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There is a high percentage of error in the approach of patients with joint pain by primary care physicians. An algorithm can help improve this misdiagnosis problem. Our study seeks to determine the effectiveness of an algorithm when used by primary care physicians for the diagnosis of cases of joint pain patients. A randomized clinical experiment was carried out. Primary care physicians from five cities in Colombia developed a series of clinical cases, which were presented to them through a website on their personal cell phones. Half of the doctors developed the cases using the diagnostic algorithm, and the other half developed the cases without the use of the algorithm. Main measures were proportion of correct diagnosis, number, type of laboratory and diagnostic images requested for the diagnostic approach of clinical cases. Two hundred and twenty-four primary care physicians participated. The overall proportion of cases correctly diagnosed was 37.3% higher in the intervention group; we found a greater difference in cases of spondyloarthritis (60.8%), followed by systemic lupus erythematosus with joint involvement (32.2%), rheumatoid arthritis (30.3%) and osteoarthritis (25.9%). The average number of tests requested to develop clinical cases was lower in the intervention group than in the control group, both globally and for each of the four diseases, with statistically significant differences for each of the comparisons. The diagnostic algorithm proved to be an effective tool when used by primary care physicians; the proportion of correct diagnoses increased, and the number of tests requested in the development of the cases decreased. [ABSTRACT FROM AUTHOR]

Current collaborative efforts in international research with resource-poor nations are frequently paternalistic and deprive these nations of the skills necessary to build independent research capacity. Resource-poor nations have become progressively suspicious of research endeavors originated in industrialized nations that have minimal impact on the health care needs of their populations. The current trend toward globalization requires that certain standards be established to guide these collaborative efforts to create strong partnerships that promote independent evidence-based health research. The objective of this paper is to present a comprehensive approach to health-related international collaborative research with resource-poor nations using as an example a model that has been developed in Colombia, South America.Journal of Perinatology (2007) 27, 738–743; doi:10.1038/sj.jp.7211827; published online 20 September 2007 [ABSTRACT FROM AUTHOR]

Background: The Recreovı´a (PR) program promotes healthy habits and lifestyles through the practice of physical activity (PA) directed and musicalized in public spaces in Bogota´ Colombia, with an average annual attendance of 800,000 participants. The objective of this study was to evaluate the changes in Emotional Facial Expression (EFE) during a PA session of the PR. The emotions evaluated were happiness, sadness, surprise, scare, disgust, and contempt, in addition, the neutral emotional state described by Ekman (1972). Methods: Descriptive cross-sectional study, with 566 subjects aged 15 to 85 years (72.1% women and 27.9% men). The sample was estimated with a 95% confidence interval and a 5% margin of error. The facial expression analysis was performed with the Face Reader facial recognition software and equipment. The data were analyzed through the techniques of Mann-Whitney U and Kruskal-Wallis with SPSS version 24 software. Results: The age ranges were distributed as follows: 15-30 (22.8%), 31- 45 (49.6%), 46-60 (26.9%) and 61-85 (0.7%). Users placed their emotions like this, neutral 47%, happiness 20%, sadness 7%, angry 6%, surprise 3%, scare 4%, disgust 8% and contempt 1%. The differences by gender were found, sadness (women 8%, men 5%, p = 0.007) and angry (women 5%, men 7%, p = 0.040). In the comparison by age, differences were found between 15-30 years and 46-60 years (neutral 35%, 47%, p = 0.000; happiness 27%, 13% p = 0.001; scare 2%, 6% p = 0.016). Conclusions: Neutrality is an emotional state that does not show happiness or sadness, it is hypothesized that during this time the learning processes predominate. The most evoked emotion during the AF session was happiness followed by far by sadness, emotion related to the ambiguities of the movements in the process of learning motor gestures and happiness corresponds to the achievement in the execution that generates adherence to the program Recreovía that contributes to the mental and social health of the participants. Key messages: Reduced levels of physical activity have a great impact on health. A sedentary lifestyle and emotional expressions is a more common risk factor that affects people’s mental health. Mental disorders are a multifactorial condition that affects health, and in this case, physical activity for Bogotanos becomes a vehicle that transforms people’s health and quality of life. [ABSTRACT FROM AUTHOR]

The article offers a taxonomic study of demersal fish of the National Natural Park Gorgona within its area of influence in the Colombian Pacific. Tables and details related to the diversity of families, species and the genera for the order of fishes present, and a taxonomic list including the complete scientific name for each taxon, general information about its distribution, reference to a voucher in a collection and a bibliographic reference are offered.

In 2010, PCV10 was introduced in the Colombian National Immunization Program (NIP) for children, with good vaccination coverage >82% since 2012. However, the NIP does not include routine pneumococcal vaccination for older adults. We assessed trends in mortality rate (MR) due to potential pneumococcal pneumonia (PPP) from 2006-2019. This ecological time-series study used Colombian nationwide administrative databases. We analyzed the pre-PCV10 (2006-2009) and post-PCV10 (2012-2019) periods, excluding the years 2010 and 2011 (transition period). ICD-10 codes included J13-J18. MRs were calculated per 100,000 people and stratified by age groups (<1, 1-4, 5-17, 18-49, 50-59, 60-64 and ≥65 years). The percent of change was calculated by the difference between the average rate in the pre-PCV and post-PCV periods for each age group. Joinpoint regression analysis was performed to assess changes in MRs. Annual percent changes (APCs) for each line segment and average APC (AAPC) over 2006-2019 were estimated. During 2006-2019, there were 102,082 deaths due to PPP. The highest MRs were seen for the age groups <1 and ≥65 years. Mean MRs decreased in age groups <18 years in the post-PCV10 period. A decreasing trend was seen primarily in those <1 year (AAPC -6.8; 95%CI: -8.6;-5.1) and 1-4 years (AAPC -5.0; 95%CI: -7.2;-2.8%) from 2006-2019. In contrast, for the age groups 50-59 years and 60-64 years, there was a significant increasing trend (AAPC 1.6%;95%CI 1.7%-5.1% and AAPC 3.4; 95%CI: 1.7;5.1, respectively) from 2006-2019. In ≥65 years, there was a significant increasing trend from 2011-2016 (APC 6.6; 95% CI: 0.5;13.1), followed by a non-significative decrease trend from 2016-2019 (APC -2.8; 95%CI-10.4;5.5). This study provided additional evidence for the benefits of childhood PCV programs. For older adults, MR has been consistently higher in post-vaccination period compared to pre-vaccination. These findings can inform decision-makers about the needs for pneumococcal vaccination among older adults in Colombia. [ABSTRACT FROM AUTHOR]

We assessed the public health and economic impact of adding males to the existing female-only quadrivalent HPV vaccine (4vHPV) program in Colombia, analyzing different gender-neutral vaccination (GNV) vaccine coverage rates (VCRs). The predicted health outcomes included HPV 6/11/16/18-related disease and deaths averted [cervical intraepithelial neoplasia, cervical, vaginal, vulvar, penile, anal and head and neck cancers, genital warts (GW), and recurrent respiratory papillomatosis], direct healthcare cost prevented by vaccination, and incremental cost-effectiveness ratios (ICERs). [Extracted from the article]

Variables to determine initial inertia were date of diagnosis, HbA1c level at diagnosis, type of treatment time between the diagnosis and pharmacological treatment. Follow-up inertia was found in 84.3% of patients without initial inertia(215 of 255) and associated factors were non-HbA1c between 3-6 months after diagnosis (93%) and inadequate treatment adjustment (7%). [Extracted from the article]

Objective: To evaluate the performance of the Systemic Lupus Erythematosus Risk Probability Index (SLERPI) in Colombian patients with systemic lupus erythematosus (SLE)., Methods: The Colombian cohort included 435 SLE patients and 430 controls with other autoimmune diseases (ADs). Clinical and serological data were collected, and SLE was indicated by SLERPI scores > 7. The American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012, and European League Against Rheumatism (EULAR)/ACR-2019 criteria were used as reference standards. The impact of overt polyautoimmunity (PolyA) on SLERPI performance was assessed. Additionally, multivariate lineal regression analysis was performed to evaluate the contribution of SLERPI features to the overall SLERPI score., Results: SLE patients had higher SLERPI scores (P < 0.0001), with almost 90% meeting "definite" lupus criteria. Main factors influencing SLERPI included immunological disorder (β:44.75, P < 0.0001), malar/maculopapular rash (β:18.43, P < 0.0001), and anti-nuclear antibody positivity (β:15.65, P < 0.0001). In contrast, subacute cutaneous lupus erythematosus/discoid lupus erythematosus (β:2.40, P > 0.05) and interstitial lung disease (β:-21.58, P > 0.05) were not significant factors to the overall SLERPI score. SLERPI demonstrated high sensitivity for SLE, both for the overall SLE group and for those without overt PolyA (95.4% and 94.6%, respectively), but had relatively low specificity (92.8% and 93.7%, respectively). The model showed high sensitivity for hematological lupus (98.8%) and lupus nephritis (96.0%), but low sensitivity for neuropsychiatric lupus (93.2%). Compared to the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria, SLERPI yielded the highest sensitivity and lowest specificity., Conclusion: SLERPI efficiently identified SLE patients in a Colombian cohort, showing high sensitivity but low specificity. The model effectively distinguishes SLE patients, even in the presence of concurrent overt PolyA. Key Points •SLERPI has a high sensitivity, but low specificity compared to ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria in the Colombian population. •Within the SLERPI score, immunological disorder, malar/maculopapular rash, and anti-nuclear antibody positivity are the strongest predictors of SLE. •SLERPI model can efficiently distinguish patients with SLE, regardless of concomitant overt PolyA. •SLERPI demonstrates high sensitivity in identifying hematological and nephritic subphenotypes of SLE., (© 2024. The Author(s).)

Huntington's disease (HD) is a genetic disorder caused by a CAG trinucleotide expansion in the huntingtin ( HTT ) gene. Juan de Acosta, Atlántico, a city located on the Caribbean coast of Colombia, is home to the world's second-largest HD pedigree. Here, we include 291 descendants of this pedigree with at least one family member with HD. Blood samples were collected, and genomic DNA was extracted. We quantified the HTT CAG expansion using an amplicon sequencing protocol. The genetic heterogeneity was measured as the ratio of the mosaicism allele's read peak and the slippage ratio of the allele's read peak from our sequence data. The statistical and bioinformatic analyses were performed with a significance threshold of p < 0.05. We found that the average HTT CAG repeat length in all participants was 21.91 (SD = 8.92). Of the 291 participants, 33 (11.3%, 18 females) had a positive molecular diagnosis for HD. Most affected individuals were adults, and the most common primary and secondary alleles were 17/7 (CAG/CCG) and 17/10 (CAG/CCG), respectively. The mosaicism increased with age in the participants with HD, while the slippage analyses revealed differences by the HD allele type only for the secondary allele. The slippage tended to increase with the HTT CAG repeat length in the participants with HD, but the increase was not statistically significant. This study analyzed the genetic and molecular features of 291 participants, including 33 with HD. We found that the mosaicism increased with age in the participants with HD, particularly for the secondary allele. The most common haplotype was 17/7&#95;17/10. The slippage for the secondary allele varied by the HD allele type, but there was no significant difference in the slippage by sex. Our findings offer valuable insights into HD and could have implications for future research and clinical management.

Human immunodeficiency virus (HIV) infection still represents a major public health problem worldwide, and its vaccine remains elusive. The study of HIV-exposed seronegative individuals (HESN) brings important information about the natural resistance to HIV, allows a better understanding of the infection, and opens doors for new preventive and therapeutic strategies. Among HESN groups, there are some men who have sex with men (MSM) with high-risk sexual behaviors, who represent an adequate cohort for HESN study because of their major HIV exposure without infection. This study aimed to compare the immunological profile of Colombian seronegative MSM with different risk sexual behaviors. This study included 60 MSM at high-risk (n = 16) and low-risk (n = 44) of HIV-1 acquisition. No sex worker nor homozygous delta 32 mutation subjects were included. All participants were negative for anti-HIV-1/2 antibodies and HIV-1 proviral DNA. A higher frequency of sexual partners in the last 3 months before the study participation (median, 30 vs. 2), lifetime sexual partners (median, 1,708 vs. 26), and unprotected anal intercourse (median 12.5 vs. 2) was determined in high-risk MSM than low-risk MSM. High-risk MSM also showed a quiescent profile of T cells and natural killer (NK) cells, with a significantly lower percentage of CD4+CD38+, CD4+HLADR-CD38+, CD4+Ki67+ T cells, and NKG2D+ NK cells (CD3-CD16+CD56+), a significantly higher percentage of CD4+HLADR-CD38-, and a tendency to show a higher percentage of CD8+HLADR+CD38- T cells than the low-risk group. Likewise, they showed higher mRNA levels of Serpin A1 from PBMCs. The results suggest that this MSM cohort could be HESN individuals and their resistance would be explained by a quiescent profile of T cells and NK cells and an increased Serpin A1 expression. Further study on MSM at high risk of exposure to HIV-1 is necessary to better understand the natural resistance to HIV., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Ossa-Giraldo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL., Methods: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities., Results: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively., Conclusions: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

This pilot study aimed to assess the feasibility and possible effects of the "PalliActive Caregivers," nursing intervention, on the uncertainty in illness and quality of life of family caregivers of patients with cancer receiving palliative care. This pilot study used a randomized controlled design. The participants were 80 family caregivers. The experimental group received the novel "PalliActive Caregivers" intervention. Data were collected using a sociodemographic form, the Uncertainty in Illness Scale, the Quality of Life scale, and an Intervention satisfaction questionnaire. The caregivers who received the intervention "PalliActive Caregivers" reported a high degree of satisfaction (9.74 on a 10-point scale). The intervention showed a significant decrease in uncertainty regarding illness in the experimental group (P = .009), as well as a significant decrease in the psychological well-being of quality of life within the experimental and control groups, before and after the intervention (P = .013, P = .010). It is recommended that future studies using the "PalliActive Caregivers" intervention examine the effects on other variables such as the burden of patient's symptoms, caregiver burden and rewards, self-efficacy in symptom management, competence, unmet needs, and satisfaction with care.

Attention Deficit Hyperactivity Disorder (ADHD) is a highly heritable and prevalent neurodevelopmental disorder that frequently persists into adulthood. Strong evidence from genetic studies indicates that single nucleotide polymorphisms (SNPs) harboured in the ADGRL3 ( LPHN3 ), SNAP25 , FGF1 , DRD4 , and SLC6A2 genes are associated with ADHD. We genotyped 26 SNPs harboured in genes previously reported to be associated with ADHD and evaluated their potential association in 386 individuals belonging to 113 nuclear families from a Caribbean community in Barranquilla, Colombia, using family-based association tests. SNPs rs362990- SNAP25 (T allele; p = 2.46 × 10 -4 ), rs2282794- FGF1 (A allele; p = 1.33 × 10 -2 ), rs2122642- ADGRL3 (C allele, p = 3.5 × 10 -2 ), and ADGRL3 haplotype CCC (markers rs1565902-rs10001410-rs2122642, OR = 1.74, P permuted = 0.021) were significantly associated with ADHD. Our results confirm the susceptibility to ADHD conferred by SNAP25 , FGF1 , and ADGRL3 variants in a community with a significant African American component, and provide evidence supporting the existence of specific patterns of genetic stratification underpinning the susceptibility to ADHD. Knowledge of population genetics is crucial to define risk and predict susceptibility to disease.

Aim: To quantify Substance P (SP) and Calcitonin gene-related peptide (CGRP) expression in healthy human periodontal ligament from premolars after root canal preparation with Reciproc Blue, WaveOne Gold, XP EndoShaper and hand files., Methodology: A total of 50 human periodontal ligament samples were obtained from healthy mandibular premolars where extraction was indicated for orthodontic reasons. Prior to extraction, 40 of these premolars were equally divided into four groups, and root canals were prepared using four different systems: Reciproc Blue, WaveOne Gold, XP EndoShaper and a hand instrumentation technique. The remaining 10 healthy premolars were extracted without treatment and served as a negative control group. All periodontal ligament samples were processed, and SP and CGRP were measured by radioimmunoassay. The Kruskal-Wallis test was used to establish significant differences between groups and LSD post hoc comparisons were also performed., Results: Greater SP and CGRP values were found in the hand instrumentation group, followed by the XP EndoShaper, WaveOne Gold and the Reciproc groups. The lower SP and CGRP values were for the healthy periodontal ligament group. The Kruskal-Wallis test revealed significant differences between groups (P < 0.05). Post hoc Least Significant Difference (LSD) tests revealed significant differences (P < 0.05) in SP and CGRP expression between all the comparisons except for the Reciproc Blue and WaveOne Gold group (P > 0.05)., Conclusion: All the root canal preparation techniques tested increased SP and CGRP expression in human periodontal ligament, with hand files and XP EndoShaper instruments being associated with greater neuropeptide release compared to Reciproc Blue and WaveOne Gold files., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

The hospital-to-home transition in palliative care is a vital process that requires continuity of care through the discharge process. However, little is known about the perceptions of patients with cancer and their family caregivers during this important palliative care transition in the Colombian health care context. The purpose of this study was to explore the experiences of the patient-family caregiver dyad in palliative care during the transition process between hospital and home in a health care institution in Bogota, Colombia. Using a grounded constructivist theory design, 30 patients with cancer receiving palliative care and 30 family caregivers participated in this study. The data were collected through 36 dyad interviews conducted in either the hospital or home of the participants. For the analysis, the constructivist analytical method was used. Findings revealed that "Looking for control at the end of life through the bond" was the main category of the study. This category could be further elaborated into 4 categories: (1) yearning for home; (2) recognizing burden; (3) experiencing uncertainty, a lack of control; and (4) achieving control. By understanding the patient and family caregiver perspective of care during the hospital-to-home transition, health care systems have the possibility to implement care programs in palliative care with an innovative educational component for health care professionals.

Multifunctional T cells have been shown to be protective in chronic viral infections. In mycobacterial infections, however, evidence for a protective role of multifunctional T cells remains inconclusive. Short-term cultures of peripheral blood mononuclear cells stimulated with the Mycobacterium tuberculosis RD1 antigens 6-kDa early secretory antigenic target (ESAT6) and 10-kDa culture filtrate antigen (CFP10), which are induced in the early infection phase, have been mainly used to assess T cell multifunctionality, although long-term culture assays have been proposed to be more sensitive than short-term assays for assessment of memory T cells, which are essential for long-term immunity. Here we used a long-term culture assay system to study the T cell immune responses to the M. tuberculosis latency-associated DosR antigens and reactivation-associated Rpf antigens, compared to ESAT6 and CFP10, in patients with pulmonary tuberculosis (PTB) and household contacts of PTB patients with long-term latent tuberculosis infection (ltLTBI), in a community in which M. tuberculosis is endemic. Our results showed that the DosR antigens Rv1737c (narK2) and Rv2029c (pfkB) and the Rv2389c (rpfD) antigen of M. tuberculosis induced higher frequencies of CD4 + or CD8 + mono- or bifunctional (but not multifunctional) T cells producing interferon gamma (IFN-γ) and/or tumor necrosis alpha (TNF-α) in ltLTBI, compared to PTB. Moreover, the frequencies of CD4 + and/or CD8 + T cells with a CD45RO + CD27 + phenotype were higher in ltLTBI than in PTB. Thus, the immune responses to selected DosR and Rpf antigens may be associated with long-term latency, correlating with protection from M. tuberculosis reactivation in ltLTBI. Further study of the functional and memory phenotypes may contribute to further discrimination between the different states of M. tuberculosis infections., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

Immune response to DosR and Rpf antigens from Mycobacterium tuberculosis (Mtb) seems to be important for latency maintenance. Little is known about the dynamics of the immune response to these antigens in an endemic community. Thus, the IFNγ response and cytokine production in response to PPD, Esat6-Cfp10 (E6-C10), DosR and Rpf antigens in healthy HHC of tuberculosis (TB) patients over a 12 (T12) months period (short-term, stLTBI) was investigated. This response was compared with a group of LTBI, who have remained healthy for 5-7 years (long-term, ltLTBI). According to the IFNγ response, two groups of HHCs were identified in stLTBI in response to E6-C10. At T12, E6-C10(+) HHCs displayed a decrease in the IFNγ levels and a generalized decrease in cytokines production. The E6-C10(-) HHC showed an increase in the IFNγ response and cytokine levels. In stLTBI, the responses to E6-C10, DosR, and Rpf may be interpreted as a protective immune response controlling Mtb infection and may be leading to a state of latent infection. Comparing the response of stLTBI and ltLTBI, we observed significant changes in the proportions of CD45RO(+)CD27(+) T cells to specific DosR and Rpf, which may indicate a persistent immune response to Mtb antigens in ltLTBI., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: This study examined whether cultural factors, as compared to geographical distance, have produced a population sub-structure among different groups from the La Guajira population (Amerindian Wayúu and other resident groups) that co-exist within the same region., Aims: The aims of this study were to analyse this population to discover whether cultural barriers result in the sub-structure, to evaluate whether there is a genetic drift effect and to describe migration dynamics using a genetic, genealogical and demographic approach., Subjects: This study examined a sample of 290 individuals who were grouped based on a genealogical criterion to distinguish between native individuals and migrants., Materials and Methods: Using demographic information, the age and gender structure of the population and genetic drift estimators were analysed. Using 15 autosomal microsatellites, heterozygosity, Hardy-Weinberg equilibrium (HWE), inbreeding, sub-structure, recent migration rate and genetic relationships were also evaluated using a Principal Component analysis (PCA) using reference populations., Results: La Guajira is a young population that is growing and exposed to a moderate effect of genetic drift (Neme 11.903). The Wayúu are highly diverse (Ho 0.727) and different from other groups, with the exception of Wayúu-Guajiro. This trend was also observed in other Amerindian populations., Conclusion: This study found a high level of admixture and gene flow within the Wayúu population despite cultural differences. Thus, although the Wayúu population differs from other population groups, it is not an isolated population.

Mycobacterium tuberculosis DosR regulon-encoded proteins elicit strong immune T-cell responses in individuals with latent tuberculosis (LTBI). Also, resuscitation (Rpf) proteins can induce such responses. However, variations in the immunogenicity of the DosR and Rpf proteins have been observed in European and African populations, and no data are published from other geographic areas. In Colombian LTBI and patients with recently diagnosed PTB, we therefore studied the immune response to DosR, Rpf, stress, and nominal antigens from Mtb, in 7-day stimulated cultures. Three DosR (Rv1737c, Rv2029c, Rv2628c) and 2 Rpf (Rv0867 and Rv2389c) antigens were recognized most prominently on the basis of the net IFNγ production (DosR) or the percentage of responding individuals (Rpf). Results show that the selected DosR antigens induced a higher proportion of CD4-T cells producing IFNγ from LTBI, compared to pulmonary TB patients (PTB), while there were no differences in the proportion of CD8-T cells. An increased frequency of CD4, but not CD8 T-cells with a CD45RO(+)CD27(+) phenotype was observed in LTBI in response to Rv2029c, Rv0867c, and Rv2389c, compared to PTB. The levels of cytokines and chemokines in the supernatants of stimulated cells, showed that the DosR and Rpf antigens induced higher levels of IFNγ in cultures from LTBI compared to PTB, although the induced pattern of cytokines and chemokines was also antigen dependent. In summary, our results are consistent with the significant immunogenicity of Mtb DosR and Rpf antigens in LTBI individuals, and confirm and extend previously reported data from other TB affected human populations., (Copyright © 2011. Published by Elsevier Ltd.)

n a study parallel to the present one, we conducted a genotype characterization of Plasmodium falciparum based on isolates of patients infected with malaria, who come from a small location in Colombia. The analysis involved extraction of DNA from hematological smears, amplification of the dihydrofolate reductase gene and the dihydropteroate synthase (DHPS) gene for each sample by PCR, and detection through mutation-specific primers nested PCR of mutations associated with resistance to pyrimethamine and sulfadoxine. Given the difficulty in quantifying the DNA extracts due to the type of sample and its heterogeneity, different volumes of the product of the first PCR were tested as template for the nested PCR. Surprisingly, for some samples, we found contradictory results between determinations, which differed only in the amount of template used. This prompted a more general concern that in a natural isolate, where the parasite population is heterogeneous, the nested PCR with mutation-specific primers technique can produce erroneous results that underestimate the complexity of the sample. To test this hypothesis, we designed experiments in this study using position 581 of the DHPS gene as an indicator system and constructed samples simulating the heterogeneity of natural samples. In effect, our data show that the results obtained in the nested PCR can be altered by the amount of template used in the reaction and, therefore, some heterogeneous samples might be classified mistakenly as homogeneous, simple mutant or simple wild type. These observations may explain, at least in part, contradictory results found in the literature. Our data also suggest the need for a more cautious approach to interpretation of the results of nested PCR assays with mutation-specific primers and their implications in the definition of resistance to the pyrimethamine-sulfadoxine combination., (Copyright 2001 Elsevier Science (USA).)

Objective: The objective of this study was to investigate whether early discharge from the hospital was feasible for selected very low birth weight (VLBW) infants., Study Design: A randomized clinical trial of discharge of VLBW infants from the neonatal intensive care unit at 1300 gm versus 1800 gm was done comparing weight gain and incidence of infection. Forty-three VLBW infants treated in the neonatal intensive care unit and follow-up clinics of the Hospital Universitario del Valle, Cali, Colombia, were entered into the study at 1300 to 1350 gm when they met behavioral criteria for discharge and the family home was approved., Results: There were no differences in weight gain or incidence of infection in the home group compared with the hospital group. A significant saving in hospital days and hospital costs was realized for the home group. Family cooperation was heightened in the home group., Conclusions: Early discharge from the hospital at weights as low as 1300 to 1350 gm is safe for the VLBW infant when properly selected on the basis of behavioral criteria and environmental approval. The potential savings in hospital costs should be considered when resources are allocated for continued support for these infants.

Preclinical and clinical studies have established the safety and immunogenicity of the chemically synthesised SPf66 malaria vaccine. The present study is a phase III randomised, double-blind, placebo-controlled, efficacy trial completed in La Tola, Colombia. 1548 volunteers over one year of age received three doses of either the vaccine (n = 738) or placebo (n = 810). Active and passive case detection methods were used to document clinical episodes of malaria among the study population. The follow-up period began one month after the third dose and lasted for one year. 168 and 297 episodes of Plasmodium falciparum malaria were documented in the SPf66 group and the placebo group, respectively; this corresponds to a crude protective efficacy of 38.8%. Incidence rates for first or only P falciparum malarial episodes were 22.3% per annum among the vaccinee group and 33.5% among the placebo group (RR = 1.5; 95% Cl 1.23, 1.84). Therefore, the protective efficacy of SPf66 against first or only episodes was 33.6% (95% Cl 18.8, 45.7), being highest in children aged 1-4 years (77%) and adults older than 45 years (67%). The estimated protective efficacy against second episodes was 50.5% (95% Cl 12.9-71.9). Our study shows that the chemically synthesised SPf66 malaria vaccine is safe, immunogenic, and protective against P falciparum malaria in semi-immune populations subject to natural challenge.