Biomedica : revista del Instituto Nacional de Salud最新文献

Introduction: Multiple genetic and environmental factors interact with the development of acute coronary syndrome. Smoking is one of the environmental factors that might alter the metabolic pathways shared by genes associated with this condition.

Objective: To investigate the association of acute coronary syndrome with genetic variants related to inflammation, lipid metabolism, and platelet aggregation among subjects from the northeastern region of Colombia. The effects of interactions between polymorphisms and smoking were also evaluated.

Materials and methods: We analyzed data from 330 acute coronary syndrome cases and 430 controls. Associations between 20 polymorphisms and acute coronary syndrome were evaluated using logistic regression, adjusting for confounders. Gene and smoking interaction terms were calculated, and variants were analyzed separately in smokers and non-smokers for their association with acute coronary syndrome.

Results: Two variants were associated with acute coronary syndrome, rs10455872 in the LPA gene (OR = 2.69; 95% CI: 1.61-4.49) and rs429358 in the APOE gene (OR = 1.93; 95% CI: 1.30-2.87). We identified smoking interactions with the variants rs6511720 in the LDLR gene (p = 0.04) and rs2227631 in the SERPINE1 gene (p = 0.02), with significant effects in non-smokers (rs6511720: OR = 0.40; 95% CI: 0.19-0.88; and rs2227631: OR = 0.69; 95% CI: 0.48-1.00), but not in smokers (rs6511720: OR = 1.28; 95% CI: 0.66-2.46; and rs2227631: OR = 1.30; 95% CI: 0.91-1.87).

Conclusions: Variants in the candidate genes LPA and APOE are associated with an increased risk of acute coronary syndrome in a population from northeastern Colombia. The effects of rs6511720 in LDLR and rs2227631 in SERPINE1 differ according to smoking habits and are significant in non-smokers. These results are helpful for early risk screening of acute coronary syndrome, mainly in individuals without defined conventional risk factors.

Methemoglobinemia results from an increased concentration of methemoglobin in the blood, impairing oxygen delivery to tissues. It is considered a rare condition that requires a high diagnostic suspicion.We report the case of a pediatric patient with malaria who presented with cyanosis and hypoxemia as manifestations of methemoglobinemia induced by primaquine treatment.The patient responded adequately after antimalarial drug suspension and ascorbic acid administration.

Introduction: Psychological resilience and self-compassion are qualities that nurses should have when helping people with health problems.

Objective: To determine the effect of resilience on self-handicapping and self-compassion in nursing students.

Materials and methods: This research has a correlational design. The study sample included nursing students who met the inclusion criteria (n = 369). Data were collected using the Connor-Davidson Resilience Scale, Self-Handicapping Scale, and Self-Compassion Scale questionnaires.

Results: The questionnaire scores of the nursing students were above the average, with 63.91 ± 14.54 for the Connor-Davidson Resilience Scale and 82.68 ± 11.32 for the Self-Handicapping Scale; their self-compassion level was high, with a mean of 13.92 ± 2.87 points on the Self-Compassion Scale. We found a significant negative correlation between the mean scores of the Connor-Davidson Resilience Scale (r = -0.409; p = 0.000) and the Self-Compassion Scale (r = -0.524; p = 0.000) with the Self-Handicapping Scale. We also obtained a positive and significant correlation between the mean scores of the Connor-Davidson Resilience Scale and the Self-Compassion Scale (r = 0.486; p = 0.000). According to the regression analysis, the effect of these two scales on the Self-Compassion Scale was 30.2%.

Conclusions: Considering the study results, we can argue that as the students' resilience and self-compassion increase, their tendency to self-handicap decreases. For health professionals and patients' safety, it is very important to determine the levels of resilience, self-handicapping, and self-compassion because these factors may increase anxiety and stress in nursing students, affecting the proper care of patients during the work period.

Introduction: Entomological surveillance of adult Aedes aegypti mosquitoes provides better risk indicators than in immature stages.

Objective: To determine the usefulness of MosquiTRAP™ traps for Ae. aegypti surveillance, targeted vector control, and the design of dengue prevention measures in Sincelejo, Colombia.

Materials and methods: Forty-nine MosquiTRAP™ traps were deployed over six months to capture gravid Ae. aegypti females in two neighborhoods with historical reports of dengue cases. Entomological indices were calculated to monitor mosquito population dynamics, and the infection frequency of the captured mosquitoes with dengue, zika, and chikungunya virus were assessed. The rates of trap approval and adherence were evaluated, and risk maps were developed based on mosquito abundance. These maps facilitated the identification of specific areas for targeted vector control interventions.

Results: A total of 1,475 mosquitoes were captured, of which 99.1% were identified as A. aegypti. The trap positivity index ranged from 85.7 to 42.9% per inspection, with a mean female Aedes index of two to three mosquitoes per house. Evidence of Ae. aegypti infestation was observed in both neighborhoods, although specific hotspots of high mosquito abundance were identified. No viral infection was detected in the captured mosquitoes.

Conclusions: MosquiTRAP™ traps are useful for Ae. aegypti surveillance as a potential tool to guide vector control and prevention measures for diseases transmitted by this mosquito species.

Introduction. Candida species are the main etiological agent of fungal infections in the pediatric population, especially in neonates and in intensive care unit patients. Invasive candidiasis is associated with unfavorable clinical outcomes, such as prolonged hospitalization time, and mortality.Objective. To describe demographic, clinical and microbiological characteristics of pediatric patients (older than one month and younger than 18 years) hospitalized in a pediatric intensive care unit with a diagnosis of invasive candidiasis between 2012 and 2020.Materials and methods. A retrospective, observational, cohort study was conducted at a high-complexity center in southwestern Colombia.Results. We included 100 pediatric patients diagnosed with invasive candidiasis, 51% female with a median age of 6.5 years (IQR = 2-11.5). We obtained 114 isolates of Candida spp. The median hospital stay was 51 days (IQR = 29-77), with a pediatric intensive care unit stay of 27 days (IQR = 16-58). Tachycardia was present in 85% of the patients 24 hours before Candida spp. isolation. Nearly half of the isolates were found in bloodstream samples (49.1%), respiratory samples (21.9%), and peritoneal fluid (20.2%). The most frequently isolated species were C. albicans (36.8%), followed by non-albicans species, such as C. parapsilosis (22.8%), and C. tropicalis (21.1%). The overall mortality rate at discharge was 36%.Conclusions. In pediatric intensive care units, invasive candidiasis is a common condition representing a significant threat due to its high morbidity, prolonged hospital stay, and considerable mortality rate. While C. albicans remains as the predominant species, non-albicans Candida species exhibit a growing trend, posing new diagnostic and therapeutic challenges.

The growing scientific and biotechnological interest in biobanks highlights the need to establish guidelines that allow for important scientific advances and guarantee the rights of the donors of biological samples and their associated data. In line with this need, on January 13, 2023, the Congress of Colombia enacted Law 2287 on biobanks, beginning a path that other countries have followed for almost 25 years. As a result, new questions Will arise that are beyond the scope of this regulation and transcend bioethical conflicts.This manuscript aims to summarize key aspects of the mentioned law and reflects on its scope from bioethics, the ethics of biomedical research, and other bioethical currents or theories.

Introduction: Sjögren’s syndrome is a systemic autoimmune disease. The usefulness of immunohistochemistry in minor salivary gland biopsies has been described to be helpful in indirectly characterizing the lymphocyte phenotype in difficult diagnosis cases.

Objective: To describe sociodemographic, clinical, serological, histopathological, and immunohistochemical variables in patients with sicca syndrome and a minor salivary gland biopsy focus score greater than or equal to one.

Materials and methods: We conducted an observational, retrospective study that included patients under study for potential sicca syndrome whose minor salivary gland biopsy was available and had obtained a focus score greater than or equal to one. Immunohistochemistry was performed on the minor salivary gland biopsy with chromogen red staining for CD8 T lymphocytes and brown staining for CD4 T lymphocytes. Expression ratio of CD20:CD3 and CD4:CD8 markers was determined with the MoticEasyScan Pro 6™ (MOTIC) device and the QuPath™ software. Qualitative variables were analyzed using the chi-square or Fisher’s exact test, and quantitative variables were analyzed according to their assumption of normality.

Results: Twenty-eight patients were analyzed: 16 patients had Sjögren’s syndrome, and 8 of them had polyautoimmunity. An association was found between atrophy in the minor salivary gland biopsy and development of polyautoimmunity (OR = 11.1; 95% CI: 1.12-112; p value = 0.033). The CD20:CD3 and CD4:CD8 ratios were normal, with no statistically significant differences between patients with and without Sjögren’s syndrome. In the subgroup of patients with Sjögren’s syndrome, CD4 T lymphocytes were predominant, with 15 cases out of 16 with CD4:CD8 ratios equal to or greater than 2:1.

Conclusions: Glandular atrophy was associated with the development of polyautoimmunity and a predominance of CD4 T lymphocytes in patients with Sjögren’s syndrome. This finding highlights the potential value of immunohistochemistry of minor salivary gland biopsies in this group.

Introduction: In a previous study, we identified an inverse relationship between adverse perinatal outcomes and iron status during late pregnancy of women recruited from a maternal hospital in Cartagena, Colombia. Some of these outcomes have also been linked to maternal inflammatory states. However, there is currently no clarity regarding the relationship between iron levels and proinflammatory markers during this period.

Objective: To estimate the relationship between inflammatory markers and serum ferritin in third-trimester pregnancies.

Materials and methods: Serum ferritin, hemoglobin, and proinflammatory cytokine levels were determined in women in Cartagena in their third trimester of pregnancy. We analyzed the relationship between ferritin levels and proinflammatory cytokines, as well as the relationship between serum ferritin, hemoglobin, and inflammatory cytokine levels with adverse perinatal outcomes.

Results: The levels of IL-6 were significantly associated with serum ferritin levels (β = 0.42, SE = 0.21, p = 0.04) but not with maternal age. Maternal serum ferritin had a positive weak correlation with the absolute number of lymphocytes and monocytes. Hemoglobin and maternal serum ferritin were weakly and inversely associated with birth weight. Serum ferritin but not IL-6 or IL-8 was associated with preterm birth.

Conclusions: We observed direct and mild associations of serum iron markers (serum ferritin, hemoglobin, and hematocrit) with lymphocyte counts. The inflammation marker, IL-6, was mildly associated with serum ferritin levels in late pregnancy. Women with elevated white blood cell counts and serum ferritin levels tended to have infants with lower birth weights. This fact suggests a potential involvement of iron in inflammatory processes during pregnancy, and conditions associated with inflammation in the final trimester may have adverse effects on perinatal outcomes.

Introduction. Spending on drugs to treat cancer will increase by 9-12% annually until 2025. For health systems in high and middle-income countries –such as Colombia– and with an increasing trend of new cancer cases, clinical research can contribute to the efficient use of the system resources available without undermining the timeliness and quality of healthcare.Objective. To calculate the savings generated to the Colombian health system by the implementation of externally funded clinical trials for cancer.Materials and methods. We conducted an observational, longitudinal, descriptive, and retrospective study analyzing participant’s medical records of clinical trials between 2016 and 2022 at the Clínica IMAT Oncomédica Auna, Colombia.Results. The total savings to the health system for external financing of oncology drugs was USD $1,526,320, and the monthly weighted average savings per patient was USD $3,257. The participation of breast cancer patients in randomized controlled clinical trials (n = 138) accounted for 24% (USD $369,363) of the total savings. Participants with clinical stage IV and III accounted for 41.7% (USD $636,475) and 31.06% (USD $473,159), respectively, of the total savings to the general social security health system in Colombia from external financing of oncological drugs.Conclusion. The participation of cancer patients in clinical trials mitigated costs to the Colombian health system, especially in women with breast cancer and in those patients with clinical stage IV of the disease.