El análisis de orina como herramienta diagnóstica en casos de malaria grave

Malaria accounts for a significant morbidity and mortality rate around the world, especially in communities with limited access to healthcare. Some clinical signs in urine, like haematuria, coluria and proteinuria, help for the early diagnosis of severe malaria cases.A narrative review was conducted by analyzing 91 publications on studies about severe malaria cases and the use of urinalysis.A urinalysis can detect metabolic disturbances and organ injury. Its diagnostic utility for frequent complications caused by malaria, such as hepatic injury, kidney dysfunction and hemolysis, has been confirmed by recent Colombian studies.This test is an easy-to-use tool in outpatient clinics and with hospitalized patients to promptly recognize complicated cases, allowing the timely identification of different lesions in patients with malaria, thus contributing to the reduction of severe morbidity and mortality.La malaria produce complicaciones y muerte especialmente en poblaciones con acceso limitado a la atención en salud. La malaria grave puede reconocerse tempranamente mediante la detección en la orina de hallazgos como la hematuria, la coluria y la proteinuria.Se hizo una revisión narrativa basada en estudios sobre malaria grave y el empleo del análisis de orina mediante la consulta de 91 publicaciones.Mediante el análisis de la orina, se pueden detectar alteraciones metabólicas y lesiones en distintos órganos. En estudios recientes en Colombia se ha confirmado su utilidad como apoyo en el diagnóstico de la disfunción renal, la disfunción hepática y la anemia asociada con hemólisis, las cuales son complicaciones frecuentes en la malaria.El examen constituye una herramienta de fácil aplicación en la consulta ambulatoria y en pacientes hospitalizados para reconocer tempranamente casos complicados, y permite la detección oportuna de diferentes lesiones en el paciente con malaria, contribuyendo así a la reducción de la morbilidad grave y la mortalidad

Malaria grave en mujeres gestantes hospitalizadas entre el 2010 y el 2014 en el departamento de Antioquia, Colombia

Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas.Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014.Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used.Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding.Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.Introducción. La malaria (o paludismo) durante la gestación impacta negativamente la salud de la madre y del neonato, con alto riesgo de complicaciones clínicas y mortalidad. En las regiones de alta endemia se han caracterizado, especialmente, la anemia materna y el bajo peso al nacer, pero es poco conocido el espectro clínico en las zonas de baja endemia.Objetivo. Caracterizar clínica y epidemiológicamente los episodios de malaria en mujeres gestantes hospitalizadas en el departamento de Antioquia entre el 2010 y el 2014.Materiales y métodos. Se hizo un estudio descriptivo, transversal y retrospectivo, con historias clínicas de mujeres gestantes con malaria por Plasmodium falciparum y P. vivax. Se utilizaron los criterios diagnósticos de malaria complicada de la Organización Mundial de la Salud (OMS) y de la Guía para la atención clínica integral del paciente con malaria vigente en Colombia.Resultados. Se analizaron 111 casos; el 13,5 % se clasificó como complicación grave según los criterios de la OMS, porcentaje que ascendió a 23,4 % según los criterios de la guía colombiana. Las complicaciones detectadas fueron disfunción hepática, anemia, acidosis y trombocitopenia grave. No se observó diferencia en la frecuencia de las complicaciones según la especie de plasmodio. El 39,4 % de los casos presentó signos generales de peligro; la palidez y la ictericia fueron los más frecuentes. El 40,5 % presentó signos de peligro para la gestación como la cefalea persistente, el dolor abdominal y el sangrado vaginal.Conclusiones. La malaria grave se presenta con gran frecuencia en las mujeres gestantes, sin diferencia según la especie de plasmodio, y se manifiesta con signos de peligro precozmente reconocibles. Se encontró un subregistro hospitalario del 88 % de los casos graves y falta de exámenes de laboratorio para un diagnóstico más completo. Se requiere un protocolo para el diagnóstico clínico de las mujeres gestantes con malaria

Leukogram Profile and Clinical Status in vivax and falciparum Malaria Patients from Colombia

ABSTARCT: Hematological alterations are frequent in malaria patients; the relationship between alterations in white blood cell counts and clinical status in malaria is not well understood. In Colombia, with low endemicity and unstable transmission for malaria, with malaria vivax predominance, the hematologic profile in malaria patients is not well characterized. The aim of this study was to characterize the leukogram in malaria patients and to analyze its alterations in relation to the clinical status. METHODS: 888 leukogram profiles of malaria patients from different Colombian regions were studied: 556 with P. falciparum infection (62.6%), 313 with P. vivax infection (35.2%), and 19 with mixed infection by these species (2.1%). RESULTS: Leukocyte counts at diagnosis were within normal range in 79% of patients and 18% had leucopenia; the most frequent alteration was lymphopenia (54%) followed by monocytosis (11%); the differential granulocyte count in 298 patients revealed eosinophilia (15%) and high basophil counts (8%). Leukocytosis, eosinopenia, and neutrophilia were associated with clinical complications. The utility of changes in leukocyte counts as markers of severity should be explored in depth. A better understanding of these hematological parameters will allow their use in prompt diagnosis of malaria complications and monitoring treatment response

Barriers to the care of febrile patients in a malaria endemic area : El Bagre (Antioquia, Colombia) 2016.

Objetivo: Identificar limitaciones de los pacientes con síndrome febril agudo para acceder a los servicios de atención institucional, con énfasis en la identificación de barreras de comunicación.Método: Estudio descriptivo que involucra técnicas de investigación cualitativa con pacientes de los servicios de atención de la malaria y con personal asistencial y administrativo del municipio de El Bagre Antioquia, Colombia en el 2016. Se aplicaron encuestas semiestructuradas individuales, entrevistas y grupos focales. Los usuarios señalaron dificultades con el transporte, insuficiente número de citas y falta de personal para acceder a la atención. Resultados: Las dificultades de comunicación se relacionaron con la información suministrada sobre trámites y documentación para asistir a los puestos de salud, poca información sobre el diagnóstico, control y adherencia al tratamiento antimalárico y el no uso de algunos pacientes del español para comunicarse en forma verbal o escrita. Conclusiones: Esto exige crear modelos de salud basados en transformaciones estructurales que abarquen las necesidades de los actores del sistema de salud y las comunidades, permitiendo establecer las bases para un proyecto multicultural de sociedad.Objective: identify constraints of patients with acute febrile syndrome to institutional care services access, emphasizing the identification of communication barriers. Method: this is a descriptive study that involves qualitative research techniques including malaria care service patients as well as assistance and administrative personnel of El Bagre town in Antioquia, Colombia in 2016. Semi-structured individual surveys, interviews and focus groups were used. Results: users listed difficulties including transportation, insufficient number of appointments and absence of personnel to access healthcare. Communication difficulties were related to the information provided in the paperwork and documents filled out to attend healthcare facilities, scarce information about diagnostic, control, and adherence to antimalarial treatment; additionally some patients did not use Spanish to communicate in oral or write form. Conclusion: the creation of health models based on structural transformations that encompass the needs of Healthcare System actors and communities is a must, which allows the establishment of foundations for a multicultural society Project

Utilidad de los signos clínicos y parasitológicos en el pronóstico de la malaria grave en Colombia

Introduction. Early recognition of danger signs in patients with malaria can reduce complications and deaths, but little is known about their prognostic value for severe malaria, especially in areas of low transmission and unstable malaria.Objective. To assess the prognostic value for severity of different clinical and parasitological signs in patients with malaria.Materials and methods. A prospective cohort of patients from five municipalities in Colombia with diagnosis of Plasmodium falciparum or P. vivax malaria in whom the association between clinical and parasitological signs with complicated malaria was studied.Results. A predictive model with 47.4% sensitivity, 92.8% specificity, 63.2% positive predictive value and 87.1% negative predictive value was obtained which includes jaundice, dark urine, hyperpyrexia and signs of dehydration.Conclusions. To impact the morbidity of complicated proposed a strategy is proposed for the early recognition of danger signs by non-medical personnel, which could be complemented by other elements of health care, such as providing adequate and appropriate antimalarial treatment. Diagnostic criteria for moderate complication are also proposed.Introducción. El pronto reconocimiento de los signos de peligro en los pacientes con malaria puede reducir las complicaciones y muertes. Sin embargo, se conoce poco sobre su valor pronóstico para la malaria complicada, especialmente en las zonas de transmisión baja e inestable de la enfermedad.Objetivo. Estimar el valor pronóstico de gravedad que tienen diversos signos clínicos y parasitológicos en los pacientes con malaria.Materiales y métodos. Se hizo un estudio en una cohorte prospectiva con pacientes de cinco municipios de Colombia, con diagnóstico de malaria por Plasmodium falciparum y P. vivax, en quienes se estudió la asociación de los signos clínicos y los parasitológicos con la malaria complicada.Resultados. Se obtuvo un modelo de predicción con una sensibilidad de 47,4 % y especificidad de 92,8 %, valor pronóstico positivo de 63,2 % y valor pronóstico negativo de 87,1 %, el cual incluye ictericia, orina oscura, hiperpirexia y signos de deshidratación.Conclusiones. Con el fin de causar un impacto en la morbilidad complicada de la malaria, se propone una estrategia de reconocimiento de los signos de peligro por el personal no médico, que se acompañede otros elementos de la atención, como el suministro de un tratamiento antipalúdico adecuado y oportuno. Se proponen los criterios del diagnóstico de complicación moderada

Urinalysis and Clinical Correlations in Patients with P. vivax

Background. Urinalysis is a poorly reviewed diagnostic tool in malaria patients; its application can show the presence of severe malaria. Methods. Urinalysis was performed in a total of 620 patients diagnosed with malaria by thick blood smear; complications were classified according to WHO major criteria for severity and minor criteria according to the Colombian malaria guideline. Results. Severe or moderate clinical complications were diagnosed in 31.1% of patients, hepatic dysfunctions were diagnosed in 25.8%, anemia was diagnosed in 9.8%, thrombocytopenia was diagnosed in 7.7%, renal dysfunction was diagnosed in 4.8%, neurological and pulmonary complications were diagnosed in 2.1% and 2.4%, hypoglycemia was diagnosed in 1.1% of patients with blood glucose analysis, and acidosis was diagnosed in 10 of 25. Bilirubinuria was found in 24.3%, associated with urobilinuria, proteinuria, and increased specific gravity; urobilinuria was found in 30.6% associated with elevated serum bilirubin and alanine aminotransferase; 39.2% had proteinuria, associated with higher blood urea nitrogen, serum bilirubin, aspartate, alanine-transaminase, hematuria, and increased specific gravity. Severe or moderate liver and renal complications were associated with proteinuria and bilirubinuria. Urobilinuria was associated with thrombocytopenia and neurological and hepatic dysfunction. Ketonuria was associated with neurological dysfunctions. Conclusions. The most frequent alterations in the urinalysis were bilirubinuria, proteinuria, urobilinuria, and increased specific gravity, related to thrombocytopenia and liver, kidney, and neurological alterations

Clinical presentation of severe malaria due Plasmodiun falciparum. Case - control study in Tumaco and Turbo (Colombia)

RESUMEN: Antecedentes y problema: son muy pocos los estudios latinoamericanos sobre malaria por Plasmodium falciparum (P falciparum) complicada y se requiere estudiarla para identificar un patrón propio. Objetivos. Identificar las complicaciones presentes en pacientes de Tumaco (Nariño) y Turbo (Antioquia) en Colombia, con malaria por P falciparum. Métodos. Diseño de casos y controles. Se aplicaron los criterios diagnósticos de complicación OMS-2000 (Organización Mundial de la Salud). Resultados. Se captaron 64 casos (con malaria por P. falciparum complicada) y 135 controles (con malaria por P. falciparum no complicada). El tiempo de evolución de la enfermedad (promedio 5,6 días en los casos y 5,9 en los controles) y la frecuencia de síntomas fueron similares en ambos grupos (p>0,05), pero la dificultad respiratoria y la ictericia fueron más frecuentes en los casos que en los controles (p0.05). However, respiratory distress and jaundice was more frequent in the cases (p<0.05). The mean glycemia and creatinina values were similar in both groups; hemoglobin and platelet count were lower in the cases (p<0.05) when compared to controls. On the other hand, blood ureic nitrogen, aspartatoaminotransferase, and total and direct bilirrubin were lower in controls (p<0.05). The frequency of complications in the cases was as follows: hyperparasitaemia 48%, liver dysfunction 44%, acute respiratory distress syndrome 9%, kidney failure 6%, severe thrombocytopenia 5%, severe anemia 3%, cerebral malaria 3% and severe hipoglycemia 2%. The WHO criteria for severe malaria were compared with others and the implications are discussed

Allelic frequencies for SNP variants in the gene Nramp1 in bovine infected with Brucella abortus or classified by resistance to the pathogen

La resistencia natural a la brucelosis en bovinos ha sido asociada a factores genéticos, principalmente a algunos polimorfismos de nucleótido simple ubicados dentro del gen Nramp1. La presente investigación evalúa el efecto de variantes tipo polimorfismos de nucleótido simple presentes en regiones codificantes y en la región 3 UTR del gen Nramp1, en la clasificación de los animales como resistentes o susceptibles, además se determinan los genotipos predominantes en animales naturalmente infectados y comprobados como positivos por la presencia de anticuerpos anti Brucella abortus. Se establecieron las frecuencias genotípicas y alélicas para cinco polimorfismos de nucleótido simple identificados dentro del gen Nramp1 en animales de las razas blanco orejinegro (Bos taurus taurus) y cebú (Bos taurus indicus) y en muestras serológicamente positivas provenientes de animales cruzados (Bos taurus x Bos indicus). La determinación de genotipos se realizó mediante la metodología polimorfismo conformacional de cadena sencilla. Se realizó un ensayo de desafío infeccioso in vitro, para estimar la capacidad de los macrófagos bovinos para controlar la sobrevivencia bacterial, lo que permitió definir los individuos como resistentes o susceptibles. Los resultados sugieren una asociación significativa del SNP4 (p = 0,0506) con la variación para el fenotipo de susceptibilidad, pues se encontró el genotipo homocigoto (BB) en alta frecuencia en animales catalogados como resistentes y el genotipo heterocigoto (AB) en alta frecuencia en animales catalogados como susceptibles y en animales con títulos de anticuerpos anti Brucella abortus.;The natural resistance to brucellosis in cattle has been associated to genetic factors mainly to some single nucleotide polymorphism (SNP), located within Nramp1 gen. The current research has studied the effect of nucleotide variants to be found in coding regions and other one located in 3 non translated region of Nramp1 gene, on the animal classification as resistant or susceptible, moreover was identified the main genotypes to be found on the infected animals, confirmed as positives by antibody antibrucella titles. Was established the genotypic and allelic frequencies for five single nucleotide polymorphism in animals from blanco orejinegro (Bos taurus taurus) and zebu breeds (Bos taurus indicus) and serum samples belonging to positive crossbred animals (Bos taurus x Bos indicus). The genotype was defined by the methodology known as single strand conformational polymorphism . To estimate the macrophage capacity to control the bacterial survival, an in vitro assay was performed, which allowed define the phenotype as resistant or susceptible. The results suggest a significant association for SNP4 (p = 0.0506) with the phenotypic variation for resistant or susceptibility, because was found the genotype (BB) at higher frequency in susceptible animals and naturally infected animals, than those resistant animals.Ganado de leche-Ganadería lech

Evidence of clinical and radiographic changes in machined and modified surface osseointegrated implants. 3 to 12 months follow up

ABSTRACT: The aim of this study is to undertake a clinical and radiographic evaluation between two different patient groups: machined versus modified surface, to find out if there is statistically significant difference that support the use of implants with different surface properties. Sixty screw, external hex connection implants were examined: one group with 30 machined surface implants (SuperCAT®), and a second group with 30 implants with modified surface (RBM®), for restoring a single tooth. The surgical procedure was performed according with the manufacturer’s protocol. After six months the second phase surgery was performed and the temporary restoration was placed. At this point, the first radiographic evaluation was made. The Roos et al (1997) parameters were followed for the clinical and radiographic evaluation. A 100% of osseointegration was accomplished in both groups. The average marginal bone loss was 0.78 mm, without significant differences between the groups. All implants were reported as success grade 1, with no complications. There are not significant differences between the two groups of machined and modified implant surfaces for single tooth restoration.RESUMEN: En este estudio se realizó una evaluación clínica y radiográfica entre un grupo de pacientes con implantes de superficie maquinada y otro grupo con superficie modificada para determinar si existe alguna diferencia significativa que justifique la utilización de una u otra superficie; para ello se trabajó con dos tipos de implantes de la casa comercial Lifecore®, un grupo con 30 implantes de superficie maquinada o lisa (SuperCAT®) y 30 implantes de superficie modificada o rugosa (RBM®), de conexión externa, tipo tornillo, para la restauración de diente único. El procedimiento quirúrgico se realizó de acuerdo con las recomendaciones del fabricante y a los seis meses se realizó la cirugía de destape y se colocó una restauración temporal. Se siguieron los parámetros de Roos y colaboradores (1997) para la evaluación clínica y radiográfica. Se obtuvo el 100% de oseointegración de los implantes para ambos grupos. La pérdida ósea promedio fue de 0,78 mm. No se encontraron diferencias estadísticamente significativas en la evaluación clínica y radiográfica entre los dos grupos de implantes de superficie maquinada o modificada para la restauración de diente único

Diagnostic accuracy of loop-mediated isothermal amplifcation (LAMP) for screening malaria in peripheral and placental blood samples from pregnant women in Colombia

ABSTARCT: Pregnant women frequently show low-density Plasmodium infections that require more sensitive methods for accurate diagnosis and early treatment of malaria. This is particularly relevant in low-malaria transmission areas, where intermittent preventive treatment is not recommended. Molecular methods, such as polymerase chain reaction (PCR) are highly sensitive, but require sophisticated equipment and advanced training. Instead, loop mediated isothermal amplifcation (LAMP) provides an opportunity for molecular detection of malaria infections in remote endemic areas, outside a reference laboratory. The aim of the study is to evaluate the performance of LAMP for the screening of malaria in pregnant women in Colombia. Methods: This is a nested prospective study that uses data and samples from a larger cross-sectional project conducted from May 2016 to January 2017 in three Colombian endemic areas (El Bagre, Quibdó, and Tumaco). A total of 531 peripheral and placental samples from pregnant women self-presenting at local hospitals for antenatal care visits, at delivery or seeking medical care for suspected malaria were collected. Samples were analysed for Plasmodium parasites by light microscopy (LM), rapid diagnostic test (RDT) and LAMP. Diagnostic accuracy endpoints (sensitivity, specifcity, predictive values, and kappa scores) of LM, RDT and LAMP were compared with nested PCR (nPCR) as the reference standard. Results: In peripheral samples, LAMP showed an improved sensitivity (100.0%) when compared with LM 79.5% and RDT 76.9% (p<0.01), particularly in afebrile women, for which LAMP sensitivity was two-times higher than LM and RDT. Overall agreement among LAMP and nPCR was high (kappa value=1.0). Specifcity was similar in all tests (100%). In placental blood, LAMP evidenced a four-fold improvement in sensitivity (88.9%) when compared with LM and RDT (22.2%), being the only method, together with nPCR, able to detect placental infections in peripheral blood. Conclusions: LAMP is a simple, rapid and accurate molecular tool for detecting gestational and placental malaria, being able to overcome the limited sensitivity of LM and RDT. These fndings could guide maternal health programs in low-transmission settings to integrate LAMP in their surveillance systems for the active detection of low-density infections and asymptomatic malaria cases