Rosa Magdalena Uscátegui

Malaria vivax en niños: aspectos clínicos y respuesta a la cloroquina

Introducción: En Colombia, no hay información actualizada sobre malaria vivax en niños. Objetivo: Describir el cuadro clínico-paraclínico de la enfermedad y evaluar la eficacia de la cloroquina (dosis estándar) para curar el ataque agudo de paludismo vivax en niños (4-10 años). Metodología: Diseño experimental, balanceado, no ciego; 82 pacientes, residentes en Turbo o El Bagre. Seguimiento, 30 días. Resultados: Los síntomas y signos concordaron con la literatura. Hubo desnutrición de largo plazo en 62%, anemia en 53%, retinol bajo (19 μg/dl), recuento leucocitario normal, pruebas hepáticas y creatinina normales. A los 25-28 días postratamiento todas las alteraciones, excepto la desnutrición, habían desaparecido. Falla de la cloroquina: dos posibles fallas tardías. Proporción de falla según tres técnicas de análisis según la intención de tratar: 2.4% (0 a 24%), según el protocolo 2.6% (0 a 25%), según el peor escenario 7.3% (0 a 29%). Conclusión: El cuadro clínico-paraclínico fue similar al de los adultos. El paludismo, más que la desnutrición, fue responsable de las alteraciones clínicas-paraclínicas. La cloroquina sola, sin primaquina, resultó altamente eficaz para el ataque agudo de malaria vivax en niños y debe conservarse como primera opción terapéutica.

Environmental risk factors and metabolic syndrome components in overweight youngsters

INTRODUCTION The environmental risk factors such as food intake and physival activity, are determinants in the etiology of metabolic syndrome in overweight adolescents. OBJECTIVE To explore the association between environmental risk factors and components presence of metabolic syndrome in overweight youngsters in Medellín. MATERIALS AND METHODS Adolescents between the ages of 10 and 18 were selected for a cross sectional study. Body composition by anthropometry, blood pressure, lipid profile, glucose, insulin, food intake and physical activity level were assessed in the study population. RESULTS The prevalence for metabolic syndrome components of hypertriglyceridemia was 40.9%; hypertension, 20.9%; low HDLc, 15.6%; high waist circumference, 4.0%, and hyperglycemia, 0.9%; the overall prevalence of metabolic syndrome was 3.1%. There was a statistical difference (p<0.005) between the consumption of calories, simple and total carbohydrates and the presence of the components; no association was found between the level of physical activity and the presence of components (p>0.05). The logistic regression model showed a higher probability of having at least one component if the youngster was male (p=0.022), with a higher BMI (Body Mass Index)(p=0.019) and was located in the fourth simple carbohydrates consumption quartile (p=0.036). CONCLUSIONS Environmental risk factors associated with components of metabolic syndrome were the increased consumption of calories, simple and complex carbohydrates, all directly related to the BMI. In contrast, the level of physical activity, family history and personal risk factors showed no association. The metabolic syndrome only occurred in youngsters with obesity.

The Effect of Retinol Supplement on Blood Cytokine Concentrations in Children with Non-Severe Malaria Vivax

Malaria, malnutrition, low concentrations of retinol and intestinal parasitism coexist among the habitants of tropical regions of the world (Nacher, 2002). The Turbo municipality is one of the highly endemic malaria regions of Colombia. During 2006, 5.674 cases of malaria were reported in Turbo, corresponding to annual parasite index >10 (number of malaria cases per 1,000 persons per year). From these, 85% were caused by Plasmodium vivax (Eventos de interes en salud Publica, 2006). Also, the Uraba region, where Turbo is a major urban area, is one of the regions of Colombia with more cases of malnutrition in children under 15 years; 53.3% of children under 10 years presented chronic malnutrition risk (T/E 0.7 mmol/l (20 μg/dL) (WHO, 2009) once malaria receded. Within the children with malaria, 85% had anemia, and their haemoglobin values increased after one month of antimalarial treatment, although anemia persisted in 51% of them (Uscategui & Correa, 2007). During malaria, TH1 cytokines like interferon gamma (IFN ┛) and tumor necrosis factor alpha (TNF-┙), are required to control the primary parasitemia. Nevertheless antinflammatory cytokines or TH2 cytokines, such as interleukin 10 (IL-10) and transforming growth factor beta (TGF-┚), that modulate the proinflammatory effect, must be present along with those of the TH1 type, in order to prevent emergence of immune pathology (Schofield et al., 2005). Some in vitro studies revealed that retinol had an effect on the TH1/TH2 balance, as evidenced by reduction of IFN -┛ and TNF -┙ secretion by TH1 cells or by promoting TH2 cells growth and differentiation to produce larger quantities of the IL-10 (Cantorna et al., 1994; Iwata et al., 2003). Vitamin A deficiency has been associated with an increase in TH1 response, intestinal parasitism and malnutrition (Jason et al., 2002; Azevedo et al., 2005). Furthermore, the prevalence of TH1 cytokines in children with malaria has been associated with severe anemia (Kurtzhals et al., 1999).

Examining for an association between candidate gene polymorphisms in the metabolic syndrome components on excess weight and adiposity measures in youth: a cross-sectional study

BackgroundA polymorphism in a gene may exert its effects on multiple phenotypes. The aim of this study is to explore the association of 10 metabolic syndrome candidate genes with excess weight and adiposity and evaluate the effect of perinatal and socioeconomic factors on these associations.MethodsThe anthropometry, socioeconomic and perinatal conditions and 10 polymorphisms were evaluated in 1081 young people between 10 and 18 years old. Genotypic associations were calculated using logistic and linear models adjusted by age, gender, and pubertal maturation, and a genetic risk score (GRS) was calculated by summing the number of effect alleles.ResultsWe found that AGT-rs699 and the IRS2-rs1805097 variants were significantly associated with excess weight, OR = 1.25 (CI 95% 1.01–1.54; p = 0.034); OR = 0.77 (CI 95% 0.62–0.96; p = 0.022), respectively. AGT-rs699 and FTO-rs17817449 variants were significantly and directly associated with body mass index (BMI) (p = 0.036 and p = 0.031), while IRS2-rs1805097 and UCP3-rs1800849 were significantly and negatively associated with BMI and waist circumference, correspondingly. Each additional effect allele in GRS was associated with an increase of 0.020 log(BMI) (p = 0.004). No effects from the socioeconomic and perinatal factors evaluated on the association of the candidate genes with the phenotypes were detected.ConclusionsOur observation suggests that AGT-rs699 and FTO-rs17817449 variants may contribute to the risk development of excess weight and an increase in the BMI, while IRS2-rs1805097 showed a protector effect; in addition, UCP3- rs1800849 showed a decreasing waist circumference. Socioeconomic and perinatal factors had no effect on the associations of the candidate gene.