Generation and characterization of avian IgY antibodies for detecting beta-casein A1 in bovine milk.

Beta-casein is a primary milk protein that constitutes approximately 30% of the casein in bovine milk, with the two most common types in cattle being A1 and A2. The A2 protein differs from the A1 version due to a mutation in the codon at position 67, resulting in a histidine to proline substitution. However, the bioactive peptide, beta-casomorphine-7 (BCM7), which originates from partial proteolysis of the A1 variant, has been linked to several gastrointestinal disorders in humans. Production of A1 beta casein-free products is increasing demand in the milk market, worldwide. This study generated and characterized a polyclonal IgY antibody that specifically recognizes the A1 beta-casein protein present in cow's milk. A commercially available IgY anti-A1 antibody was used as a positive control, and the sensitivity and specificity of both the commercial and produced anti-A1 antibodies were evaluated. The results showed 100% sensitivity and specificity of 100% of the commercial IgY anti-A1. The in-house produced anti-A1 antibody demonstrated a sensitivity of 95.2% and a specificity of 100%, indicating its potential as a reliable and cost effective tool for detecting A1 beta-casein protein in milk samples.

Targeting Trypanosoma evansi with disulphide-rich peptides derived from a phage display library.

A phage-display library was generated using a Bus thalamus scorpion toxin (BTK-2) as a peptide scaffold. BTK-2 belongs to the disulfide-rich family of proteins with pronounced structural stability due to the presence of three disulfide bridges that connects antiparallel beta-sheets and one alpha helix. Using BTK-2 as a phage display scaffold, we introduced mutations in five residues located in the alpha-helix and two residues located in the smaller loop, keeping intact the disulfide bridges to create a peptide phage-displayed library with disulfide-rich family properties. The library was subjected to in vivo and in vitro phage display selections against Trypanosoma evansi, the etiological agent of "Surra", a disease that affects a wide range of mammals. The development of T. evansi specific biomarkers is essential to improve diagnostic methods and epidemiological studies leading to a more accurate clinical decision for the treatment of this disease of economic impact for commercial livestock production. In this study, we identified two disulfide-rich peptides targeting T. evansi parasites. Further specificity studies are necessary to investigate the potential of selected peptides as new biomarkers to aid diagnostic and treatment procedures of T. evansi infections.

Radical parametrectomy after 'cut-through' hysterectomy in low-risk early-stage cervical cancer: Time to consider this procedure obsolete.

OBJECTIVE: The goal of this study is to identify predictive factors in patients with a diagnosis of early-stage cervical cancer after simple hysterectomy in order to avoid a radical parametrectomy. METHODS: A retrospective review was performed of all patients who underwent radical parametrectomy and bilateral pelvic lymphadenectomy at MD Anderson Cancer Center and at the Instituto de Cancerologia Las Americas in Medellin, Colombia from December 1999 to September 2017. We sought to determine the outcomes in patients diagnosed with low-risk factors (squamous, adenocarcinoma or adenosquamous lesions<2cm in size, and invading<10mm) undergoing radical parametrectomy and pelvic lymphadenectomy. RESULTS: A total of 30 patients were included in the study. The median age was 40.4years (range; 26-60) and median body mass index (BMI) was 26.4kg/m2 (range; 17.7-40.0). A total 22 patients had tumors<1cm and 8 had tumors between 1 and 2cm. A total of 6 (33%) of 18 patients had evidence of lymph-vascular invasion (LVSI). No radical parametrectomy specimen had residual tumor, involvement of the parametrium, vaginal margin positivity, or lymph node metastasis. None of the patients received adjuvant therapy. After a median follow-up of 99months (range; 6-160) only one patient recurred. CONCLUSION: Radical parametrectomy may be avoided in patients with low-risk early-stage cervical cancer detected after a simple hysterectomy. Rates of residual disease (parametrial or vaginal) and the need for adjuvant treatments or recurrences are very low.

Outpatient laparoscopic nerve-sparing radical hysterectomy: A feasibility study and analysis of perioperative outcomes.

OBJECTIVE: The goal of our study was to report on the feasibility of outpatient laparoscopic radical hysterectomy in patients with early-stage cervical cancer. METHODS: We included all patients who underwent a laparoscopic radical hysterectomy at the Instituto de Cancerología - Las Americas in Medellin, Colombia, between January 2013 and July 2015. The control group was a similar cohort of patients who were admitted after their surgery. RESULTS: Seventy-six patients were included [outpatient (31) and admitted (45)]. There were no statistically significant differences between groups regarding age, clinical stage, histology, nodal count, need of adjuvant treatment, visual pain scores at discharge or follow up time. All patients underwent a transversus abdominis plane block. The median operative time was 150min (range, 105-240) in the outpatient group vs. 170min (range, 97-300) in the admitted group (p=0.023). The median estimated blood loss was 50ml (range, 20-150) in the outpatient group vs. 120ml (range, 20-1000) in the admitted group (p=0.001). All patients were able to void spontaneously and tolerate a diet before discharge. In patients who were admitted, the median hospital stay was 1day, (range; 1-6), and 39 (87%) were discharged at postoperative day 1. There were 6 postoperative complications, 3 in each group. There were no recurrences in the follow-up period in the outpatient group, and there were 3 (6.6%) recurrences in the admitted group. CONCLUSION: Outpatient laparoscopic radical hysterectomy is feasible and can be performed safely in a developing country in well-selected patients.

Traquelectomía radical laparoscópica en pacientes con cáncer de cuello uterino en estado IB1 en el Instituto de Cancerología - Las Américas, Medellín, Colombia

Objetivo: Revisar nuestra experiencia en traquelectomía radical laparoscópica en cáncer de cérvix en estado temprano. Métodos: Estudio observacional descriptivo retrospectivo de las pacientes que se sometieron a traquelectomía radical laparoscópica en el Instituto de Cancerología - Las Américas, Medellín, Colombia, entre Mayo de 2009 y Enero 2015. Resultados: Se completó satisfactoriamente el procedimiento en 13 pacientes en estadío IB1, 12 (92%) tuvieron tumores menores a 2 cm y una recibió quimioterapia neoadyuvante por un tumor de 3 cm. El tipo histológico más frecuente fue el escamoso en 7 pacientes (54%). En 5 pacientes (38%) no se evidenció enfermedad residual luego del procedimiento. El tiempo quirúrgico promedio fue de 240 min (130-340 min); la mediana de pérdida sanguínea fueron 100 ml (50-200 ml). Dos pacientes tuvieron cistotomía incidental durante la cirugía, reparadas por vía laparoscópica, una de ellas desarrollo una fístula vésico-vaginal que cerró espontáneamente. Ninguna paciente requirió transfusión sanguínea ni conversión a laparotomía. La estancia hospitalaria promedio fue de 1 día (1-3). Dos pacientes requirieron histerectomía laparoscópica. No se han reportado recurrencias ni embarazos con un seguimiento promedio 27,9 meses (8,3-64,4). Conclusión: La traquelectomía radical laparoscópica es factible y se puede realizar de manera segura en un país en desarrollo, en pacientes bien seleccionados, con cáncer de cérvix temprano que desean preservar su fertilidad. Los tiempos de seguimiento aún son cortos para conclusiones definitivas sobre el resultado obstétrico. La seguridad oncológica parece similar a la de la traquelectomía abdominal y/o vaginal.

Objective: To review our experience with laparoscopic radical trachelectomy in patients with early-stage cervical cancer. Methods: We performed a observational descriptive retrospective review of all patients who underwent a laparoscopic radical trachelectomy at the Instituto de Cancerología - Las Americas, Medellin, Colombia, between May 2009 and January 2015. Results: 13 patients completed surgery, 12 patients (92%) were diagnosed as IB1 with tumor size less than 2 cm, and one patient received neoadjuvant chemotherapy due to a 3 cm cervical tumor; histology was squamous cell carcinoma in 7 patients (54%). Five patients (38%) showed no residual disease. The mean surgical time was 240 min (130-340 min); the estimated blood loss was 100 ml (50-200 ml). Two patients had a cystotomy during surgery; one of them developed a vesicovaginal fistula that healed spontaneously. No transfusions were given. No conversions were made. Mean hospital stay 1 day (1-3 day). 2 patients required laparoscopic hysterectomy. To date, no recurrence or pregnancies has been recorded with the median follow up 27.9 months (8.3-64.4 month). Conclusion: Laparoscopic radical trachelectomy is feasible and can be performed safely in a developing country in well-selected patients with early cervical cancer who wish to preserve their fertility. Follow up times are still too short to drive definitive conclusions on obstetric results. The oncological safety appears similar to that of the abdominal trachelectomy and/or vaginal.

Xpert MTB/RIF test performance assay in respiratory samples at real work settings in a developing country.

INTRODUCTION: The Xpert MTB/RIF test detects DNA from Mycobacterium tuberculosis complex and susceptibility to rifampin. It has been evaluated repeatedly under "ideal" conditions including centrifugation of sputum and bronchoalveolar lavage, Ziehl Neelsen (ZN) and auramine/rhodamine staining, as well as with solid and liquid automated culture methods. Results from such evaluations cannot be extrapolated to low-income countries that do not routinely use all these processes. OBJECTIVE: To assess the performance of the Xpert MTB/RIF test in respiratory samples under "real" conditions of work in a low-income country and its correlation with phenotypic susceptibility testing. MATERIALS AND METHODS: We conducted a cross-sectional study to assess the performance of the Xpert MTB/RIF test in =12 year-old patients with suspected pulmonary tuberculosis. In routine sample processing at the Hospital we do not use sputum centrifugation, staining with auramine/rhodamine or automated liquid culture. RESULTS: We screened 152 patients of whom 108 were eligible for the study and 103 were included in the analysis; 34% of the samples were positive. The overall test sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91%, 92%, 83% and 96%, respectively. In ZN-negative samples the sensitivity, specificity, PPV and NPV were 87%, 91%, 68% and 97%, respectively. The results of sensitivity and resistance to rifampin were concordant with susceptibility testing using the multiple proportions method (kappa=1, p<0.0001). CONCLUSIONS: The Xpert MTB/RIF test overall performance was similar to the one achieved under ideal conditions. Its performance in ZN-negative samples was better under "real" conditions of work in a low-income country.

Radical trachelectomy in early-stage cervical cancer: A comparison of laparotomy and minimally invasive surgery.

OBJECTIVES: Radical trachelectomy is considered standard of care in patients with early-stage cervical cancer interested in future fertility. The goal of this study was to compare operative, oncologic, and fertility outcomes in patients with early-stage cervical cancer undergoing open vs. minimally invasive radical trachelectomy. METHODS: A retrospective review was performed of patients from four institutions who underwent radical trachelectomy for early-stage cervical cancer from June 2002 to July 2013. Perioperative, oncologic, and fertility outcomes were compared between patients undergoing open vs. minimally invasive surgery. RESULTS: A total of 100 patients were included in the analysis. Fifty-eight patients underwent open radical trachelectomy and 42 patients underwent minimally invasive surgery (MIS=laparoscopic or robotic). There were no differences in patient age, body mass index, race, histology, lymph vascular space invasion, or stage between the two groups. The median surgical time for MIS was 272min [range, 130-441min] compared with 270min [range, 150-373min] for open surgery (p=0.78). Blood loss was significantly lower for MIS vs. laparotomy (50mL [range, 10-225mL] vs. 300mL [50-1100mL]) (p<0.0001). Nine patients required blood transfusion, all in the open surgery group (p=0.010). Length of hospitalization was shorter for MIS than for laparotomy (1day [1-3 days] vs. 4days [1-9 days]) (p<0.0001). Three intraoperative complications occurred (3%): 1 bladder injury, and 1 fallopian tube injury requiring unilateral salpingectomy in the MIS group and 1 vascular injury in the open surgery group. The median lymph node count was 17 (range, 5-47) for MIS vs. 22 (range, 7-48) for open surgery (p=0.03). There were no differences in the rate of postoperative complications (30% MIS vs. 31% open surgery). Among 83 patients who preserved their fertility (33 MIS vs. 50 open surgery), 34 (41%) patients attempted to get pregnant. Sixteen (47%) patients were able to do so (MIS: 2 vs. laparotomy: 14, p=0.01). The pregnancy rate was higher in the open surgery group when compared to the MIS group (51% vs. 28%, p=0.018). However, median follow-up was shorter is the MIS group compared with the open surgery group (25months [range, 10-69] vs. 66months [range, 11-147]). To date, there has been one recurrence in the laparotomy group and none in the MIS group. CONCLUSIONS: Our results suggest that radical trachelectomy via MIS results in less blood loss and a shorter hospital stay. Fertility rates appear higher in patients undergoing open radical trachelectomy.

Immediate radical trachelectomy versus neoadjuvant chemotherapy followed by conservative surgery for patients with stage IB1 cervical cancer with tumors 2cm or larger: A literature review and analysis of oncological and obstetrical outcomes.

Radical trachelectomy is the treatment of choice in women with early-stage cervical cancer wishing to preserve fertility. Radical trachelectomy can be performed with a vaginal, abdominal, or laparoscopic/robotic approach. Vaginal radical trachelectomy (VRT) is generally not offered to patients with tumors 2cm or larger because of a high recurrence rate. There are no conclusive recommendations regarding the safety of abdominal radical trachelectomy (ART) or laparoscopic radical trachelectomy (LRT) in such patients. Several investigators have used neoadjuvant chemotherapy in patients with tumors 2 to 4cm to reduce tumor size so that fertility preservation may be offered. However, to our knowledge, no published study has compared outcomes between patients with cervical tumors 2cm or larger who underwent immediate radical trachelectomy and those who underwent neoadjuvant chemotherapy followed by radical trachelectomy. We conducted a literature review to compare outcomes with these 2 approaches. Our main endpoints for evaluation were oncological and obstetrical outcomes. The fertility preservation rate was 82.7%, 85.1%, 89%; and 91.1% for ART (tumors larger than >2cm), ART (all sizes), NACT followed by surgery and VRT (all sizes); respectively. The global pregnancy rate was 16.2%, 24% and 30.7% for ART, VRT, and NACT followed by surgery; respectively. The recurrence rate was 3.8%, 4.2%, 6%, 7.6% and 17% for ART (all sizes), VRT (all sizes), ART (tumors>2cm), NACT followed by surgery, and VRT (tumors>2cm). These outcomes must be considered when offering a fertility sparing technique to patients with a tumor larger than 2cm.

Xpert MTB/RIF test performance assay in respiratory samples at real work settings in a developing country / Rendimiento de la prueba Xpert MTB/RIF en muestras respiratorias en el escenario real de trabajo en un país en desarrollo

Introduction: The Xpert MTB/RIF test detects DNA from Mycobacterium tuberculosis complex and susceptibility to rifampin. It has been evaluated repeatedly under "ideal" conditions including centrifugation of sputum and bronchoalveolar lavage, Ziehl Neelsen (ZN) and auramine/rhodamine staining, as well as with solid and liquid automated culture methods. Results from such evaluations cannot be extrapolated to low-income countries that do not routinely use all these processes. Objective: To assess the performance of the Xpert MTB/RIF test in respiratory samples under "real" conditions of work in a low-income country and its correlation with phenotypic susceptibility testing. Materials and methods: We conducted a cross-sectional study to assess the performance of the Xpert MTB/RIF test in =12 year-old patients with suspected pulmonary tuberculosis. In routine sample processing at the Hospital we do not use sputum centrifugation, staining with auramine/rhodamine or automated liquid culture. Results: We screened 152 patients of whom 108 were eligible for the study and 103 were included in the analysis; 34% of the samples were positive. The overall test sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91%, 92%, 83% and 96%, respectively. In ZN-negative samples the sensitivity, specificity, PPV and NPV were 87%, 91%, 68% and 97%, respectively. The results of sensitivity and resistance to rifampin were concordant with susceptibility testing using the multiple proportions method (kappa=1, p<0.0001). Conclusions: The Xpert MTB/RIF test overall performance was similar to the one achieved under ideal conditions. Its performance in ZN-negative samples was better under "real" conditions of work in a low-income country.

Introducción. La prueba Xpert MTB/RIF detecta el ADN del complejo Mycobacterium tuberculosis y la sensibilidad a rifampicina. La prueba ha sido evaluada en condiciones "ideales" que incluyen la centrifugación de esputo y el lavado broncoalveolar, la tinción de Ziehl Neelsen (ZN) y de auramina-rodamina y los métodos de cultivo sólido y de cultivo líquido automatizado. Los resultados de tales evaluaciones no pueden extrapolarse a países de bajos ingresos que no utilizan habitualmente todos estos procesos. Objetivo. Evaluar el rendimiento de la prueba Xpert MTB/RIF en muestras respiratorias bajo condiciones "reales" de trabajo y su correlación con las pruebas fenotípicas de sensibilidad. Materiales y métodos. Se llevó a cabo un estudio transversal para evaluar el rendimiento de la prueba Xpert MTB/RIF en pacientes =12 años con sospecha de tuberculosis pulmonar. En el procesamiento rutinario de muestras en el Hospital del estudio no se usa la centrifugación del esputo, la tinción con auramina-rodamina ni el cultivo líquido automatizado. Resultados. Se incluyeron 152 pacientes, de los cuales 108 eran elegibles y 103 se incluyeron en el análisis. El 34 % de las muestras fueron positivas; la sensibilidad de la prueba fue de 91 %, la especificidad de 92 %, el valor diagnóstico positivo de 83 % y el valor diagnóstico negativo global de 96 %. En las muestras negativas con Ziehl Neelsen, la sensibilidad fue de 87 %, la especificidad de 91 % y los valores diagnósticos positivo y negativo alcanzaron 68 y 97 %, respectivamente. Los resultados de sensibilidad o resistencia a la rifampicina concordaron con los de la prueba fenotípica de sensibilidad (valor de kappa=1, p<0,0001). Conclusiones. El rendimiento global de la prueba fue similar al obtenido bajo condiciones "ideales". En las muestras negativas con Ziehl Neelsen se obtuvo un mejor rendimiento en las condiciones "reales" de trabajo de un país de bajos ingresos.

Neumonitis intersticial linfoidea en niños infectados por el virus de inmunodeficiencia humana-1 en zona de alta prevalencia de tuberculosis pulmonar / Lymphoid interstitial pneumonitis in children infected with type 1 human immunodefi ciency virus from areas with high pulmonary tuberculosis prevalence

Antecedentes : Poco se sabe sobre la neumonitis intersticial linfoidea (NIL) en niños con infección por el virus de inmunodeficiencia humana-1 (VIH-1) Objetivos: Describir las características clínicas y patológicas de NIL en niños infectados por VIH-1 en un centro de referencia para VIH pediátrico en Cali (Colombia). Métodos: Se llevó a cabo una descripción de serie de casos de NIL basados en revisión retrospectiva de historias clínicas de todos los casos de niños con enfermedad pulmonar crónica y LIP confirmada por biopsia entre los años 2001 y 2012. Resultados y conclusiones: Diez de 12 casos con NIL fueron confirmados por biopsia pulmonar. Se observó una respuesta clínica y de función respiratoria luego del tratamiento con prednisona, excepto en un caso que presentó tos persistente. No se encontraron casos de tuberculosis pulmonar (TP) en nuestra serie y el papel de la biopsia pulmonar fue crítico para alcanzar un diagnóstico preciso.

Background: Little is known about Lymphoid Interstitial Pneumonitis (LIP) in children with HIV infection. Aims: To describe the clinical and pathological characteristics of LIP in infected children in a referral center for pediatric HIV in Cali (Colombia). Methods: Case series based on retrospective analysis of clinical charts among HIV-infected children with chronic lung disease and lung-biopsy proven LIP between the years 2001 and 2012. Results and conclusions: 10 of 12 cases of LIP were confirmed by lung biopsy. Significant clinical and respiratory functional improvement was obtained in all cases after prednisone therapy, excepting one child who presented persistent cough. No case of pulmonary TB was detected in our cohort. Lung biopsy was critical to obtain an accurate diagnosis.

Extragastrointestinal stromal tumor in the rectovaginal septum in an adolescent.

•We report a rare case of EGIST in rectovaginal septrum.•Adolescent patient who died due to an aggressive EGIST•Infrequent type of pelvic EGIST and literature review.

Brote hospitalario de Achromobacter denitrificans relacionado con el uso de clorhexidina contaminada / Achromobacter denitrificans hospital outbreak associated with the use of contaminated chlorhexidine

El objetivo de este artículo es describir una serie de casos de pacientes con pseudobacteriemia causada por Achromobacter denitrificans, germen aislado a partir de los hemocultivos de 14 pacientes hospitalizados en una institución de alta complejidad de Medellín. Los casos estuvieron asociados con el uso de clorhexidina al 4 % en jabón contaminado. Todos los pacientes recibieron antibióticos con resultados favorables, posiblemente debido a la baja virulencia de este microorganismo y a las medidas oportunas adoptadas por el Grupo de Control de Infecciones del hospital.

The aim of this paper is to describe a case series of pseudobacteremia caused by Achromobacter denitrificans, isolated from blood cultures from 14 hospitalized patients in a tertiary care institution in Medellín. The cases were associated with the use of contaminated 4% chlorhexidine soap. All patients received antibiotic treatment and had favorable results, possibly because of the low virulence of this organism and the timely measures taken by the hospital infections control group.

Leptospirosis con inmunoglobulina M positiva en pacientes hospitalizados en una institución de tercer nivel de Medellín, Colombia, en 2009 / Leptospirosis and positive IgM in hospitalized patients in a tertiary care institution in Medellín, Colombia, 2009. Case report and literature review

La leptospirosis es una enfermedad zoonótica que debe ser incluida entre los diagnósticos infecciosos por descartar en nuestros pacientes, ya que es subdiagnosticada y puede causar complicaciones graves. Ocurre en poblaciones desarrolladas y en regiones tropicales, tanto a nivel urbano como rural, pudiendo causar epidemias o endemias. La mayoría de las veces los pacientes cursan con cuadros clínicos benignos o, incluso, asintomáticos, pudiendo asemejarse a otras enfermedades infecciosas, lo cual dificulta la sospecha diagnóstica, pero se debe tener en cuenta que en algunos casos ocasiona cursos clínicos graves y complicaciones fatales. El objetivo de esta comunicación es recordar la relevancia de tener una sospecha clínica para hacer un diagnóstico oportuno de esta entidad, reportando una serie de 14 casos con clínica indicativa de leptospirosis, que presentaron resultado positivo de serología para Leptospira spp., lo cual apoyaba el diagnóstico. De ellos, seis pacientes tuvieron complicaciones graves y dos tuvieron desenlaces fatales. Los datos se obtuvieron de pacientes procedentes de diferentes municipios de Antioquia y Chocó, que consultaron y fueron hospitalizados en una institución de tercer nivel de Medellín durante el año 2009.

Due to the fact that leptospirosis is a zoonotic disease that goes underdiagnosed and may cause serious complications, it must be included among the infectious diagnoses to rule out for infected patients. It occurs in developed populations and in tropical regions, both in urban and rural areas, causing epidemics or becoming endemic. Patients usually show benign symptoms or are even asymptomatic, and it may resemble other infectious diseases, which complicates its diagnosis; however, in some cases, it causes severe and fatal complications. The purpose of this paper is to remark the importance of having a high clinical suspicion to make a timely diagnosis of this disease, reporting a series of 14 patients with symptoms suggestive of leptospirosis, who had a positive serology for Leptospira spp., supporting the clinical diagnosis. Out of those patients, six had serious complications and two had fatal outcomes. Data were obtained from patients from different municipalities of Antioquia and Chocó, who consulted and were hospitalized in a tertiary care institution in Medellín, Colombia, during 2009.

Bacteriemia por Elizabethkingia meningoseptica en paciente con leucemia linfoblástica aguda / Bacteriemia by Elizabethkingia meningoseptica in acute linfoblastic leukemia patients

Se reporta un caso de bacteriemia por Elizabethkingia meningoseptica en un paciente inmunocomprometido, con antecedentes de leucemia linfoblástica aguda, que ingresa por infiltración al sistema nervioso central y sospecha de proceso infeccioso. Elizabethkingia meningoseptica es una bacteria oportunista en infecciones intrahospitalarias, con notable resistencia antimicrobiana, la cual es un inusual patógeno en humanos.

A case report of bacteraemia by Elizabethkingia meningoseptica in an immunocompromised patient, who was admitted to the hospital with an acute Linfoblastic leukemia and infection diagnosis, is presented. E. meningoseptica is an emerging bacterium in nosocomial infections with remarkable antimicrobial resistance and an unusual pathogen in humans.

Alteraciones metabólicas con terapia antirretroviral altamente efectiva en niños positivos para VIH, Cali, Colombia / Metabolic alterations with anti-retroviral highly effective therapy in positive children for VIH, Cali, Colombia

Objetivos: describir las alteraciones metabólicas en niños con diagnóstico de VIH y en tratamiento con terapia antirretroviral altamente efectiva (Highly Active Antiretroviral Therapy, HAART). Métodos: se realizó una primera fase descriptiva de los valores de lípidos y glucemia en una cohorte de niños positivos para VIH. De una clínica pediátrica se reclutaron, entre junio de 2003 y junio de 2005, niños mayores de un mes y menores de 16 años en terapia HAART. Estos resultados se compararon con valores de la población. En una segunda fase, se estudió la densidad ósea en estos niños, utilizando DEXA (dual energy X-ray absorptiometry) y antropometría, y se comparó la de controles sanos. Resultados: se incluyeron 38 niños positivos para VIH. En 59,5% de los niños se clasificaron con displidemia. Al compararlo con la población de referencia, el grupo positivo para VIH presentó una prevalencia mayor de hipertrigliceridemia y HDLc (highdensity lipoprotein) anormalmente bajo. Tomando en cuenta la variación por edad, los valores de colesterol total y LDLc (lowdensity lipoprotein), mostraron un aumento en el grupo que recibía inhibidores de proteasa (IP) contra el que no. La diferencia del puntaje Z de BMD (bone mineral density) entre los grupos fue de 0,56 (IC95%: 0,1- 1,0), teniendo un menor puntaje Z el grupo positivo para VIH. El puntaje Z de la densidad de masa ósea mostró un declive con el tiempo de exposición, que no fue evidente en el grupo control. Conclusiones: encontramos alteraciones en los lípidos similares a las descritas en el adulto seropositivo. En el grupo con IP se encontraron alteraciones del colesterol que cambiaban según la edad. Se encontró una pérdida de la densidad ósea, progresiva con el tiempo de exposición e independiente de la edad. Consideramos que esta relación podría ser de origen multifactorial, incluyendo los efectos de la infección y del tratamiento.

Objectives: our goal is to describe metabolic alterations in children with HIV and under highly effective anti-retroviral treatment (HAART). Methodology: a first descriptive phase of lipid levels and glucemia was carried out in a cohort of HIV positive children. In a paediatric hospital, children >1 month and <16 years old under HAART were recruited from June, 2003 to June, 2005. The results were compared to population values. During the second phase, bone density was studied in these children using DEXA and anthropometric values and compared to healthy control subjects. Results: thirty eight positive children were included. 59.5% of the children were classified as having dyslipidemia. Upon comparison to the reference population, the HIV(+) group showed larger hypertrigliceridemia prevalence and abnormally low cHDL. Taking into account age variations, total colesterol values and cLDL showed increase in the group that received PI against those that did not. The difference of the BMD Z-Score among the groups was 0,56 (CI95%: 0.1, 1.0), the HIV(+) group having a smaller Z-Score. The bone mass density Z-Score showed a decline according exposition time, which was not evident in the control group. Conclusions: alterations in lipids similar to those described in the seropositive adult were found. The group with PI showed cholesterol alterations that changed according to age. Progressive bone density loss according to exposition time was found regardless of age. It is considered that this relationship could have multifactorial origin, including infection and treatment effects.