Láser de baja frecuencia para aftas mayores recurrentes. Caso Clínico / Low frequency laser for major recurrent aphthous stomatitis. Clinical case

La estomatitis aftosa recurrente (menor, mayor o herpética) es una de las enfermedades bucodentales más frecuentes, de etiología multifactorial y con predisposición genética. Para esta patología su diagnóstico es clínico, y tomando como base la historia clínica se puede discriminar con otras patologías ulcerativas. La terapia con láser de baja potencia (LLLT) se propone como un tratamiento no invasivo, actuando como un fotomodulador celular, por lo que reduce el dolor, la inflamación, y estimula la regeneración tisular, previniendo daños. En el presente artículo se reporta a un niño de 11 años con una herida dolorosa de 4 meses en el borde posterior de la lengua que apareció tras una mordedura, en el que a la exploración clínica se encontró una lesión amarillenta con zonas enrojecidas, rodeada de un halo blanquecino de bordes redondeados. Para el tratamiento se utilizó LLLT, luego de una semana disminuyó el dolor, el paciente comenzó a comer correctamente, a los 15 días se observó una reducción de los bordes rojizos de la lesión, pasado el mes la lesión había remitido casi por completo. La LLLT se describe como un tratamiento eficaz, no invasivo, reduciendo los síntomas, y mejorando la calidad de vida del paciente al promover la curación de las lesiones.

Recurrent aphthous stomatitis (minor, major or herpetic) is one of the most frequent bucodental diseases, of multifactorial etiology and with genetic predisposition. The diagnosis of this pathology is clinical, and based on the clinical history it can be discriminated with other ulcerative pathologies. Low power laser therapy (LLLT) is proposed as a non-invasive treatment, acting as a cellular photo modulator, which reduces pain, inflammation, and stimulating tissue regeneration, preventing damage. This article reports an 11-year-old boy with a 4-month-old painful wound on the posterior edge of the tongue that appeared after a bite, in which clinical examination revealed a yellowish lesion with reddened areas, surrounded by a whitish halo with rounded edges. LLLT was used for the treatment, after one week the pain decreased, the patient started to eat properly, after 15 days a reduction of the reddish edges of the lesion was observed, after one month the lesion had almost completely remitted. LLLT is described as an effective, non-invasive treatment, which reduces symptoms and improves the patient's quality of life promoting the healing of the lesions.

Revegetación natural de áreas afectadas por minería de oro en la selva pluvial tropical del Chocó, Colombia / Natural revegetation of areas impacted by gold mining in the tropical rain forest of Chocó, Colombia

Introducción: La minería de oro a cielo abierto ocasiona impactos drásticos sobre los bosques naturales en regiones tropicales de alta biodiversidad, y la eficiencia de "revegetación", un proceso de resembrar y reconstruir el suelo, continúa siendo poco estudiado. Objetivo: Evaluar el efecto del tiempo sucesional y la distancia al bosque de referencia sobre la estructura biológica y composición de especies en minas de oro revegetadas. Métodos: Realizamos inventarios de vegetación en minas abandonadas en el bosque tropical lluvioso de Chocó, Colombia. Las minas contaban con 6, 10, 15, 19 y 24 años de sucesión natural. En cada escenario, establecimos cuatro parcelas de 2×50 m: a 50 m y 100 m de distancia desde el borde bosque-mina (ecotono). Resultados: Se identificaron 300 especies (193 géneros y 75 familias). La riqueza, diversidad y equitatividad cambian poco con el tiempo sucesional en las minas, pero alcanzan valores superiores en el bosque de referencia. La composición de especies es similar entre las minas con distinto tiempo sucesional, pero difiere ampliamente del bosque de referencia (solo 7 % de semejanza). La calidad del sustrato y las estrategias reproductivas de plantas herbáceas (principalmente Cyperaceae y Melastomataceae) y arbóreas (Cespedesia spathulata y Miconia reducens) que crecen espontáneamente en las minas, juegan un papel importante en la revegetación natural temprana. Conclusiones: 24 años de sucesión natural es poco tiempo para apreciar una recuperación sustancial de la vegetación en las minas si se compara con el bosque, y la distancia desde el ecotono parece no tener efecto significativo; sin embargo, la calidad de sustrato y estrategias reproductivas de plantas herbáceas son importantes en la etapa temprana de recuperación de las áreas impactadas por la minería de oro en Chocó.

Introduction: Open pit gold mining causes drastic impacts on natural forests in tropical regions of high biodiversity, and the efficacy of "revegetation", a process of replanting and rebuilding the soil, is still poorly studied. Objective: To evaluate the effect of successional time, and distance to the reference forest, on the biological structure and species composition of revegetated gold mines. Methods: We inventoried the adjacent forest and abandoned gold mines in the tropical rain forest of Chocó, Colombia. The mines had 6, 10, 15, 19 and 24 years of natural succession. In each scenario, we set four 2 × 50 m plots: two 50 m and two 100 m from the forest-mine edge (ecotone). Results: We identified 300 plant species (193 genera, 75 families). The richness, diversity and evenness changed little with successional time in the mines but reached higher values in the forest. The species composition was similar between the mines with different successional times but differed widely from the forest (only 7 % similarity). The substrate quality and reproductive strategies of herbaceous plants (mainly Cyperaceae and Melastomataceae) and trees (Cespedesia spathulata and Miconia reducens) that grow spontaneously in the mines, play an important role on the early natural revegetation. Conclusions: The 24 years of natural succession have been insufficient to reach a community of a complexity similar to that of the forest, and distance from the ecotone has no significant effect; however, the substrate quality and reproductive strategies of herbaceous plants are important in the early stages of mine recovery in the Chocó.

Influencia de un panel molecular de reacción de polimerasa en cadena múltiple en el diagnóstico o descarte de neumonía asociada a ventilación mecánica en una cohorte chilena de pacientes críticos con COVID-19

Resumen Introducción: La neumonía asociada a ventilación mecánica (NAVM) es frecuente en pacientes críticos con COVID-19. Su diagnóstico precoz es fundamental para su pronóstico. Objetivo: Demostrar la utilidad del panel FilmArray Pneumo (PFA-P) en la confirmación o descarte de NAVM en estos pacientes. Métodos: Estudio retrospectivo de 71 pacientes críticos con COVID-19 con sospecha de NAVM en quienes se realizó cultivos y PFA-P para confirmación diagnóstica. Se describen las características clínicas, microbiología y mortalidad. Se define la validez y seguridad de PFA-P. Resultados: El uso de FAP-P y cultivos descartó NAVM en 29 pacientes (40,8%). En 41 pacientes se confirmó NAVM y la mortalidad a 30 días fue 48,8%. Se estudiaron 48 muestras, los cultivos fueron positivos en 30 (62,5%) y se detectaron 33 bacterias, PFA-P detectó 32 de estas 33 bacterias; 37 bacterias fueron detectadas exclusivamente por PFA-P. Las bacterias prevalentes fueron Klebsiella pneumoniae (31,4%) Pseudomonas aeruginosa (21,4%) y Acinetobacter calcoaceticusbaumannii (14,2%). La sensibilidad, especificidad, valor predictor positivo y valor predictor negativo de PFA-P con respecto a cultivos fue 96,9%, 92,5%, 46,4% y 99,8, respectivamente. Un paciente tuvo NAVM por Burkholderia cepacia bacteria no detectada por FAP-P. Conclusiones: La FAP-P es una técnica molecular eficaz para descartar y diagnosticar la NAVM permitiendo una suspensión rápida de los antimicrobianos o un tratamiento dirigido temprano.

Abstract Background: Ventilator-associated pneumonia (VAP) is frequent in critical COVID-19 patients. Its early diagnosis is essential for its prognosis. Aim: To demonstrate the usefulness of the FilmArray Pneumo panel (FAP-P) in confirming or ruling out VAP in these patients. Methods: Retrospective study of 71 critical COVID-19 patients with suspected VAP in whom cultures and FAP-P were performed for diagnostic confirmation. Clinical characteristics, microbiology and mortality are described. The validity and safety of FAP-P is defined. Results: The use of FAP-P and cultures ruled out VAP in 29 patients (40.8%). In 41 patients, VAP was confirmed and the 30-day mortality was 48.8%. Forty-eight samples were studied, the cultures were positive in 30 (62.5%) and 33 bacteria were detected, FAP-P detected 32 of these 33 bacteria; 37 bacteria were exclusively detected by PFA-P. The most prevalent bacteria were Klebsiella pneumoniae (31.4%), Pseudomonas aeruginosa (21.4%) and Acinetobacter calcoaceticus-baumannii (14.2%). The sensitivity, specificity, positive predictive value and negative predictive value of FAP-P with respect to cultures were 96.9%, 92.5%, 46.4% and 99.8%, respectively. One patient had VAP due to Burkholderia cepacia bacteria not detected by FAP-P. Conclusions: FAP-P is an effective molecular technique to rule out and diagnose VAP, allowing rapid suspension of antibiotics or early targeted treatment.

Reporte de los primeros 50 pacientes con COVID-19 en ventilación mecánica hospitalizados en la Unidad de Cuidados Intensivos del Complejo Asistencial Dr. Sótero del Río

Background: Since March, Chile experienced an exponential increase in SARS-CoV2 cases, which led to an almost full occupancy of the intensive care units (ICU). Aim: To characterize patients with SARS-CoV2 disease who required hospitalization in the ICU and invasive mechanical ventilation (IMV) in our hospital. Material and Methods: A prospective observational study was performed, which included the first 50 patients, aged 54 ± 13 years (58% men), with SARS-CoV2 disease, with ICU and IMV requirements between March 23 and June 2, 2020. Demographics, comorbidities, symptoms, laboratory and imaging, therapies performed and IMV characteristics were registered. The most relevant outcomes observed were lethality, number of days in the ICU and connection to an IMV. Results: Ninety percent of patients were overweight or obese, 46% had hypertension and many had diabetes mellitus. They had elevated inflammatory parameters and typical patterns of COVID-19 in computed tomography. Most of the patients got protective lung ventilation with a high rate of use of neuromuscular blockade (NMB) and prone position. Antibiotics, hydroxychloroquine, and lopinavir/ritonavir were administered according to the protocol of the institution. Lethality was 16% (8 cases) at the end of this study. Conclusions: The information obtained in this study provides characteristics and early outcomes of hospitalized patients with confirmed COVID-19 and IMV, admitted to the ICU of our center.

Prevalencia de Chlamydia trachomatis en la población femenina asintomática atendida en los servicios de citología cervical de tres instituciones prestadoras de servicios de salud en Medellín, Colombia / Prevalence of Chlamydia trachomatis in an asymptomatic female population attending cervical cytology services of three healthcare centers in Medellín, Colombia

Introduction:The sexually transmitted infection caused by Chlamydia trachomatis is the most common of bacterial etiology in the world. Although it can be asymptomatic in most cases, it can produce several reproductive health problems in women such as cervicitis, endometritis, and salpingitis. Despite its importance, the epidemiological data on this infection is insufficient in Medellín. Objective: To determine the prevalence of C. trachomatis in women from Medellín, identify possible risk factors, and evaluate its relationship with the human papillomavirus infection (HPV). Materials and methods: We conducted a multicenter cross-sectional study to detect C. trachomatis infection in 1,282 women using PCR and the LightMix 480 HT CT/NG™ commercial kit (Roche, Basel, Switzerland). Results: The total prevalence of C. trachomatis infection was 4.1% (95% CI: 2.9-5.3). We found an association between the presence of the infection and age, cigarette consumption, and the use of hormonal contraceptives. Conclusion: The prevalence of the infection is similar to that reported in other parts of the world with young women being the most affected population. No relation was found with the presence of HPV.

Introducción. La infección de transmisión sexual causada por Chlamydia trachomatises la más frecuente de etiología bacteriana en el mundo. Aunque puede ser asintomática en la mayoría de los casos, C. trachomatis puede generar diversos problemas de salud reproductiva en mujeres, como cervicitis, endometritis y salpingitis. A pesar de su importancia, en Medellín no se cuenta con suficientes datos epidemiológicos sobre esta infección. Objetivo. Determinar la prevalencia de C. trachomatis en mujeres de Medellín, determinar los posibles factores de riesgo y evaluar la relación con la infección por el virus de papiloma humano (HPV). Materiales y métodos. Se hizo un estudio transversal multicéntrico para detectar la infección por C. trachomatis en 1.282 mujeres mediante reacción en cadena de la polimerasa (PCR) convencional y el estuche comercial LightMix 480 HT CT/NG™ (Roche, Basilea, Suiza). Resultados. La prevalencia total de la infección por C. trachomatis fue de 4,1 % (IC95%2,9-5,3). Se encontró una relación significativa de la infección con la edad, el consumo de cigarrillo y el uso de anticonceptivos hormonales. Conclusión. La prevalencia de la infección es similar a la reportada en otros lugares del país y del mundo, siendo las mujeres más jóvenes lasmás afectadas. En cuanto a la presentación del HPV, no se encontró ningún tipo de relación con C. trachomatis.

La criticidad de las Unidades de Intensivo. Ampliando las Unidades en tiempos de pandemia / Expanding ICU facilities in a pandemic scenario

Our country is suffering the effects of the ongoing pandemic of coronavirus disease (COVID-19). Because the vulnerability of healthcare systems, especially the intensive care areas they can rapidly be overloaded. That challenge the ICUs simultaneously on multiple fronts making urgent to increase the number of beds, without lowering the standards of care. The purpose of this article is to discuss some aspects of the national situation and to provide recommendations on the organizational management of intensive care units such as isolation protocols, surge in ICU bed capacity, ensure adequate supplies, protect and train healthcare workers maintaining quality clinical management.

Seroprevalence of arenavirus and hantavirus in indigenous populations from the Caribbean, Colombia

Abstract INTRODUCTION: In Colombia, there is insufficient epidemiological surveillance of zoonotic hemorrhagic viruses. METHODS: We performed a sero-epidemiological study in indigenous populations of Wayuü, Kankuamos, and Tuchin communities using Maciel hantavirus and Junin arenavirus antigens for IgG detection by ELISA. RESULTS IgG antibodies to hantavirus and arenavirus were found in 5/506 (1%) and 2/506 (0.4%) serum samples, respectively. CONCLUSIONS: Arenavirus and hantavirus circulate in indigenous populations from the Colombian Caribbean region, and the results indicate that the indigenous populations are exposed to these zoonotic agents, with unknown consequences on their health, despite low seroprevalence.

Atención de los pacientes con trauma grave durante los primeros días: evolución entre la urgencia, el pabellón y la unidad de cuidados intensivos / Features of patients with trauma admitted to an emergency room of a general hospital

Background: Trauma is the main cause of death among people aged 5 to 44 years. Aim: To describe features, treatment and evolution of trauma patients admitted to an emergency room. Material and Methods: Adult patients admitted in the emergency department of a public hospital due to severe trauma were studied and followed during their hospital stay. Results: We included 114 patients aged 40 ± 17 years (78%men) with an injury severity score of 21 ± 11. Trauma was penetrating in 43%. Traumatic brain injury (TBI) was the most common diagnosis in 46%. In the emergency room, 8% had hypotension, 5% required vasopressors and 23% required mechanical ventilation. The initial lactate was 3.6 ± 2.9 mmol/L. Sixty-five patients (57%) required emergency surgery. The intraoperative lactate was 3 ± 1.7 mmol/L and 20% required vasopressors. Sixty-four patients (56%) were admitted to the ICU, with APACHEII and SOFA scores of 16 ± 8 and 5 ± 3, respectively. ICU lactate was 3.2±1.5 mmol/L. In the ICU 40% required vasopressors and 63% mechanical ventilation. Thirty two percent had coagulopathy, 43% received transfusions and 10% required massive transfusions. The hospital stay was 13 (6-32) days, being significantly longer in patients with TBI. ICU and hospital mortalities were 12.5 and 18.4% respectively. The only predictor for mortality was the APACHEII score (Hazard Ratio 1.18, 95% confidence intervals 1.03-1.36). Conclusions: APACHE score was a predictor of mortality in this group of patients.

Infección y enfermedad por Rickettsia spp. del grupo de las fiebres manchadas en pacientes febriles del Urabá antioqueño, Colombia / Rickettsia spp. infection of the group of spotted fevers in febrile patients of the Urabá Antioquia, Colombia

RESUMEN Objetivo: determinar la frecuencia de la infección y enfermedad por Rickettsia spp. del grupo de las fiebres manchadas en pacientes febriles del Urabá antioqueño, que asistieron a centros hospitalarios de la región. Métodos: se incluyeron en el estudio pacientes febriles provenientes de 9 instituciones de salud de la región del Urabá, los cuales fueron encuestados para determinar sus variables clínicas y demográficas. De estos pacientes se obtuvieron muestras de suero durante las fases aguda y convaleciente de la enfermedad. Para cada muestra se determinó la seropositividad (título ≥ 64) y su título de anticuerpos seriados dobles mediante inmunofluorescencia indirecta para IgG contra el antígeno de Rickettsia rickettsii. Resultados: se analizaron 89 pacientes febriles con 89 muestras de fase aguda y 60 en fase convaleciente. Los síntomas más comunes de los pacientes fueron cefalea, ictericia, mialgias, náuseas, dolor abdominal, trombocitopenia y vómito. El 55,1 % de los pacientes provenía de áreas rurales. Se obtuvo seropositividad del 40,4 % con títulos entre 64-512, infección previa en un 33,7 % y rickettsiosis en 6 pacientes (6,7 %). Los pacientes con seroconversión o serorefuerzo provenían de los municipios de Apartadó (n = 2), Chigorodó (n = 1), Necoclí (n = 2) y Turbo (n = 1); el hallazgo clínico más destacado fue la trombocitopenia. Conclusiones: se demostró que la infección y la enfermedad rickettsial continúan siendo activas en la zona del Urabá. Este hallazgo permite alertar a las autoridades de salud de la región para que se brinde tratamiento con antibióticos a los casos sospechosos de manera temprana y de esta forma evitar las muertes o secuelas derivadas de este tipo de infecciones.

SUMMARY Objective: Determine the frequency of infection and disease by Rickettsia spp. of the spotted fever group in febrile patients from Urabá Antioquia attended by hospital centers of the region. Methods: Patients from nine health institutions of the Urabá region were included in the study. These patients received a survey with questions about their clinical and socio-demographic variables. Eighty-nine acutephase serum samples, and 60 convalescent serum samples, were obtained from these patients, and each sample was tested (IgG) by Indirect Immunofluoerscence Assay (IIFA) using a dilution of 1:64 against R. rickettsii. Furtherly, positive sera were tittered by two-fold serial dilutions using the same antigen. Results: Patients showed symptoms such as fever, headache, jaundice, myalgias, nausea, abdominal pain, petechiae, thrombocytopenia and vomiting. Most of these patients came from rural areas (55,1 %). Seropositivity was obtained in 40,4 % patients with titers between 64-512, a 33,7 % with previous infection and the disease was found in 6 patients (6,7 %). Patients with seroconversion, or a fourlfold rise antibody titer between acute and convalescent samples, came from the municipalities of Apartadó (n = 2), Chigorodó (n = 1), Necoclí (n = 2) and Turbo (n = 1), and the most relevant clinical finding was thrombocytopenia in four of the patients. Conclusions: This study demonstrated that infection and rickettsial disease continues being active in the Urabá region. This situation represents a warning for the health authorities of the region and suggests them to provide appropriate treatment to avoid deaths or sequelae derived from this type of infections.

Design and analytical validation of a duplex PCR for Ehrlichia and Rickettsia detection in ticks / Diseño y validación analítica de una PCR dúplex para la detección de Ehrlichia y Rickettsia en garrapatas / Projeto e validação analítica de uma PCR duplex para detecção de Ehrlichia e Rickettsia em carrapatos

Abstract Background: Ehrlichia and Rickettsia are two major rickettsial genera transmitted by ticks that affect a number of wild and domestic animal species and human populations around the world. Objective: To design and validate a duplex PCR for Ehrlichia and Rickettsia in ticks. Methods: Assay validation included testing for sensitivity, specificity, reproducibility, and robustness of the PCR. The groEL and 23sr RNA genes were used for Ehrlichia and Rickettsia, respectively. Results: The limit of detection was one hundred gene copies per 50 μL of reaction for Ehrlichia spp, and one gene copy of Rickettsia per 50 μL of reaction. In general, the primers of the test only amplified in silico those bacterial agents for which they were originally designed, with the exception of the primers for Rickettsia that also amplified Methylocystis sp. The test was reproducible (intermediate precision) 96.7% of the times for both agents. The test was robust enough to tolerate concentration changes of all reagents with the exception of Taq DNA polymerase. Conclusions: The validation results indicated that this PCR is useful for detection in both bacterial genera and it is a good candidate for diagnostic validation.

Resumen Antecedentes: Ehrlichia spp. y Rickettsia spp. son dos de los principales géneros rickettsiales transmitidos por garrapatas que afectan a animales silvestres, domésticos y humanos alrededor del mundo. Objetivo: Diseñar y validar una prueba PCR dúplex para Ehrlichia y Rickettsia en garrapatas. Métodos: La validación de la prueba incluyó ensayos de sensibilidad, especificidad, reproducibilidad y robustez. En la PCR se usó groEL y ARNr 23S como genes blanco para Ehrlichia y Rickettsia, respectivamente. Resultados: El límite de detección fue de 100 copias del gen por 50 μL de reacción para Ehrlichia spp y una copia del gen de Rickettsia por 50 μL de reacción. En general, los cebadores de la prueba solo amplificaron in silico los agentes bacterianos para los cuales fueron originalmente diseñados, con la excepción de los cebadores de Rickettsia que también amplificaron Methylocystis sp. La prueba fue reproducible (precisión intermedia) en un 96.7% de las veces para ambos agentes. La prueba fue suficientemente robusta como para tolerar cambios de concentración de los diferentes reactivos, con excepción de la Taq DNA polimerasa. Conclusión: Los resultados de validación indican que la PCR es útil para detectar ambos géneros bacterianos y podria usarse para validación diagnostica.

Resumo Antecedentes: Ehrlichia e Rickettsia são dois dos principais gêneros de rickettsias transmitidos por carrapatos que infectam tanto animais selvagens quanto animais domésticos e até homens em todo o mundo. Objetivo: O objetivo principal foi elaborar e validar uma PCR duplex para Ehrlichia e Rickettsia em carrapatos. Métodos: A validação incluiu testes de sensibilidade, especificidade, reprodução e robustez. Para o PCR, utilizamos os genes groEl e 23Sr-RNA para Ehrlichia e Rickettsia, respectivamente. Resultados: O limite de detecção foi de 100 cópias de genes por 50 ml de reação para Erliquia spp e uma cópia de gene de Rickettsia por 50 ml de reação. Em geral, os iniciadores dos testes amplificaram em modelos computacionais os agentes bacterianos para os quais eles foram projetados, exceto os primers de Rickettsia que também amplificou Methylocystis sp. Os testes foram reproduzíveis (precisão intermediária) 96,7% para ambos os agentes e foram também robustos para tolerar mudanças de concentração em todos os reagentes, exceto o reagente Taq DNA polymerase. Conclusões: Os resultados da validação indicaram que o PCR é útil para detecção em ambos os gêneros bacterianos, portanto, um bom exame para validação diagnóstica.

Hospitalization costs due to severe acute respiratory infection (SARI) in three Central American countries / Costos de hospitalización de infección respiratoria aguda grave (IRAG) en tres países de América Central

Objective: To estimate the direct medical costs of severe acute respiratory infection (SARI) in children and adults from three Central American countries with a bottom-up costing approach. Methods: The costs of inpatients treatment were estimated through the retrospective bottom-up costing in a randomized sample of clinical records from SARI patients treated in teaching tertiary hospitals during 2009 - 2011 period. Activities incurred per patient were registered and a setting-specific cost per activity was acquired. Average cost per patient in the group of children and elderly adults was estimated for each country. In Nicaragua, only the pediatric population was included. Costs were expressed in local currency (2011), American dollars, and international dollars (2005) for country comparison. Results: The care cost per case in children in Guatemala was the cheaper (I$971.95) compared to Nicaragua (I$1,431.96) and Honduras (I$1,761.29). In adults, the treatment cost for Guatemala was the more expensive: I$4,065.00 vs. I$2,707.91 in Honduras. Conclusion: Bottom-up costing of SARI cases allowed the mean estimates per treated case that could have external validity for the target population diagnosed in hospitals with similar epidemiological profiles and level of complexity for the study countries. This information is very relevant for the decision-making.

Objetivo: Estimar los costos directos de la atención de infección respiratoria aguda (IRAG) en niños y adultos en tres países de América Central. Métodos: Los costos de pacientes hospitalizados fueron estimados a través de análisis retrospectivo en una muestra aleatoria de registros de historias clínicas de casos de IRAG tratado en hospitales universitarios durante el periodo 2009-2011. Las actividades incurridas por paciente fueron registradas y un costo especifico para cada sitio fue estimado. El costo por cada niño y adulto mayor fue estimado para cada país. En Nicaragua sólo se incluyó población pediátrica. Los costos fueron expresados en moneda local (2011), dolar americano y dolar internacional (2005). Resultados: El costo por caso en niños en Guatemala fue el más barato (I$971.95) comparado al de Nicaragua (I$1,431.96) y Honduras (I$1,761.29). En adultos, el costo de tratamiento para Guatemala fue el más costoso: I$4,065.00 vs. I$2,707.91 en Honduras. Conclusión: Los costos de tratar casos IRAG estimados a partir de costos promedios pro caso pueden tener validez externa para hospitales con perfiles epidemiologicos similares y nivel de complejidad de atención para los países del estudio. Esta información es muy relevante para la toma de decisiones.

Enfermedades virales transmitidas por garrapatas / Tick-borne viruses and their diseases

RESUMEN Los virus transmitidos por garrapatas (VTG) pertenecen a las familias Flaviviridae, Bunyaviridae, Reoviridae, Asfarviridae y Orthomyxoviridae y son agentes causales de diferentes enfermedades en humanos y animales. Debido a la creciente importancia epidemiológica que están teniendo los VTG, esta revisión pretende englobar el conocimiento actual de estos agentes y las enfermedades que producen, así como exponer las estrategias abordadas en prevención y tratamiento que se han implementado hasta el momento en diferentes países. Es evidente que para la región Neotropical hacen falta estudios sobre los VTG presentes en la región, ya que la gran mayoría de los artículos, tanto revisiones de tema como trabajos originales, presentan datos de las regiones Neártica y Paleártica. Considerando el panorama actual de los estudios de VTG en la región Neotropical y las particularidades de la misma, es muy probable que existan otros VTG aún no identificados que podrían tener algún impacto en salud pública.

SUMMARY Tick-borne viruses (TBVs) belong to the Flaviviridae, Bunyaviridae, Reoviridae, Asfarviridae and Orthomyxoviridae families and cause different diseases in humans and animals. Due to the epidemiologic relevance of TBVs, this review highlights the actual knowledge of these agents and the diseases they cause, besides of the prevention and treatment strategies implemented so far. It is evident that studies that address the TBVs present in the Neotropical region are missing, since most of the studies, both reviews and original articles, present data from the Nearctic and Palearctic regions. Considering the current picture of the TBVs studies in the Neotropical area and its peculiarities, is probable that other not yet identified TBVs exist in this zone and have an impact in public health.

Detección del virus del dengue en larvas y pupas de Aedes aegypti recolectadas en áreas rurales del municipio de Anapoima, Cundinamarca, Colombia / Dengue virus detection in Aedes aegypti larvae and pupae collected in rural areas of Anapoima, Cundinamarca, Colombia

Resumen Introducción. La incidencia y la prevalencia del dengue en Cundinamarca son elevadas y, recientemente, se detectó Aedes aegypti en algunas áreas rurales del departamento. Objetivo. Evaluar la transmisión transovárica del virus del dengue en larvas y pupas recolectadas en áreas rurales del municipio de Anapoima. Materiales y métodos. Se recolectaron ejemplares vivos en 53 viviendas y se transportaron al laboratorio de Anapoima, donde se clasificaron, se agruparon y se congelaron. Llevadas a Bogotá, se las homogeneizó, se les extrajo el ARN con Trizol ® , se las sometió a una reacción en cadena de la polimerasa de transcripción inversa (Reverse Transcription Polymerase change reaction, RT-PCR) y a PCR convencional, y los productos amplificados se analizaron en geles de agarosa al 2 %. Resultados. En 54,7 % de las viviendas evaluadas se encontraron formas inmaduras del vector y el serotipo más frecuente fue el DENV-1. Sin embargo, en algunos pools se detectó la presencia simultánea de los serotipos DENV 1 y 2, DENV 1 y 3, y DENV 1 y 4, así como los serotipos DENV 1, 2 y 3. Conclusión. Los resultados confirmaron la transmisión vertical del virus de manera natural en el área rural del municipio, lo cual reafirma la capacidad vectorial de A. aegypti y explica, en parte, la persistencia del virus en la región y la posibilidad de que en la fase adulta el vector lo transmita sin haber consumido sangre infectada. Esta situación aumenta el riesgo de infección por el virus del dengue en Colombia y, por lo tanto, la necesidad de adelantar programas de prevención y control en todas las zonas con presencia del mosquito.

Abstract Introduction: There is a high incidence and prevalence of dengue in the department of Cundinamarca, and recently Aedes aegypti, the main vector of dengue virus (DENV), was detected in some of its rural areas. Objective: To evaluate viral transovarial transmission in larvae and pupae collected in rural areas of the municipality of Anapoima, Cundinamarca. Materials and methods: Live larvae and pupae were collected from 53 homes and later they were taken to the laboratory in Anapoima, where they were classified, pooled and frozen. In Bogotá, they were homogenized, RNA was extracted with Trizol™ , and RT-PCR and conventional PCR were performed. The amplified products were analyzed on 2% agarose gels. Results: In 54.7% of the houses we found A. aegypti in immature stages, and DENV-1 was the most frequent serotype. However, the simultaneous presence of DENV 1 and 2, DENV 1 and 3, DENV 1 and 4, and DENV 1, 2 and 3 serotypes was detected in some pools. Conclusion: The results confirmed the natural vertical transmission of the virus in the rural area under study. These findings confirmed the vector capacity of A. aegypti, and partly explains the persistence of the virus in the region and the possibility of transmission by the vector during adulthood without having ingested infected blood. This situation increases the risk of DENV infection in Colombia and the need for prevention and control programs in all areas where the mosquito is present.

Formación del banco de semillas durante la revegetación temprana de áreas afectadas por la minería en un bosque pluvial tropical del Chocó, Colombia / Soil seed bank formation during early revegetation of areas affected by mining in a tropical rain forest of Chocó, Colombia

ResumenLa minería es una de las principales actividades económicas en muchas regiones tropicales y también es la causa de la devastación de amplias superficies de bosques tropicales naturales. El conocimiento del potencial regenerativo de las áreas alteradas por minería es vital para la restauración ecológica de estas áreas críticas. El objetivo del presente trabajo fue evaluar el efecto de la edad de abandono de las minas y su distancia al bosque adyacente sobre la formación del banco de semillas del suelo en minas abandonadas en el San Juan, Chocó, Colombia. Para ello, se determinó la abundancia y composición de especies del banco de semillas, así como la dinámica de la lluvia de semillas, en minas de distinta edad (6 y 15 años), tras el cese de la actividad minera, y distancia a la matriz del bosque adyacente (50 y 100 m). La lluvia de semillas estuvo compuesta por cinco especies de plantas, todas de dispersión anemócora, y fue mayor en la mina de 6 años que en la de 15. No hubo diferencias significativas en la cantidad de semillas recolectadas a 50 m y 100 m de distancia del bosque adyacente. El banco de semillas estuvo representado por ocho especies: dos de dispersión anemócora (comunes a la lluvia de semillas) y el resto de dispersión zoócora. La abundancia de semillas en el suelo no varió con la edad de la mina, pero fue mayor a distancias próximas al bosque que alejadas de este. Durante la regeneración temprana, la formación del banco de semillas en el seno de las minas parece estar relacionada con la cercanía a otras áreas alteradas más que con su proximidad al bosque adyacente o la edad de las minas. Al respecto, el establecimiento de perchas artificiales o conservación de árboles remanentes en el seno de las minas podrían promover la entrada de semillas dispersadas por aves. No obstante, dado que el banco de semillas del suelo puede verse afectado por la alta precipitación de la zona, se recomienda promover estudios que valoren medidas encaminadas a favorecer la formación del banco de semillas del suelo de las minas en ambientes de alta pluviosidad como en la región del Chocó.

Abstract:Mining is one of the main economic activities in many tropical regions and is the cause of devastation of large areas of natural tropical forests. The knowledge of the regenerative potential of mining disturbed areas provides valuable information for their ecological restoration. The aim of this study was to evaluate the effect of age of abandonment of mines and their distance from the adjacent forest, on the formation of soil seed bank in abandoned mines in the San Juan, Chocó, Colombia. To do this, we determined the abundance and species composition of the soil seed bank, and the dynamics of seed rain in mines of different cessation period of mining activity (6 and 15 years), and at different distances from the adjacent forest matrix (50 and 100 m). Seed rain was composed by five species of plants with anemocorous dispersion, and was more abundant in the mine of 6 years than in the mine of 15 years. There were no significant differences in the number of seeds collected at 50 m and 100 m from the adjacent forest. The soil seed bank was represented by eight species: two with anemocorous dispersion (common among the seed rain species) and the rest with zoochorous dispersion. The abundance of seeds in the soil did not vary with the age of the mine, but was higher at close distances to the forest edge than far away. During the early revegetation, the formation of the soil seed bank in the mines seems to be related to their proximity to other disturbed areas, rather than their proximity to the adjacent forest or the cessation activity period of mines. Therefore, the establishment of artificial perches or the maintenance of isolated trees in the abandoned mines could favour the arrival of bird-dispersed seeds at mines. However, since the soil seed bank can be significantly affected by the high rainfall in the study area, more studies are needed to evaluate management actions to encourage soil seed bank formation in mines of high-rainfall environments in the Chocó region. Rev. Biol. Trop. 65 (1): 393-404. Epub 2017 March 01.

Correlação dos níveis socioeconômicos e de educação dos pais com o índice CEO-D na primeira infância / Correlation of the socioeconomic and parents' education levels with the CEO-D index in early childhood

Introdução: estudos mostram que condições socioeconômicas podem interferir no nível de conhecimento dos pais sobre higiene bucal dos filhos, influenciando diretamente no índice de cárie. Objetivo: Avaliar o nível sócioeconômico e o conhecimento de uma amostra de 127 pais/responsáveis e correlacioná-lo com o índice de cárie diagnosticado em seus filhos com idades variando entre 3 e 5 anos. Método: foi aplicado um questionário composto por questões fechadas, abordando condições socioeconômicas e conhecimento dos pais/responsáveis sobre saúde e higienização bucal na primeira infância. Um único examinador calibrado realizou o levantamento epidemiológico nos filhos dos pais participantes. Os dados foram analisados por estatística descritiva e pelo teste de correlação linear de Pearson a um nível de significância de 5%. Resultados e Discussão: 60% dos pais possuíam renda de 3 a 5 salários mínimos, 70% com ensino médio completo e 73% das crianças com ceo-d=0. Ao avaliar a correlação entre o conhecimento dos pais/responsáveis e demais variáveis, observou-se diferença estatisticamente significante com o nível econômico/renda (p=0,006) e também com o grau de escolaridade dos pais (p=0,001). Houve diferença estatisticamente significante entre a correlação de índice de ceo-d e o conhecimento sobre saúde bucal (p=0,02). Não foi constatada correlação estatisticamente significante entre o índice ceo-d e a renda familiar (p=0,95), nem com o grau de escolaridade dos pais (p=0,06). Conclusão: concluiu-se que houve correlação negativa entre o índice de ceo-d das crianças e o conhecimento dos pais/responsáveis sobre saúde bucal, e correlação positiva entre o conhecimento dos pais/responsáveis e o nível sócioeconômico.(AU)

Introduction: studies show that socioeconomic conditions may interfere with parents' knowledge about oral hygiene of children, and then influencing caries index. Objective: to evaluate the socioeconomic level and knowledge of a sample of 127 parents/guardians and correlate it with caries index diagnosed in their children, ranging 3 to 5 years. Method: a questionnaire composed of closed questions was applied, addressing socioeconomic conditions and knowledge of parents/guardians about health and oral hygiene in early childhood. A single calibrated examiner performed the epidemiological survey on children of the participating parents. Data were analyzed by descriptive statistics and Pearson's linear correlation test at a significance level of 5%. Results and Discussion: 60% of the parents had income of 3 to 5 minimum wages, 70% with complete secondary education and 73% of the children with ceo-d = 0. When assessing the correlation between parents/guardians' knowledge and other variables, a statistically significant difference was observed with economic/income level (p = 0.006) and also with the parents' educational level (p = 0.001). There was a statistically significant difference between the correlation of ceo-d index and knowledge about oral health (p = 0.02). No statistically significant correlation was found between the ceo-d index and the family income (p = 0.95), nor with the parents' educational level (p = 0.06).Conclusion: it was concluded that there was a negative correlation between the children's ceo-d index and the knowledge of the parents/guardians about oral health, and a positive correlation between the knowledge of the parents/guardians and the socio-economic level.(AU)

Características y evolución de los pacientes que ingresan a una Unidad de Cuidados Intensivos de un hospital público / Characteristics and evolution of patients admitted to a public hospital intensive care unit

Background: The epidemiology of critical patients in Chile could differ from that reported in international studies. Aim: To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013). Patients and Methods: A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival. Results: We analyzed data from 1075 aged 54 ± 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 ± 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital. Conclusions: This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013.

Evidencia serológica retrospectiva de infecciones por Leptospira spp, dengue, hantavirus y arenavirus en indígenas Emberá-Katío, Colombia / Serological evidence of Leptospira spp, dengue, hantavirus and arenavirus infection in Embera-Katío indigenous population, Colombia

We have developed a study in the Embera-Katío indigenous community and we found that the seropositivity for IgG antibodies to Leptospira spp. was 18.1%; to dengue was 61.1%; to arenavirus was 3.1% and to hantavirus was 1.5%. We conclude that this indigenous community live in conditions that promote the reemerging and emerging, infections.

Diagnóstico diferencial de dengue y chikungunya en pacientes pediátricos / Dengue and Chikungunya differential diagnosis in pediatric patients

Introducción. Las infecciones por el virus del dengue y del chikungunya presentan síntomas clínicos similares, lo cual dificulta el diagnóstico clínico. Además, son transmitidas por los mismos vectores, por lo que en una región puede haber circulación e infección simultánea con los dos virus. Los resultados de cada enfermedad, no obstante, son diferentes: la fiebre del chikungunya rara vez es fatal, pero puede dejar secuelas de tipo articular y neurológico, en tanto que el dengue es potencialmente fatal. De ahí la importancia de un diagnóstico preciso y oportuno. Objetivo. Comparar el diagnóstico presuntivo basado en los hallazgos clínicos con el diagnóstico diferencial hecho mediante pruebas de laboratorio. Materiales y métodos. Se utilizaron pruebas virológicas y serológicas específicas para dengue y chikungunya en ocho muestras de sangre de pacientes pediátricos con síndrome febril. Se empleó la reacción en cadena de la polimerasa con transcriptasa inversa para detectar los virus del dengue y del chikungunya y el método de ELISA basado en la captura de IgM para confirmar los casos de dengue. Resultados. Con base en los hallazgos clínicos, dos pacientes se clasificaron como casos probables de dengue o chikungunya, dos como casos probables de chikungunya y en cuatro no hubo diagnóstico presuntivo de infección viral. Las pruebas de laboratorio confirmaron la infección por el virus del dengue en dos pacientes, por el virus del chikungunya en otros dos e infección simultánea de dengue y chikungunya en los cuatro restantes. Conclusión. Los hallazgos clínicos no fueron suficientes para hacer un diagnóstico en pacientes pediátricos con síndrome febril, por lo cual se requirieron pruebas específicas de laboratorio para establecer con precisión el agente etiológico causante de la enfermedad.

Introduction: Dengue and Chikungunya infections have similar clinical symptoms, which makes their clinical diagnosis complex. Moreover, both are transmitted by the same mosquito vectors, which results in virus co-circulation and co-infection. However, the outcome of these diseases differs: Chikungunya fever is rarely fatal but can have permanent and severe rheumatic and neurological sequelae, whereas dengue disease is potentially fatal. Thus, accurate diagnosis is critical. Objective: To compare presumptive diagnoses based on clinical findings with the differential diagnoses based on specific laboratory tests for each virus. Materials and methods: We performed specific virological and serological tests for both dengue and Chikungunya infections on eight acute-phase blood samples collected from pediatric patients with febrile syndrome. We used RT-PCR to detect dengue and Chikungunya virus, and IgM-capture ELISA to confirm infection by dengue virus. Results: Based on clinical findings, two patients were diagnosed as probable cases of dengue or Chikungunya, and two were diagnosed as probable cases of chikungunya. Four had no presumptive diagnosis of viral infection. Laboratory tests confirmed dengue infection in two patients, Chikungunya infection in two patients, and co-infection by the two viruses in the other four patients. Conclusion: Clinical findings were not sufficient to make a diagnosis in pediatric patients with febrile syndrome; specific laboratory tests were required to establish the etiologic agent of the disease.

Costos de tratamiento hospitalario de la infección respiratoria aguda grave en niños de Nicaragua / Cost of treatment for severe acute respiratory infection in Nicaraguan children

Objetivo: Estimar los costos de tratamiento hospitalario de la infección respiratoria aguda grave (IRAG) en niños en Nicaragua. Métodos: Se estimaron costos de tratamiento de pacientes hospitalizados a partir del microcosteo retrospectivo de una muestra aleatoria de casos ocurridos durante el periodo 2009-2011 en Nicaragua y atendidos en un hospital pediátrico universitario de alta complejidad. Se calculó una muestra aleatoria de pacientes con diagnósticos de IRAG (CIE-10), según parámetros extraídos de la literatura. En esta, se estimó el costo promedio por paciente. Los costos fueron expresados en moneda local de 2011 y dólares americanos. Resultados: El costo promedio total de atención de caso en niños fue de 314,9 US$ (intervalo de confianza [IC] 95%: 280,1-349,7 US$) y de 971,6 (655,5-1.287,8 US$) para los que requirieron UCI. El 41% de los costos en los que solo requieren hospitalización general se explican por gastos de hotelería, mientras que en los que requieren UCI el 52% es por medicamentos. Conclusión: El microcosteo de los casos incluidos de IRAG permitió estimar un valor medio por caso tratado, con sus respectivos IC y estos podrían tener validez para el total de la población atendida por estos diagnósticos en hospitales con similar perfil epidemiológico y similar nivel de complejidad en Nicaragua.

Objective: To estimate the costs of treatment for severe acute respiratory infection (SARI) in children in Nicaragua. Methods: A cost assessment was carried out on a random sample of inpatients during 2009-2011 who were treated in one pediatric universitary hospital in Nicaragua. A random sample of patients diagnosed with SARI (ICD-10) was calculated based on parameters from the literature. The average cost per patient was estimated. Costs were expressed in local currency and US dollar values in 2011. Results: The total average cost of healthcare per case was US$314.9 (confidence interval [CI]95%: 280.10-US$349.70) and US$971.60 (655.50-US$1287.80) for those requiring intensive care unit (ICU). Around 41% of the general hospitalization costs are due to the cost of the hospitalization while for those costs involving ICU care, 52% are due to drugs costs. Conclusion: We estimated an average cost per case expressed with their respective CI by microcosts analysis for SARI health care in Nicaraguan children. These costs may be representative of the population with this diagnosis in Nicaraguan hospitals with similar epidemiological profile.

Alta correlación en la detección de anticuerpos y antígenos de virus del dengue en muestras de suero y plasma / High correlation in dengue antibodies and antigen detection using serum or plasma samples

Introducción. El diagnóstico adecuado de dengue por laboratorio es importante para la atención, así como para el control de brotes y epidemias. Hasta el momento, las pruebas ELISA para diagnóstico serológico de la infección se encuentran validadas en muestras de suero; sin embargo, en algunas ocasiones la cantidad o calidad de la muestra es inadecuada, o solo se tiene acceso a sangre anticoagulada tomada para el análisis de los parámetros hematológicos en el hemograma. Objetivo. Evaluar el desempeño de cuatro pruebas ELISA en muestras de suero y plasma de casos sospechosos de dengue. Materiales y métodos. Se procesaron 42 muestras -21 de suero y 21 de plasma- por las técnicas de ELISA de captura para IgM, ELISA de captura para IgG, ELISA indirecta para IgG y ELISA para la detección del antígeno viral NS1. Resultados. El porcentaje de muestras positivas encontrado fue IgM 33.3%, IgG Captura 33.3%, IgG Indirecta 90.5%, NS1 23.8%. El 42.9% de las muestras fueron positivas por RT-PCR (n=9). Todas las pruebas se comportaron igual tanto en sueros como plasmas (coeficiente Kappa 1.0). Conclusión. Los resultados obtenidos muestran una alta concordancia entre las mediciones realizadas en suero y en plasma, lo cual sugiere que la muestra de plasma puede utilizarse para el diagnóstico y la confirmación de los casos de dengue.

Introduction. Appropriate dengue laboratory diagnosis is an important tool to manage the disease, as well to control possible outbreaks. Currently, ELISA dengue serological tests are validated to use with serum, however sometimes samples quality or quantity is inappropriate or there is only availability of anti-coagulated blood samples which have been used in total blood tests -haemogram-. Objective. To assess the performance of four dengue ELISA tests in serum or plasma samples obtained from presumptive dengue cases. Methodology. Forty two samples, 21 of serum and plasma each, were processed to dengue Capture IgM ultramicro-ELISA, Capture IgG ELISA, Indirect IgG ELISA and NS1 antigen ELISA. Nine out of 21 patients were diagnosed as dengue cases following the diagnostic algorithm. Results. The percentage of positive samples found was Capture IgM 33.3%, Capture IgG 33.3%, Indirect IgG 90.5% and NS1 dengue antigen 23.8%. Comparing the results between all ELISA tests it can be said that they had similar performances both in serum and plasma, the Kappa coefficient obtained was 1.0. Conclusions. These results show a high concordance between the measurements carried out in serum and plasma, which leads to suggest the latter may be used as a tool in the diagnosis and confirmation of dengue cases.