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Introducción: La brucelosis es un enfermedad zoonotica relacionada al contacto con perros y con ganado vacuno, porcino y caprino, el agente etiológico pertenece al género Brucella con diez especies de importancia para el ser humano; su capacidad para evadir el sistema inmune y sobrevivir en el fago-lisosoma genera un cuadro clínico crónico en el ser humano caracterizado por fiebre ondulante y afectación osteoarticular. Su amplia variedad de expresión clínica genera un reto al momento del diagnóstico y tratamiento; por tal razón es relevante el reconocimiento de las pruebas diagnósticas que permitan establecer el posible contacto con el microorganismo. Objetivo: Establecer la seroprevalencia a Brucella spp en una población de estudiantes de Medicina Veterinaria con posible exposición ocupacional. Materiales y Métodos: Estudio descriptivo observacional donde se estudiaron 272 sueros obtenidos de estudiantes de medicina veterinaria mediante la técnica de rosa de bengala. Resultados: El 18,4% (50/272) de los sujetos presento positividad por rosa de bengala; 28 hombres (56%) y 22 mujeres (44%). Conclusiones: La serología mediante rosa de bengala en esta población de riesgo evidenció un 18,5% de sujetos seropositivos. Se sugiere el empleo de barreras efectivas de protección durante el contacto con animales portadores del microorganismo durante el entrenamiento como estudiantes de Medicina veterinaria.

Introduction: In recent years, Colombia recognized orphan diseases as a problem of public health interest and ordered its mandatory notification. Objective: Describe the information on orphan-rare diseases obtained in Cali through SIVIGILA in the first 2 years of registration. Materials and methods: Analytical cross-sectional observational study. Absolute and relative frequen-cies were calculated. Normality analysis of Shapiro Wilk was performed. Prevalence was calculated. The relationship of different sociodemographic and clini-cal variables and mortality risk was evaluated, using Generalized Linear Models, the Poisson distribution family, Logarithmic link function and robust variance models. Results: 635 cases were notified, 78 in 2016 for a pre-valence of 3,25 / 100.000 and 557 in 2017 for a pre-valence of 23,01 / 100.000. Most cases belong to the tax system. The communes with the highest number of cases and the highest prevalence were 17 and 22. Among the first most common orphan-rare diseases, sickle cell disease was the most reported in Cali with 25 cases in 2016 (prevalence 1,04/100.000) and 77 ca-ses in 2017 (prevalence 3,1/100.000). The estimated crude mortality rate for the study period was 0,83 / 100.000, and the diseases with the highest mortality were sickle cell disease in women (0,12 / 100.000) and polyneuropathy in men (0,13 / 100.000). Discussion: It is necessary to carry out and publish in the future, deeper analyzes through the detailed review of medical records and the incorporation of other available sources such as the Individual Registry of Provision of Services (RIPS) and the Unique Regis-try of Affiliates (RUAF), with in order to reduce the sub-registry and provide the whole community with more precise and detailed information.

Introduction: Glioblastoma (GBM) treatment starts in most patients with surgery, either resection surgery or biopsy, to reach a histology diagnose. Multidisciplinar team, including specialists in brain tumors diagnose and treatment, must make an individualize assessment to get the maximum benefit of the available treatments., Material and Methods: Experts in each GBM treatment field have briefly described it based in their experience and the reviewed of the literature., Results: Each area has been summarized and the consensus of the brain tumor group has been included at the end., Conclusions: GBM are aggressive tumors with a dismal prognosis, however accurate treatments can improve overall survival and quality of life. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case., (Copyright © 2020 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: There are no reports describing polymorphisms in target genes of anti- Toxoplasma drugs in South American isolates., Objective: This study sought to perform cloning and sequencing of the dihydrofolate reductase ( dhfr ) and dihydropteroate-synthase ( dhps ) genes of the reference Rh strain and two Colombian isolates of Toxoplasma gondii ., Materials and Methods: Two isolates were obtained from the cerebrospinal fluid of HIV-infected patients with cerebral toxoplasmosis. A DNA extraction technique and PCR assay for the dhfr and dhps genes were standardized, and the products of amplification were cloned into Escherichia coli and sequenced., Results: One polymorphism (A « G) was found at position 235 of exon 2 in the dhps gene. In addition, two polymorphisms (G « C) at positions 259 and 260 and one polymorphism (T « G) at position 371 within exon 4 of the dhps gene were detected. In this last exon, a bioinformatic analysis revealed a non-synonymous polymorphism in the coding region that could lead to the substitution of Glu (CAA or CAG) for His (encoded by codons AAU or AAC). A structural model of the T. gondii DHPS protein was calculated, and the results revealed modifications in secondary structure due to mutations., Conclusions: The methods described in this study can be used as a tool to search for polymorphisms in samples from patients with different clinical manifestations of toxoplasmosis and to examine their relationship with the therapeutic response.

Introduction: Eight Giardia duodenalis genotypes (A-H) have been described to date. Genotypes A and B have been isolated from humans and a wide range of mammals; however, genotypes C-H have shown greater host specificity., Objective: Identifying G. duodenalis genotypes from cysts in faeces obtained from children attending the Instituto Colombiano de Bienestar Familiar (ICBF) day care centres and from dogs in Ibagué by PCR-RFLP targeting both the b -giardin and glutamate dehydrogenase genes., Materials and Methods: Cysts from G. duodenalis positive samples were concentrated, DNA was extracted and the b -giardin and glutamate dehydrogenase genes were analysed by PCR-RFLP. The MHOM/CO/04/G40 strain was used as positive control (this was obtained from the Grupo de Parasitología at the Instituto Nacional de Salud )., Results: Of the total human samples, 11/23 (48%) were genotyped as A and 12/23 (52%) as B; PCR-RFLP revealed that four canine samples were genotypes C and D, these being host-specific., Conclusions: Only genotypes associated with human infection (AII, BIII and BIV) were found in the children and host-specific genotypes were observed in canines (C and D). No interaction could be established between animal and human transmission cycles due to the small canine sample size and as the former did not come into contact with children attending ICBF day-care centres.

Objective: Evaluating the effect of ivermectin on soil-transmitted helminthes (STH) infection frequency in a Colombian population included in the Onchocerciasis Elimination Program for the Americas (OEPA)., Methods: This was an impact evaluation study which adopted a longitudinal approach using the population of Naicioná (1996) as baseline for comparison to people from the same population as controls (2008). The cross-sectional approach involved comparing the reference population of Naicioná (2008) to the population of Dos Quebradas (2008) used as controls. Fecal samples were processed by a modified Ritchie-Frick method., Results: Ascaris lumbricoides was the most frequently found parasite in Naicioná (60/121; 49.6 %: 37.8-63.895%CI) and in Dos Quebradas (36/76; 47.4 %: 33.2-65.6 95 % CI). Ivermectin's main effect on the population aged over 5 years was a decreased risk of Trichiuris trichiura infection in both longitudinal assessment (86 % reduction: 74-93 95 % CI) and cross-sectional assessment (63 %:24-82 95 % CI). A 93 % reduction (45-99 95 % CI) in Strongyloides stercoralis frequency was found in longitudinal assessment, compared to 85 % in cross-sectional assessment (-031-99 95 % CI)., Conclusions: Ivermectin use in the OEPA is not sufficient for STH morbidity control. Integrated programs including education and basic sanitation are required.

Objective: To assess the nutritional status of orthopaedic patients., Design: Prospective observation study., Setting: Tertiary hospital, Clinical Nutrition Unit., Patients: 107 patients (56.1% women, 43.9% men, 62.1 +/- 20.4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis., Material and Methods: Medical history, anthropometric data and three nutritional screening tools were considered: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). It was assessed the prevalence of malnutrition in patients on admission to hospital, using different methods and determining if a correlation exists between malnutrition and other factors, such as the development of pressure sores of the dependence in activities of daily living., Results: The risk of malnutrition is 22 and 24/100 patients admitted at hospital, if MNA and SGA are used, respectively (SGA caregorized 4% of the group as "malnourished"). 80% patients are considered to be at high risk of malnutrition using MUST. 1.7% patients presented a Body Mass Index (BMI) lower than 18.5. There is a strong agreement between malnutrition and neropsychological status (p = 0.001), and the dependence in activities of daily living (p = 0.002), and between medium and high risk of malnutrition and the development of pressure sores (p = 0.003). If MNA and SGA (p = 0.000) are used, post-surgical patients presents a deteriorating nutritional status., Conclusions: The prevalence of malnutrition in patients on admission to hospital is elevated. Orthopaedic surgery patients with hip and knee prosthesis presented a deteriorating nutritional status, and a higher incidence of pressure sores in a month.

Introduction: The development of polyclonal antibodies requires laboratory animals, as the usually rabbits, which are bled for obtaining the immunoglobulins. Hens are an alternative to developing IgY polyclonal antibodies., Objective: In the current study, hens were used to develop IgY anti-Giardia duodenalis antibodies and to evaluate five protocols for its purification., Materials and Methods: Three hens were immunized intramuscularly immunized with Colombian Giardia duodenalis isolates trophozoites on day 0, 15, 30, 45, 60, 90 and 120. The hen eggs were collected before each immunization, and IgY purified from yolk by delipidation (D) and precipitation (P) using five different protocols: M1: (P: ammonium sulfate/D:dextran sulfate-calcium chloride), M2: (D: dextran sulfate-calcium chloride/P: ammonium sulfate), M3: (D: chloroform/P: ammonium sulfate 50%), M4: (D: solution A/P: solution B) and M5: (D: chloroform/P: ammonium sulfate 30%). The immunochemistry evaluation of IgY anti-Giardia duodenalis was assayed by immunodiffusion, counterimmunoelectrophoresis (CIE) and Western blot. The purity of IgY was assayed by SDS-PAGE under reducing and nonreducing conditions. Immunoglobulin concentration (mg/mL) was estimated by spectrophotometry and densitometry., Results: IgY anti-Giardia duodenalis by CIE had titres up to 1:32. SDS-PAGE, without 2-mercaptoethanol showed a 180 kd band characteristic of the whole to IgY and, with 2-mercaptoethanol, two bands of 68 and 30 kd, characteristic of its light and heavy chains, respectively. The greatest concentrations of immunoglobulin were recovered by method two (M2), producing 4.6 mg of IgY per mL of initial egg yolk., Conclusions: The easy and inexpensive production of IgY anti-Giardia duodenalis in hens is an advantage for using it to develop immunoassays that detect the parasite in fecal eluates.

Introduction: Natural and experimental Giardia infections have been reported from bovines, equines, goats, canines, felines and rodents such as mice, rats and gerbils. The latter have provided successful animal models for Giardia duodenalis and Giardia muris experimental infections., Objective: The gerbil model was used to establish the pattern of infection of Colombian Giardia human isolates., Materials and Methods: Giardia cysts were obtained from stool specimens of symptomatic giardiasis patients by means of sucrose-percoll gradients. Animal inoculation was performed by gastric intubation and injection with 5 x 10(3) Giardia cysts. The course of infection was established by counting cysts every day and trophozoites weekly throughout a period of 30 days., Results: The pattern of cyst excretion was found to be intermittent. Cysts were released during the second and third weeks of infection but not during the first or fourth weeks. The mean minimal number of cysts released per 2-hr collection period was 79 and the mean maximum number was 17,943. Colonization of the small intestine by trophozoites was observed with a mean number ranging from 15,000 to 6,577,778 trophozoites/ml., Discussion and Conclusions: Gerbils inoculated with G. duodenalis isolates obtained from geographical areas outside Colombia resolved the infection between 86 and 114 days after infection, whereas gerbils infected with Colombian G. duodenalis isolates resolved the infection at 30 days. The gerbil proved to be a good animal model for experimental infection with Colombian isolates of G. duodenalis. Experimental Giardia infection of gerbils permit a sufficient yield of cysts and trophozoites to be used as antigens for the immunization of other animals and to obtain Giardia antibodies that could be used for Giardia antigen detection assays in stool specimens.

Background: The non invasive diagnosis of amebic liver abscess allows the use of empirical therapy without the requirement of invasive diagnostic procedures., Aim: To determine the discriminatory capacity of clinical, laboratory and ultrasound studies for the etiological diagnosis of liver abscess., Patients and Methods: Sixty one patients were initially included in this prospective study, but 12 did not comply with the inclusion criteria. Of the rest, 29 (59%) had an amebic liver abscess, 16 (33%) had a pyogenic liver abscess and four (8%) had an abscess of mixed etiology. Blood cultures were done in 42 patients. Ultrasound guided needle aspiration was done in 7 patients with amebic liver abscess and 13 patients with non amebic liver abscess., Results: The clinical picture and ultrasound findings were similar in all types of amebic abscess. ELISA test for IgG anti-Entamoeba histolytica antibodies were positive in 100% of patients with amebic liver abscess. Antibodies measured by gel diffusion were positive in 93%. All patients with mixed liver abscess had positive antibodies and some of them positive culture. Blood cultures were positive for anaerobic bacteria in five patients. Cultures of aspirated material were positive in 7 patients (obligate anaerobic bacteria in 3 and facultative anaerobic bacteria in the rest). The most common complications, whatever the etiology, were right pleural effusion and systemic inflammatory response., Conclusions: A final model of binomial regression analysis revealed that age under 40 years, an hematocrit greater than 35% and an elevation in prothrombin time of less than 1.5 seconds had enough discriminatory capacity for the diagnosis of amoebic liver abscess.

Little is known about the role of IgA in the immune response against Giardia duodenalis infection. The current study identified the antigens of Colombian G. duodenalis isolates which stimulate the production of IgA anti-G. dudoenalis. Cyst and trophozoite stage proteins were separated by SDS-PAGE and their antigenicity was determined by Western blot. Without 2-mercapto ethanol (2-ME), the protein profile of the cyst stage showed 24 proteins within a molecular weight range of 23-270 kDa; with 2-ME, 35 polypeptides ranging from 22 to 241 kDa were distinguished. The trophozoite stage protein profile without 2-ME was formed by 16 proteins within the range of 24-270 kDa; with 2-ME, 45 proteins were present between 18 and 241 kDa. The identification of 20 and 29 antigens from the cyst and trophozoite stage, respectively, suggested that G. duodenalis stimulates a specific humoral immune response in the human host. The antigens of 31, 57, 110, 133, and 170 kDa recognized by anti-G duodenalis IgA in both cysts and trophozoites corresponded with G. duodenalis isolates from other geographic regions, whereas those of 35, 38, 43, 45, 49, 52, 60, 62, 65, 72, 82, 99, 145, 155, and 185 kDa seemed specific to Colombian isolates. This indicated that antigens of 57, 65, 145, and 170 kDa, recognized by anti-G. duodenalis IgA antibodies in cysts (with frequencies between 82% and 96%) and trophozoites (with frequencies between 86% and 97%) can be considered identification markers for G. duodenalis infections.

Antigen profiles were described for Giardia duodenalis cysts and trophozoites that are recognized by IgG and its anti-G. dudodenalis subclasses (IgG1, IgG2, IgG3, IgG4). Antigens were identified by Western blot from G. duodenalis cyst and trophozoite isolates. Cysts and trophozoites were each subjected to protein separation by SDS-PAGE. The proteins were then transferred to nitrocellulose membranes by electroimmunoblot, and their antigenicity was determined by exposing them to sera from patients with confirmed diagnosis of G. duodenalis infection. The antigen-antibody reaction was revealed by specific alkaline phosphatase antibody conjugates against IgG, IgG2, IgG3, IgG4: bands were visualized by addition of the substrate 5-bromo-4-chloro-3-indolyl-phosphate and the stain nitro blue tetrazolium. The bands were read and analyzed by linear regression using Quantity One software. Thirty two antigens were simultaneously recognized by total IgG anti-G. duodenalis in the cyst and trophozoite stages. The antigens varied in molecular weight from 22 to 185 kDa. Nineteen antigens were identified by both IgG, and IgG3 anti-G duodenalis, with molecular weights ranging from 42 to 180 kDa. IgG2 and IgG4 did not identify any antigen in either stage. The antigens of molecular weights 27, 30, 31, 33, 45, 49, 57, 78, 89 and 170 kDa are shared with G. duodenalis isolates from other geographical regions of Colombia. The recognition of cyst and trophozoite antigens of Colombian G. duodenalis isolates by IgG, IgG1 and IgG3 anti-G. duodenalis suggested that they are involved in the induction of the host immune response.

Objective: To determine if a vaccine against influenza significantly decreases episodes of acute upper respiratory infection (AURI) and work absenteeism caused by AURI, in healthy adult employees of a banking entity in the city of Medellín, Colombia., Methods: This was a double-blind randomized placebo-controlled study with 493 volunteers. The volunteers were randomly assigned to two groups, an experimental group and a control group, with 247 and 246 employees, respectively. The experimental group participants received a dose of 0.5 mL of an influenza vaccine containing surface antigens of the strains recommended by the World Health Organization for the 1996-1997 period, with subtypes A/Wuhan/359/95 (H3N2), A/Texas/36/91 (H1N1), and B/Beijing/184/93. An illness was considered an episode of AURI when a participant reported having a sore throat, fever, and a cough lasting more than 24 hours. Evaluations were made every 2 weeks over a 6-month period; the severity of the episodes was assessed in terms of lost workdays due to AURI (defined according to the ninth revision of the International Classification of Diseases, or ICD-9), through monthly evaluations of incapacitating work absences certified by the Colombian Social Security system, over the period of a year., Results: Side effects associated with the vaccine were erythema (relative risk (RR) = 8.0; P = 0.02) and local edema (RR = 4.5; P = 0.03). The proportion of the annual cumulative incidence of episodes of AURI was 78.5% for the vaccinated persons and 91.5% for those in the placebo group, with a reduction of 14%, with values between 7% and 20% (RR = 0.86; 95% confidence interval (CI) = 0.80-0.93). The annual cumulative incidence of incapacitating AURI was 15.8% in those vaccinated, with a reduction of 31% in comparison to the placebo group (22.8%), with values between 0% and 52% (RR = 0.69; 95% CI = 0.48-1.0). These levels of protection, both against more mildly symptomatic forms of AURI and those causing lost workdays, increased significantly (between 62% and 89%) in the months of May and October, when outbreaks caused by the influenza virus were confirmed in Colombia., Conclusions: The results demonstrated that the influenza vaccination strategy decreased the AURI episodes as well as the number of work absences due to AURI in the healthy adult employees of a banking entity in the city of Medellín, Colombia. The impact that influenza has on this population group is small, and the effect of this vaccination measure is greater then the influenza virus is in circulation.

Background: To establish the distribution of the different forms of dominant ataxias and Friedreich ataxia in Spanish population., Patients and Methods: We have performed a molecular study in 121 patients presenting ataxia as the first sign of neurodegenerative disease. In these patients, we have performed a molecular study of SCA 1, SCA 2, SCA 3, SCA 6, SCA 7, SCA 8, DRPLA, alpha-TTP (tocopherol transfer protein) and Friedreich's ataxia genes., Results: The study showed that the Friedreich ataxia is the most frequent form representing 34.4% of the total of the hereditary ataxias. One patient presented mutation in alpha-TTP gene. Among the dominant forms SCA 3 was the most frequent (27.3%) followed by SCA 7 (16%), SCA 6 (9%) and SCA 2 (4.5%). We have not found mutations in SCA 1 and DRPLA genes. Two of 60 apparently sporadic cases presented mutations in the SCA 6 and SCA 8., Conclusions: The genetic analysis is the principal method to distinguish the different clinic forms of ataxia. We have not found mutations in 41.2% of dominant forms and in 43.3% of recessive forms. These results suggest the existence of new candidates genes.

We report a case of a 6-year-old child with a third-degree atrioventricular heart block, ventricular septal rupture, tricuspid regurgitation and pericardial effusion after closed chest trauma. The role of the two dimensional echocardiography and color Doppler flow study in the early and reliable detection of cardiac lesions due to blunt chest traumas pointed out.

Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35.2). Tinea pedis occurred in 25% of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton rubrum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.

Mycological tests were made in 212 patients who had lesions with clinical appearance of dermatophytic infection. The results show that the combined use of direct microscopy and culture helps to detect a larger number of dermatophytic conditions. The findings were the agent most connected with these kinds of mycosis, the most frequent clinical conditions, the lesions in more than one body areas and the most common species. The isolation of Trichophyton soudanense, an endemic species in Africa but considered very rare in Cuba, is reported.

Two cases of chromomycosis of unusual location, one in the face and other in the auricular area, are reported. Though these two areas are highly vulnerable as far as trauma is concerned, the literature reviewed includes few cases in these areas.