- and three-dose titers. CONCLUSION: More than a decade after HPV vaccination, single-dose VE against HPV16 or 18 infection remained high and HPV16 or 18 antibodies remained stable. A single dose of bivalent HPV vaccine may induce sufficiently durable protection that obviates the need for more doses.

Female breast cancer in Central and South America.

RATIONALE AND OBJECTIVE: The burden of breast cancer has increased worldwide. Breast cancer mortality has been increasing in Central and South America (CSA) in the last few decades. We describe the current burden of breast cancer in CSA and review the current status of disease control. METHODS: We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years for 2003-2007 and the estimated annual percentage change to describe time trends. RESULTS: In the most recent 5-year period, Argentina, Brazil, and Uruguay had the highest incidence rates (67.7-71.9) and Bolivia and El Salvador had the lowest (7.9-12.7). For most countries, mortality rates were ≤12.3, except in Uruguay, Argentina and Cuba (14.9-20.5). Age-specific rates increased after the age of 40-50 years and reached a maximum after age 65 years (mean age at diagnosis 56-62 years). Most countries have developed national screening guidelines; however, there is limited capacity for screening. CONCLUSION: The geographic variation of breast cancer rates may be explained by differences in the prevalence of reproductive patterns, lifestyle factors, early detection, and healthcare access. Extending early-detection programs is challenging because of inequalities in healthcare access and coverage, limited funding, and inadequate infrastructure, and thus it may not be feasible. Given the current status of breast cancer in CSA, data generated by population-based cancer registries is urgently needed for effective planning for cancer control.

Hodgkin lymphoma burden in Central and South America.

RATIONALE AND OBJECTIVE: Hodgkin lymphoma (HL) is largely curable owing to improvements in treatment since the 1960s; nevertheless, high mortality rates have been reported in Central and South America. We describe the current burden of HL in the Central and South American region. METHODS: We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, and national-level mortality data from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) per 100,000 person-years for 2003-2007 and present distributions by histological subtype. RESULTS: HL incidence rates varied 7-fold in males and 11-fold in females (male-to-female ratio 1:1-2.5:1). The highest ASRs were seen Argentina, Brazil, Costa Rica (males), Cuba (males) and Uruguay (females), whereas the lowest were in Bolivia and El Salvador. ASMRs varied by 4-fold in males and 6-fold in females (male-to-female ratio 1:1-4.3:1), with ASMRs <0.7 for most countries, except Cuba (≥1.0). In most countries, age-specific incidence rates of HL showed a bimodal pattern. Trends in HL in Argentina, Brazil, Chile, and Costa Rica remained stable in 1997-2008. Of all HL cases, 48% were unspecified as to histological subtype. Nodular sclerosis and mixed cellularity were the most frequent histologies. CONCLUSION: The geographic variation in HL across the region may in part reflect differences in data quality and coverage, and differences in the adoption of modern therapies and healthcare access. Our results highlight the need for high-quality data and increased coverage in order to provide vital guidance for future cancer control activities.

The burden of non-Hodgkin lymphoma in Central and South America.

RATIONALE AND OBJECTIVE: The burden of non-Hodgkin lymphoma (NHL) has increased in some Central and South American countries. We describe the current patterns and trends in NHL incidence and mortality in Central and South America. METHODS: We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, and national-level cancer mortality data from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and mortality rates (ASMRs) per 100,000 person-years for 2003-2007, and presented distributions by histological subtype. RESULTS: NHL incidence and mortality rates varied between countries by 2-8- and 6-fold, respectively. ASRs per 100,000 ranged from 1.4 to 10.9 among males and 1.3-9.2 among females. Corresponding ASMRs were between 0.5 and 4.8 among males and between 0.5 and 3.0 among females. The highest incidence was observed in Uruguay (males), Ecuador, Peru and Colombia (males). The highest mortality was seen in Uruguay and Costa Rica. Trends in NHL incidence and mortality in Argentina, Brazil, Chile and Costa Rica did not show marked changes. B-cell neoplasms and NHL not otherwise specified (NOS) accounted for 44% and 34% of all NHL cases. Diffuse large B-cell lymphoma, NOS, was the most frequent histological subtype. CONCLUSION: The geographic variations in NHL rates may partially reflect differences in registration practices, disease classification, diagnostic practice, and death certification quality. There is a need for high-quality data and improvements in the accuracy of NHL histological diagnosis. Given the expected increase in NHL, careful monitoring of rates remains a priority to guide cancer control programs.

Seroprevalencia de tamizaje frente a virus linfotrópico de células T (HTLV) y factores asociados a coinfección en donantes voluntarios de sangre de Colombia / Seroprevalence of screening versus T-cell lymphotropic virus (HTLV) and factors associated with co-infection in blood donors in Colombia

Objetivo: Determinar la seroprevalencia de tamizaje para HTLV y factores asociados a coinfección en donantes voluntarios de sangre de Colombia. Materiales y métodos: Se realizó un estudio de corte transversal retrospectivo inferencial; la población fue de 971 registros de donantes voluntarios de sangre; se calculó prevalencia de HTLV y se calcularon odds ratios (OR). Resultados: El 49,3 % de los donantes estaba entre 18 y 33 años; el 53,4 % era de género femenino; el 44,3 % convivía con una pareja; se observó que la principal coinfección fue sífilis (7,0 %). Se observa una tendencia al aumento de la prevalencia de HTVL entre 2010 (0,23 %) y 2011 (0,24 %) en la sede de proceso de Bogotá. En relación con los factores asociados, se encontró asociación positiva con mayor edad y convivencia con pareja y asociación negativa con régimen contributivo. La regresión de Poisson múltiple mostró que la prevalencia de coinfección es de 2,92 (IC 95 % 1,92-4,45) veces en las personas de 34 a 64 años comparado con los menores de 34 años; asimismo, el régimen contributivo protege de coinfección 0,69 (IC95 % 0,48-0,99) a las personas vinculadas al régimen contributivo comparadas con las del régimen subsidiado. Conclusión: En general, se encontró una proporción importante de donantes con resultados reactivos; se establecieron claramente factores asociados a coinfección y la prevalencia fue mayor que en otros reportes.

Objective: To determine the seroprevalence of HTLV screening and factors associated with co-infection in blood donors in Colombia. Materials and Methods: We performed a retrospective cross-sectional study inferential, the population was of 971 records of volunteer blood donors, we calculated prevalence of HTLV and calculated odds ratios (OR). Results: 49.3 % of donors were between 18 and 33 years, 53.4 % were female, 44.3 % lived with a partner, it was observed that the major syphilis coinfections are 7.0 %. There is a trend to increased prevalence of HTLV between 2010 (0.23 %) and 2011 (0.24 %) in the process of Bogotá. Headquarters in related factors associated, positive association was found with increasing age and living with partner, and negative association with con-tributory system in multiple Poisson regression showed that the prevalence of co-infection is 2.92 (95 % CI 1.92 to 4.45) times in people 34 to 64 years compared to under 34 years, also the contributory scheme protects coinfection 0.69 (95 % CI 0.48-0.99) in people with contributory scheme compared to the subsidized regime. Conclusión: In general there is a significant proportion of donors with reactive results are set out clearly and factors associated with coinfection prevalence is higher than in other reports.

Seguimiento a variables fisiológicas de donantes de sangre que presentaron Reacciones Adversas a la Donación. Fundación Hematológica Colombia / Follow up to physiological variables of blood donors who reported adverse reactions to the Grant Donor Program. Fundación Hematológica Colombia / Acompanhamento a variavéis fisiológicas de doadores de sangue que apresentaram Reações Adversas à Doação. Fundação Hematológica Colômbia

Introducción: las RAD son un proceso inesperado que afecta la percepción deldonante, y sus variables fisiológicas se convierten en una herramienta de evaluación del estado de salud del donante. Métodos: se realizó un estudio de corte transversal retrospectivo e inferencial, en el banco de sangre Fundación Hematológica Colombia.Resultados: la población de estudio la conformaron 627 registros de RAD, delos cuales 65,9% (n=413) eran del género femenino; el promedio de edad fue de 27,4 años; peso promedio de la población 62,4 kilogramos; el tipo de reacción que predominó es la moderada en un 49,2%. Se observó que la tensión arterial sistólica y diastólica sufrió cambios significativos durante el seguimiento (p= 0,000) en lostres tipos de reacción.

Introduction: adverse vasovagal reactions are an unexpected process that affects donor's 'perception; in this the physiological variables become an evaluation tool of their health state.Method: a cross-sectional retrospective and inferential study was made in Fundación Hematológica Colombia.Results: the study population was formed by 627 adverse vasovagal records, in which 65.9% (n=413) were females, the average age was 27,4 years, the average weight of the population was 62,4 kilograms, the moderate reaction was the most predominant with 49,2%. Both systolic and diastolic blood pressure suffered significant changes during the monitoring (p=0,000) in the three types of reactions.

Introdução: as RAD são um processo inesperado que afeta a percepção do doador; neste, as variavéis fisiológicas se convertem em ferramenta de avaliação do estado de saúde do doador.Métodos: foi feito um estudo de corte transversal retrospectivo e inferencial no banco de sangue Fundação Hematológica Colômbia.Resultados: com base em 627 registros de RAD, o estudo apontou 65,9% (n=413) como do gênero feminino; e a média de idade, de 27,4 anos; peso médio da população, 62,4 quilogramos; o tipo de reação que predominou foi a moderada em 49,2%. Observou-se que a tensão arterial sistólica e diastólica sofreu mudanças significativas durante o acompanhamento (p= 0,000) nos três tipos de reação.

Effect of Helicobacter pylori infection on growth velocity of school-age Andean children.

BACKGROUND: Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection. METHODS: Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures. RESULTS: In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates. CONCLUSIONS: This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

Detección de antibióticos en leches: un problema de salud pública / Detecting antibiotics in milk: a public health problem

Objetivo Determinar la presencia de antibióticos en leches crudas y procesadas en el municipio de Montería. Materiales y métodos Se realizaron tres muestreos con intervalo de dos meses, en una empresa acopiadora de leche en la ciudad de Montería, además, se analizaron muestras de leche pasteurizadas de seis marcas comerciales. A todas las muestras de leche se les realizó la prueba de la acidez por alcoholimetría, también se determinó la presencia del antiséptico H2O2 a través de KI al 35 por ciento y V2O5 al 1 por ciento en H2SO4 diluido. Posteriormente se detecto la presencia de antibióticos (Total antibiotic Bio K 331 (BioX Diagnostic® Jemelle, Belgique). Se determinó el límite de sensibilidad de la prueba con controles positivos de penicilina 0.004UI/ml, oxitetraciclina 0.100 μg/ml y cloramfenicol 5.000 μg/ml, realizando diluciones seriadas dobles. Para cada muestreo se emplearon leches como controles negativos y positivos. El primer muestreo evaluó 212 muestras de leche, el segundo 167 y el tercero 66, para un total de 445 muestras. Resultados todas las muestras fueron negativas a la acidez por alcoholimetría, se evidenció la presencia de antibióticos en 111(25 por ciento) muestras de leches crudas; en ninguna leche pasteurizada se detectaron antibióticos. La sensibilidad de la prueba demostró que penicillina fue detectable a 0.002UI/ml; oxitetraciclina a 0.005μg/ml y cloramfenicol a 1,25 μg/ ml. Conclusiones El 25 por ciento de trazas de antibióticos en leches demuestra la inexistencia de un control sanitario, así como evidencia el uso indiscriminado de antibióticos en la industria pecuaria y un riesgo para la salud pública.

Objective Determining the presence of antibiotics in raw and processed milk in the city of Monteria. Materials and methods Three samplings were three samples were taken in a dairy company in the city of Monteria at two-month intervals. Pasteurised milk samples were taken from six trademarks. All milk samples were tested for acidity by alcoholometry; the presence of antiseptic H2O2 was determined by using 35 percent KI and 1 percent V2O5 diluted in H2SO4. The incidence of antibiotics (Total antibiotic Bio K 331 (Diagnostic Jemelle dioxide, Belgique) was then determined. The test’s sensitivity limit was determined by using 0.004 UI/ml penicillin, 0.100 mg/ml oxytetracycline and 5,000 mg/ml chloramphenicol as positive controls in two-fold serial dilutions. Aliquots of milk were used as positive and negative controls for each sample. The first sampling evaluated 212 samples of milk, the second 167 and the third 66, for a total of 445 samples. Results All samples were negative for alcoholometry acidity. Antibiotics were detected in 111 (25 percent) samples of raw milk; however, no antibiotics were detected in the pasteurised milk. The test’s sensitivity revealed that penicillin was detectable in a maximum 0.002UI/ml dilution, oxytetracycline in 0.005ìg/ml and chloramphenicol in 1.25 mg / ml. Conclusions Traces of antibiotics being found in 25 percent of milk samples revealed a lack of public health controls, as well as evidence of the indiscriminate use of antibiotics in the livestock industry and a risk to public health.

[Detecting antibiotics in milk: a public health problem]. / Detección de Antibióticos en Leches: Un Problema de Salud Pública.

OBJECTIVE: Determining the presence of antibiotics in raw and processed milk in the city of Monteria. MATERIALS AND METHODS: Three samplings were three samples were taken in a dairy company in the city of Monteria at two-month intervals. Pasteurised milk samples were taken from six trademarks. All milk samples were tested for acidity by alcoholometry; the presence of antiseptic H2O2 was determined by using 35 % KI and 1 % V2O5 diluted in H2SO4. The incidence of antibiotics (Total antibiotic Bio K 331 (Diagnostic Jemelle dioxide, Belgique) was then determined. The test's sensitivity limit was determined by using 0.004 UI/ml penicillin, 0.100 mg/ml oxytetracycline and 5,000 mg/ml chloramphenicol as positive controls in two-fold serial dilutions. Aliquots of milk were used as positive and negative controls for each sample. The first sampling evaluated 212 samples of milk, the second 167 and the third 66, for a total of 445 samples. RESULTS: All samples were negative for alcoholometry acidity. Antibiotics were detected in 111 (25 %) samples of raw milk; however, no antibiotics were detected in the pasteurised milk. The test's sensitivity revealed that penicillin was detectable in a maximum 0.002UI/ml dilution, oxytetracycline in 0.005ìg/ml and chloramphenicol in 1.25 mg/ml. CONCLUSIONS: Traces of antibiotics being found in 25 % of milk samples revealed a lack of public health controls, as well as evidence of the indiscriminate use of antibiotics in the livestock industry and a risk to public health.

Efectos de la acidosis y alcalosis en retículo sarcoplásmico de corazón / The effect of acidosis and alcalosis in the sarcoplasmic reticulum of the heart

Se presentan los resultados del estudio de algunas funciones del retículo sarcoplásmico aislado del corazón de perro en condiciones acidosis y de alcalosis, en el rango de un pH de 6.0 a 7.8. El agua intravesicular medida a pH 6.0 es de 4.7 micronl por mg de proteína y disminuye un 15% hasta 4 micronl a pH 8.0 que se relaciona con un descenso en la turbidez de un 13.5%. Se encuentra un pH óptimo de 7.2 para la ATP asa dependiente de Ca**2+ con una actividad específica de 580 nmolas de ATP hidrolizado/min/mg de proteína. La ATP basal, dependiente de Mg**2+ es insensible a cambios de pH. Se alcanza una acumulación máxima de calcio de 45.1 + ou - 1.4 nmolas por mg de proteína entre pH 6.0 y 6.6. A pH mayor la cantidad de calcio acumulado disminuye progresivamente. La velocidad de transporte de calcio en estado estacionario muestra un pH óptimo de 6.7. Las constante cinéticas calculadas para el transporte de calcio muestran que la afinidad del retículo por este catión es máxima entre pH 6.87 y 7.02. La velocidad máxima del transporte disminuye progresivamente al pasar de pH 6.1 a 7.16. Cuando se cambia el pH de ácido a alcalino durante el proceso de transporte, se produce la salida del cacio acumulado en forma proporcional al incremento de pH. Este efecto es reversible. Se observa un desacople entre la acumulación de calcio y la hidrólisis de ATP a pH superiores a 6.6 debido al aumento en la velocidad de salida del calcio. Los valores encontrados de pK y de número de portones por mg de proteína que se disocian de grupos ionizables son 6.53 y 0.68 respectivamente para la ATP asa dependiente de calcio, 7.09 y 0.60 para el transporte de calcio y 7.41 y 0.39 para la salida de calcio. Concluimos que el transporte y la afinidad por el calcio del retículo sarcoplásmico cardiaco son óptimos entre pH 6.8 y 7.0, lo que corresponde con la zona de ph intracelular informado para el tejido cardiaco normal. Nuestros datos están de acuerdo con una disminución de la contractilidad durante la acidosis. Se propone una vía de salida de calcio en retículo que es sensible al pH y diferente de la bomba de calcio que es la única vía de entrada