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Nieto-Martinez R, Barengo NC, Restrepo M, Grinspan A, Assefi A, Mechanick JI. Large scale application of the Finnish diabetes risk score in Latin American and Caribbean populations: a descriptive study. Front Endocrinol (Lausanne) 2023; 14:1188784. [PMID: 37435487 PMCID: PMC10332265 DOI: 10.3389/fendo.2023.1188784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background The prevalence of type 2 diabetes (T2D) continues to increase in the Americas. Identifying people at risk for T2D is critical to the prevention of T2D complications, especially cardiovascular disease. This study gauges the ability to implement large population-based organized screening campaigns in 19 Latin American and Caribbean countries to detect people at risk for T2D using the Finnish Diabetes Risk Score (FINDRISC). Methods This cross-sectional descriptive analysis uses data collected in a sample of men and women 18 years of age or older who completed FINDRISC via eHealth during a Guinness World Record attempt campaign between October 25 and November 1, 2021. FINDRISC is a non-invasive screening tool based on age, body mass index, waist circumference, physical activity, daily intake of fruits and vegetables, history of hyperglycemia, history of antihypertensive drug treatment, and family history of T2D, assigning a score ranging from 0 to 26 points. A cut-off point of ≥ 12 points was considered as high risk for T2D. Results The final sample size consisted of 29,662 women (63%) and 17,605 men (27%). In total, 35% of subjects were at risk of T2D. The highest frequency rates (FINDRISC ≥ 12) were observed in Chile (39%), Central America (36.4%), and Peru (36.1%). Chile also had the highest proportion of people having a FINDRISC ≥15 points (25%), whereas the lowest was observed in Colombia (11.3%). Conclusions FINDRISC can be easily implemented via eHealth technology over social networks in Latin American and Caribbean populations to detect people with high risk for T2D. Primary healthcare strategies are needed to perform T2D organized screening to deliver early, accessible, culturally sensitive, and sustainable interventions to prevent sequelae of T2D, and reduce the clinical and economic burden of cardiometabolic-based chronic disease.
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Affiliation(s)
- Ramfis Nieto-Martinez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
- Precision Care Clinic Corp., Saint Cloud, FL, United States
- Foundation for Clinic, Public Health, Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Noël C. Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine & Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
- Faculty of Medicine, Riga Stradiņš University, Riga, Latvia
| | - Manuela Restrepo
- Medical Affairs Latin America, Merck Kommanditgesellschaft auf Aktien (KGaA), Darmstadt, Germany
| | - Augusto Grinspan
- Medical Affairs Latin America, Merck Kommanditgesellschaft auf Aktien (KGaA), Darmstadt, Germany
| | - Aria Assefi
- Medical Affairs Latin America, Merck Kommanditgesellschaft auf Aktien (KGaA), Darmstadt, Germany
| | - Jeffrey I. Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Bussaneli DG, Vieira AR, Santos-Pinto L, Restrepo M. Molar-incisor hypomineralisation: an updated view for aetiology 20 years later. Eur Arch Paediatr Dent 2022; 23:193-198. [PMID: 34392496 DOI: 10.1007/s40368-021-00659-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The term Molar-Incisor Hypomineralisation (MIH) was introduced in 2001 by Weerheijm, Jälevik and Alaluusua, and describes a defect of systemic origin that affects one to four first permanent molars, often associated with permanent incisors. In the past 20 years, this definition dictated the work regarding MIH prevalence, associated risk factors, association with dental caries, impact on quality of life, and therapeutic options. PURPOSE In this report, we offer an updated and comprehensive view of MIH centred on the patient and the tooth. CONCLUSION MIH today is globally recognized as a potential public health problem and it is not a defect of purely systemic origin but rather a condition with complex aetiology that in some instances may be the result of gene-environmental interactions.
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Affiliation(s)
- D G Bussaneli
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University (Unesp), Araraquara School of Dentistry, Araraquara, São Paulo, Brazil
| | - A R Vieira
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - L Santos-Pinto
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University (Unesp), Araraquara School of Dentistry, Araraquara, São Paulo, Brazil
| | - M Restrepo
- Basic and Clinical Research Group in Dentistry, School of Dentistry, CES University, Medellín, Colombia.
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Fragelli C, Barbosa TS, Bussaneli DG, Restrepo M, Cordeiro RCL, Santos-Pinto L. Aesthetic perception in children with molar incisor hypomineralization. Eur Arch Paediatr Dent 2020; 22:227-234. [PMID: 32524329 DOI: 10.1007/s40368-020-00541-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/24/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the relationship between aesthetic perception and molar incisor hypomineralization (MIH) in schoolchildren aged 8-12 years. METHODS The study included 467 pupils enrolled in elementary schools. Once authorization was received, the students were examined for DMFT and dmft indexes (WHO criteria), and for MIH (EAPD criteria). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA), a questionnaire divided into several items, including physical, psychological and social domains; perception about tooth pleasantness, tooth alignment, tooth discoloration and tooth health; and reported pleasant colour. Data analysis was carried out using descriptive statistics, the Chi-square, the Mann-Whitney and the Kruskal-Wallis tests, and linear regression at a significance level of 0.05. RESULTS The tooth health perception was worse when the child had MIH, and the tooth alignment and tooth discoloration perceptions, when MIH affected the incisors. The number of teeth affected by MIH was associated with higher averages in the tooth discoloration perception. CONCLUSIONS Children with MIH showed more negative perceptions toward tooth health, tooth alignment and tooth discoloration. However, none of the clinically investigated variables negatively impacted the reported pleasant colour question.
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Affiliation(s)
- C Fragelli
- Department of Pediatric and Orthodontic Dentistry, Araraquara School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil.
| | - T S Barbosa
- Department of Dentistry, Life Science Institute, Federal University of Juiz de Fora - Governador Valadarez Campus, Gov. Valadares, MG, Brazil
| | - D G Bussaneli
- Department of Morphology, Araraquara School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, 14801-385, Brazil
| | - M Restrepo
- Facultad de Odontología, Universidad CES-Medellín, Antioquia, Colombia
| | - R C L Cordeiro
- Department of Pediatric and Orthodontic Dentistry, Araraquara School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - L Santos-Pinto
- Department of Pediatric and Orthodontic Dentistry, Araraquara School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
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Amati F, Pascual-Guardia S, Marin-Corral J, Aliberti S, Blasi F, Shaffer A, Restrepo M. 2019 ATS/IDSA CRITERIA TO IDENTIFY P. AERUGINOSA AND MRSA PROMOTE OVERUTILIZATION OF MRSA THERAPY IN NON-SEVERE CAP. Chest 2020. [DOI: 10.1016/j.chest.2020.05.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Amati F, Restrepo M, Mantero M, Blasi F, Nambiar A. DIAGNOSTIC TRAJECTORIES OF INTERSTITIAL LUNG DISEASE AFTER IMPLEMENTATION OF A MULTIDISCIPLINARY DISCUSSION TEAM MEETING. Chest 2020. [DOI: 10.1016/j.chest.2020.05.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jergova S, Dugan E, Hernandez M, Arthur A, Restrepo M, Sagen J. (279) Management of SCI-Induced Chronic Pain in Rats: Intensive Locomotor Training and Recombinant GABAergic Cell Tranplants. The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mesenburg M, Restrepo M, Ferreira L, Wehrmeister F, Barros A, Victora C. 2.4-O3The role of ethnicity as determinant of reproductive, maternal, newborn and child health in Latin American and the Caribbean. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Mesenburg
- International Center for Equity in Health; Federal University of Pelotas, Brazil
| | | | - L Ferreira
- International Center for Equity in Health; Federal University of Pelotas, Brazil
| | - F Wehrmeister
- International Center for Equity in Health; Federal University of Pelotas, Brazil
| | - A Barros
- International Center for Equity in Health; Federal University of Pelotas, Brazil
| | - C Victora
- International Center for Equity in Health; Federal University of Pelotas, Brazil
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López-Jaramillo P, Nieto-Martínez RE, Aure-Fariñez G, Mendivil CO, Lahsen RA, Silva-Filho RL, Andreotti LA, Manrique ME, Pasquel-Andrade MA, Rangel I, Vidrio M, Castañeda R, Restrepo M, Pinto ME. Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting. Rev Panam Salud Publica 2017; 41:e172. [PMID: 31410086 PMCID: PMC6664235 DOI: 10.26633/rpsp.2017.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/31/2017] [Indexed: 12/14/2022] Open
Abstract
To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 – 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.
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Affiliation(s)
- Patricio López-Jaramillo
- Metabolic Syndrome and Diabetes Clinic Fundación Oftalmológica de Santander Bucaramanga Colombia Metabolic Syndrome and Diabetes Clinic, Fundación Oftalmológica de Santander, Bucaramanga, Santander, Colombia
| | - Ramfis E Nieto-Martínez
- Human Physiology Universidad Centro-Occidental Lisandro Alvarado Barquisimeto Venezuela Human Physiology, Universidad Centro-Occidental Lisandro Alvarado, Barquisimeto, Venezuela
| | - Gestne Aure-Fariñez
- Centro Medico Docente la Trinidad Centro Medico Docente la Trinidad Caracas Venezuela Centro Medico Docente la Trinidad, Caracas, Venezuela
| | - Carlos O Mendivil
- Universidad de los Andes Universidad de los Andes Bogotá Colombia Universidad de los Andes, Bogotá, Colombia
| | - Rodolfo A Lahsen
- Clínica Las Condes Clínica Las Condes Santiago Chile Clínica Las Condes, Santiago, Chile
| | - Ruy L Silva-Filho
- Federal University of Pernambuco Federal University of Pernambuco Recife Brazil Federal University of Pernambuco, Recife, Brazil
| | - Luiz A Andreotti
- Diabetes Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil Diabetes Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mónica E Manrique
- Nutrition and Diabetes Unit Clínica Alemana Santiago Chile Nutrition and Diabetes Unit, Clínica Alemana, Santiago, Chile
| | | | - Ignacio Rangel
- Medical School Monterrey Technological Institute Monterrey Mexico Medical School, Monterrey Technological Institute, Monterrey, Mexico
| | - Maricela Vidrio
- Research Cardiometabolic Unit Occidente SC Guadalajara Mexico Research Cardiometabolic Unit, Occidente SC, Guadalajara, Mexico
| | - Rutila Castañeda
- Center for Clinical Research Center for Clinical Research Mexico City Mexico Center for Clinical Research, Mexico City, Mexico
| | - Manuela Restrepo
- Merck Colombia Merck Colombia Bogotá Colombia Merck Colombia, Bogotá, Colombia
| | - Miguel E Pinto
- School of Medicine Alberto Hurtado Cayetano Heredia University Lima Perú School of Medicine Alberto Hurtado, Cayetano Heredia University, Lima, Perú
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Jolivet A, Rimbaud D, Restrepo M, Louison A, Lambert V, Carles G. Intoxication au plomb chez la femme enceinte dans l’Ouest Guyanais : émergence d’un problème de santé publique. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Munoz C, Vanegas A, Arbelaez A, Restrepo M, Vasquez G, Correa L, Arias L, Gonzalez L. FRI0366 Cocaine-Levamisole Induced Vasculitis: A Series of 11 Cases. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Castaño A, Volcy M, García FA, Uribe CS, Bigal ME, Restrepo M. Headache in Symptomatic Intracranial Hypertension Secondary to Leptospirosis: A Case Report. Cephalalgia 2016; 25:309-11. [PMID: 15773829 DOI: 10.1111/j.1468-2982.2004.00841.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Castaño
- Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia.
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Khushman M, Scherfenberg N, Hosein P, Velez M, Carcas Peirce L, Dammrich D, Hurtado-Cordovi J, Parajuli R, Pollack T, Harwood A, Macintyre J, Merchan J, Loaiza-Bonilla A, Akunyili I, Restrepo M, Narayanan G, Portelance L, Sleeman D, Levi J, Rocha-Lima C. Safety and Efficacy of Neoadjuvant Folfirinox in Patients (Pts) with Locally Advanced Pancreatic Adenocarcinoma (Lapc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fleming GB, Singanayagam A, Akram AR, Taylor JK, Restrepo M, Hill AT, Chalmers JD. S122 Statin use is associated with improved long term outcomes after community-acquired pneumonia. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Campbell-Lendrum DH, Angulo VM, Esteban L, Tarazona Z, Parra GJ, Restrepo M, Restrepo BN, Guhl F, Pinto N, Aguilera G, Wilkinson P, Davies CR. House-level risk factors for triatomine infestation in Colombia. Int J Epidemiol 2007; 36:866-72. [PMID: 17698884 DOI: 10.1093/ije/dym065] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chagas disease, transmitted domestically by triatomine bugs, is the most important vector-borne disease in Latin America. The association between triatomine infestation and housing characteristics was investigated based on a standardized survey in 41 971 houses in 15 Departments in Colombia. METHODS Multivariate logistic regression was used to test for associations of two highly correlated infestation measures of infestation (householders reporting having seen triatomines inside the house, and sending triatomines to the survey team), with 15 household-level risk factors. Risks were measured relative to a reference category of houses with up to three inhabitants, area up to 50 m(2), unplastered adobe walls, thatch roof and no outbuildings or domestic animals. RESULTS The probability of seeing triatomines was highest for households with over seven inhabitants (OR = 1.24, 95% CI 1.11-1.39), overhead storage space (OR = 1.16, 95% CI 1.03-1.32), grain shed (OR = 1.25, 95% CI 1.02-1.52), cats (OR = 1.27, 95% CI 1.14-1.42) and pigs (OR = 1.16, 95% CI 1.03-1.30). Lowest risks were in houses with wooden walls (OR = 0.46, 95% CI 0.34-0.61), fully plastered walls (OR = 0.78, 95% CI 0.68-0.88), roofs made of tiles (OR = 0.51, 95% CI 0.33-0.78) and flagstone floors (OR = 0.57, 95% CI 0.42-0.76). Results for householders returning triatomines support this set of risk factors, but with wider confidence intervals. CONCLUSIONS Surveillance of a few easily assessed household characteristics provides an accurate, rapid assessment of house-level variation in risk. Measured effect sizes for specific structural characteristics could be used to maximize the cost-effectiveness of programmes to reduce vector infestation and interrupt Chagas disease transmission by improving house quality.
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Restrepo BI, Alvarez JI, Castaño JA, Arias LF, Restrepo M, Trujillo J, Colegial CH, Teale JM. Brain granulomas in neurocysticercosis patients are associated with a Th1 and Th2 profile. Infect Immun 2001; 69:4554-60. [PMID: 11401999 PMCID: PMC98532 DOI: 10.1128/iai.69.7.4554-4560.2001] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neurocysticercosis (NCC) is a common central nervous system (CNS) infection caused by Taenia solium metacestodes. Despite the well-documented importance of the granulomatous response in the pathogenesis of this infection, there is limited information about the types of cells and cytokines involved. In fact, there has been limited characterization of human brain granulomas with any infectious agent. In the present study a detailed histological and immunohistochemical analysis of the immune response was performed on eight craniotomy specimens where a granuloma surrounded each T. solium metacestode. The results indicated that in all the specimens there was a dying parasite surrounded by a mature granuloma with associated fibrosis, angiogenesis, and an inflammatory infiltrate. The most abundant cell types were plasma cells, B and T lymphocytes, macrophages, and mast cells. Th1 cytokines were prevalent and included gamma interferon, interleukin-18 (IL-18), and the immunosuppressive, fibrosis-promoting cytokine transforming growth factor beta. The Th2 cytokines IL-4, IL-13, and IL-10 were also present. These observations indicate that a chronic immune response is elicited in the CNS environment with multiple cell types that together secrete inflammatory and anti-inflammatory cytokines. In addition, both collagen type I and type III deposits were evident and could contribute to irreversible nervous tissue damage in NCC patients.
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Affiliation(s)
- B I Restrepo
- Molecular Parasitology Group, Corporación para Investigaciones Biológicas, Medellín, Colombia, Texas, USA
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Arango C, Maloney E, Rugeles MT, Bernal E, Bernal C, Borrero I, Herrera S, Restrepo M, Espinal A, Blattner WA. HTLV-I and HTLV-II coexist among the Embera and Inga Amerindians of Colombia. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20:102-3. [PMID: 9928743 DOI: 10.1097/00042560-199901010-00021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lopera TM, Restrepo M, Blair S, García HI. Humoral immune response to the anti-malaria vaccine SPf66 in the Colombian Atrato River region. Mem Inst Oswaldo Cruz 1998; 93:495-500. [PMID: 9711340 DOI: 10.1590/s0074-02761998000400015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The immunogenicity of anti-malaria synthetic vaccine SPf66 was tested in a region of the Colombian middle Atrato river. The specific serum antibodies against SPf66 were quantified in vaccinees and placebo injected controls for a two-years period post-immunization. The frequency of individuals showing seroconversion of anti-SPf66 antibodies three months after completion of the immunization schedule was higher in vaccinees than in controls (52.7% and 25.5%, respectively, p < 0.01). However, an over than four-fold increase of the specific anti-SPf66 antibody titers was observed only in 1.4% of vaccinees and 0.2% of the controls (p < 0.01). The anti-SPf66 antibody titers augmented in vaccinees from first dose application to three months after the third dose, continuously decreasing thereafter to reach below baseline values two years after completion of the immunization schedule. The results show that SPf66 has very low immunogenicity and induces a short term humoral immune response (six months).
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Affiliation(s)
- T M Lopera
- Instituto Colombiano de Medicina Tropical, Medellin, Colombia.
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Graybill JR, Vazquez J, Darouiche RO, Morhart R, Greenspan D, Tuazon C, Wheat LJ, Carey J, Leviton I, Hewitt RG, MacGregor RR, Valenti W, Restrepo M, Moskovitz BL. Randomized trial of itraconazole oral solution for oropharyngeal candidiasis in HIV/AIDS patients. Am J Med 1998; 104:33-9. [PMID: 9528717 DOI: 10.1016/s0002-9343(97)00307-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Oropharyngeal candidasis (thrush) is the most common opportunistic infection in individuals who are positive for the human immunodeficiency virus (HIV) and those who have progressed to AIDS. Itraconazole has a broad in vitro spectrum of activity, including a wide variety of Candida species. Our study determined the relative efficacy of a new oral solution formulation of itraconazole and fluconazole tablets in the treatment of oropharyngeal candidiasis. PATIENTS AND METHODS This was a prospective randomized, third-party-blind, multicenter trial conducted at 12 centers in the United States. One hundred seventy-nine HIV-positive patients with mycologically documented oropharyngeal candidiasis were treated with itraconazole oral solution 200 mg/ day for 7 or 14 days, or fluconazole tablets 100 mg/day for 14 days. Severity of disease was scored clinically before treatment and at clinical evaluations on days 3, 7, 14, 21, 35, and 42. Semi-quantitative cultures of mouth washings were also obtained on these days. RESULTS Both 14-day and 7-day regimens of itraconazole oral solution were equivalent to fluconazole for most efficacy parameters. The clinical response rate was 97% after 14 days of itraconazole and 87% after 14 days of fluconazole. Itraconazole oral solution given for 7 days was also equivalent to fluconazole treatment for 14 days. Approximately one half of patients in all three groups relapsed by 1 month after completion of treatment. There were few adverse reactions to either drug. CONCLUSION Itraconazole oral solution is well tolerated and offers an alternative at least as effective as fluconazole in the treatment of oropharyngeal candidiasis.
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Affiliation(s)
- J R Graybill
- Audie Murphy VA Hospital, San Antonio, Texas 78284, USA
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Abstract
Sera from 86 Colombian patients with parasitologically confirmed cutaneous leishmaniasis were studied by immunoblot analysis in order to identify a specific pattern for Leishmania infection. A soluble extract of Leishmania panamensis was used as the antigen. Sera from patients with Chagas' disease and sera from patients with no record of infection with trypanosomatids were also studied. The sera from patients with cutaneous leishmaniasis specifically recognized fractions of 120 kDa (76.7%), 123 and 129 kDa (69.7%), 138 kDa (61.6%), 141 kDa (53.4%), and 78 kDa (44.1%). No band common to all patients infected with Leishmania parasites was found at the time of diagnosis. Likewise, the pattern of immunoblot change after the patients were treated and apparently cured with meglumine antimoniate (Glucantime) was studied by evaluating sera pretreatment and 1 year posttreatment. Only minor changes in the color intensity at the same serum dilution between pre- and posttreatment sera were found, although the antibody titers by indirect immunofluorescence were negative for the posttreatment sample. This study shows that Western blot analysis is a more sensitive test for the detection of anti-Leishmania antibodies. However, the importance of whether the presence of antibodies correlates with the presence of Leishmania antigens could not be resolved by the data obtained from this study.
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Affiliation(s)
- D M Isaza
- Instituto Colombiano de Medicina Tropical, Medellín, Columbia.
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Isaza DM, Restrepo M, Restrepo R, Caceres-Dittmar G, Tapia FJ. Immunocytochemical and histopathologic characterization of lesions from patients with localized cutaneous leishmaniasis caused by Leishmania panamensis. Am J Trop Med Hyg 1996; 55:365-9. [PMID: 8916790 DOI: 10.4269/ajtmh.1996.55.365] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Localized cutaneous leishmaniasis (LCL) in Colombia is caused primarily by Leishmania panamensis, a different species from those reported in Brazil, French Guiana, and Venezuela. Because different parasites may elicit disparate immune responses, the present study was undertaken to establish the leukocyte participation in the immune response against L. panamensis. Epidermal and dermal immune complexes were studied using an avidinbiotin immunoperoxidase technique and specific monoclonal antibodies. In LCL, the epidermis showed keratinocytes expressing intercellular adhesion molecule-1, a universal expression of human leukocyte antigen-DR, and a hyperplasia of CD1a+ Langerhans cells. The dermal granuloma observed had a mean +/- SEM value for the CD4/CD8 ratio of 0.80 +/- 0.06. The expression of the activation molecules CD25 (interleukin-2 receptor) and CD18 (lymphocyte function-associated antigen-1 beta), 10.5% and 38.1% respectively, suggests that many cells are primed and proliferating. Most T cells in the granuloma expressed alpha beta T cell receptor (TCR) (40.3%) whereas only a few (6.7%) expressed gamma delta TCR. The results show that Colombian LCL patients possessed the appropiate activation and accessory signals from immunocompetent cells to trigger the effector phase of the immune response and eventually eliminate the parasite.
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Affiliation(s)
- D M Isaza
- Instituto Colombiano de Medicina Tropical, Medellin, Colombia
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21
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Restrepo M, Botero D, Marquez RE, Boudreau EF, Navaratnam V. A clinical trial with halofantrine on patients with falciparum malaria in Colombia. Bull World Health Organ 1996; 74:591-7. [PMID: 9060219 PMCID: PMC2486805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A total of 120 semi-immune adult male malaria patients from an area of multidrug-resistant Plasmodium falciparum malaria were hospitalized for 42 days in Medellin, Colombia (an area of no malaria transmission), and treated with halofantrine in a double-blind, randomized, prospective clinical trial according to five different treatment schedules. Each patient was assigned to one of the following halofantrine schedules: I, one dose of 1000 mg; II, three doses of 500 mg; III, two doses of 500 mg; IV, three doses of 250 mg; and V, one dose of 750 mg. Best results (75% cure rate) were obtained with schedule II, although there was no statistically significant difference compared with the other schedules. A total of 46 patients experienced recrudescent malaria. Drug levels in plasma 72 hours after beginning treatment showed no statistically significant difference between relapsing and cured patients. Side-effects (mainly gastrointestinal) were uncommon and mild. Cardiotoxicity was studied by electrocardiogram. A mean prolongation of 28.5 ms (6.6 +/- 6.3% increase from baseline) was observed in the Q-Tc interval on day 1 of the trial.
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Affiliation(s)
- M Restrepo
- Instituto Colombiano de Medecina Tropical, Medellin, Colombia
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22
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Restrepo MI, Restrepo Z, Elsa Villareal CL, Aguirre A, Restrepo M. Diagnostic tests for amoebic liver abscess: comparison of enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE). Rev Soc Bras Med Trop 1996; 29:27-32. [PMID: 8851212 DOI: 10.1590/s0037-86821996000100006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The liver abscess is the most frequent extraintestinal complication of intestinal amoebiasis: its diagnosis is suggested by the clinical picture but it must be confirmed by paraclinic tests. Themost stringent diagnosis requires identification of E. histolytica. But this is possible only in a few cases. Serological tests greatly improve the diagnosis of this severe complication of amoebiasis. We compared the Enzyme Linfed Immunosorbent Assay and the Counterimmunoelectrophoresis techniques. Both techniques were used to detect amoebic antibodies in 50 control patients, 30 patients with liver abscess and 30 patients with intestinal amoebiasis. All the sera from control patients gave negative results in both techniques. When analysing the sera from patients with intestinal amoebiasis, 10% of them were positive by ELISA but non by CIE. The sera of patients with liver abscess, we found that 90% were positive by the ELISA method and 66.6% by the CIE technique. In patients with amoebic liver abscess, the results showed that the ELISA was more sensitive than the CIE, as it presented a higher sensitivity (100%) than that of the CIE technique (66%).
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Affiliation(s)
- M I Restrepo
- Instituto Nacional de Salud (INS), Medellín, Colombia
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23
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Munera MI, Cuesta F, Abadia A, Vasquez J, Restrepo M. Determination of pefloxacin concentration in mesenteric lymph nodes by high-performance chromatography. Antimicrob Agents Chemother 1994; 38:632-4. [PMID: 8203867 PMCID: PMC284512 DOI: 10.1128/aac.38.3.632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Ten patients who had undergone laparotomies for different abdominal pathological conditions were studied to determine the levels of pefloxacin in mesenteric lymph nodes. Each patient was given 400 mg of oral pefloxacin every 12 h for the 3 days prior to surgery. Drug levels in tissue were determined by high-pressure liquid chromatography (reverse phase); the mean +/- standard deviation was 17.1 +/- 11.9 micrograms/g, with a range of 2.12 to 36.6 micrograms/g. This indicates an adequate pefloxacin concentration in lymph nodes and makes the drug a good option for the treatment of conditions in which lymph nodes act as an infection-promoting and/or relapse-favoring factor.
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Affiliation(s)
- M I Munera
- Corporación Investigaciones Biológicas, Medellín, Colombia
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24
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Abstract
The possible relationship between erythrocyte antigens and the presence of malaria infection by P. vivax and P. falciparum was sought in four different ethnic groups of two departments of Colombia. Malaria infection by P. falciparum was found in 91.4% of malaria infected blacks. No significant differences were found between the presence of malaria infection and ABO antigens. In the other blood groups, it was observed that groups MNSs conferred black people a greater Rr for malaria by both species of Plasmodium and that Duffy-negative blacks and indians appeared to be resistant to P. vivax infection. A predominance of P. vivax infection was observed in Katio Indians while P. falciparum was predominant in Kuna Indians; the reason for this finding still needs to be explored.
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Affiliation(s)
- F Montoya
- Corporación para investigaciones Biológicas C.I.B. Medellín, Colombia
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25
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Velema JP, Blettner M, Restrepo M, Muñoz N. The evaluation of agreement by means of log-linear models: proxy interviews on reproductive history among floriculture workers in Colombia. Epidemiology 1991; 2:107-15. [PMID: 1932307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We used data from Colombia to compare responses from husbands and wives concerning the reproductive history of the women. We analyzed agreement in two ways: First, we compared kappa statistics between independent subgroups. Second, we evaluated agreement by means of log-linear models. Men underreported the total number of pregnancies and the number of abortions of their wives. Agreement on the term of the pregnancy was dependent on the ages of the partners. Log-linear modeling provides an attractive alternative to more usual ways of studying agreement.
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Affiliation(s)
- J P Velema
- International Agency for Research on Cancer, Lyon, France
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26
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Restrepo M, Muñoz N, Day NE, Parra JE, de Romero L, Nguyen-Dinh X. Prevalence of adverse reproductive outcomes in a population occupationally exposed to pesticides in Colombia. Scand J Work Environ Health 1990; 16:232-8. [PMID: 2389129 DOI: 10.5271/sjweh.1790] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A prevalence survey of adverse reproductive outcomes was carried out in a population of 8867 persons (2951 men and 5916 women) who had been working in the floriculture industry in the Bogotá area of Colombia for at least six months. These workers were exposed to 127 different types of pesticides. The prevalence rates for abortion, prematurity, stillbirths, and malformations were estimated for pregnancies occurring among the female workers and the wives of the male workers before and after they started working in floriculture, and these rates were related to various degrees of exposure. A moderate increase in the prevalence of abortion, prematurity, and congenital malformations was detected for pregnancies occurring after the start of work in floriculture.
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Affiliation(s)
- M Restrepo
- Instituto Nacional de Salud, Sanidad del Ambiente, Bogotá, Colombia
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Restrepo M, Muñoz N, Day N, Parra JE, Hernandez C, Blettner M, Giraldo A. Birth defects among children born to a population occupationally exposed to pesticides in Colombia. Scand J Work Environ Health 1990; 16:239-46. [PMID: 2389130 DOI: 10.5271/sjweh.1789] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A case-referent study of birth defects was nested in a prevalence survey of adverse reproductive outcomes carried out among 8867 floriculture workers in Bogotá, Colombia. A total of 535 children born to these workers and reported by their parents as malformed and 1070 children selected at random as referents were invited to a medical examination including consultation with a geneticist and a clinical teratologist and a review of the medical records. Seventy-six percent of both groups attended the examination. Of 403 children reported as malformed, a birth defect was confirmed for only 154 (38%). On the other hand, of the 817 children reported as normal, 735 (90%) were normal, but 68 had a birth defect and 14 had other conditions. A case-referent analysis was then carried out including 222 children with birth defects and 443 referents. An increased risk was found only for birthmarks, and specifically for hemangiomas, for children with parents exposed to pesticides in the floriculture industry.
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Affiliation(s)
- M Restrepo
- Instituto Nacional de Salud, Sanidad del Ambiente, Bogotá, Colombia
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Abstract
HLA antigens and their relationship with malaria infection were studied in four different ethnic groups in Colombia (South America): two groups of indians (Kunas and Katios), one of negroes and a group of mixed ancestry. A total of 965 persons were studied, 415 with malaria and 550 as controls. HLA-A,B, and C antigen frequencies in the four groups are reported. The association of each HLA antigen with malaria infection due to P. vivax and to P. falciparum was evaluated. Negroes, Kunas and Katios indians variously lack from 6 to 9 of the HLA antigens found in the mixed group. In the designated ethnic groups, antigens B5, B13, B15, Cw2 and Cw4 showed borderline association with malaria infection. However, in the mixed ethnic group, statistically significant associations were found with malaria infection and the presence of A9, Aw19, B17, B35, and Z98 (a B21-B45: crossreacting determinant) with few differences when P. vivax infection and P. falciparum infection were considered individually. This finding may represent a lack of general resistance to malaria in the group that harbors antigens of Caucasian origin. These individuals have been in direct and permanent contact with malaria only in the past 65 years. In contrast, indians, both Kunas and Katios, and Negroes have lived for centuries in malaria endemic areas, and it is possible that a natural selection system has developed through which only those individuals able to initiate an acute immune response to malaria have survived.
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Rojas W, Northup J, Gallo O, Montoya AE, Montoya F, Restrepo M, Nimnich G, Arango M, Echavarria M. Reduction of malaria prevalence after introduction of Romanomermis culicivorax (Mermithidae: Nematoda) in larval Anopheles habitats in Colombia. Bull World Health Organ 1987; 65:331-7. [PMID: 3499249 PMCID: PMC2490995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The worldwide resurgence of malaria has become a major public health problem. New methods of controlling the vectors of the disease are required, and we therefore studied the biological control of Anopheles albimanus by Romanomermis culicivorax in Colombia. The investigation was carried out in El Valle and Nuquí, two towns on the northern Pacific coast of the country. All of the mosquito larval habitats surrounding El Valle were seeded with the eggs and adults of R. culicivorax. The nematode established itself in the new habitat and recycled over 27 months. The larval population of A. albimanus, the only malarial vector detected in the two towns, decreased in El Valle. In contrast, no change in the larval populations of the vector was detected in ponds located near Nuquí, the untreated control town. A rapid and progressive decrease of the prevalence of malaria among schoolchildren in El Valle was observed during the 2-year evaluation period.
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Abstract
La administración de levamisol a la dosis para adultos, de 150 mg durante 2 a 3 meses, estuvo asociada la disminución y finalmente a la desaparición de microfilarias circulantes de Mansonella ozzardi. No se presentaron reacciones secundarias a la droga y la eosinofilia circulante, sirvió como indicador de la presencia de microfilarias.
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Trujillo H, Jaramillo C, Restrepo M, Mejía GI, Zapata CT, Ramírez R, Betancur R. [Rotavirus and other enteropathogens in the etiology of acute diarrhea in Medellín, Colombia, 1982]. Bol Oficina Sanit Panam 1985; 98:251-60. [PMID: 3157392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Botero D, Restrepo M, Montoya A. Prospective double-blind trial of two different doses of mefloquine plus pyrimethamine-sulfadoxine compared with pyrimethamine-sulfadoxine alone in the treatment of falciparum malaria. Bull World Health Organ 1985; 63:731-7. [PMID: 3910296 PMCID: PMC2536382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This double-blind study is based on the treatment of 75 adult male patients suffering from Plasmodium falciparum malaria in Medellín, Colombia, a city in which there is no malaria transmission. The patients, who came from regions with high resistance to antimalarials, were divided into three groups receiving single-dose treatment as follows: a combination of 280 mg mefloquine, 800 mg sulfadoxine and 40 mg pyrimethamine; a combination of 420 mg mefloquine, 1200 mg sulfadoxine and 60 mg pyrimethamine; and a combination of 1500 mg sulfadoxine and 75 mg pyrimethamine. After treatment, follow-up examination was performed daily for I week and then weekly for another 3 weeks. The cure rate in the mefloquine groups (within the study period of 28 days) was 100%, and in the third group 75%. Normal blood levels of the administered drugs were found in 6 patients of the third group who were not cured; they were subsequently cured with a single dose of 1000 mg of mefloquine. Drug tolerance was good and no toxic effects were demonstrated in blood and urine examinations. While the doses in the drug combinations (containing mefloquine) gave very good results, we would recommend a slightly higher dose combination of mefloquine with sulfadoxine-pyrimethamine for the treatment of falciparum malaria in areas with a high prevalence of chloroquine resistance.
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Abstract
The frequencies of blood groups, Rh and HLA antigens were studied in a series of patients with paracoccidioidomycosis as well as in control subjects. Statistical analysis of the results showed that only 2 antigens (HLA-A9 and HLA-B13) had a significantly increased frequency among patients with paracoccidioidomycosis compared with healthy controls. Among patients with paracoccidioidomycosis antigen HLA-A9 was significantly more prevalent in progressive pulmonary forms of the disease than in patients with extra pulmonary involvement. These observations suggest that HLA-A9 may influence susceptibility to the mycosis as well as its course.
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Restrepo A, Restrepo M, de Restrepo F, Aristizábal LH, Moncada LH, Vélez H. Immune responses in paracoccidioidomycosis. A controlled study of 16 patients before and after treatment. Sabouraudia 1978; 16:151-63. [PMID: 694716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serum electrophoresis patterns and various measures of specific and non-specific immune competence were determined in 16 patients with paracoccidioidomycosis, at time of diagnosis and 6 months after therapy. The results were compared with those furnished by the study of 16 control subjects, matched by age and sex. Once treated, the patients approached normality in some parameters. Untreated patients had significantly diminished albumin levels with increased alpha 1, alpha 2 and gamma fractions. Immune gamma globulin G (IgG) was elevated and remained so during therapy. Both before and after treatment patients had diminished total numbers and decreased percentages of E rosettes; they also had depressed lymphocyte transformation with phytohemagglutinin (PHA) and paracoccidioidin (P). Also, untreated patients exhibited the lowest skin test responses to PHA, purified protein derivative (PPD), P and candidin (C); significant differences, however, were limited to the former 2 antigens. All untreated patients had detectable antibody titers against P. brasiliensis; these titers had a tendency to drop during treatment. No direct correlation was found between elevated serum fractions, presence of antibodies and depressed cellular immunity.
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Jaramillo C, Restrepo M, García LF. [Comparison of antigens among 3 strains of Toxplasma gondii and one of Besnoitia jellisonii]. Rev Latinoam Microbiol 1976; 18:93-6. [PMID: 828289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Restrepo M, Jaramillo V, Kurzer A. [Toxoplasmosis in pregnancy and its placental transmission. Preliminary report]. Rev Colomb Obstet Ginecol 1971; 22:133-8. [PMID: 5159336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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39
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Botero D, Restrepo A, Zuluaga H, Lopez JH, Restrepo M, Diaz F, Leiderman E, Acosta M. [New approach to the teaching of microbiology and parasitology]. Educ Med Salud 1971; 5:40-52. [PMID: 5092649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Restrepo A, Robledo M, Ospina S, Restrepo M, Correa A. Distribution of paracoccidioidin sensitivity in Colombia. Am J Trop Med Hyg 1968; 17:25-37. [PMID: 5637020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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