Biomedica : revista del Instituto Nacional de Salud最新文献

Introduction. Botulinum toxins have at least 30 therapeutic indications across different medical specialties. Some Latin American studies have described the experience of applying botulinum toxin in isolated clinical contexts. However, researchers have yet to provide comprehensive analysis about its use across diverse clinical indications.Objective. To classify the therapeutic use of botulinum toxin in a public health center in Bogotá, identifying the risks of pharmacological interactions and possible barriers related to its use. This knowledge will promote a better understanding of the indications, practices, and regulations regarding the use of the botulinum toxin in the Colombian context.Materials and methods. A cross-sectional study was conducted to analyze the use of botulinum toxin in a public institution in Bogotá, Colombia, applying the prescriptionindication methodology. Sociodemographic, clinical, and pharmacoepidemiologic data were extracted from medical records and the electronic prescription database Mi prescripción. A bivariate statistical analysis was performed using JAMOVI software, version 2.2.5.Results. A total of 197 patients received a prescription for botulinum toxin. Although the main indication was temporomandibular joint disorder, 70.6% of the prescriptions were classified under neurological conditions. In pediatric patients, the main indication was spastic cerebral palsy (90%). Most described clinical uses (92.4%) were aligned with the indications approved by the Instituto Nacional de Vigilancia de Medicamentos y Alimentos de Colombia. Risks of drug interactions were identified in 30.9% of the cases and were significantly associated with an anticholinergic load (p < 0.001).Conclusions. Botulinum toxin is used for multiple indications in multiple medical specialties. There is consistency between prescription and indication of the medication recommended by regulatory entities. Reviewing patient’s pharmacological history is essential before prescribing botulinum toxin to reduce the risk of drug interactions.

Introduction: Between 1959 and 1969, Colombia implemented the Campaña de Erradicación de la Malaria (Malaria Eradication Campaign) as part of a global initiative.

Objective: To estimate the institutional costs of the Campaña de Erradicación de la Malaria in Colombia.

Material and methods: A partial economic evaluation was conducted to describe costs and outcomes based on microdata from reports by the Servicio de Erradicación de la Malaria, the División de Campañas Directas, and the Pan American Health Organization, from 1958 to 1969. Costs were classified according to the operational phases of the Campaña de Erradicación de la Malaria –attack, surveillance, and maintenance– and expenditures were categorized into personnel, benefits, equipment, and other associated costs.

Results: The total cost of the Campaña de Erradicación de la Malaria was USD $41’788,924; 74.1% funded by national sources. The attack phase accounted for 80.4% of the total expenditure (USD $33’603,645), while the remaining USD $8’185,279 corresponded to the preparatory, consolidation, and maintenance phases. Forty percent of the attack phase expenditure was allocated to personnel responsible for spraying activities, while 19% percent was spent on insecticide acquisition. The average cost per household spraying was USD $2.70. The campaign prevented an estimated 568,439 malaria cases.

Conclusions: The institutional cost of the Campaña de Erradicación de la Malaria in Colombia amounted to USD $41’788,924, with 74.1% corresponding to national resources. Although the campaign prevented an average of 41,965 malaria cases per year, it ultimately failed to achieve malaria eradication.

Introduction. Taeniasis and cysticercosis are diseases caused by Taenia solium prevalent in Latin America, Africa, and Asia, and associated with serious economic and health problems. To date, few studies have evaluated the knowledge, attitudes, and practices related to these parasitoses among health professionals.Objective. To evaluate the knowledge, attitudes, and practices associated with T. solium among students and professionals in the field of bioanalysis, residing in an urban, nonendemic area for T. solium in Maracay, Aragua, central region of Venezuela.Materials and methods. We conducted a cross-sectional study using a survey to collect data from students (n = 41) and professionals (n = 41) of bioanalysis regarding knowledge, attitudes, and practices related to taeniasis and cysticercosis in Maracay, Venezuela.Results. Among all participants, 67.1% recognized T. solium as a public health problem prevalent in rural areas, while 30.5% correctly identified the causative agent. Limited knowledge was observed regarding the transmission of taeniasis (6.1%), human cysticercosis (11.0%), and porcine cysticercosis (17.1%), as well as the signs and symptoms of taeniasis (4.9%) and the characteristics of pork meat infected with T. solium cysticerci (3.7%). Professionals had greater knowledge of taeniasis, porcine cysticercosis, severe disease caused by T. solium, and neurocysticercosis (p < 0.05). Students knew better the causative agent and the preferred diagnostic method for taeniasis (p < 0.05). Most participants exhibited positive attitudes and practices. Professionals outperformed students in providing information regarding T. solium and dealing with patients infected with Taenia spp. (p < 0.05).Conclusion. This study on knowledge, attitudes, and practices regarding T. solium among professionals and students of bioanalysis in Venezuela showed deficiencies in clinical epidemiological and diagnostic aspects. We recommend updating knowledge on taeniasis and cysticercosis and developing further studies with larger sample sizes and the inclusión of other disciplines.

Introduction: The prevalence of tick-borne infections remains unknown in most Latin American countries, including Venezuela.

Objective: To estimate the prevalence of tick-borne infections in humans and dogs in Puerto Ordaz, Bolívar state, Venezuela.

Material and methods: An exploratory, descriptive, and prospective study was conducted involving 181 individuals –who voluntarily agreed to participate and provided their written informed consent– and 10 dogs brought in by their owners. A clinical-epidemiological survey was conducted, and venous and capillary blood samples were collected. Buffy coat and blood smear tests were prepared and stained using Giemsa.

Results: Tick-borne infections were detected in 85.1% (n = 154) of the participants. The most frequent infection was caused by Ehrlichia spp. (n = 153; 84.5%), followed by Babesia spp. (n = 39; 21.5%), and Anaplasma spp. (n = 39; 21.5%). Women were the most affected (n = 117; 64.6%), with ages ranging from 5 to 97 years. Among infected individuals, 29.3% (n = 53) were co-infected with Ehrlichia spp. and Babesia spp., while 6.4% (n = 12) presented co-infection with all three pathogens under study. All the dogs (n = 10) presented tick-borne infections: 10 with Ehrlichia spp., 5 with Anaplasma spp., and 5 with Babesia spp. A statistically significant association was found between the presence of peridomestic ticks –favored by not walking the dog and having sick or elderly individuals– and tick-borne infections (p < 0.05).

Conclusions: A high prevalence of tick-borne diseases is evidenced, both in the studied humans and dogs.

Introduction: Nesfatin-1, a peptide coded by the NUCB2 gene, has recently been implicated in the regulation of insulin synthesis and glucose homeostasis. These findings suggest a potential role for nesfatin-1 in the etiology of type 2 diabetes mellitus.

Objective: To analyze the relationship between circulating levels of nesfatin-1 and type 2 diabetes mellitus.

Material and methods: We used PubMed, Scopus, and DOAJ platforms to search published articles from 2012 to 2024. The keywords used were “diabetes mellitus”, “diabetes”, “type 2 diabetes”, “nesfatin-1”, “NUCB2”, “ELISA”, “plasma”, and “serum”. We included all case-control and cross-sectional studies conducted in humans, with full-text availability, and written in English or Spanish.

Results: We included eight studies comprising 305 patients with type 2 diabetes mellitus and 205 controls. The results showed a significant relationship between nesfatina-1 and type 2 diabetes mellitus with a high heterogeneity index (t2 = 3.91; χ2 = 349.63, p < 0.00001; I2 = 98%).

Conclusions: The results show a significant relationship between nesfatin-1 and type 2 diabetes mellitus, supporting its potential use as a biomarker for this disease

Introduction: Aedes albopictus has spread to 85 countries due to its ability to adapt to new climatic conditions. In Ecuador, it was first identified in Guayaquil in 2017 and since then it has expanded into new geographical areas. Its importance for public health has been linked to its vector capacity to transmit arboviruses.

Objective: To characterize Ae. albopictus breeding sites that have contributed to its dispersal into geographical regions of Ecuador without prior records.

Material and methods: Entomological sampling was conducted in 18 provinces between 2018 and 2024. We collected larvae from various types of water-holding containers. We generated spatiotemporal distribution maps of Ae. albopictus and performed statistical analyses to identify significant differences in the number of mosquitoes between different breeding sites.

Results: Between 2018 and 2024, the presence of Ae. albopictus was recorded in 311 localities in the provinces of Manabí, Guayas, Santo Domingo de los Tsáchilas, Orellana, Imbabura, and Sucumbíos. Cans, tires, and plastic tanks were identified as effective breeding sites, while natural containers, such as bamboo internodes, puddles, and bromelia axils, were less frequent. Spearman’s correlation showed a significant positive relationship (p value < 5.0 × 10-4) between the frequency of breeding sites and the number of individuals.

Conclusions: Entomological surveillance activities contributed to establish Ae. albopictus distribution in urban areas of six provinces in Ecuador. A positive correlation was identified between the number of mosquitoes and the frequency of breeding sites, such as tires, tanks, and other water-holding plastic containers.

This is the first report of hemorrhagic cutaneous syndrome induced by contact with venomous caterpillars in a 29-year-old woman living in the northern Ecuadorian Amazon.Reported cases of hemorrhagic cutaneous syndrome are rare and are characterized by dermal lesions, systemic bleeding, and coagulation abnormalities.The woman had contact on her right thigh with caterpillars resting on the trunk of a tree which resulted in local irritation and pain, headache, dizziness, and vomiting. After 48 hours, ecchymosis occurred at the contact site, the neck, thorax, abdomen, and extremities. She was hospitalized and presented abundant vaginal bleeding and extended coagulation times with a normal platelet count. She was treated with paracetamol and tranexamic acid, achieving resolution of the bleeding and normalization of coagulation parameters. The patient was discharged in good condition; at the six-month follow-up, she remained asymptomatic.Although Lonomia spp. caterpillars are recorded in the Ecuadorian Amazon, this is the first reported case. This report highlights the unavailability of antilonomic serum in the region, underlining the need for implementing strategies to guarantee serum access and promoting medical and community awareness of hemorrhagic cutaneous syndrome by contact with Lonomia spp. in endemic areas.

Introducción. La tuberculosis es la principal causa de muerte en los pacientes con infección por el virus de la inmunodeficiencia humana. La coinfección de Mycobacterium tuberculosis y HIV es muy frecuente. Objetivo. Establecer la prevalencia de la infección por HIV en pacientes hospitalizados con tuberculosis, y determinar sus características y desenlaces. Materiales y métodos. Se realizó un estudio retrospectivo, de corte transversal, en pacientes con tuberculosis -pulmonar o extrapulmonar- y coinfección por HIV, hospitalizados en una institución de referencia de Bogotá entre el 2019 y el 2021. Resultados. En el grupo de los 102 pacientes con tuberculosis, la prevalencia de infección por HIV fue del 52,3% (54). Entre estos 54, 24 pacientes (44,4%) tuvieron confirmación microbiológica o histopatológica de la tuberculosis y, 19 (35,2 %), infección por VIH de novo. En los 54 coinfectados, la mediana de la edad fue de 38 años (RIC: 29-42). El 79,6 % (43/54) fueron hombres. La mediana del número de linfocitos T CD4+ fue de 59 células/μl (RIC: 32-120), y el 72,2 % (39/54) tenía menos de 200 células/μl. El 31,4 % (17/54) de los pacientes con antecedente de infección por HIV recibía terapia antirretroviral. En cuanto a la forma clínica, la tuberculosis fue pulmonar en el 51,9 % (28/54) y extrapulmonar en el 48,1 % (26/54) de los pacientes. La tuberculosis extrapulmonar fue meníngea (29,6 %), miliar (12,9 %), pleural (3,7 %) y peritoneal (3,7 %). Hubo 33,3 % de mortalidad intrahospitalaria, asociada con el número de linfocitos T CD4+ (p < 0,05), el diagnóstico de novo de HIV (p < 0,04) y la presencia de tuberculosis meníngea (p < 0,03). Conclusión. La coinfección de Mycobacterium tuberculosis y HIV es frecuente y se relaciona con una inmunosupresión avanzada, por lo que debe hacerse una búsqueda activa de la infección con HIV en estos casos. La tuberculosis meníngea fue la forma extrapulmonar más frecuente y se asoció con mortalidad.

Snakebite envenomation remains a neglected public health problem in many tropical and subtropical countries. It mainly affects rural populations and has a higher incidence in men. Most cases have been reported in Africa, Latin America, and Asia. More than 300 species of snakes have been identified in Colombia, of which around 18% are of medical importance. This fact places the country as the third with the highest number of cases in the region, with 6,231 reported by 2023. Snakebite envenomation in pregnant women is a rare event, and it implies a higher risk of fetal and neonatal death. We report the case of a newborn with neonatal hypoxia and fetal distress, resulting from a cesarean section of a 22-year-old primigravida at 36 weeks of gestation after an ophidian accident involving a bite in the dorsum of her left hand. The newborn was admitted to the intensive care unit in critical condition and with progressive clinical deterioration. However, following the timely administration of antivenom and mechanical ventilation, the infant showed a remarkable recovery and was discharged after only 12 days of hospitalization. We underline the need to improve the availability of antivenoms and to strengthen pharmacovigilance systems to ensure their effectiveness and safety. In conclusion, this clinical case highlights the importance of an early consultation, the availability and prompt administration of the antivenom, and the expertise of healthcare workers in managing this event in pregnant women and neonates.