Low Levels of Complement Factor H in the First Trimester of Pregnancy Are Associated with Spontaneous Preterm Birth.

Preterm birth (PTB) remains a significant public health concern, and prediction is an important objective, particularly in the early stages of pregnancy. Many studies have relied on cervical characteristics in the mid-trimester, with limited results. It is therefore crucial to identify novel biomarkers to enhance the ability to identify women at risk. The complement pathway is implicated in the process of placentation, and recent proteomics studies have highlighted the potential roles of some complement proteins in the pathophysiology of PTB. To determine the association between the occurrence of spontaneous preterm birth (sPTB) and the concentration of complement C3, factor B, and factor H in the blood of pregnant women during the first trimester. This prospective cohort study included women with singleton pregnancies, both with and without a history of sPTB, from two health institutions in Bucaramanga, Colombia. The outcome was sPTB before 37 weeks. A blood sample was obtained between 11 + 0 to 13 + 6 weeks. ELISA immunoassay was performed to quantify the levels of C3, factor B, and factor H. A total of 355 patients were analyzed, with a rate of sPTB of 7.6% (27/355). The median plasma concentration for C3, factor B, and factor H were 488.3 µg/mL, 352.6 µg/mL, and 413.2 µg/mL, respectively. The median concentration of factor H was found to be significantly lower in patients who delivered preterm compared to patients who delivered at term (382 µg/mL vs. 415 µg/mL; p = 0.034). This study identified a significant association between low first-trimester levels of factor H and sPTB before 37 weeks. These results provide relevant information about a new possible early biomarker for sPTB. However, the results must be confirmed in different settings, and the predictive value must be examined.

Microclimate factors related to dengue virus burden clusters in two endemic towns of Mexico.

In dengue-endemic areas, transmission control is limited by the difficulty of achieving sufficient coverage and sustainability of interventions. To maximize the effectiveness of interventions, areas with higher transmission could be identified and prioritized. The aim was to identify burden clusters of Dengue virus (DENV) infection and evaluate their association with microclimatic factors in two endemic towns from southern Mexico. Information from a prospective population cohort study (2·5 years of follow-up) was used, microclimatic variables were calculated from satellite information, and a cross-sectional design was conducted to evaluate the relationship between the outcome and microclimatic variables in the five surveys. Spatial clustering was observed in specific geographic areas at different periods. Both, land surface temperature (aPR 0·945; IC95% 0·895-0·996) and soil humidity (aPR 3·018; IC95% 1·013-8·994), were independently associated with DENV burden clusters. These findings can help health authorities design focused dengue surveillance and control activities in dengue endemic areas.

Métodos de aprendizaje automático para predecir el comportamiento epidemiológico de enfermedades arbovirales: revisión estructurada de literatura / Machine learning methods to predict epidemiological behavior of arbovirals diseases: structured literature review

Introducción: Los métodos de aprendizaje automático permiten manejar datos estructurados y no estructurados para construir modelos predictivos y apoyar la toma de decisiones. Objetivo: Identificar los métodos de aprendizaje automático aplicados para predecir el comportamiento epidemiológico de enfermedades arbovirales utilizando datos de vigilancia epidemiológica. Metodología: Se realizó búsqueda en EMBASE y PubMed, análisis bibliométrico y síntesis de la información. Resultados: Se seleccionaron 41 documentos, todos publicados en la última década. La palabra clave más frecuente fue dengue. La mayoría de los autores (88,3 %) participó en un artículo de investigación. Se encontraron 16 métodos de aprendizaje automático, el más frecuente fue Red Neuronal Artificial, seguido de Máquinas de Vectores de Soporte. Conclusiones: En la última década se incrementó la publicación de trabajos que pretenden predecir el comportamiento epidemiológico de arbovirosis por medio de diversos métodos de aprendizaje automático que incorporan series de tiempo de los casos, variables climatológicas, y otras fuentes de información de datos abiertos.

Introduction: Machine learning methods allow to manipulate structured and unstructured data to build predictive models and support decision-making. Objective: To identify machine learning methods applied to predict the epidemiological behavior of vector-borne diseases using epidemiological surveillance data. Methodology: A literature search in EMBASE and PubMed, bibliometric analysis, and information synthesis were performed. Results: A total of 41 papers were selected, all of them were published in the last decade. The most frequent keyword was dengue. Most authors (88.3 %) participated in a research article. Sixteen machine learning methods were found, the most frequent being Artificial Neural Network, followed by Support Vector Machines. Conclusions: In the last decade there has been an increase in the number of articles that aim to predict the epidemiological behavior of vector-borne diseases using by means of various machine learning methods that incorporate time series of cases, climatological variables, and other sources of open data information.

Association Between Uropathogenic Escherichia coli Virulence Genes and Severity of Infection and Resistance to Antibiotics.

Purpose: Urinary tract infection (UTI) is the most frequent bacterial infection. Some uropathogenic Escherichia coli (UPEC) genes have been associated with disease severity and antibiotic resistance. The aim was to determine the association of nine UPEC virulence genes with UTI severity and antibiotic resistance of strains collected from adults with community-acquired UTI. Patients and Methods: A case-control study (1:3) (38 urosepsis/pyelonephritis and 114 cystitis/urethritis) was conducted. The fimH, sfa/foc, cvaC, hlyA, iroN, fyuA, ireA, iutA, and aer (the last five are siderophore genes) virulence genes were determined by PCR. The information of antibiotic susceptibility pattern of the strains was collected from medical records. This pattern was determined using an automated system for antimicrobial susceptibility testing. Multidrug-resistant (MDR) was defined as resistance to three or more antibiotic families. Results: fimH was the most frequently detected virulence gene (94.7%), and sfa/foc was the least frequently detected (9.2%); 55.3% (83/150) of the strains were MDR. The evaluated genes were not associated with UTI severity. Associations were found between the presence of hlyA and carbapenem resistance (Odds ratio [OR] = 7.58, 95% confidence interval [CI], 1.50-35.42), iutA and fluoroquinolone resistance (OR = 2.35, 95% CI, 1.15-4.84, and aer (OR = 2.8, 95% CI, 1.20-6.48) and iutA (OR = 2.95, 95% CI, 1.33-6.69) with penicillin resistance. In addition, iutA was the only gene associated with MDR (OR = 2.09, 95% CI,1.03-4.26). Conclusion: There was no association among virulence genes and UTI severity. Three of the five iron uptake genes were associated with resistance to at least one antibiotic family. Regarding the other four non-siderophore genes, only hlyA was associated with antibiotic resistance to carbapenems. It is essential to continue studying bacterial genetic characteristics that cause the generation of pathogenic and multidrug-resistant phenotypes of UPEC strains.

House Condition Scoring Scale as a Risk Indicator of Infestation by Aedes in Two Mexican Localities.

Mexico has shown an increase in dengue incidence rates. There are factors related to the location that determine housing infestation by Aedes. This study aimed to determine factors associated with housing infestation by immature forms of Aedes spp. in the dengue endemic localities of Axochiapan and Tepalcingo, Mexico, from 2014 to 2016. A cohort study was carried out. Surveys and inspections of front- and backyards were conducted every 6 months, looking for immature forms of Aedes spp. A house condition scoring scale was developed using three variables (house maintenance, tidiness of the front- and backyards, and shading of the front- and backyards). Multiple and multilevel regression logistic analysis were conducted considering the housing infestation as the outcome and the household characteristics observed 6 months before the outcome as factors; this was adjusted by time (seasonal and cyclical variations of the vector). The infestation oscillated between 5.8% of the houses in the second semester of 2015 and 29.3% in the second semester of 2016. The factors directly associated with housing infestation by Aedes were the house condition score (adjusted odds ratio [aOR]: 1.64; 95% CI: 1.40-1.91) and the previous record of housing infestation (aOR: 2.99; 95% CI: 2.00-4.48). Moreover, the breeding-site elimination done by house residents reduced the housing infestation odds by 81% (95% CI: 25-95%). These factors were independent of the seasonal and cyclical variations of the vector. In conclusion, our findings could help to focalize antivectorial interventions in dengue-endemic regions with similar demographic and socioeconomic characteristics.

Factores asociados a casos probables de hipotiroidismo congénito en neonatos nacidos en Bucaramanga, Colombia / Factors associated with probable cases of congenital hypothyroidism in neonates born in Bucaramanga, Colombia

Resumen Introducción: el hipotiroidismo congénito es un trastorno de la glándula tiroides en neonatos que se caracteriza por una baja producción de las hormonas tiroideas y conduce a daños irreversibles en el desarrollo psicomotor y cognitivo cuando se detecta tardíamente. El diagnóstico temprano de esta condición permite establecer un tratamiento y seguimiento efectivo del caso para evitar las consecuencias irreversibles inherentes a esta enfermedad. Métodos: estudio de casos y controles (1:4) anidado en una cohorte de neonatos del Hospital Universitario de Santander entre junio de 2014 y diciembre de 2016. Se consideraron casos probables de HC los neonatos con niveles de hormona estimulante de tiroides >15µU/mL en sangre de cordón o >10µU/mL en sangre de talón. Como controles se seleccionaron aleatoriamente 226 neonatos con niveles normales de hormona estimulante de tiroides. La información clínica y demográfica se consultó en las historias clínicas. Resultados: se tamizaron 6.180 neonatos detectándose 55 casos probables de HC para una prevalencia de 8,90 por 1 000 nacidos vivos (IC95 % 6,71-11,57). Los factores asociados con casos probables de HC fueron el control prenatal completo (ORa 0,30; IC95 % 0,11-0,87) y control x prenatal incompleto (ORa 0,34; IC95 % 0,13-0,88) comparado con ningún control, ser madre primigestante (ORa 2,08; IC95 % 1,08-4,02), APGAR a los 5 minutos <9 (ORa 3,69; IC95 % 1,46-9,33) y bajo peso al nacer (ORa 3,04; IC95 % 1,13-8,19). Conclusiones: la prevalencia de HC fue más alta que e estudios previos, sin embargo, la prueba confirmatoria de tiroxina T4 no se realizó en el hospital. Estos factores se pueden utilizar para vigilar estrechamente que en todos los recién nacidos con estas características se realice la tamización, así como para priorizar la confirmación de los casos probables de HC.

Abstract Background: congenital hypothyroidism is a thyroid gland disorder where a newborn has a decrease or absent thyroid function and leads to irreversible damage of the psychomotor and cognitive development when is detected late. Early diagnosis of this condition allows for establishing treatment and effective monitoring of the case to avoid inherent irreversible consequences. Methods: we conducted a nested case control study (1:4) in the Hospital Universitario de Santander from June 2014 to December 2016. Neonates with thyroid-stimulating hormone >15 µU/mL from cord blood samples or thyroid-stimulating hormone > 10 µU/mL from heel prick collected in Guthrie cards were considered as probable cases of congenital hypothyroidism (cases), and 226 newborns with normal thyroid-stimulating hormone levels were randomly chosen as controls. We consulted clinical and demographic data from medical records. Results: a total of 6,180 newborns were screened. Fifty-five cases were detected. The prevalence of probable cases of congenital hypothyroidism was 0.89 % (CI 95 % 6,71 - 11,57). The associated factors were complete antenatal care (ORa 0.30 CI95 % 0.11 - 0.87) and partial antenatal care (ORa 0.34 CI9 5% 0.13-0.88), first pregnancy (ORa 2.08 CI95 % 1.08-4.02), APGAR 5 min <9 (ORa 3.69 CI95 % 1.46-9.33), and low birth weight (ORa 3.04; CI95 % 1.13 - 8.19). Conclusions: the congenital hypothyroidism prevalence was higher than in previous studies. However, the confirmatory thyroxine T4 test was not done in this hospital. These associated factors could be used to closely monitor that all newborns with these characteristics are screened, as well as to prioritize the confirmation of probable cases of congenital hypothyroidism.

Reproducibilidad y validez de criterio de dos técnicas radiográficas para variaciones de premolares mandibulares comparadas con CBCT / Reproducibility and criterion validity of two radiographic techniques for variations in mandibular premolar compared with CBCT technique

Introducción: La existencia de variaciones anatómicas ocasiona fracasos en tratamientos endodónticos, por lo que es importante diagnosticarlas. El objetivo fue determinar la reproducibilidad y la validez de criterio de las radiografías con placa de fósforo y la radiovisografía con sensor para identificar las variaciones anatómicas detectadas por tomografía computarizada de haz cónico (CBCT) en premolares inferiores. Métodos: En 140 premolares se obtuvieron imágenes por CBCT, radiografía y radiovisografía. Se realizó lectura independiente por dos endodocistas, evaluándose la clasificación de Vertucci y las ramificaciones. Se determinó la reproducibilidad intraobservador e interobservador. Se calcularon sensibilidad, especificidad y áreas bajo la curva operador-receptor (AUC) utilizando como estándar de oro la CBCT. Resultados: La reproducibilidad intraobservador e interobservador fue mayor para radiografía. Para la Clase I de Vertucci, la radiografía presentó mayor sensibilidad (94,7%), especificidad (64,9%) y AUC (0,795) que la radiovisiografía (89,3%, 62,2% y 0,757, respectivamente), al igual que para la Clase V (Radiografía 69,2%, 93% y 0,811; Radiovisiografía 50%, 84,2% y 0,671, respectivamente). Ninguna de las técnicas aportó al diagnóstico de la Clase III (AUC <0,5). Las ramificaciones fueron infrecuentes (2,9%) y su detección fue baja (Sensibilidad 25% para radiografía y 0% para radiovisiografía). Discusión: Este es el primer estudio que evalúa la reproducibilidad y validez de estas dos técnicas radiográficas comparadas con la CBCT para la detección de variaciones anatómicas en dientes. Conclusiones: La radiografía con placa de fósforo presentó mayor reproducibilidad y validez para el diagnóstico de las Clase I y V de Vertucci, que fueron las variaciones más frecuentes.

Introduction: Considering that the existence of anatomical variations causes endodontic treatment failures, therefore it is important to diagnose them. This study aimed to determine the reproducibility and criterion validity of phosphor plate radiographs and sensor-based radiovisiography to identify anatomical variations detected by cone-beam computed tomography (CBCT) in lower premolars. Materials and Methods: 140 premolars images were obtained by CBCT, radiographs and radiovisiography. Independent interpretation was performed by two endodontists to evaluate the Vertucci classification and ramifications. Intraobserver and interobserver reproducibility were determined. Sensitivity, specificity and areas under the receiver-operator curve (AUC) were calculated using CBCT as the gold standard. Results: Intraobserver and interobserver reproducibility was higher for radiography. For Vertucci type I, radiography showed higher sensitivity (94.7%), specificity (64.9%) and AUC (0.795) than radiovisiography (89.3%, 62.2% and 0.757, respectively), similarly for type V (radiography at 69.2%, 93% and 0.8111; radiovisiography at 50%, 84.2% and 0.671, respectively). None of the techniques contributed to the diagnosis of type III (AUC < 0.5). Ramifications were infrequent (2.9%) with a low level of detection (sensitivity at 25% for radiography and 0% for radiovisiography). Discussion: This is the first study to evaluate the reproducibility and validity of these two radiographic techniques compared with CBCT for the detection of anatomical variations in teeth. Conclusions: Phosphor plate radiography showed higher reproducibility and validity for the diagnosis of Vertucci types I and V, which were the most frequent premolar variations found. This is a dissertation for the Master's degree in Dentistry available in the repository of the Universidad Santo Tomas, Bucaramanga campus.

Introdução: A existência de variações anatômicas causa falhas no tratamento endodôntico, por isso é importante diagnosticá-las. O objetivo foi determinar a reprodutibilidade e validade dos critérios das radiografias em placas de fósforo e radiovisiografia sensorial para identificar variações anatômicas detectadas pela tomografia computadorizada de feixe cônico (TCFC) em pré-molares inferiores. Métodos: obtiveram-se TCFC, imagens radiográficas e radiovisográficas em 140 pré-molares. A leitura independente foi realizada por dois endodontistas, avaliando a classificação Vertucci e suas ramificações. Foi determinada a reprodutibilidade intra e interobservador. Sensibilidade, especificidade e áreas sob a curva operação do receptor (AUC) foram calculadas utilizando a TCFC como padrão-ouro. Resultados: A reprodutibilidade intra e inter-observador foi maior para a radiografia. Para a Classe I de Vertucci, a radiografia mostrou maior sensibilidade (94,7%), especificidade (64,9%) e AUC (0,795) do que a radiovisiografia (89,3%, 62,2% e 0,757, respectivamente), assim como para a Classe V (Radiografia 69,2%, 93% e 0,811; Radiovisiografia 50%, 84,2% e 0,671, respectivamente). Nenhuma das técnicas contribuiu para o diagnóstico da Classe III (AUC <0,5). A ramificação foi pouco frequente (2,9%) e a detecção foi baixa (Sensibilidade 25% para radiografia e 0% para radiovisiografia). Discussão: Este é o primeiro estudo para avaliar a reprodutibilidade e validade dessas duas técnicas radiográficas em comparação com a TCFC para a detecção de variações anatômicas nos dentes. Conclusões: A radiografia com placas de fósforo apresentou maior reprodutibilidade e validade para o diagnóstico da Classe I e V de Vertucci, que foram as variações mais frequentes. Este foi um trabalho de conclusão de durso para o título de Mestre em Odontologia e estará no repositório da Universidad Santo Tomas seccional Bucaramanga.

Seroprevalencia de SARS-CoV-2 y factores asociados en migrantes con vocación de permanencia, Bucaramanga, Colombia / SARS-CoV-2 seroprevalence and associated factors among migrants with a vocation for permanence, Bucaramanga, Colombia / Soroprevalência de SARS-CoV-2 e fatores associados em migrantes com vocação de permanência, Bucaramanga, Colômbia

Introducción: Existen pocos reportes que evalúen la seroprevalencia contra SARS-CoV-2 en población migrante en el mundo. Estos estudios ayudan a conocer la exposición al virus en las poblaciones para implementar acciones que reduzcan el impacto de la infección por SARS-CoV-2. Objetivo: Determinar la seroprevalencia contra SARS CoV-2 en migrantes con vocación de permanencia en Bucaramanga, e identificar factores asociados a la infección previa por SARS-CoV-2. Materiales y métodos: Estudio de corte transversal analítico con muestreo consecutivo. Se incluyeron migrantes adultos en Bucaramanga durante febrero/2021. Se realizaron encuestas e inmunoensayos de quimioluminiscencia para IgM e IgG contra SARS-CoV-2 en suero. Se calcularon razones de prevalencia (RP) con regresión log-binomial. Resultados:Se incluyeron 462 participantes. La seroprevalencia de IgM fue 11,7% (IC95% 9,1­14,9), de IgG fue 32,9% (IC95% 28,8­37,3) y de IgM o IgG fue 36,1% (IC95% 31,9-40,6). Exposición a un caso confirmado (RP:1,54; IC95%1,04-2,29) o sospechoso (RP:1,56; IC95%1,13-2,16) de COVID-19, seis o más convivientes (RP:1,52; IC95%1,05-2,20), estancia en Colombia ≥2 años (RP:1,43; IC95%1,11-1,92) y presencia de síntomas (RP:1,62; IC95%1,26 - 2,10) se asociaron con mayor seroprevalencia de IgG. Discusión:En Bucaramanga, la seroprevalencia en migrantes fue similar a la de migrantes en Kuwait, pero menor que en Paris y Singapur. Conclusión: En migrantes con vocación de permanencia la seroprevalencia contra SARS-CoV-2 fue similar a la reportada en residentes de Bucaramanga. El contacto con casos sospechosos/confirmados de COVID-19 y las condiciones de hacinamiento fueron algunos de los factores asociados a la seroprevalencia.

Introduction:There are few reports assessing anti-SARS-CoV-2 seroprevalence in the migrant population in the world. These studies help to understand the exposure of populations to the virus to take actions to reduce the impact of SARS-CoV-2 infection. Objetive: To determine the anti-SARS-CoV-2 seroprevalence in migrants with a vocation for permanence in Bucaramanga and to identify factors associated with previous SARS-CoV-2 infection. Materials and Methods:Analytical cross-sectional study using consecutive sampling, which included adult migrants in Bucaramanga in February 2021. Surveys were conducted, and chemiluminescent immunoassays were performed to detect IgM and IgG antibodies to SARS-CoV-2 in serum samples. Prevalence ratios (PR) were estimated using a log-binomial regression model. Results:The study enrolled 462 participants. IgM seroprevalence was 11.7% (95% CI 9.1­14.9), IgG seroprevalence was 32.9% (95% CI 28.8­37.3), and IgM or IgG seroprevalence was 36.1% (95% CI 31.9­40.6). Contact with a confirmed case of COVID-19 (PR:1.54; 95% CI 1.04-2.29) or suspected case (PR:1.56; 95% CI 1.13­2.16); living with six or more people (PR: 1.52; 95% CI 1.05­2.20); stay in Colombia ≥ 2 years (PR:1.43; 95% CI 1.11­1.92), and presence of symptoms (PR:1.62; 95%CI 1.26­2.10) were some factors associated with higher IgG seroprevalence. Discussion: In Bucaramanga, SARS-CoV-2 seroprevalence among migrants was similar to the seroprevalences of migrants in Kuwait but lower than migrants in Paris and Singapore. Conclusions: The anti-SARS-CoV-2 seroprevalence among migrants with a vocation for permanence was similar to that reported among residents of Bucaramanga. Contact with suspected or confirmed COVID-19 cases and crowded conditions were some of the factors associated with seroprevalence.

Introdução: Existem poucos relatos que avaliam a soroprevalência contra SARS-CoV-2 na população migrante no mundo. Esses estudos ajudam a conhecer a exposição ao vírus nas populações para implementar ações que reduzam o impacto da infecção por SARS-CoV-2. Objetivo: Determinar a soroprevalência contra SARS CoV-2 em migrantes que pretendem permanecer em Bucaramanga e identificar fatores associados à infecção anterior por SARS-CoV-2. Materiais e Métodos: Estudo analítico transversal com amostragem consecutiva. Foram incluídos migrantes adultos em Bucaramanga durante fevereiro/2021. Foram realizados levantamentos e imunoensaios de quimioluminescência para IgM e IgG contra SARS-CoV-2 no soro. As razões de prevalência (RP) foram calculadas com regressão log-binomial. Resultados: foram incluídos 462 participantes. A soroprevalência de IgM foi de 11,7% (IC 95% 9,1-14,9), de IgG foi de 32,9% (IC 95% 28,8-37,3) e de IgM ou IgG foi de 36,1% (IC95% 31,9-40,6). Exposição a um caso confirmado (RP: 1,54; IC 95% 1,04-2,29) ou caso suspeito (RP: 1,56; IC 95% 1,13-2,16) de COVID-19, seis ou mais coabitantes (RP: 1,52; IC 95% 1,05 -2,20), permanência na Colômbia ≥2 anos (RP: 1,43; IC 95% 1,11-1,92) e presença de sintomas (RP: 1,62; IC95%1,26 - 2,10) foram associados a maior soroprevalência de IgG. Discussão: Em Bucaramanga, a soroprevalência em migrantes foi semelhante à de migrantes no Kuwait, mas menor do que em Paris e Cingapura. Conclusão: Em migrantes com vocação de permanência, a soroprevalência contra SARS-CoV-2 foi semelhante à relatada em residentes de Bucaramanga. O contato com casos suspeitos/confirmados de COVID-19 e as condições de superlotação foram alguns dos fatores associados à soroprevalência.

Risk Prediction of Death in Inpatient Adults With COVID-19 from Mexico.

Background: There is substantial variation in COVID-19 lethality across countries. In addition, in countries with populations with extreme economic inequalities, such as Mexico, there are regional and local differences in risk factors for COVID-19 death. The goal of this study was to test the hypothesis that the risk of death in Mexican COVID-19 patients was associated with the time between symptom onset and hospitalization and/or with the healthcare site. Also, death prognostic models were developed. Methods: The study included two COVID-19 inpatient cohorts, one prospective and one retrospective from Chiapas, Mexico. Demographic, clinical and laboratory variables were collected, and the diagnosis of SARS-CoV-2 infection was performed using RT-qPCR in samples collected seven days since symptom onset. The 30-day mortality, since symptom onset, was the outcome, and clinical variables at the first 48 hours of hospitalization were independent factors. Multivariate logistic regression analyses were conducted. Results: Of the 392 patients included, 233 died (59.4%). The time between symptom onset and hospitalization, the healthcare site and sex were not related to the 30-day mortality. Three death prognostic models were developed (AUC between 0.726 and 0.807). Age, LDH, AST, and lymphocyte count were included in all models, OSI-WHO Classification (Non-invasive ventilation or high-flow oxygen, and mechanical ventilation with or without organ support/ECMO) and leukocyte count in two models, and diabetes and diarrhea in one model. Conclusion: The population evaluated had underlying deteriorated health before COVID-19 compared with regional and country population. The factors that determine the COVID-19 mortality risk in a relatively healthy population are sex, age and comorbidities. However, as this study shows, when populations have underlying poor health, some of these factors lose their associations with mortality risk, and others become more important.

Phylogenomic analysis and Mycobacterium tuberculosis antibiotic resistance prediction by whole-genome sequencing from clinical isolates of Caldas, Colombia.

Mycobacterium tuberculosis (M. tuberculosis) was the pathogen responsible for the highest number of deaths from infectious diseases in the world, before the arrival of the COVID-19 pandemic. Whole genome sequencing (WGS) has contributed to the understanding of genetic diversity, the mechanisms involved in drug resistance and the transmission dynamics of this pathogen. The object of this study is to use WGS for the epidemiological and molecular characterization of M. tuberculosis clinical strains from Chinchiná, Caldas, a small town in Colombia with a high incidence of TB. Sputum samples were obtained during the first semester of 2020 from six patients and cultured in solid Löwenstein-Jensen medium. DNA extraction was obtained from positive culture samples and WGS was performed with the Illumina HiSeq 2500 platform for subsequent bioinformatic analysis. M. tuberculosis isolates were typified as Euro-American lineage 4 with a predominance of the Harlem and LAM sublineages. All samples were proven sensitive to antituberculosis drugs by genomic analysis, although no phenotype antimicrobial tests were performed on the samples, unreported mutations were identified that could require further analysis. The present study provides preliminary data for the construction of a genomic database line and the follow-up of lineages in this region.

Alternancia Escolar: un reto para garantizar la salud y la vida de la comunidad educativa / Educational Alternation: A challenge to protect the health and life of the school community

La inesperada llegada de la pandemia, enfrentó a todo el mundo a cambios drásticos en la forma de vida que se disfrutaba en épocas de normalidad, obligando a la población a diferentes tipos de confinamientos. Estos trajeron consigo el cierre de casi todos los sectores y en consecuencia la interrupción de muchos servicios esenciales, como las intervenciones en el sector educativo. Muchas de estas intervenciones estaban dirigidas, además de a la educación misma, a brindar protección a los escolares, detectar condiciones de riesgo de violencia intrafamiliar, maltrato y trabajo infantil, suministrar raciones alimenticias, vigilar el cumplimiento del esquema de vacunación y a evitar la deserción escolar, entre otras. Aunque los escolares no son el grupo más afectado por COVID-19, un reciente estudio de UNICEF realizado en 87 países revela que, en noviembre de 2020, los niños y los adolescentes representaron el 11% del total de infecciones1, mientras que, en Colombia, la proporción de casos pediátricos (menores de 18 años) se estima entre 7-8% y representan el 0.025% del total de fallecimientos2. Aunque se ha reportado que el riesgo de infección en escolares es menor que el del personal docente y administrativo en instituciones de educación, esta discrepancia pudiera estar sobreestimada debido a una menor probabilidad de detección considerando el curso predominantemente asintomático de la infección en niños. Sin embargo, COVID-19 puede ser una enfermedad severa en los menores, contribuyendo no solo al número de ingresos a unidades de cuidados intensivo sino al de casos fatales3. En términos de la transmisión, un estudio conducido en población infantil evidenció que esta ocurre con mayor frecuencia en el entorno familiar, relacionándose directamente con el estadio de enfermedad del caso índice: comparados con casos asintomáticos aquellos en etapa pre sintomática fueron responsables del doble de casos secundarios (1/3 versus 1/6)4. Esto indica que los niños infectados constituyen una fuente importante de contagio para sus pares, con evidencia de mayor transmisión en el nivel de secundaria comparado con el de primaria5, así como para los miembros del personal docente y administrativo de sus escuelas. Estos últimos, a su vez generarían nuevos casos de infección en la comunidad estudiantil y dada cuenta de su mayor movilidad, también en la población general6. La importancia que la socialización tiene en los procesos de enseñanza-aprendizaje y en el desarrollo psicológico de los niños, niñas, adolescentes y jóvenes es ampliamente reconocida. Además, es conocido el impacto beneficioso que tienen las actividades educativas en la salud física y mental y en general, en la probabilidad que nuestros niños alcancen todo su potencial y tengan una vida plena. En esta dirección, y ajustándose a la coyuntura, el sector educativo ha tenido que instaurar nuevas estrategias, pasando a la modalidad virtual (asistida por las tecnologías de la información y las comunicaciones ­ TICs) y a diferentes modelos de alternancia escolar. La alternancia se ofrece en diferentes modalidades como la híbrida, en la que es posible que un grupo de estudiantes reciban de manera presencial la clase y el resto lo hagan de manera virtual en forma sincrónica, con opciones de participación en ambos espacios. Otra estrategia es el desarrollo de la clase presencial y de manera asincrónica el desarrollo de actividades virtuales en casa, es decir, con grupos de estudiantes que tendrán asistencia a la institución y trabajo virtual o so-lamente asistencia a la institución. Las instituciones que no acojan la alternancia continuarán con su oferta pedagógica en la modalidad virtual. Cualquiera de los modelos de alternancia que las instituciones adopten trae consigo la presencialidad y, por lo tanto, la necesidad de realizar acciones para la disminución del riesgo, la identificación de casos (sintomáticos y asintomáticos) y sus contactos y el seguimiento y aislamiento, cuando ello se requiera. Nadie niega la importancia del regreso a la escuela, pero ésta debe hacerse en condiciones seguras que garanticen la protección de la salud y la vida de escolares, maestros, personal administrativo y de apoyo y de sus familias. Para lograr este objetivo se requiere adherencia y adaptación en cada institución educativa de los protocolos de bioseguridad emanados de los ministerios de educación y salud. Además, se requiere tener en cuenta la situación epidemiológica actual del municipio o área metropolitana y de la evolución de la epidemia en la población local y la comunidad educativa institucional. Esto último, el conocimiento cabal de la situación epidemiológica local e institucional es crucial para poder decidir responsablemente cuando se abre o se cierra una institución educativa, a fin de preservar la salud, el bienestar y la vida de sus integrantes. En particular, al momento de tomar estas decisiones, es esencial tener en cuenta los siguientes aspectos: La situación de la transmisión y la velocidad de contagio del SARS-CoV-2 en la localidad y cómo esto afectará el entorno educativo. El nivel de capacidad de los servicios de salud y especialmente las EPS para detectar y aislar casos sintomáticos y asintomáticos; detectar brotes o conglomerados de casos; identificar y seguir contactos de los casos; y establecer cercos epidemiológicos para detener la transmisión de la enfermedad dentro de la institución educativa. En qué medida la infección y enfermedad en familiares de los estudiantes, profesores y otro personal de la institución, constituye un factor de riesgo para los niños y viceversa. Dada la dinámica de la transmisión, los protocolos de bioseguridad por sí mismos, no garantizan la reducción del riesgo, si no se acompañan del cumplimiento estricto de los mismos, del acondicionamiento de las instituciones educativas para garantizar ambientes seguros, y de un análisis técnico, permanente y veraz de las condiciones de la pandemia en la localidad. Garantizar la ventilación adecuada y los recambios de aire, de los diferentes espacios de las instituciones educativas especialmente en las áreas cerradas, es un factor de especial importancia para disminuir la transmisión del virus. Por lo tanto, este aspecto es un asunto clave en la adecuación de las instituciones educativas. La decisión de abrir una institución de educación, debe estar precedida de un trabajo conjunto entre los escolares, los padres, los maestros, el personal directivo, y el personal de salud, con el fin de fijar los lineamientos básicos de las decisiones y acciones tanto en los asuntos de salud, como de protección de los escolares y del personal y sus familias, la coordinación con las entidades de salud y la anticipación de la mayoría de las situaciones que puedan derivarse de los procesos de apertura. La institución educativa debe definir, con el apoyo del sector salud, los indicadores que les permitan decidir en qué momento la institución debe cerrarse, bien sea de manera parcial o total, dada la existencia de casos en una burbuja (grupos estables de convivencia) o en varias burbujas. Además de los aspectos relacionados con minimizar el riesgo y disminuir la transmisión, en el proceso de apertura deben contemplarse otros aspectos tales como: garantizar el acceso a la educación a distancia a todos los escolares de las poblaciones distantes o rurales, marginadas, de escasos recursos, con discapacidad y cuyos familiares pertenecen a grupos de alto riesgo. Garantizar mecanismos pedagógicos que les permitan a los escolares, superar la brecha en que pudieron haber caído, por las dificultades de acceso a la educación virtual. Proveer la asistencia en salud y nutrición a los escolares, así como la atención a las niñas y adolescentes para la prevención del embarazo, el acoso y el abuso sexual. Ante la situación tan cambiante de la pandemia, es necesario tomar las decisiones de la apertura de las instituciones, en medio de gran incertidumbre. Son muchos los retos que el sector educativo tiene que superar. Pero en la planeación y toma de decisiones, como bien lo enuncia la UNICEF, "la respuesta debe servir de catalizador para mejorar los resultados del aprendizaje, hacer más equitativo el acceso a la enseñanza y fortalecer la protección, la salud y la seguridad de los niños"1. En consecuencia, si bien es prioritario el regreso a la presencialidad especialmente en los niveles de educación básica, deberán primar el principio de la protección y bienestar de los niños y los principios éticos, por encima de cualquier interés político o económico, del ejercicio de autoridad, o de una falsa sensación de seguridad. Conflicto de intereses: Los autores declaran no tener conflicto de intereses.

The unexpected arrival of the pandemic brought everyone to face drastic changes in the way people used to live in normal times, forcing them to experience different types of home confinement. These resulted in the closure of almost all sectors and, consequently, the disruption of many essential services, such as educational interventions. Many of these interventions were aimed, apart from education itself, at providing protection to schoolchildren, detecting risk conditions of domestic violence, child abuse and child labor, providing school meals, monitoring compliance with immunization programs and preventing school dropout, among others.Although schoolchildren are not the group most affected by COVID-19, a recent UNICEF study conducted in 87 countries found that in November 2020, children and adolescents accounted for 11% of reported COVID-19 infections1, while in Colombia the number of pediatric COVID-19 cases (patients aged < 18 years) is estimated at 7-8% representing 0.025% of deaths2.While the risk of infection in schoolchildren has been reported to be lower than that of teaching and administrative staff in schools, this difference may be overestimated due to a lower probability of detection considering the predominantly asymptomatic course of infection in children. However, COVID-19 can be a severe disease in young people, contributing not only to the number of admissions to intensive care units but also to the number of deaths3.As for COVID-19 transmission, a study conducted with children showed that it occurs more frequently in the home environment, which is directly related to the stage of disease of the index case (that is, compared to asymptomatic cases, those in the pre- 2Revista Cuidarte mayo - agosto 2021;12(2): e2244http://dx.doi.org/10.15649/cuidarte.2244symptomatic stage were responsible for twice as many secondary cases as index case (1/3 versus 1/6)4. This means that infected children are an important source of infection for their peers, suggesting greater transmission rates in high school compared to elementary school5, as well as in teachers and school administrative staff. The latter would in turn lead to new cases of infection in the school community and, given their greater mobility, also in the general population6.The importance of socialization in teaching-learning processes and the psychological development of children, adolescents and young people is widely recognized. Furthermore, the positive impacts that educational activities have on physical and mental health and more generally, the chances that our children will reach their full potential and have a fulfilling life are well-known. In this regard, and in response to the current situation, the education sector needed to implement new strategies, switching to online education (assisted by information and communications technology (ICT)) and different models of educational alternation.Educational alternation can be offered in different modes such as hybrid learning, in which a group of students has in-person classes and the rest of the group receive online instruction in a synchronous way, providing options for participation in both spaces. Another strategy combines in-person instruction and asynchronous online activities at home, i.e., a group of students will have in-person and remote instruction and another one will only have in-person instruction. Schools that do not implement any educational alternation model will continue with their educational online offer. Every alternation model implemented by schools entails face-to-face instruction and, therefore, the need to take actions for risk reduction, identification of symptomatic and asymptomatic cases, contact tracing, subsequent follow up and self-isolation, when required.No one denies the importance of returning to school. However, this should be safely done to protect the health and life of students, teachers, school administrative and support staff and their families. To this end, each school is required to adhere to and adapt biosafety protocols issued by the ministries of education and health. In addition, the current epidemiological situation of each municipality or urban area as well as the course of the outbreak in the local population and school community need to be taken into account. A complete understanding of the local and institutional epidemiological situation is crucial to make responsible decisions when reopening or closing schools to protect the health, wellbeing and life of the school community.The following aspects are essential to consider when making these decisions:-Transmission and speed rates of SARS-CoV-2 infection in the local population and their impact on the educational environment.-Health care services capacity, especially in Health Promotion Agencies (EPSs in Spanish), to detect and isolate symptomatic and asymptomatic cases; detect outbreaks or clusters of This means that infected children are an important source of infection for their peers, suggesting greater transmission rates in high school compared to elementary school5, as well as in teachers and school administrative staff. A complete understanding of the local and institutional epidemiological situation is crucial to make responsible decisions when reopening or closing schools to protect the health, wellbeing and life of the school community. 3Revista Cuidarte mayo - agosto 2021;12(2): e2244http://dx.doi.org/10.15649/cuidarte.2244COVID-19 cases; identify and trace contacts and implement epidemiological fences to stop disease transmission within the school community.-The degree to which coronavirus infection and disease in students, teachers and other school staff 's relatives can become a risk factor for children and vice versa.-Considering transmission dynamics of COVID-19, biosafety protocols alone do not ensure risk reduction unless supported by strict compliance, school preparation to ensure safe environments and technical, ongoing and accurate analysis of the pandemic situation in the local territory.-Proper ventilation and air circulation of school areas, especially indoors, is a key factor in reducing virus transmission. Therefore, it is a key issue to consider in school preparation.-The decision to reopen a school should be preceded by joint efforts among students, parents, teachers, school board and healthcare personnel to define the basic guidelines for decision making and management actions on healthcare issues, protection of students, staff and their families, as well as coordination with healthcare agencies and anticipation of potential challenges that may arise from school reopening.-Supported by the healthcare sector, schools need to define the indicators that will help them decide when the school should be closed, either partially or totally, given the existence of cases in one bubble (stable coexistence groups) or several bubbles.-In addition to risk and transmission reduction, aspects such as access to distance learning to all schoolchildren from remote, rural, marginalized, low-income, disabled populations and those having relatives at higher risk for COVID-19 should be considered in school reopenings.-Teaching mechanisms should be in place to overcome any gap that schoolchildren may have fallen into due to difficulties in accessing online learning.-Implementation of health and nutrition assistance for children, in addition to health care services for girls and adolescents to prevent pregnancy, harassment and sexual abuse.Faced with the rapidly changing situation of the pandemic, it is necessary to make decisions on school reopening in the midst of great uncertainty. Although there are many challenges that the education sector needs to overcome, during planning and decision making "the response should serve as a catalyst to improve learning outcomes, increase equitable access to education and strengthen the protection, health and safety of children"1 as stated by UNICEF. Consequently, while the return to in-person education is a priority, especially for basic education, the principle of protection and wellbeing of children and ethical principles should take precedence over any political or economic interest, the exercise of authority or a false sense of security.Conflict of interest statement: The authors declare that there is no conflict of interest.

A inesperada chegada da pandemia, enfrentou a todos mudanças drásticas na forma de vida que se desfrutava em épocas de normalidade, obrigando a população a diferentes tipos de confinamento. Estes levaram ao encerramento de quase todos os setores e, consequentemente, à interrupção de muitos serviços essenciais, como as intervenções no sector da educação. Muitas destas intervenções eram dirigidas, além da própria educação, a proporcionar proteção aos alunos, identificar as condições de risco de violência doméstica, maus-tratos e trabalho infantil, fornecer porções alimentares, controlar o cumprimento do plano de vacinação e evitar a deserção escolar, entre outras. Embora os alunos não sejam o grupo mais afetado pela COVID-19, um estudo recente da UNICEF realizado em 87 países revela que, em Novembro de 2020, crianças e adolescentes representaram 11% do total de infeção1, enquanto, na Colômbia, a proporção de casos pediátricos (menores de 18 anos) é estimada entre 7-8% e representam 0.025% do total de mortes2. Embora se tenha relatado que o risco de infecção em escolas é menor do que o do pessoal docente e administrativo em instituições de educação 3, esta discrepância pode ser sobrestimada devido a uma menor probabilidade de detecção, tendo em conta o curso predominantemente assintomático da infecção em crianças. No entanto, COVID-19 pode ser uma doença grave em crianças, contribuindo não só para o número de entradas nas unidades de cuidados intensivos, mas também para o número de casos fatais3. Em termos de transmissão, um estudo conduzido em população infantil evidenciou que a transmissão acontece com maior 2Revista Cuidarte mayo - agosto 2021;12(2): e2244http://dx.doi.org/10.15649/cuidarte.2244frequência no ambiente familiar, relacionadas diretamente com o estádio da doença do caso índice: comparados com casos assintomáticos aqueles em etapa pré-sintomática foram responsáveis pelo dobro de casos secundários (1/3 versus 1/6)4. Isto indica que as crianças infectadas constituem uma fonte importante de contágio para os seus pares, com evidência de maior transmissão no nível secundário comparado com o primário5, como para os membros do pessoal docente e administrativo das suas escolas. Estes últimos, por sua vez, gerariam novos casos de infecção na comunidade estudantil e dada a sua maior movimentação, também na população geral6. A importância que a socialização tem nos processos de ensino-aprendizagem e no desenvolvimento psicológico dos meninos, meninas, adolescentes e jovens é amplamente reconhecida. Além disso, é conhecido o impacto benéfico das atividades educativas na saúde física e mental e em geral, na probabilidade que nossas crianças alcançarem todo o seu potencial e terem uma vida plena. Neste sentido, e adaptando-se à conjuntura, o setor da educação teve que instaurar novas estratégias, passando à modalidade virtual (assistida pelas tecnologias da informação e das comunicações - TICs) e a diferentes modelos de alternância escolar. A alternância é oferecida em diferentes modalidades, como a híbrida, na qual um grupo de estudantes pode receber a aula em forma presencial e os restantes podem fazê-lo de forma virtual e sincronizada, com opções de participação em ambos os espaços. Outra estratégia é o desenvolvimento da classe presencial e de maneira assíncrona o desenvolvimento de atividades virtuais em casa, ou seja, com grupos de estudantes que terão assistência à instituição e trabalho virtual ou apenas assistência à instituição. As instituições que não acolham a alternância continuarão com sua oferta pedagógica na modalidade virtual. Qualquer dos modelos de alternância que as instituições adotem traz consigo a presencialidade e, portanto, a necessidade de realizar ações para a diminuição do risco, a identificação de casos (sintomáticos e assintomáticos) e respectivos contatos, bem como a monitorização e o isolamento, se necessário.Ninguém nega a importância do regresso à escola, mas isso deve ser feito em condições seguras que garantam a proteção da saúde e da vida de alunos, professores, pessoal administrativo e de apoio e das suas famílias. Para alcançar este objetivo, requer-se adesão e adaptação em cada instituição educativa dos protocolos de biossegurança emitidos dos ministérios de educação e saúde. Além disso, é necessário ter em conta a situação epidemiológica atual do município ou área metropolitana e a evolução da epidemia na população local e na comunidade educativa institucional. Este último, o pleno conhecimento da situação epidemiológica local e institucional é crucial para poder decidir responsavelmente quando se abre ou fecha uma instituição educativa, a fim de preservar a saúde, o bem-estar e a vida de seus integrantes. Em particular, no momento das tomadas de decisões, é essencial ter em conta os seguintes aspectos: Isto indica que as crianças infectadas constituem uma fonte importante de contágio para os seus pares, com evidência de maior transmissão no nível secundário comparado com o primário5, como para os membros do pessoal docente e administrativo das suas escolas., o pleno conhecimento da situação epidemiológica local e institucional é crucial para poder decidir responsavelmente quando se abre ou fecha uma instituição educativa, a fim de preservar a saúde, o bem-estar e a vida de seus integrantes. 3Revista Cuidarte mayo - agosto 2021;12(2): e2244http://dx.doi.org/10.15649/cuidarte.2244- A situação da transmissão e a velocidade de contágio do SARS-CoV-2 na localidade e como isso afetará o ambiente educacional- O nível de capacidade dos serviços de saúde e, em especial, das EPS (entidades promotoras de saúde) para detectar e isolar casos sintomáticos e assintomáticos; detectar surtos ou conglomerados de casos; identificar e acompanhar os contatos dos casos e estabelecer barreiras epidemiológicas para impedir a transmissão da doença dentro da instituição de ensino. - Em que medida a infecção e a doença nos familiares dos estudantes, professores e outro pessoal da instituição constituem um fator de risco para as crianças e vice-versa.- Dada a dinâmica da transmissão, os protocolos de biossegurança, por si só, não garantem a redução do risco, se não forem acompanhados do cumprimento estrito dos mesmos, do acondicionamento das instituições educativas para garantir ambientes seguros, e de uma análise técnica, permanente e verdadeira das condições da pandemia na localidade.- Garantir a ventilação adequada e a mudança de ar dos diferentes espaços das instituições educativas, especialmente nas áreas fechadas, é um fator de especial importância para diminuir a transmissão do vírus. Portanto, este aspecto é uma questão chave na adequação das instituições de ensino. - A decisão de abrir uma instituição de educação deve ser precedida de um trabalho conjunto entre os escolares, os pais, os professores, o pessoal dirigente, e o pessoal de saúde, a fim de estabelecer as orientações básicas das decisões e ações, tanto em matéria de saúde como de proteção dos estudantes e do pessoal e suas respectivas famílias, a coordenação com as instituições de saúde e a antecipação da maioria das situações que possam resultar dos processos de abertura. - A instituição educativa deve definir, com o apoio do sector da saúde, os indicadores que lhes permitam decidir em que momento a instituição deve ser encerrada, seja de forma parcial ou total, dada a existência de casos numa bolha (grupos estáveis de convivência) ou em várias bolhas. - Além dos aspectos relacionados com minimizar o risco e diminuir a transmissão, O processo de abertura deve contemplar outros aspectos, tais como: garantir o acesso à educação à distância a todos os alunos das populações distantes ou rurais, marginalizadas, de escassos recursos, com deficiência e cujos familiares pertencem a grupos de alto risco.- Garantir mecanismos pedagógicos que permitam aos alunos, superar a brecha em que podem ter caído, pelas dificuldades de acesso à educação virtual. - Fornecer cuidados de saúde e nutrição às crianças em idade escolar, bem como de cuidados às meninas e adolescentes para a prevenção da gravidez e do assédio sexual.Perante a situação tão variável da pandemia, é necessário tomar as decisões de abertura das instituições, no meio de grande incerteza. São muitos os desafios que o setor da educação tem que enfrentar. Mas na planificação e tomada de decisão, como bem o indica a UNICEF, "a resposta deve servir de catalisador para melhorar os resultados da aprendizagem, tornar mais equitativo o acesso ao ensino e reforçar a proteção, a saúde e a segurança das crianças"1. Embora seja prioritário o regresso à presencialidade, especialmente nos níveis de educação básica, deverão prevalecer o princípio da proteção e do bem-estar das crianças e os princípios éticos, acima de qualquer interesse político ou econômico, do exercício de autoridade ou de uma falsa sensação de segurança.Conflito de interesses: Os autores declaram não ter conflito de interesses.

Experience and perception of risk associated with knowledge, attitudes and practices regarding dengue in Riohacha, Colombia. / Experiencia y percepción del riesgo asociados a conocimientos, actitudes y prácticas sobre dengue en Riohacha, Colombia.

Recognition of the determinants of knowledge, attitudes and practices (KAP), which could be conditioned by the experiences and perceptions of the population at risk, is essential for the control of dengue. The scope of this article is to estimate the relationship between the risk perception and dengue diagnosis experiences with KAPs on dengue in an endemic Colombian population. A cross-sectional study with multi-stage random sampling was conducted. Adjusted prevalence ratios (aPR) were estimated using regression models as measures of association. Of the 206 families interviewed, 7% know dengue is caused by a virus and less than 40% recognize other symptoms besides fever. As control strategies, 31% eliminate hatchery sites and 58% use fumigation, though 73% perceive the risk of dengue. The association was identified between the perception of the risk of dengue and knowledge about the vector (aPR = 3.32 CI95% 1.06-10.36), and the experience of diagnosis of dengue with the attitude towards dengue control (aPR = 1.61 CI95% 1.09-2.37). Risk perception and experience with dengue could become determinants of KAPs in relation to this disease.

Para el control del dengue es esencial el reconocimiento de los determinantes de los conocimientos, actitudes y prácticas (CAP), los cuales podrían estar condicionados por las experiencias y percepciones de la población a riesgo. El propósito de este artículo es estimar la asociación entre la percepción del riesgo y la experiencia de dengue con los CAP sobre dengue, en una población endémica de Colombia. Estudio analítico de corte transversal y muestreo probabilístico, polietápico por conglomerados. Como medidas de asociación se estimaron las razones de prevalencia ajustadas (RPa) usando modelos de regresión. Se entrevistaron 206 familias. El 7% saben que la enfermedad del dengue es causada por un virus y menos del 40% reconocen otros síntomas diferentes a la fiebre. El 31% practica la eliminación de criaderos y el 58% fumiga como estrategias de control. El 73% percibe el riesgo de dengue. Se estimó una asociación significativa de la percepción del riesgo de dengue con el conocimiento sobre el vector (RPa = 3,32 IC95% 1,06-10,36). Además, el antecedente de diagnóstico de dengue se asoció con la actitud frente a su control (RPa = 1,61 IC95% 1,09-2,37). La percepción del riesgo y la experiencia con dengue podrían ser determinantes de los CAP en relación a esta enfermedad.

Experiencia y percepción del riesgo asociados a conocimientos, actitudes y prácticas sobre dengue en Riohacha, Colombia / Experience and perception of risk associated with knowledge, attitudes and practices regarding dengue in Riohacha, Colombia

Resumen Para el control del dengue es esencial el reconocimiento de los determinantes de los conocimientos, actitudes y prácticas (CAP), los cuales podrían estar condicionados por las experiencias y percepciones de la población a riesgo. El propósito de este artículo es estimar la asociación entre la percepción del riesgo y la experiencia de dengue con los CAP sobre dengue, en una población endémica de Colombia. Estudio analítico de corte transversal y muestreo probabilístico, polietápico por conglomerados. Como medidas de asociación se estimaron las razones de prevalencia ajustadas (RPa) usando modelos de regresión. Se entrevistaron 206 familias. El 7% saben que la enfermedad del dengue es causada por un virus y menos del 40% reconocen otros síntomas diferentes a la fiebre. El 31% practica la eliminación de criaderos y el 58% fumiga como estrategias de control. El 73% percibe el riesgo de dengue. Se estimó una asociación significativa de la percepción del riesgo de dengue con el conocimiento sobre el vector (RPa = 3,32 IC95% 1,06-10,36). Además, el antecedente de diagnóstico de dengue se asoció con la actitud frente a su control (RPa = 1,61 IC95% 1,09-2,37). La percepción del riesgo y la experiencia con dengue podrían ser determinantes de los CAP en relación a esta enfermedad.

Abstract Recognition of the determinants of knowledge, attitudes and practices (KAP), which could be conditioned by the experiences and perceptions of the population at risk, is essential for the control of dengue. The scope of this article is to estimate the relationship between the risk perception and dengue diagnosis experiences with KAPs on dengue in an endemic Colombian population. A cross-sectional study with multi-stage random sampling was conducted. Adjusted prevalence ratios (aPR) were estimated using regression models as measures of association. Of the 206 families interviewed, 7% know dengue is caused by a virus and less than 40% recognize other symptoms besides fever. As control strategies, 31% eliminate hatchery sites and 58% use fumigation, though 73% perceive the risk of dengue. The association was identified between the perception of the risk of dengue and knowledge about the vector (aPR = 3.32 CI95% 1.06-10.36), and the experience of diagnosis of dengue with the attitude towards dengue control (aPR = 1.61 CI95% 1.09-2.37). Risk perception and experience with dengue could become determinants of KAPs in relation to this disease.

Prueba de concepto de una pcr multiplex de primera generación (cualitativa) para detección del oncogén e7 de vphs de alto riesgo

Introducción: Infección persistente con el virus de papiloma humano de alto riesgo (VPH-AR) causa cáncer de cuello uterino (CCU). Existen ensayos moleculares para la detección y la genotipificación del gen L1 de VPH, sin embargo, L1 puede perderse durante la integración viral. La expresión e integración del oncogén E7 es fundamental para el desarrollo de CCU. Objetivo: Estandarizar una PCR multiplex (mPCR) del oncogén E7 (E7-mPCR) para genotipificación de los VPH-AR de mayor frecuencia en CCU (VPH-16, -18, -31, -33, -45 y -52). Métodos: Se obtuvieron cepillados cervicales de voluntarias y se analizaron amplificando por PCR el gen L1 con subsecuente hibridación reversa. Posteriormente, se escogieron 59 muestras positivas para VPH-AR y se analizaron por E7-mPCR. Resultados: Se evidenció una elevada concordancia entre los resultados del ensayo E7- mPCR y los de la PCR de L1 (concordancia observada de 95,1%, Kappa de Cohen = 0,88), encontrándose mayor número de infecciones por VPH- AR en el 15,8% con E7-mPCR. Conclusión: E7-mPCR es una herramienta diagnóstica con alta concordancia y económica que puede adaptarse a una plataforma de mayor complejidad para procesar y detectar mayor cantidad de muestras y genotipos de VPH-AR.

Introduction: The persistent infection of the high-risk Human Papiloma Virus (VPH-AR in Spanish) causes uterine cervix cancer (CCU in Spanish). There are molecular essays for detection and genotyping of gen L1 of VPH. However, L1 may get lost during the viral integration. The expression and integration of oncogene E7 is fundamental for the development of CCU. Objective: To standardize a multiplex PCR (mPCR) of oncogene E7 (E7-mPCR) for genotyping the VPH- AR of highest frequency in CCU (VPH-16, -18, -31, -33, -45 y -52). Method: We obtained cervix brushing simples from volunteers and we analyzed them by amplifying the L1 gene through PCR with a subsequent reverse hybridization. After that, we chose 59 positive VPH- AR samples and we analyzed them for E7-mPCR. Results: We found out a high concordance between the results of the essay E7-mPCR and those of L1 PC (Observed concordance was of 95.1%, Cohen's Kappa = 0.88), and we revealed a higher number of infections for VPH-AR in a 15.8% with E7-mPCR. Conclusion: E7-mPCR is an economic diagnostic tool with high concordance which can be adapted to a platform with more complexity to process and detect a higher number of samples and VPH-AR genotypes.

Introdução: a infecção persistente com o virus de papiloma humano de alto risco (HPV-AR) causa cáncer de colo do útero (CCU). Existem ensaios moleculares para detecção e para a genotipificação do gene L1 de HPV; contudo, L1 pode ser perdido durante a integrado viral. A expressão e integração do oncogênese E7 é fundamental para o desenvolvimento do CCU. Objetivo: padronizar uma PCR multiplex (mPCR) do oncogênese E7 (E7-mPCR) para genotipificação dos HPV-AR de maior frequência no CCU (HPV-16, -18, -31, -33, -45 e -52). Métodos: foram realizadas raspagens com escova cervical rodada em voluntárias e foram analisadas a partir da amplificação do gene L1 por PCR com subsequente hibridação inversa. Em seguida, foram escolhidas 59 amostras positivas para HPV-AR, as quais foram analisadas por E7-mPCR. Resultados: foi evidenciada elevada concordância entre os resultados do ensaio E7-mPCR e os da PCR de L1 (concordância observada de 95,1%, Kappa de Cohen = 0,88), encontrando-se maior número de infecções por HPV-AR em 15,8% com E7-mPCR. Conclusão: E7-mPCR é uma ferramenta diagnóstica com alta concordância e económica que pode ser adaptada a uma plataforma de maior complexidade para processar e detectar maior quantidade de amostras e genótipos de HPV-AR.

Environmental and socioeconomic determinants of leptospirosis incidence in Colombia.

Human leptospirosis is an infection that most often affects tropical countries. Since 2007, Colombia requires the notification of disease cases, enabling the observation of an increase in cases in recent years. The objectives of this article were to analyze environmental and socioeconomic variables and to evaluate their relationship with human leptospirosis cases. This is an ecological study on human leptospirosis cases aggregated by municipality and reported between 2007 and 2016. Spatial aggregation assessment was made using the Getis-Ord Gi method, and negative binomial regression was used to evaluate the relationship between environmental and socioeconomic variables with human leptospirosis. During the study period, 9,928 cases of human leptospirosis were reported, and 58.9% of municipalities reported at least one case. Four hotspots of human leptospirosis, including 18 municipalities, were identified. The results of the negative binomial model confirmed the importance of the effects of education, poverty and some climatic variables on the decadal incidence rate of human leptospirosis. Our results confirm the importance of socioeconomic determinants such as social marginality associated with violence and education, as well as ecological variables such as rainfall, height above sea level and forest coverage on the incidence rate of human leptospirosis at municipal scale.

Environmental and socioeconomic determinants of leptospirosis incidence in Colombia / Determinantes ambientales y socioeconómicos asociados con incidentes en casos de leptospirosis en Colombia / Determinantes ambientais e socioeconômicos associados a casos incidentes de leptospirose na Colômbia

Human leptospirosis is an infection that most often affects tropical countries. Since 2007, Colombia requires the notification of disease cases, enabling the observation of an increase in cases in recent years. The objectives of this article were to analyze environmental and socioeconomic variables and to evaluate their relationship with human leptospirosis cases. This is an ecological study on human leptospirosis cases aggregated by municipality and reported between 2007 and 2016. Spatial aggregation assessment was made using the Getis-Ord Gi method, and negative binomial regression was used to evaluate the relationship between environmental and socioeconomic variables with human leptospirosis. During the study period, 9,928 cases of human leptospirosis were reported, and 58.9% of municipalities reported at least one case. Four hotspots of human leptospirosis, including 18 municipalities, were identified. The results of the negative binomial model confirmed the importance of the effects of education, poverty and some climatic variables on the decadal incidence rate of human leptospirosis. Our results confirm the importance of socioeconomic determinants such as social marginality associated with violence and education, as well as ecological variables such as rainfall, height above sea level and forest coverage on the incidence rate of human leptospirosis at municipal scale.

La leptospirosis humana es una infección que afecta a la mayoría de países tropicales. Desde 2007, la notificación de esta enfermedad es obligatoria en Colombia, reflejando un aumento de casos observado durante los últimos años. Los objetivos fueron analizar las variables ambientales y socioeconómicas y evaluar su relación con los casos de leptospirosis. Se llevó a cabo un estudio ecológico de casos de leptospirosis humana agregados por municipio, registrados entre 2007 y 2016. La evaluación de la agregación espacial fue desarrollada mediante el Getis-Ord Gi method, y se implementó una regresión negativa binomial para evaluar la relación entre las variables ambientales y socioeconómicas con la leptospirosis humana. Durante el periodo de estudio, se registraron 9.928 casos de leptospirosis humana, y un 58,9% de los municipios informaron de al menos un caso de leptospirosis. Se identificaron cuatro epicentros de leptospirosis humana, incluyendo 18 municipios. Los resultados del modelo binomial negativo confirmaron la importancia de los efectos de la educación, pobreza y algunas variables climáticas en la tasa de incidencia de leptospirosis humana por decenios. Nuestros resultados confirmaron la importancia de determinantes socioeconómicos tales como: marginalidad social, asociada con la violencia y educación, así como variables ecológicas como: precipitaciones, altura sobre el nivel del mar y superficie forestal en la tasa de incidencia de la leptospirosis humana dentro una escala municipal.

A leptospirose humana é uma infecção que majoritariamente afeta países tropicais. Desde 2007, a notificação da doença é compulsória na Colômbia, o que levou a um aumento do número de casos nos últimos anos. Os objetivos foram analisar variáveis ambientais e socioeconômicas e avaliar sua relação com casos de leptospirose humana. Foi feito um estudo ecológico de casos de leptospirose humana notificados entre 2007 e 2016 agregados por município. Uma análise de agregação espacial foi desenvolvida por meio do método Getis-Ord Gi e regressão binomial negativa foi implementada para avaliar a relação entre variáveis ambientais e socioeconômicas e leptospirose humana. Durante o período do estudo, 9.928 casos de leptospirose humana foram notificados e 58,9% de municípios notificaram ao menos um caso de leptospirose. Quatro hotspots incluindo 18 municípios foram identificados. Os resultados do modelo binomial negativo confirmaram a importância dos efeitos de educação, pobreza e algumas variáveis climáticas na taxa de incidência decenal de leptospirose humana. Nossos resultados confirmam a importância de determinantes socioeconômicos tais como marginalidade social associada a violência e educação, bem como as variáveis ecológicas, tais como precipitação, altitude acima do nível do mar e cobertura florestal sobre a incidência de leptospirose humana no nível municipal.

Association between the level of education and knowledge, attitudes and practices regarding dengue in the Caribbean region of Colombia.

BACKGROUND: Community integration in dengue control requires assessments of knowledge, attitudes and practices (KAPs), which can vary widely according to demographic and educational factors. We aimed to describe and compare the KAPs according to level of education in municipalities in the Caribbean region of Colombia. METHODS: A survey was administered from October to December 2015, including families selected through probabilistic sampling in eleven municipalities. The analysis focused on the comparative description of the responses according to level of education. The KAP prevalence ratios (PR) according to education were estimated using Poisson regression (robust), including age and sex as adjustment variables. RESULTS: Out of 1057 participants, 1054 (99.7%) surveys were available for analysis, including 614 (58.3%) who had a high school level of education or higher and 440 (41.7%) who had a lower level of education (not high school graduates). The high school graduates showed a higher frequency of correct answers in relation to knowledge about dengue symptoms and transmission. On the other hand, graduates showed a higher probability of practices and attitudes that favor dengue control, including not storing water in containers (PR: 2.2; 95% Confidence Interval [CI]: 1.42-3.43), attend community meetings (PR: 1.33; 95% CI: 1.07-1.65), educate family members and neighbors in prevention measures (PR: 1.35; 95% CI: 1.15-1.59). CONCLUSIONS: Level of education could be a key determinant of knowledge of the disease and its transmission, as well as attitudes and practices, especially those that involve the integration of community efforts for dengue control.

Estandarización de ELISA para el diagnóstico de fasciolosis bovina, ovina y humana / Standardization of ELISA for the diagnosis of bovine, ovine and human fasciolosis

RESUMEN Introducción: La fasciolosis representa un grave problema para el sector pecuario y la salud humana en muchos países. En Colombia, afecta principalmente al ganado bovino y ovino, con escasos reportes en humanos. Objetivo: Estandarizar un Ensayo de Inmunoadsorción Enzimática para bovinos, ovinos y humanos como herramienta de tamizaje de fasciolosis. Metodología: Se utilizaron 50 muestras de bovinos, 50 de ovinos y 39 de humanos con diagnóstico de fasciolosis confirmado por serología y examen de materia fecal. Se utilizaron cuatro presentaciones del antígeno excretor-secretor de Fasciola hepatica. Se calcularon la sensibilidad, la especificidad y la concordancia. Resultados: La sensibilidad del ELISA en humanos, ovinos y bovinos fue de 100% y la especificidad fue de 97%, 85,2% y 96,2%, respectivamente. El coeficiente Kappa de Cohen fue superior a 0,8 en las tres especies. Conclusiones: La prueba de ELISA estandarizada para el diagnóstico de la fasciolosis humana, ovina y bovina demostró una excelente sensibilidad y buena especificidad. Se propone realizar la validación a mayor escala para su posterior uso como herramienta en el tamizaje de esta parasitosis.

ABSTRACT Introduction: Fascioliasis represents a serious problem for livestock production and human health in the world. In Colombia, it mainly affects bovine and ovine cattle, with few cases reported in humans. Objective: To standardize an Enzyme-Linked ImmunoSorbent test (ELISA) in bovine, ovine, and human individuals as a screening tool of fascioliasis. Methods: 50 bovine, 50 ovine and 39 human samples with fascioliasis confirmed by serology and stool test were used. Sensitivity, specificity and concordance were calculated. Results: Sensitivity of the ELISA in humans, bovine and ovine cattle was 100 % and specificity was 97%, 85.2% and 96.2%, respectively. Cohen´s Kappa coefficient was >0.8 in all groups. Conclusions: Standardized ELISA test for bovine, ovine and human fascioliasis exhibited an excellent sensitivity and good specificity. It is proposed to carry out a large-scale validation for its ulterior use as a screening tool for the diagnosis of this parasitic infection.

ADE and dengue vaccination.

The vaccine against Dengue virus (DENV), Dengvaxia® (CYD), produced by Sanofi-Pasteur, has been registered by several national regulatory agencies; nevertheless, the performance and security of this vaccine have been challenged in a series of recent papers. In this work, we intend to contribute to the debate by analyzing the concept of an enhancing vaccine, presenting objections to the epidemiological model base of the concept and, likewise, presenting data that contradict that concept.