Doris Gómez Camargo

Concordancia entre cinco definiciones de síndrome metabólico. Cartagena, Colombia

Fundamentos: Durante la ultima decada el sindrome metabolico fue definido en cinco diferentes guias. Con cada definicion se modifica la capacidad predictiva del sindrome sobre la enfermedad cardiovascular. El objetivo del presente estudio fue determinar el grado de concordancia entre estas cinco guias en Cartagena (Colombia). Metodos: Se realizo un estudio de corte transversal en adultos. El tamano minimo de muestra se estimo con informacion del censo DANE 2005. Se realizo un muestreo por conglomerados bietapico que incluyo 670 individuos. Para estimar la prevalencia del sindrome se aplicaron las guias OMS (Organizacion Mundial de la Salud), AHA/NHBLI (Asociacion Americana del Corazon), ATPIII (Panel de Tratamiento de Adultos), IDF (Federacion Internacional de Diabetes) y JIS (Declaracion Provisional Conjunta). La concordancia fue calculada con el indice Kappa de Cohen. Resultados: Segun las guias JIS, IDF, ATPIII, AHA/NHBLI y OMS, la prevalencia de sindrome metabolico fue del 36,3%, 35,1%, 30,3%, 24,2% y 4,9% respectivamente. La concordancia entre JIS e IDF fue de 0,893 mientras que el indice entre estas guias y AHA/NHBLI fue de 0,778 y 0,750 respectivamente. El ATP III tuvo una concordancia mas baja con JIS e IDF (0,711 y 0,645, respectivamente) pero con AHA/NHLBI la concordancia fue de 0,863. La OMS presento un acuerdo con las demas guias de entre 0,14 y 0,16. Conclusiones: Existe concordancia significativa entre las cuatro guias mas recientes. Los puntos de corte para obesidad abdominal podrian justificar las diferencias encontradas.

Análisis filogenético de secuencias suramericanas del gen ns1 del serotipo dengue-2, relacionadas con sangrado clínico severo

Objective The objective of this in silico study was to compare nucleotide and amino acids DENV-2-NS1 sequences isolated from febrile patients, with and without disease severity, from different South American countries. Matherials and Methods A bayesian MCMC phylogenetic analysis was carried out using 28 complete sequences of the gene NS1 of the DENV-2 serotype (1 056 bp), using MrBayes v.3.2.0 software, with the model SYM+G (2.5 million generations). We also carried out a phylogenetic analysis with Neighbor-Joining method (Jukes-Cantor model). In addition, the amino acids sequences were aligned and compared with each other, using Clustal W included in MEGA v.5.2 software. Results In the amino acids sequences associated with bleeding, the most frequent substitution was isoleucine → threonine at posicion 93. These sequences showed a high percentage (94.6 %) of amino acid homology in comparison with the percentage of amino acids homology (74 %) of DENV-2 isolates not associated with bleeding. Five clades were identified that group the vast majority of the DENV-2-NS1 sequences analyzed (19/24; 79.2 %) with posterior probability values greater than or equal to 58 %. Seven sequences (87.5 %) associated with bleeding were phylogenetically related within clades 4 and 5, the posterior probability values were 58 % and 97 %, respectively. Conclusion Neither phylogenetic characteristics nor differences between amino acids of the DENV-2-NS1 sequences studied were found that could be associated directly with severity of the disease.

Coexistencia de Pseudomonas Aeruginosa y Candida Albicans en Infecciones Nosocomiales en Cartagena de Indias (Colombia)

Nosocomial infections are a major health problem, whose risk factors include prolonged hospitalization, invasive procedures and broad-spectrum antimicrobial treatments. Pseudomonas aeruginosa and Candida albicans are commonly isolated microorganisms from the respiratory tract of seriously ill patients. It has been shown that these pathogens may have an interaction of great significance where the morphological characteristics and virulence of each organism is significantly expanding mutually modulate risk and severity of urinary and respiratory infections, causing high morbidity and mortality. The aim of this paper is to illustrate the clinical and microbiological characteristics that result from the presence of both P. aeruginosa and C. albicans in critically ill patients in hospitals in Cartagena de Indias (Colombia). In all cases, initial bacterial process (in this case caused by P. aeruginosa) was treated according to antimicrobial susceptibility and found to decrease the bacterial agent, led to the growth of C. albicans and the development of a new infection that worsened the clinical condition of these patients. Joint infections P. aeruginosa and C. albicans should always be suspected in a hospitalized patient, especially in intensive care units where they use the tubes, catheters and other invasive study materials, as these organisms are opportunistic in nature and clearly can worsen the prognosis and lead to complications in patients who have been hospitalized for various causes or diseases of low complexity, a longer hospital stay and increasing costs.

Parámetros hematológicos de pacientes con fibrosis quística de la costa caribe colombiana: análisis y asociación con aislamiento de pseudomonas aeruginosa

Hemogramme is a fundamental tool to asses cystic fibrosis (CF) patients, because multiple factors could change its parameters. The aim of this study was to analyze and describe hematologic patterns of CF patients and determinate their association with infection by Pseudomonas aeruginosa and administration of micronutrients. A conventional Hemogramme, sputum culture, medical history and physical examination were performed to 19 CF patients. 7 patients (36.8%) presented anemia, only symptomatic in one patient and mild in all cases. 4 patients (21%) received an inadequate supplementation with micronutrients. It wasn’t a significant association between anemia and micronutrients supplementation regimen with RR 0,63 CI95%(0,18 – 3,81). 4 (21%) presented leucocytosis, in 2 patients (10.5%) we found eosinophilia. We isolated Pseudomonas aeruginosa in 8 patients (42%). Finding a significant association between anemia and infection by Pseudomonas aeruginosa with a un RR of 8,25 CI95%(1,22 – 12,06), not being significant between abnormalities in leucocytes values and Pseudomonas aeruginosa. The prevalence of anemia in our study was higher than what is reported in literature and it’s probably a ferropenic anemia, that is maybe related to infection by Pseudomonas aeruginosa, while administration of micronutrients is possibly not related with that. Lots of factors in CF patients influence levels of leucocytes without having any clinical manifestation. Chronic administration of drugs could be an important factor that could alter hematologic parameters.