Relationship between vitamin B12 levels and insulin resistance in postmenopausal women from Colombia Caribbean / Relação entre níveis de vitamina B12 e resistência à insulina em mulheres na pós-menopausa da Colômbia Caribe

Introduction: The high prevalence of low vitamin B12 serum levels has been recognized as a public health problem in Latin America; however, the current magnitude of this deficiency in Colombia is uncertain. Low levels of vitamin B12 can induce clinical and subclinical hematological and neurological disorders. Epidemiological studies have demonstrated a relationship between vitamin B12 deficiency and cardiovascular diseases (CVDs). However, the role of vitamin B12 in insulin resistance has been poorly studied. Objective: This study aimed to evaluate the relationship between vitamin B12 serum levels and biochemical and anthropometric markers related to CVDs and insulin resistance in postmenopausal women from Colombia Caribbean. Methods: Correlational, descriptive study. By convenience sampling, 182 postmenopausal women from the medical consultation service of a health institution were linked. Serum vitamin B12 levels, anthropometric variables (body mass index, abdominal perimeter), and biochemical variables (glycemia, insulin, lipid profile, HOMA IR) were evaluated. Results: The average value of the vitamin B12 serum level was 312.5 ± 122.5 pg/mL (230.6 ± 90.4 pmol/L); 46.7% of the women had less than adequate levels of 300 pg/mL (> 221 pmol/L), and 9. 9% were deficient, with levels of less than 200 pg/mL (148 pmol/L). The women with metabolic syndrome were 63.7%, and according to HOMA IR, 52.7 % had insulin resistance. A significant inverse relationship was shown between serum vitamin B12 levels with basal glycemic (P =0.002) and HOMA-IR (P =0.040). Conclusions: A significant inverse relationship between vitamin B12 levels and basal glycemia and HOMA-IR was observed. These findings highlight vitamin B12 deficiency in postmenopausal women and suggest nutritional supplementation.Keywords: Vitamin B12, Insulin resistance, Diet, Postmenopause, Cardiovascular diseases (AU).

Introdução: A alta prevalência de baixos níveis séricos de vitamina B12 foi reconhecida como um problema de saúde pública na América Latina, mas a magnitude atual dessa deficiência na Colômbia é incerta. Baixos níveis de vitamina B12 podem induzir distúrbios hematológicos e neurológicos clínicos e subclínicos. Na verdade, estudos epidemiológicos demonstram uma relação entre deficiência de vitamina B12 e doenças cardiovasculares (DCVs). No entanto, o papel da vitamina B12 na resistência à insulina tem sido pouco estudado. Objetivo: O objetivo deste estudo foi avaliar a relação entre os níveis séricos de vitamina B12 e marcadores bioquímicos e antropométricos relacionados com doenças cardiovasculares e resistência à insulina em mulheres pós-menopáusicas da Colômbia Caribe. Métodos: Estudo correlacional, descritivo. Por amostragem de conveniência, foram vinculadas 182 mulheres na pós-menopausa do serviço de consulta médica de uma instituição de saúde. Níveis séricos de vitamina B12, variáveis antropométricas (índice de massa corporal, perímetro abdominal) e variáveis bioquímicas (glicemia, insulina, perfil lipídico, HOMA IR) foram avaliadas. Resultados: O valor médio do nível sérico de vitamina B12 foi de 312,5 ± 122,5 pg/mL (230,6 ± 90,4 pmol/L); 46,7% das mulheres tinham níveis abaixo do adequado de 300 pg/mL (> 221 pmol/L), e 9,9% eram deficientes, com níveis abaixo de 200 pg/mL (148 pmol/L).As mulheres com síndrome metabólica foram 63,7% e, segundo o HOMA IR, 52,7% apresentavam resistência à insulina. Uma relação inversa significativa entre os níveis séricos de vitamina B12 com glicemia basal (P = 0,002) e HOMA-IR (P = 0,040) foi mostrada. Conclusões: Foi observada uma relação inversa significativa entre os níveis de vitamina B12 e glicemia basal e HOMA-IR. Esses achados destacam a deficiência de vitamina B12 em mulheres na pós-menopausa e sugerem suplementação nutricional (AU).

PREVALENCE OF POTENTIALLY PATHOGENIC MICROBIOLOGICAL AGENTS IN VAGINAL EXUDATES OF ASYMPTOMATIC PREGNANT WOMEN, BARRANQUILLA, COLOMBIA, 2014-2015.

OBJECTIVE: To determine the prevalence of potentially pathogenic microbiological agents in vaginal exudates in a sample of asymptomatic pregnant women in the Department of Atlantico, Colombia. METHODS: Descriptive cross-sectional study of a sample of asymptomatic pregnant women who attended a private primary healthcare institution in Barranquilla, Colombia, between 2014 and 2015. Pregnant women having received antimicrobial treatment within the last 30 days, with vaginal bleeding, mental disability or immunosuppression, were excluded. Consecutive sampling was performed. The prevalence of colonization time by some of the microbiological agents as well as specific prevalence were estimated: number of women with infection by agent type/number of women at risk assessed. RESULTS: Overall prevalence was 24.8% (56/226); 55.4% (31/56) was due to vaginitis causal agents, and 44.6% (25/56) to vaginosis. The specific prevalence by type of pathogen, 13.3% (30/226) was vaginitis due to colonization by Candida spp. and 0.4% (1/226) was vaginitis due to T. vaginalis. Bacterial vaginosis (BV) was found in 8.0% (18/226). CONCLUSIONS: Substantial colonization of the lower genital tract by potentially pathogenic germs is found in pregnant women between 35 and 37 weeks of gestation. Further studies are required in order to determine the benefit of population screening in terms of avoiding poor maternal and perinatal out- comes, and the impact on the resulting overcosts.

TITULO: PREVALENCIA DE AGENTES MICROBIOLÓGICOS POTENCIALMENTE PATÓGENOS EN EL EXUDADO VAGINAL DE GESTANTES ASINTOMÁTICAS, BARRANQUILLA, COLOMBIA, 2014-2015. OBJETIVO: Establecer la prevalencia de agentes microbiológicos potencialmente patógenos en el exudado vaginal de gestantes asintomáticas del departamento del Atlántico, Colombia. METODOS: Estudio de corte transversal descriptivo. Se incluyeron gestantes asintomáticas que acudieron a una institución privada de atención primaria en salud en Barranquilla, Colombia, en 2014 y 2015. Se excluyeron gestantes con tratamiento antimicrobiano en los últimos 30 días, sangrado genital, discapacidad mental e inmunosupresión. Se hizo un muestreo consecutivo no estricto. Se calculó la prevalencia de periodo de colonización por algunos de los agentes microbiológicos y la específica: número de mujeres con infección por tipo de agente/número de mujeres evaluadas en riesgo. RESULTADOS: La prevalencia global fue de 24,8 % (56/226). De estas, el 55,4 % (31/56) fue debido a vaginitis y el 44,6 % (25/56) por vaginosis. La prevalencia específica según tipo de patógenos fue: vaginitis por Candida spp. en 13,3 % (30/226) y por T. vaginalis 0,4 % (1/226). La VB se presentó en 8,0 % (18/226) y una flora intermedia de 3,1 % (7/226). CONCLUSIONES: Existe una importante colonización del tracto genital inferior de gérmenes potencialmente patógenos en mujeres gestantes de 35 a 37 semanas. Se requieren estudios adicionales para determinar el beneficio de la tamización poblacional en términos de malos resultados maternos perinatales evitados y costos.

Prevalence of potentially pathogenic microbiological agents in vaginal exudates of asymptomatic pregnant women, barranquilla, colombia, 2014-2015 / Prevalencia de agentes microbiológicos potencialmente patógenos en el exudado vaginal de gestantes asintomáticas, barranquilla, colombia, 2014-2015

ABSTRACT Objective: To determine the prevalence of potentially pathogenic microbiological agents in vaginal exudates in a sample of asymptomatic pregnant women in the Department of Atlantico, Colombia. Materials and Methods: Descriptive cross-sectional study of a sample of asymptomatic pregnant women who attended a private primary healthcare institution in Barranquilla, Colombia, between 2014 and 2015. Pregnant women having received antimicrobial treatment within the last 30 days, with vaginal bleeding, mental disability or immunosuppression, were excluded. Consecutive sampling was performed. The prevalence of colonization time by some of the microbiological agents as well as specific prevalence were estimated: number of women with infection by agent type/number of women at risk assessed. Results: Overall prevalence was 24.8% (56/226); 55.4% (31/56) was due to vaginitis causal agents, and 44.6% (25/56) to vaginosis. The specific prevalence by type of pathogen, 13.3% (30/226) was vaginitis due to colonization by Candida spp. and 0.4% (1/226) was vaginitis due to T. vaginalis. Bacterial vaginosis (BV) was found in 8.0% (18/226). Conclusion: Substantial colonization of the lower genital tract by potentially pathogenic germs is found in pregnant women between 35 and 37 weeks of gestation. Further studies are required in order to determine the benefit of population screening in terms of avoiding poor maternal and perinatal outcomes, and the impact on the resulting overcosts.

RESUMEN Objetivo: establecer la prevalencia de agentes microbiológicos potencialmente patógenos en el exudado vaginal de gestantes asintomáticas del departamento del Atlántico, Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron gestantes asintomáticas que acudieron a una institución privada de atención primaria en salud en Barranquilla, Colombia, en 2014 y 2015. Se excluyeron gestantes con tratamiento antimicrobiano en los últimos 30 días, sangrado genital, discapacidad mental e inmunosupresión. Se hizo un muestreo consecutivo no estricto. Se calculó la prevalencia de periodo de colonización por algunos de los agentes microbiológicos y la específica: número de mujeres con infección por tipo de agente/número de mujeres evaluadas en riesgo. Resultados: la prevalencia global fue de 24,8 % (56/226). De estas, el 55,4 % (31/56) fue debido a vaginitis y el 44,6 % (25/56) por vaginosis. La prevalencia específica según tipo de patógenos fue: vaginitis por Candida spp. en 13,3 % (30/226) y por T. vaginalis 0,4 % (1/226). La VB se presentó en 8,0 % (18/226) y una flora intermedia de 3,1 % (7/226). Conclusión: existe una importante colonización del tracto genital inferior de gérmenes potencialmente patógenos en mujeres gestantes de 35 a 37 semanas. Se requieren estudios adicionales para determinar el beneficio de la tamización poblacional en términos de malos resultados maternos perinatales evitados y costos.

Caracterización y perfil de susceptibilidad de uropatógenos asociados a la presencia de bacteriuria asintomática en gestantes del Departamento del Atlántico, Colombia, 2014-2015. Estudio de corte transversal / Characterization and susceptibility profile of uropathogens associated with the presence of asymptomatic bacteriuria in pregnant women in the department of Atlántico, Colombia 2014-2015. Cross-sectional study

RESUMEN Objetivo: La bacteriuria asintomática con manejo inadecuado en el embarazo, se asocia con pielonefritis que puede llevar a complicaciones maternas y fetales. El objetivo de este estudio fue caracterizar los uropatógenos y su perfil de susceptibilidad, asociados a la presencia de bacteriuria asintomática en una muestra de mujeres gestantes. Materiales y métodos: Estudio descriptivo de corte transversal, en gestantes atendidas en el programa de control prenatal en una institución de primer nivel en el departamento del Atlántico, Colombia. Se realizó un muestreo por conveniencia a partir del universo de pacientes atendidas en el programa. Se hizo el diagnóstico de bacteriuria asintomática por la presencia de recuentos ≥ 105 colonias / mL de un solo germen. Para la identificación y determinación del perfil de susceptibilidad de las bacterias aisladas se utilizó el sistema automatizado Phoenix® BD. Se describe la prevalencia de bacteriuria asintomática, y la frecuencia y susceptibilidad por tipo de germen. Resultados: Ingresaron 226 gestantes. La frecuencia de bacteriuria asintomática fue del 10,6 %. El uropatógeno más frecuentemente aislado fue la Escherichia coli en un 25 % de los casos, seguida por Enterococcus faecalis en un 20,8 %. La resistencia a la ampicilina fue del 33,3 y 20 % respectivamente; el resto de enterobacterias identificadas presenta una resistencia natural a dicho antibiótico. La resistencia de E. coli para el sulfametoxazol fue del 66,6%, y de la E. coli y el E. faecalis a la nitrofurantoína fue del 16,6 y 20% respectivamente. Conclusiones: Se encuentra resistencia importante en el nivel de atención de los gérmenes más frecuentemente aislados en gestantes con bacteriuria asintomática a la ampicilina y el trimetoprim. La nitrofurantoína sigue siendo una buena opción para el tratamiento en la primera mitad del embarazo.

ABSTRACT Objective: Asymptomatic bacteriuria, when inadequately managed during pregnancy, is associated with pyelonephritis, which may give rise to maternal and foetal complications. The objective of this study was to characterize uropathogens associated with the presence of asymptomatic bacteriuria and their susceptibility profile in a sample of pregnant women. Materials and methods: Descriptive, cross-sectional study in pregnant women coming to antenatal care at a Level I center in the Department of Atlantico, Colombia. A convenience sampling was made from the universe of patients seen in the programme. Asymptomatic bacteriuria was diagnosed on the basis of the finding of counts ≥ 105 colonies /mL of a single germ, unaccompanied by symptoms. An automated Phoenix® BD system was used for the identification and determination of the susceptibility profile of the bacterial isolates. The prevalence of asymptomatic bacteriuria, and the frequency and susceptibility by germ type are described. Results: Overall, 226 pregnant women were included. The frequency of asymptomatic bacteriuria was 10.6 %. The uropathogen most frequently isolated was Escherichia coli in 25 % of cases, followed by Enterococcus faecalis in 20.8 %. Ampicillin resistance was 33.3 % and 20 %, respectively; the rest of the enterobacteria identified show natural resistance to this antibiotic. For trimetoprim sulfametoxazol resistence was 66 %. Regarding Nitrofurantoin resistance was 1.6 % and 20 % for E. coli and E. faecalis, respectively. Conclusions: There is significant resistance of the most frequently isolated germs in pregnant women with asymptomatic bacteriuria to ampicillin, trimetoprim sulfametoxazol Nitrofurantoin continues to be a good treatment option during the first half of the pregnancy.