Biomedica : revista del Instituto Nacional de Salud最新文献

The lionfish (Pterois volitans) is an invasive species in the Caribbean Sea that can accidentally inject venom into humans through its spines. Here, we report a case of lionfish envenomation, highlighting a potential emerging threat to public health in Colombia. The case describes a healthy 59-year-old woman who suffered an accidental sting on the fourth finger of her left hand after contact with a lionfish spin while diving in Aruba.On-site treatment included hot compresses, antihistamines, and systemic corticosteroids. However, the patient experienced severe pain, coldness, and paleness in the affected finger. One day later, the patient traveled to Bogotá, Colombia, and developed swelling, loss of sensitivity, and changes in skin coloration. In the emergency unit, the patient received pharmacological treatment with 100 mg of aspirin administered orally and 60 mg of enoxaparin administered subcutaneously; also, a calcium antagonist was prescribed for vasospasm management (30 mg of nifedipine 30 administered orally), and complementary studies were ordered. Paraclinical results were normal, and the Doppler ultrasound of the left upper limb arterial vessels showed no abnormalities. The treatment was successful, and the patient fully recovered.Given the novelty of this affection for our country, the patient’s favorable evolution after latestage pharmacological management, and the limitations of the initial treatment, we present a broad discussion based on the review of related literature.

Neisseria meningitidis is the main cause of bacterial meningitis worldwide and is transmitted through respiratory secretions. Meningitis is a serious public health problema because of its high morbidity and mortality rates and the risk of causing epidemics. Although vaccines are available to prevent meningococcal disease, serogroup B infections are still challenging, given that many countries do not include meningococcal B vaccines in their national immunization programs. In addition, recent data suggests somewhat sustained N. meningitidis B infections during the COVID-19 pandemic and increasing levels of meningococcal disease after its control. These findings agree with previous observations indicating that respiratory viruses facilitate respiratory bacterial infections. This essay intends to present epidemiological data on meningococcal disease and discusses studies exploring why the prevention of bacterial and viral infections is an intricate subject.

We present a 28 year-old woman with a five-year history of an asymptomatic slowly growing 10 mm nodule on her right thigh, with clinical features suggestive of either a dermatofibroma or a keloid.The nodule was excised, and histopathological examination revealed prominent dermal granulomas containing numerous giant cells, focal microabscesses, abundant pigmented yeasts with dark walls –some arranged in chains–, and septate hyphae with blackish walls, findings initially suggestive of chromoblastomycosis. The abundance of moniliform hyphae arranged in linear chains allowed us to diagnose cutaneous pheohyphomycosis without hypodermal invasion.We highlight the chronic nature of the condition, its localized presentation, and the prominence of granulomas rich in giant cells –with scarce abscesses– as notable findings.The patient’s clinical course remains unknown, as she did not return for follow-up.

This case is about a previously healthy five-year-old girl who presented with hand, foot, and mouth disease, and subsequently developed onychomadesis one month later, with detachment of the nail plates on both fingers and toes. However, the condition resolved spontaneously.After hand, foot, and mouth disease, she exhibited nail bed elevation at the proximal región of the nails on the second and third fingers of both hands. This elevation was painless, without bleeding, and later involved all toes. The condition resolved spontaneously over the following three months, with new, healthy nail growth.In Latin America, onychomadesis is a rare complication of hand, foot, and mouth disease in our region and is associated with atypical forms of the disease, indicating altered host response to common infections with coxsackie viruses. Reporting such cases is essential to understand these benign and self-limited variations, prevent misdiagnoses, and inform parents appropriately.

Introduction: Previous studies have described an epidemic of HIV-1 in the indigenous Warao population living in the Orinoco Delta, Venezuela. The Warao face extraordinary challenges amid of their ongoing HIV-1 epidemic, the highest reported HIV-1 prevalence in indigenous groups (9.6%) in South America.

Objective: To investigate the antibody reactivity to HIV-1 synthetic peptides in seropositive individuals, with a particular focus on the indigenous Warao population from Venezuela.

Materials and methods: The HIV-1 Pol region from infected patients' isolates was amplified, sequenced, and analyzed using phylogenetic tools. Custom-designed synthetic peptides were derived from conserved regions of HIV-1 glycoproteins 41 and 120, based on reference sequences. Multiple antigen blot assays were used to evaluate the presence of antibodies against synthetic peptides.

Results: The most frequent HIV-1 subtype was B, the most common in Venezuela, although some individuals were infected with subtype A1. Distinct patterns of reactivity to synthetic peptides were observed between the sera of the general population and the Warao population; the sera of the latter exhibited a high intensity of peptide recognition.

Conclusions: The use of synthetic peptides, coupled with the robust performance of multiple antigen blot assays, enriches our understanding of antibody responses in different HIV-1-infected populations.

Nocardiosis is caused by a branched Gram-positive bacillus that affects mostly immunosuppressed patients. The clinical manifestations can be localized or disseminated, and the treatment depends on the affected organs, the severity of the disease, and the susceptibility profile.Nocardiosis should be considered in the differential diagnosis of localized or disseminated abscesses in immunosuppressed patients. Early clinical suspicion would allow the start of empirical treatment, prompt microbiological research, and may positively impact survival.We present a case series of 14 patients with infection by Nocardia spp. who attended different health institutions in Bogotá between January 2008 and November 2023. The clinical microbiology laboratory provided information on demographic, clinical, and laboratory variables.Fourteen patients were analyzed, with an average age of 49.8 years (30 to 72 years); 10 were men, and nine had a diagnosis involving immunosuppression: six had cancer and three had other underlying immunosuppression. Diabetes and hypertension were the most common comorbidities. The infection was chronic in 10 patients; the organs involved were the brain and lungs in 7 cases. Nocardia species’ was identified in five subjects; one of the patients presented infection with Cryptococcus spp. Nocardiosis treatment was prolonged and included trimethoprim-sulfamethoxazole in 12 cases; four patients died.Infection by Nocardia spp. is primarily opportunistic, presents unique clinical and microbiological aspects, and is a differential diagnosis of localized or systemic abscesses in immunosuppressed patients. Clinical suspicion allows a careful approach in terms of diagnosis, and initiation of empiric antibiotic treatment can positively impact survival.

Introduction: International asthma management and prevention recommendations emphasize the importance of early and accurate diagnosis and adequate disease control. However, these aspects remain a serious concern, especially in children with low socioeconomic status.

Objective: To describe asthma prevalence, underdiagnosis, severity, and control among children with low socioeconomic status in Bogotá, Colombia.

Materials and methods: We conducted a cross-sectional study using the International Study of Asthma and Allergies Questionnaire in children aged 7-11 in two public schools. The children with affirmative answers in the questionnaire were evaluated clinically and functionally at the mobile health care unit. Asthma prevalence, underdiagnosis, control level, severity, and patients' quality of life were assessed with validated instruments.

Results: We screened 920 schoolchildren with an age of 9.5 ± 1.1; 186 were evaluated clinically and functionally by spirometry, and 122 of them were diagnosed with asthma (17.2%). Underdiagnosis was 68%. Most patients had moderate and severe asthma, and 90% were cases of not well or very poorly controlled asthma.

Conclusions: Screening children in school settings is a suitable strategy for detecting asthma and reducing underdiagnosis in communities with low socioeconomic status and limited access to health care services. The asthma underdiagnosis and poor disease control were high.

Introduction: Suicide is a public health problem with significant social and economic consequences. In Colombia, suicide affects mostly young people.

Objective: To estimate the years of life potentially lost and the economic burden associated with suicide in Colombia between 2005 and 2021.

Material and methods: We conducted a retrospective study to estimate the years of life potentially lost and the economic burden related to suicide from the perspective of society. We modified the human capital method and considered two scenarios. Information on suicide mortality and economic variables was collected from official sources, and indirect costs due to premature mortality were calculated. The costs are expressed in 2021 US dollars, considering the average of the 2021 representative market rate (COP $3,743).

Results: Between 2005 and 2021, 40,157 deaths by suicide were recorded in Colombia, mainly in young men between 15 and 29 years old. These deaths represented 2,104,731 years of life potentially lost. The total economic costs associated with suicide ranged from USD $4.21 billions to USD $7.1 billions in the two scenarios considered, with an average annual cost between USD $247.6 and USD $422.2 millions in each case. The most densely populated departments had the highest accumulated costs by population rates. Vaupés, Amazonas, and Quindío had the highest costs per thousand inhabitants.

Conclusions: It is necessary to address suicide in Colombia from a comprehensive and multidimensional perspective, investing in mental health programs and preventive approaches to reduce the economic burden and social impact. The results offer valuable information to design suicide prevention policies and strategies and highlight the importance of targeting specific population groups and regions.

Introduction. Oxidative stress and inflammation are biological processes crucial in developing chronic inflammatory diseases.Objective. This study aimed to identify the ancestry components and mitochondrial haplogroups of individuals from various regions of Colombia. We also compared relative frequencies of gen variants potentially associated with oxidative stress response and inflammation.Materials and methods. A structural genomic analysis was conducted on five genomes and 58 exomes from individuals across different regions of Colombia. Genetic ancestry components and mitochondrial haplogroups were evaluated with specific molecular markers. Additionally, we compared the frequencies of gene variants related to oxidative stress and inflammation.Results. Two main ancestry groups were identified: one group exhibited a predominantly African ancestry, having mitochondrial haplogroups L1, L2, L3, B2, and D1; the other group showed predominantly European and East Asian ancestry, having mitochondrial haplogroups H2, U2, B2, A2, C, D1, and D4. Furthermore, non-Afro-Colombian individuals revealed a higher frequency of the variants rs2458236 in the dual oxidase 1 gene (DUOX1), rs2536512 in superoxide dismutase 3 gene (SOD3), rs4073 in interleukin 8 gene (IL-8), and rs1143627 and rs1143634 in interleukin 1 beta gene (IL-1β).Conclusion. This study highlights significant differences in the allele frequencies of gene variants associated with oxidative stress and inflammation. These differences correspond to the primary genetic ancestry components of the individuals studied.