[Characterization of the national malaria diagnostic network, Colombia, 2006-2010]. / Caracterización de la Red Nacional de Diagnóstico de Malaria, Colombia, 2006-2010.

INTRODUCTION: The implementation and development of activities of the quality assurance system of malaria diagnosis, allows the adequate operation of the national diagnostic network, needed to strengthen prevention and control actions of this important public health problem. OBJECTIVE: To characterize the malaria diagnosis network in Colombia between 2006 and 2010. MATERIALS AND METHODS: A retrospective study was made by reviewing the annual reports of malaria diagnosis network activities that were sent by the Public Health Laboratories (PHL) between 2006 and 2010. The study included analysis of diagnostic coverage in population at risk and an evaluation of activities and training to the people responsible for malaria diagnosis. RESULTS: Malaria diagnostic coverage has increased in Colombia, from 53% of municipalities covered in 2006 to 80% in 2010. The number of places that perform diagnosis increased by 31% with a significant increase, for the same period, of the number of microscopists (56%) and laboratories (30%), to 1,195 and 1,780 respectively, registered in 2010. During the period of study, the percentage of PHL that carried out at least 3 of the activities of the quality assurance system for the diagnostic network at local level was 67%. CONCLUSIONS: It is necessary to continue strengthening the malaria diagnosis network to provide timely and adequate diagnosis in order to reduce the morbidity and mortality by malaria.

Exposure to polymers reverses inhibition of pulmonary surfactant by serum, meconium, or cholesterol in the captive bubble surfactometer.

Dysfunction of pulmonary surfactant in the lungs is associated with respiratory pathologies such as acute respiratory distress syndrome or meconium aspiration syndrome. Serum, cholesterol, and meconium have been described as inhibitory agents of surfactant's interfacial activity once these substances appear in alveolar spaces during lung injury and inflammation. The deleterious action of these agents has been only partly evaluated under physiologically relevant conditions. We have optimized a protocol to assess surfactant inhibition by serum, cholesterol, or meconium in the captive bubble surfactometer. Specific measures of surface activity before and after native surfactant was exposed to inhibitors included i), film formation, ii), readsorption of material from surface-associated reservoirs, and iii), interfacial film dynamics during compression-expansion cycling. Results show that serum creates a steric barrier that impedes surfactant reaching the interface. A mechanical perturbation of this barrier allows native surfactant to compete efficiently with serum to form a highly surface-active film. Exposure of native surfactant to cholesterol or meconium, on the other hand, modifies the compressibility of surfactant films though optimal compressibility properties recover on repetitive compression-expansion cycling. Addition of polymers like dextran or hyaluronic acid to surfactant fully reverses inhibition by serum. These polymers also prevent surfactant inhibition by cholesterol or meconium, suggesting that the protective action of polymers goes beyond the mere enhancement of interfacial adsorption as described by depletion force theories.

Caracterización de la Red Nacional de Diagnóstico de Malaria, Colombia, 2006-2010 / Characterization of the National Malaria Diagnostic Network, Colombia, 2006-2010

Introducción. La implementación y desarrollo de actividades del sistema de gestión de la calidad del diagnóstico de malaria, permiten el adecuado funcionamiento de la red nacional de diagnóstico, necesario para fortalecer acciones de prevención y control de este evento, importante en salud pública. Objetivo. Caracterizar la Red de Diagnóstico de Malaria en Colombia, entre 2006 y 2010. Materiales y métodos. Se hizo un estudio retrospectivo mediante la revisión de los informes anuales de actividades de la Red de Diagnóstico de Malaria, enviados por los laboratorios de salud pública entre 2006 y 2010. Se analizó la cobertura de diagnóstico en la población en riesgo, las actividades de evaluación del desempeño y las capacitaciones al personal que hace el diagnóstico. Resultados. La cobertura del diagnóstico de malaria se ha incrementado en el país, pasando de 53 % de los municipios, en 2006, a 80 %, en 2010. El número de sitios que hacen el diagnóstico aumentó en 31 %, con un incremento en el número de microscopistas (56 %) y de laboratorios (30 %), para un total de 1.195 y 1.780, respectivamente, registrados en 2010. En el periodo de estudio, se mantuvo el porcentaje de laboratorios de salud pública (67 %) que llevan a cabo, al menos, tres de las actividades del sistema de gestión de la calidad a la Red de Diagnóstico de Malaria a nivel local. Conclusiones. Es necesario continuar con el fortalecimiento de la Red de Diagnóstico de Malaria, para brindar diagnóstico oportuno y con calidad con el fin de reducir la morbimortalidad por esta causa.

Introduction. The implementation and development of activities of the quality assurance system of malaria diagnosis, allows the adequate operation of the national diagnostic network, needed to strengthen prevention and control actions of this important public health problem. Objective. To characterize the malaria diagnosis network in Colombia between 2006 and 2010. Materials and methods. A retrospective study was made by reviewing the annual reports of malaria diagnosis network activities that were sent by the Public Health Laboratories (PHL) between 2006 and 2010. The study included analysis of diagnostic coverage in population at risk and an evaluation of activities and training to the people responsible for malaria diagnosis. Results. Malaria diagnostic coverage has increased in Colombia, from 53% of municipalities covered in 2006 to 80% in 2010. The number of places that perform diagnosis increased by 31% with a significant increase, for the same period, of the number of microscopists (56%) and laboratories (30%), to 1,195 and 1,780 respectively, registered in 2010. During the period of study, the percentage of PHL that carried out at least 3 of the activities of the quality assurance system for the diagnostic network at local level was 67%. Conclusions. It is necessary to continue strengthening the malaria diagnosis network to provide timely and adequate diagnosis in order to reduce the morbidity and mortality by malaria.

Evaluación de dos pruebas rápidas [NOW® ICT Malaria Pf/Pv y OptiMAL®] para el diagnóstico de paludismo en Tumaco, Colombia / Evaluation of two rapid diagnostic tests, NOW® ICT Malaria Pf/Pv and OptiMAL®, for diagnosis of malaria

Introducción. El Instituto Nacional de Salud con el fin de mejorar el acceso al diagnóstico de paludismo, evaluó dos pruebas rápidas para el diagnóstico de dicha enfermedad. Objetivo. Evaluar la sensibilidad, especificidad y concordancia de dos pruebas inmunocromatográficas, NOW® ICT Malaria Pf/Pv y OptiMAL®, frente a la gota gruesa. Materiales y métodos. Se llevó a cabo un estudio descriptivo de concordancia en 214 pacientes de Tumaco, captados mediante búsqueda pasiva y brigadas de atención, que presentaran, por lo menos, uno de los síntomas de la tríada clásica. Resultados. NOW® ICT tuvo una sensibilidad general de 98,4 por ciento (intervalo de confianza de 95 por ciento (IC95 por ciento): 90,3-99,9), especificidad general de 98,0 por ciento (IC95 por ciento: 93,9-99,5). Para Plasmodium falciparum la sensibilidad fue de 98,2 por ciento (IC95 por ciento: 89,4-99,9) especificidad de 98,1 por ciento (IC95 por ciento: 94,1-99,5). Esta sensibilidad disminuyó a 80 por ciento en el rango de 200-4.000 parásitos/µl. Los valores de sensibilidad y especificidad de NOW® ICT para Plasmodium vivax fueron del 100 por ciento y no se afectó la sensibilidad en los rangos de parasitemias establecidos. OptiMAL® tuvo una sensibilidad general de 95,2 por ciento (IC95 por ciento: 85,8-98,8) y especificidad general de 99,3 por ciento (IC95 por ciento: 95,8-100,0). Para P. falciparum OptiMAL® tuvo una sensibilidad de 94,7 por ciento (IC95 por ciento: 84,5-98,6) y especificidad de 99,4 por ciento (IC95 por ciento: 96,0-100,0). La sensibilidad disminuyó a 60 por ciento en el rango de de 200-4.000 parásitos/µl. La sensibilidad de OptiMAL® para P. vivax fue 66,7 por ciento (IC95 por ciento: 24,1-94,0), pero disminuyó a 50 por ciento en el rango de 300-2.500 parásitos/µl. Conclusiones. Se obtuvieron buenos resultados en la sensibilidad y la especificidad para ambas pruebas, pero superiores para NOW® ICT.

Introduction. To increase the accessibility of malaria diagnosis, the Instituto Nacional de Salud de Colombia undertook a field trial to evaluate the sensitivity and specificity of two rapid diagnostic tests. Objective. The sensitivity, specificity and concordance was compared for two rapid diagnostic tests for malaria, NOW® ICT Malaria Pf/Pv and OptiMAL®, Materials and methods. A descriptive and concordance study was performed with 214 patients in the southwestern coastal city of Tumaco, Colombia, each of whom presented at least one of the symptoms of the classical malaria triad. Two strategies were applied for patient recruitment—one by passive search and a second through local health brigades. Results. NOW® ICT showed a general sensitivity of 98.4% (95%CI: 90.3-99.9), and a general specificity of 98.0% (95%CI: 93.9-99.5). For Plasmodium falciparum, the sensitivity was 98.2% (95%CI: 89.4-99.9) and the specificity 98.1% (95%CI: 94.1-99.5). The sensitivity was lower (80.0%) when parasitemia ranged from 200 to 4,000 parasites/ ìl. The sensitivity and specificity of the NOW® ICT for P. vivax malaria were 100%. The sensitivity for this test was not affected for the established ranges of parasitemia for P. vivax. The overall figures for OptiMAL® were 95.2% (95%CI: 85.8-98.8) sensitivity and 99.3% (95%CI: 95.8-100.0) specificity. For P. falciparum malaria OptiMAL® showed 94.7% (95%CI: 84.5-98.6) sensitivity and 99.4% (95%CI: 96.0-100.0) specificity. The sensitivity was lower (60.0%) when samples with 200-4,000 parasites/ìl were tested. For P. vivax, OptiMAL® presented a 66.7% (95%CI: 24.1-94.0) sensitivity, which diminished to 50% with a parasitemia between 300-2.500 parasites/ ìL. Conclusions. Good results for sensitivity and specificity were obtained for malaria diagnosis using NOW® ICT and OptiMAL®, with NOW®ICT showing higher sensitivity and specificity values than OptiMAL®.

[Evaluation of two rapid diagnostic tests, NOW ICT Malaria Pf/Pv and OptiMAL, for diagnosis of malaria]. / Evaluación de dos pruebas rápidas [NOW ICT Malaria Pf/Pv y OptiMAL] para el diagnóstico de paludismo en Tumaco, Colombia.

INTRODUCTION: To increase the accessibility of malaria diagnosis, the Instituto Nacional de Salud de Colombia undertook a field trial to evaluate the sensitivity and specificity of two rapid diagnostic tests. OBJECTIVE: The sensitivity, specificity and concordance was compared for two rapid diagnostic tests for malaria, NOW ICT Malaria Pf/Pv and OptiMAL. MATERIALS AND METHODS: A descriptive and concordance study was performed with 214 patients in the southwestern coastal city of Tumaco, Colombia, each of whom presented at least one of the symptoms of the classical malaria triad. Two strategies were applied for patient recruitment-one by passive search and a second through local health brigades. RESULTS: NOW ICT showed a general sensitivity of 98.4% (95%CI: 90.3-99.9), and a general specificity of 98.0% (95%CI: 93.9-99.5). For Plasmodium falciparum, the sensitivity was 98.2% (95%CI: 89.4-99.9) and the specificity 98.1% (95%CI: 94.1-99.5). The sensitivity was lower (80.0%) when parasitemia ranged from 200 to 4,000 parasites/microl. The sensitivity and specificity of the NOW ICT for P. vivax malaria were 100%. The sensitivity for this test was not affected for the established ranges of parasitemia for P. vivax. The overall figures for OptiMAL were 95.2% (95%CI: 85.8-98.8) sensitivity and 99.3% (95%CI: 95.8-100.0) specificity. For P. falciparum malaria OptiMAL showed 94.7% (95%CI: 84.5-98.6) sensitivity and 99.4% (95%CI: 96.0-100.0) specificity. The sensitivity was lower (60.0%) when samples with 200-4,000 parasites/microl were tested. For P. vivax, OptiMAL presented a 66.7% (95%CI: 24.1-94.0) sensitivity, which diminished to 50% with a parasitemia between 300-2.500 parasites/microL. CONCLUSIONS: Good results for sensitivity and specificity were obtained for malaria diagnosis using NOW ICT and OptiMAL, with NOW ICT showing higher sensitivity and specificity values than OptiMAL.