Cardiovascular diseases (CVD) are the leading cause of death in the world, and they are considered a serious public health problem in Colombia. The main goal of this study was to analyze CVD mortality spatially and temporarily in the Pacific region of Colombia during the 2002-2015 period, and its association with some municipal socio-economic indicators using spatial statistical analysis techniques. It involved a descriptive-ecological study in the 177 municipalities of the Pacific region that used CVD mortality data, under codes I00-I99 of the International Classification of Diseases (ICD-10), and seven municipal socio-economic indicators. The analysis included the calculation of crude and standardized mortality rates, according to sex, for CVD and its main causes, and modeling of CVD death counts using Bayesian hierarchical models. During the 2002-2015 period, standardized rates of CVD mortality showed a downward trend in men (129.0 to 119.3) and in women (129.0 to 110.0), the main causes of death being ischemic heart diseases, followed by cerebrovascular diseases. In general, the risk of CVD mortality was higher in the less economically and socially privileged municipalities.

Objetivo: Describir el perfil y la tendencia de la mortalidad general y específica, durante el periodo 2002-2014, de los departamentos de la región del Pacífico de Colombia: Cauca, Chocó, Nariño y Valle del Cauca. Metodología: Estudio descriptivo-ecológico que usa datos secundarios de mortalidad, nacimientos y proyecciones poblacionales provenientes del Departamento Administrativo Nacional de Estadística. Se calcularon tasas anuales de mortalidad general y específicas (por edad, sexo y para seis grandes grupos de causas de muerte), utilizando la lista corta de clasificación de las causas de mortalidad 6/67 de la Organización Panamericana de la Salud (enfermedades transmisibles, neoplasias/tumores, enfermedades del sistema circulatorio, afecciones originadas en el período perinatal, causas externas y demás causas). Las tendencias fueron evaluadas mediante un modelo de regresión de Poisson con efectos aleatorios. Resultados: Se encontró mayor mortalidad en el sexo masculino (razón hombre / mujer entre 1,26-1,61) y en la población mayor a 65 años. Se observó una tendencia descendente en la mortalidad general en los cuatro departamentos, siendo Valle del Cauca el que presentó las mayores tasas de mortalidad general y específica. La principal causa de muerte, y con tendencia ascendente, fueron las enfermedades del sistema circulatorio, seguida de demás causas, causas externas y neoplasias. Conclusiones:La mortalidad general mostró una tendencia descendente, con mayor magnitud en hombres, y riesgo diferencial según sexo a partir de 15-19 años, atribuido al grupo de causas externas. La principal causa de muerte fueron las enfermedades del sistema circulatorio, seguido de todas las demás causas y neoplasias. Las causas externas mostraron una marcada tendencia al descenso.

Este estudio tuvo como objetivo analizar la mortalidad por VIH/sida en Cali, Colombia, en el periodo 1986-2012, y a partir de ahí, comprender, desde el punto de vista conceptual, los determinantes sociales relacionados. Se llevó a cabo un estudio observacional, longitudinal, retrospectivo, con un total de 14 192 casos. Se encontró una tendencia creciente de la tasa de mortalidad, en especial a partir del año 1996; en el 2011 se presentó la mayor tasa de todo el periodo. La medición de la desigualdad reveló que se han producido más muertes en estratos medios y bajos, en comparación con el estrato alto. Este estudio aporta evidencia sobre las desigualdades persistentes en la mortalidad por VIH/sida como expresión de inequidades de tipo estructural en la ciudad de Cali. En la perspectiva de Breilh, son procesos críticos de determinación económica y social que pudieron afectar la mortalidad, especialmente de los grupos con más vulnerados socialmente.

The objective of this research was to identify environmental risk factors for cutaneous leishmaniasis (CL) in Colombia and map high-risk municipalities. The study area was the Colombian Andean region, comprising 715 rural and urban municipalities. We used 10 years of CL surveillance: 2000-2009. We used spatial-temporal analysis - conditional autoregressive Poisson random effects modelling - in a Bayesian framework to model the dependence of municipality-level incidence on land use, climate, elevation and population density. Bivariable spatial analysis identified rainforests, forests and secondary vegetation, temperature, and annual precipitation as positively associated with CL incidence. By contrast, livestock agroecosystems and temperature seasonality were negatively associated. Multivariable analysis identified land use - rainforests and agro-livestock - and climate - temperature, rainfall and temperature seasonality - as best predictors of CL. We conclude that climate and land use can be used to identify areas at high risk of CL and that this approach is potentially applicable elsewhere in Latin America.

Objective: The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real -life access conditions experienced by the Colombian population.Methods: A validation study with experts and a pilot study were performed. It was conducted in the municipality of jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households.Results: The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists.Discussion: The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services. (C) 2016 SESPAS. Published by Elsevier Espana, S.L.U.

Introduccion. La leptospirosis es una enfermedad zoonotica urbana y rural que afecta a los humanos en todos los continentes, aunque su transmision y presentacion clinica puede variar. En Colombia hay poca informacion acerca de la importancia de la leptospirosis en entornos urbanos. Objetivos. Establecer la seroprevalencia de infeccion por Leptospira en humanos, identificar la reactividad serologica y explorar factores asociados con la seropositividad. Materiales y metodos. Se realizo un estudio transversal en 259 habitantes de barrios perifericos de Cali, estratificado por sexo y edad. Se obtuvo informacion general de cada persona, tiempo de residencia en el barrio, ocupacion, exposicion a fuentes contaminadas como agua o animales, y suero para la prueba de microaglutinacion con 19 serovares de Leptospira. Resultados. La poblacion evaluada correspondio principalmente a estudiantes (37,1%), amas de casa (32%) y trabajadores en oficios varios (24,6%). Se encontraron anticuerpos anti- Leptospira en 23,3% (IC95% 18,3 a 28,3) de las personas, siendo mas frecuente en mayores de 57 anos y significativamente mayor en hombres que en mujeres (p = 0,045). Se encontro asociacion entre la seropositividad y el contacto con animales (p = 0,038). De los 19 serovares evaluados, se detecto reactividad frente a 16, pero los titulos de anticuerpos fueron bajos. Conclusiones. La alta prevalencia de infeccion encontrada en el estudio sugiere la transmision frecuente de leptospiras en barrios de Cali considerados de alto riesgo. Se destaca el contacto con animales como un factor asociado con la presencia de anticuerpos contra leptospiras.

A number of issues affect adherence to treatment and quality of life among women living with HIV/AIDS. In particular, women living in poverty have a higher risk of mortality due to their vulnerable conditions and socioeconomic exclusion. The objective of this study was to evaluate the effectiveness of an intervention that combines microfinance, entrepreneurship and adherence to treatment (IMEA) for women with HIV/AIDS and living in poverty in Cali, Colombia. A pre-post research design without a control was utilized, and 48 women were included in the study. The evaluation showed effectiveness of the program in the majority of the results (knowledge of HIV and treatment, adherence to treatment, self-efficacy, and the formation of a microenterprise) (p < 0.001); the global indicator increased from 28.3% to 85.5% (p < 0.001). The findings of this study demonstrate that the intervention was partially effective; the health outcomes showed beneficial effects. However, at the end of the study and throughout the follow-up phase, only one third of the participants were able to develop and maintain a legal operating business. It is concluded that the IMEA project should be tested in other contexts and that its consequent results should be analyzed; so it could be converted into a large scale public health program.

The vector competence (VC) of Aedes aegypti (Linnaeus) (Diptera: Culicidae) varies geographically and is affected by both genetic and environmental factors. Understanding the molecular mechanisms that influence VC may help develop novel control strategies. The selection of susceptible and refractory strains is the first step in this process. We collected immature A. aegypti in the field and established strains that were susceptible and refractory to Dengue-2 virus by isofamily selection through several generations. Infection was detected by immunofluorescence of head or midgut tissues to determine infection barriers and the % of VC by tissue. We selected three strains: Susceptible (Cali-S) (96.4% susceptible at F-19), Refractory with a midgut escape barrier (Cali-MEB) (44.1% refractory at F-15), and Refractory with a midgut infection barrier (Cali-MIB) (40% refractory at F-16). The effects of the infection were measured using Kaplan-Meier survival rates over the first seven generations. All selected strains showed a similar decrease in survival and in the number of eggs laid/female through the seven generations, suggesting that changes were a result of the selection process rather than the virus infection. The results of this study suggest that VC is associated with multiple genes, which have additive effects on susceptibility.

ABSTRACT Resistance to antimonial drugs has been documented in Leishmania isolates transmitted in South America, Europe, and Asia. The frequency and distribution of resistance to these and other antileishmanial drugs are unknown. Technical constraints have limited the assessment of drug susceptibility of clinical strains of Leishmania. Susceptibility of experimentally selected lines and 130 clinical strains of Leishmania panamensis, L. braziliensis, and L. guyanensis to meglumine antimoniate and miltefosine was determined on the basis of parasite burden and percentage of infected U-937 human macrophages. Reductions of infection at single predefined concentrations of meglumine antimoniate and miltefosine and 50% effective doses (ED50s) were measured and correlated. The effects of 34°C and 37°C incubation temperatures and different parasite-to-host cell ratios on drug susceptibility were evaluated at 5, 10, and 20 parasites/cell. Reduction of the intracellular burden of Leishmania amastigotes in U-937 cells exposed to the predefined concentrations of meglumine antimoniate or miltefosine discriminated sensitive and experimentally derived resistant Leishmania populations and was significantly correlated with ED50 values of clinical strains (for meglumine antimoniate, ρ = −0.926 and P < 0.001; for miltefosine, ρ = −0.906 and P < 0.001). Incubation at 37°C significantly inhibited parasite growth compared to that at 34°C in the absence of antileishmanial drugs and resulted in a significantly lower ED50 in the presence of drugs. Susceptibility assessment was not altered by the parasite-to-cell ratio over the range evaluated. In conclusion, measurement of the reduction of parasite burden at a single predetermined drug concentration under standardized conditions provides an efficient and reliable strategy for susceptibility evaluation and monitoring of clinical strains of Leishmania.

Objective  To evaluate the environmental and ecological factors associated with Leishmania transmission and vector abundance in Chaparral, Tolima‐Colombia.

BACKGROUNDChildren have a lower response rate to antimonial drugs and higher elimination rate of antimony (Sb) than adults. Oral miltefosine has not been evaluated for pediatric cutaneous leishmaniasis.METHODSA randomized, noninferiority clinical trial with masked evaluation was conducted at 3 locations in Colombia where Leishmania panamensis and Leishmania guyanensis predominated. One hundred sixteen children aged 2-12 years with parasitologically confirmed cutaneous leishmaniasis were randomized to directly observed treatment with meglumine antimoniate (20 mg Sb/kg/d for 20 days; intramuscular) (n = 58) or miltefosine (1.8-2.5 mg/kg/d for 28 days; by mouth) (n = 58). Primary outcome was treatment failure at or before week 26 after initiation of treatment. Miltefosine was noninferior if the proportion of treatment failures was ≤15% higher than achieved with meglumine antimoniate (1-sided test, α = .05).RESULTSNinety-five percent of children (111/116) completed follow-up evaluation. By intention-to-treat analysis, failure rate was 17.2% (98% confidence interval [CI], 5.7%-28.7%) for miltefosine and 31% (98% CI, 16.9%-45.2%) for meglumine antimoniate. The difference between treatment groups was 13.8%, (98% CI, -4.5% to 32%) (P = .04). Adverse events were mild for both treatments.CONCLUSIONSMiltefosine is noninferior to meglumine antimoniate for treatment of pediatric cutaneous leishmaniasis caused by Leishmania (Viannia) species. Advantages of oral administration and low toxicity favor use of miltefosine in children.CLINICAL TRIAL REGISTRATIONNCT00487253.

Phlebotomine vector ecology was studied in the largest recorded outbreak of American cutaneous leishmaniasis in Colombia in 2004. In two rural townships that had experienced contrasting patterns of case incidence, this study evaluated phlebotomine species composition, seasonal abundance, nocturnal activity, blood source, prevalence of Leishmania infection, and species identification. CDC miniature light traps were used to trap the phlebotomines. Traps were set indoors, peridomestically, and in woodlands. Natural infection was determined in pools by polymerase chain reaction-Southern blot, and blood sources and species identification were determined by sequencing. Large differences were observed in population abundance between the two townships evaluated. Lutzomyia longiflocosa was the most abundant species (83.1%). Abundance was higher during months with lower precipitation. Nocturnal activity was associated with human domestic activity. Blood sources identified were mainly human (85%). A high prevalence of infection was found in L. longiflocosa indoors (2.7%) and the peridomestic setting (2.5%). L. longiflocosa was responsible for domestic transmission in Chaparral.

Introduction: Dengue viruses transmitted principally by the urban mosquito Aedes aegypti, cause one of the major public health problems confronting tropical cities. Insecticide spraying has been the mainstay of mosquito control; however, its continuous use has selected for resistance. Other important methods of control involve community participation.Objective: This study evaluated two control methods for Ae. aegypti that can be used by the community: Lethal ovitraps (LOs) and Bacillus thuringiensis var israeliensis (Bti) briquettes.Materials and methods: The project study was carried out in four similar neighborhoods within a representative district in the city of Cali, Colombia. Three interventions (LO, Bti, LO+Bti plus education and one control (education only) area were evaluated for efficacy in post-intervention entomological surveys. Additionally, entomological indices were also compared to results from a pre-intervention survey carried out on a sample of city blocks in the same neighborhoods. Relative vector abundance in relation to weather conditions using the same entomological sampling methods was compared.Results: The interventions did not achieve significant differences in vector abundance among the treatments. However, the interventions achieved a significant reduction in entomological indices compared with those observed during the pre-intervention survey: House index 15.1% vs. 8.5%, mean pupae per house 1.15 vs. 0.073, and Adult index 56.3% vs. 34.8% (p<0.05).Conclusions: The lack of significant differences among the interventions, and between treated and control blocks suggested that educational activities together with periodic visits to the houses produced similar reductions of immature and adult Aedes aegypti.

INTRODUCTION:Dengue viruses transmitted principally by the urban mosquito Aedes aegypti, cause one of the major public health problems confronting tropical cities. Insecticide spraying has been the mainstay of mosquito control; however, its continuous use has selected for resistance. Other important methods of control involve community participation.OBJECTIVE:This study evaluated two control methods for Ae. aegypti that can be used by the community: Lethal ovitraps (LOs) and Bacillus thuringiensis var israeliensis (Bti) briquettes.MATERIALS AND METHODS:The project study was carried out in four similar neighborhoods within a representative district in the city of Cali, Colombia. Three interventions (LO, Bti, LO+Bti plus education and one control (education only) area were evaluated for efficacy in post-intervention entomological surveys. Additionally, entomological indices were also compared to results from a pre-intervention survey carried out on a sample of city blocks in the same neighborhoods. Relative vector abundance in relation to weather conditions using the same entomological sampling methods was compared.RESULTS:The interventions did not achieve significant differences in vector abundance among the treatments. However, the interventions achieved a significant reduction in entomological indices compared with those observed during the pre-intervention survey: House index 15.1% vs. 8.5%, mean pupae per house 1.15 vs. 0.073, and Adult index 56.3% vs. 34.8% (p < 0.05).CONCLUSIONS:The lack of significant differences among the interventions, and between treated and control blocks suggested that educational activities together with periodic visits to the houses produced similar reductions of immature and adult Aedes aegypti.

Dos formulaciones de oxcarbazepina (Trileptal®, Novartis, y Oxcarbazepina®, Tecnoquímicas S. A.), previamente demostradas como equivalentes farmacéuticos, fueron evaluadas en cuanto a bioequivalencia por medio de un estudio aleatorizado, cruzado, en dos períodos, con dosis oral única de 1.200 mg, en 24 hombres adultos voluntarios sanos entre 18-35 años. Se evaluaron los siguientes parámetros farmacocinéticos: Área bajo la curva (AUC), Concentración máxima (Cmáx) y Tiempo para alcanzar la concentración máxima (Tmáx). Hubo un intervalo de lavado de siete días entre los dos períodos. Las concentraciones plasmáticas se evaluaron por HPLC/UV con el método de la adición estándar. No se encontraron diferencias significativas entre las dos preparaciones. Se concluyó que las dos preparaciones son equivalentes farmacéuticos y bioequivalentes y que, en consecuencia, son intercambiables para propósitos terapéuticos.

Two formulations of oxcarbazepine (Trileptal (R), Novartis, y Oxcarbazepina (R), Tecnoquimicas S.A.), previously shown to be pharmaceutical equivalents, were evaluated concerning their bioequivalence by means of a randomized, crossover, single oral dose (1.200 mg), two-period study in 24 healthy adult males. The following pharmacokinetic parameters were determined: Area under the curve (AUC), Maximal concentration (C-max), and Time to reach maximal concentration (T-max). There was a 206 wash-out interval of seven days between the two periods. Plasmatic concentrations of the drug were measured with HPLC/UV with standard addition. No significant differences were found between the two preparations. It was concluded that they are pharmaceutical equivalents as well as bioequivalent. Consequently, they are interchangeable for therapeutic purposes.

INTRODUCTION In Cali, Colombia, catch basins (streetside storm drains) are one of the main larval habitats of Aedes aegypti and Culex quinquefasciatus. Since 1999, these mosquitoes have been controlled by the Secretaría de Salud Municipal (Secretary of Municipal Public Health) using the larvicide triflumuron. Because of high densities of these mosquitoes that remain in the city, treatment failure was suspected -possibly insecticide resistance of the target species. OBJECTIVES The efficacy of triflumuron and VectoMax (biorational mixture of Bacillus thuringiensis var. israelensis plus Bacillus sphaericus) were evaluated in the control of A. aegypti and C. quinquefasciatus in catch basins. The residual effect of a single application of the biorational formulation was determined in catch basins during periods of high and low rainfall. MATERIALS AND METHODS The efficacy of the products was measured in 60 catch basins located in a residential neighborhood of Cali for a period of 90 days. The mean number of immature instars (A. aegypti and C. quinquefasciatus larvae and pupae of both species) was determined biweekly from 40 catch basins with insecticide intervention (20 treated with triflumuron, 20 with VectoMax) and 20 untreated (control group). The residual effect of the biorational larvicide was evaluated biweekly in 10 catch basins during each of the 2 climatic periods. Results. The catch basins treated with VectoMax presented a significantly lower mean number of immature instars of both species compared with the control ( p<0.01). In contrast, the triflumuron treatment significantly reduced only immature instars of A. aegypti compared with the control ( p<0.001). The residual effect of VectoMax was higher during low rainfall compared to the control ( p<0.001). Conclusion. The biorational formulation was the more effective treatment for the control of both species during the period of evaluation (15 days).

Introduction. In Cali, Colombia, catch basins (streetside storm drains) are one of the main larval habitats of Aedes aegypti and Culex quinquefasciatus. Since 1999, these mosquitoes have been controlled by the Secretaria de Salud Municipal (Secretary of Municipal Public Health) using the larvicide triflumuron. Because of high densities of these mosquitoes that remain in the city, treatment failure was suspected -possibly insecticide resistance of the target species.Objectives. The efficacy of triflumuron and VectoMax (R) (biorational mixture of Bacillus thuringiensis var. israelensis plus Bacillus sphaericus) were evaluated in the control of A. aegypti and C. quinquefasciatus in catch basins. The residual effect of a single application of the biorational formulation was determined in catch basins during periods of high and low rainfall.Materials and methods. The efficacy of the products was measured in 60 catch basins located in a residential neighborhood of Cali for a period of 90 days. The mean number of immature instars (A. aegypti and C. quinquefasciatus larvae and pupae of both species) was determined biweekly from 40 catch basins with insecticide intervention (20 treated with triflumuron, 20 with VectoMax (R)) and 20 untreated (control group). The residual effect of the biorational larvicide was evaluated biweekly in 10 catch basins during each of the 2 climatic periods.Results. The catch basins treated with VectoMax (R) presented a significantly lower mean number of immature instars of both species compared with the control (p<0.01). In contrast, the triflumuron treatment significantly reduced only immature instars of A. aegypti compared with the control (p<0.001). The residual effect of VectoMax (R) was higher during low rainfall compared to the control (p<0.001).Conclusion. The biorational formulation was the more effective treatment for the control of both species during the period of evaluation (15 days).

In order to study the infectious agents causing human disseminated cryptococcosis in the state of Pará, North Brazil, 56 isolates of Cryptococcusspp. (54 isolated from cerebral spinal fluid and two from blood cultures) from 43 cases diagnosed between 2003-2007 were analysed. The species were determined through morphological and physiological tests and genotypes were determined by URA5-RFLP and PCR-fingerprinting (wild-type phage M13). The following species and genotypes were identified: Cryptococcus neoformans VNI (28/56, 50%), Cryptococcus gattii VGII (25/56, 44.64%) and C. gattii VGI (3/56, 5.26%). The genotype VNI occurred in 12 out of 14 HIV-positive adults, whereas the genotype VGII occurred in 11 out of 21 HIV-negative adults (p < 0.02, OR = 6.6 IC95% 0.98-56.0). All patients less than 12 years old were HIV negative and six cases were caused by the VGII genotype, one by the VGI and one by VNI. Therefore, endemic primary mycosis in HIV-negative individuals, including an unexpectedly high number of children, caused by the VGII genotype deserves further study and suggests the need for surveillance on cryptococcal infection in the state of Pará, Eastern Amazon.

The objective of the present study was to evaluate the specificity of the Montenegro skin test (MST) in an area in Brazil, state of Grande do Sul State (RS), which was considered to be non-endemic for leishmaniasis. Sixty subjects presented a positive MST and were reevaluated by clinical examination, serology and polymerase chain reaction (PCR) of peripheral blood for the detection of subclinical Leishmania infection. None of the subjects presented clinical signs or symptoms of current leishmaniasis or a history of the disease. Leishmania (Viannia) DNA was detected in blood by PCR and hybridization in one subject. The PCR skin test-positive individual remained asymptomatic throughout the study. Clinical examination showed no scars suggestive of past cutaneous leishmaniasis. Human subclinical infection with Leishmania (Viannia) in RS was confirmed by PCR. This is the first report of subclinical infection with this parasite in the human population of this area.