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Biomedical subjects

Jaime Carmona-Fonseca

Publications and source records attributed to Jaime Carmona-Fonseca.

13 recordsLinked to original sources
PubMed2006

Therapeutic efficacy test in malaria falciparum in Antioquia, Colombia.

OBJECTIVE: Evaluate the frequency of failure of eight treatments for non-complicated malaria caused by Plasmodium falciparum in patients from Turbo (Urabá region), El Bagre and Zaragoza (Bajo Cauca region), applying the 1998 protocol of the World Health Organization (WHO). Monotherapies using chloroquine (CQ), amodiaquine (AQ), mefloquine (MQ) and sulphadoxine-pyrimethamine (SP), and combinations using chloroquine-sulphadoxine-pyrimethamine (CQ-SP), amodiaquine-sulphadoxine-pyrimethamine (AQ-SP), mefloquine-sulphadoxine-pyrimethamine (MQ-SP) and artesunate-sulphadoxine-pyrimethamine (AS-SP), were examined. METHODOLOGY: A balanced experimental design with eight groups. Samples were selected based on statistical and epidemiological criteria. Patients were followed for 21 to 28 days, including seven or eight parasitological and clinical evaluations, with an active search for defaulting patients. A non-blinded evaluation of the antimalarial treatment response (early failure, late failure, adequate response) was performed. RESULTS: Initially, the loss of patients to follow-up was higher than 40%, but the immediate active search for the cases and the monetary help for transportation expenses of patients, reduced the loss to 6%. The treatment failure was: CQ 82%, AQ 30%, MQ 4%, SP 24%, CQ-SP 17%, AQ-SP 2%, MQ-S-P 0%, AS-SP 3%. CONCLUSION: The characteristics of an optimal epidemiological monitoring system of antimalarial treatment response in Colombia are discussed. It is proposed to focus this on early failure detection, by applying a screening test every two to three years, based on a seven to 14-day follow-up. Clinical and parasitological assessment would be carried out by a general physician and a field microscopist from the local hospital, with active measures to search for defaulter patients at follow-up.

Adolescent↗
PubMed2006

Effect of Solanum nudum Dunal (Solanaceae) steroids on hepatic trophozoites of Plasmodium vivax.

Steroids isolated from the plant Solanum nudum showed antiplasmodial activity against the blood stages of Plasmodium falciparum. It has been demonstrated that these steroids are neither mutagenic in vitro nor clastogenic in vivo. This study evaluated the effect of five steroids of S. nudum (SN-1, SN-2, SN-3, SN-4 and SN-5) on hepatic trophozoites of P. vivax, using an experimental design, non-balanced, with blind determination of the effect expressed as the percentage reduction of hepatic trophozoites. The sporozoites used to inoculate human hepatoma cells HepG2-A16 were obtained from gametocytemic blood of volunteers infected only with P. vivax, and passed into laboratory-reared Anopheles albimanus mosquitoes. Steroids were added at three different doses (100, 10 and 1 microg/mL) just after inoculation of the cells with sporozoites. The effect was determined by indirect immunofluorescence assays using the monoclonal antibodies Pv210 or Pv47E-2E10 and steroid cytotoxicity on HepG2-A16 cells was assessed by the MTT method. All the steroids reduced the number of hepatic P. vivax trophozoites, SN-2 and SN-4 reduced the number of hepatic trophozoites by 47% and 39% (p < 0.05), respectively.

Animals↗
PubMed2006

Prevention of sporogony of Plasmodium vivax in Anopheles albimanus by steroids of Solanum nudum Dunal (Solanaceae).

The sporontocidal activity of three steroids (SN-1, SN-2 and SN-4) from Solanum nudum Dunal (Solanaceae) was determined against naturally circulating isolates of Plasmodium vivax in Anopheles albimanus. Laboratory-reared Anopheles albimanus mosquitoes were infected with P. vivax from gametocytemic blood of volunteers resident in Buenaventura, Valle del Cauca (Colombian Pacific Coast) by using an artificial membrane feeder. Prior to mosquito feeding, gametocytemic blood was centrifuged, plasma was separated, packed blood red cells were washed with RPMI 1640 and then resuspended in non-immune AB serum, then the steroids were added at different doses. On day 7 after infection, the presence and number of oocysts in mosquitoes was determined. The steroid SN-2 reduced the infection of mosquitoes by 90% and the mean number of oocysts by 60%. These data confirmed that the experimental steroid is capable of interrupting the sporogonic development of P. vivax in Anopheles albimanus. This experimental steroid has potential for transmission blocking in vivax malaria.

Animals↗
PubMed2006

[Cytochrome P-450 and the response to antimalarial drugs].

OBJECTIVES: To assess the relationship between the genetic and phenotypic factors linked to the cytochrome P-450 enzyme system and the response to the antimalarial drugs chloroquine, amodiaquine, mefloquine, and proguanil, as well as to determine how certain biological and social factors of the host influence the behavior of this enzymatic complex. METHODS: We performed a systematic review of the medical bibliographic databases PubMed, Excerpta Medica, LILACS, and SciELO by using the following Spanish and English descriptors: "CYP-450" and "citocromo P-450" in combination with "proguanil" (and with "mefloquina," "cloroquina," and "amodiaquina"), "farmacocinética de proguanil" (and the same using "mefloquina," "cloroquina," and "amodiaquina"), "resistencia a proguanil" (and the same using "mefloquina," "cloroquina," and "amodiaquina"), "metabolismo," "farmacogenética," "enfermedad," "inflamación," "infección," "enfermedad hepática," "malaria," "nutrición," and "desnutrición." The same terms were used in English. The search included only articles published in Spanish, English, and Portuguese on or before 30 June 2005 that dealt with only four antimalarial drugs: amodiaquine, chloroquine, mefloquine, and proguanil. RESULTS: Some genetic factors linked to human cytochrome P-450 (mainly its polymorphism), as well as other biological and social factors (the presence of disease itself, or of inflammation and infection, the use of antimalarials in their various combinations, and the patient's nutritional status) influence the behavior of this complex enzymatic system. It has only been in the last decade that the genetics of the cytochromes has been explored and that the mechanisms underlying some therapeutic interactions and aspects of drug metabolism have been uncovered, making it possible to characterize the biotransformation pathway of amodiaquine and chloroquine. Hopefully new research will help answer the questions that still remain, some of which pertain to the metabolism of other antimalarial drugs, the distribution in the population of the genetic alleles linked to the enzymes involved in their metabolism, the contribution of these genetic mutations to therapeutic failure, and the possibility of predicting the response to antimalarial therapy. CONCLUSIONS: The therapeutic response to antimalarial drugs is a multifactorial process that is poorly understood, so that it is not possible to ascribe to a specific phenotype or genotype a role in the response to antimalarial therapy. Attention should be given to biological and social factors, such as diet, nutritional status, and inflammatory and infectious processes that are often present in areas where malaria is endemic.

Administration, Oral↗
PubMed2006

Efficacy of three chloroquine-primaquine regimens for treatment of Plasmodium vivax malaria in Colombia.

Plasmodium vivax malaria is an important cause of morbidity in Central and South America. In Colombia, this is the most prevalent malaria infection, representing 75% of the reported cases. To define the efficacy of the chloroquine and primaquine regimen to eliminate hypnozoites and prevent relapses, we conducted a random controlled clinical trial of three primaquine regimens in an open-label study. We evaluated the anti-relapse efficacy of total primaquine doses of 45, 105, and 210 mg administered at a dosage of 15 mg/day in 210 adults with P. vivax infection from the northwestern region of Colombia. Cure rates for blood-stage P. vivax malaria by day 28 of follow-up were 100% in all groups. Post-treatment reappearance of parasitemia during the six months of follow-up was 45%, 36.6% and 17.6%, respectively, for each group. When compared with other groups, administration of 210 mg was a significant protection factor for reappearance of parasitemia in a malaria-endemic area.

Adult↗
PubMed2006

[Plasmodium vivax malaria: treatment of primary attacks with primaquine, in three different doses, and a fixed dose of chloroquine, Antioquia, Colombia, 2003-2004].

INTRODUCTION: Chloroquine (CQ) and primaquine (PQ) are used in Colombia for treatment of uncomplicated vivax malaria but there are few efficacy studies of this scheme. OBJECTIVES: (a) to investigate the clinical picture of vivax malaria in adult patients; (b) to evaluate the antimalarial treatment response to the standard scheme CQ-PQ; (c) to compare the efficacy of the standard scheme and two alternative schemes with equal dose of CQ and different PQ dose; (d) to identify the adverse effects of CQ-PQ treatment. MATERIALS AND METHODS: Randomized, nonblind design; three groups, defined according to total dose of PQ: 45, 105 and 210 mg. All patients received CQ (1500 mg, in 48 hours), which was followed by PQ. Patients were recruited in Turbo and El Bagre. The follow-up period was 28 days. Antimalarial treatment response was classified according to the WHO-2001 protocol (early failure, late failure, adequate response). RESULTS: In total 228 patients were recruited, 18 were lost between days 4 and 27; the antimalarial treatment response was evaluated in 210. The clinical findings were similar to those described by other authors. Parasitaemia clearance was confirmed during the first 24 hours of CQ treatment in 11% of patients. At 48 hours 66% and at 72 hours 97% of patients were negative. All patients (210) displayed adequate treatment response to the CQ-PQ treatment. The different doses of PQ did not affect this response. CONCLUSIONS: CQ-PQ should be conserved as the first treatment choice and should be evaluated in other areas. Simultaneous administration of CQ and PQ is proposed.

Acute Disease↗
PubMed2005

[Demographic and epidemiologic changes in Colombia during the 20th century: facts and explanations].

INTRODUCTION: Research, education, organization and administration activities in health need an updated panoramic view of demographic and epidemiologic changes and tendencies. OBJECTIVES: To describe the main changes in demography and epidemiology during the 20th century in Colombia and to comment on the causative models used by some authors. MATERIALS AND METHODS: A descriptive and longitudinal study. Second hand information from various sources was used. The final section of the review includes a discussion on the interpretation of data given by the original authors. RESULTS: In 1905-2005, population increased from 4,737,588 inhabitants to 48,864,013. The age distribution of the population showed dramatic changes: the true pyramid, as seen in 1951, changed into a distorted figure (no apparent differences between 0 and 14 years of age). Both children and youngsters lost representation on age structure, while adult and older individuals gain representation. During 1905-1938, the birth rate was 43% and by the end of 2005 it will be 22%. Mortality dropped a 75%, falling from 23% in 1905-1912 to 6% in 1885-1993, but it rose a 33% after 1993, and will reach 8.3% in 2010. In 1938, the urban population was 31% and in 2002, 72%. Mortality discriminated by cause changed in a significant manner during the second half of the 20th century. Infectious-parasitic and perinatal diseases, the main cause of death by the end of the 1960-1969 decade, lost importance on behalf of degenerative diseases, accidents and homicides which are now the most frequent. Conclusions. Our present population density is relatively low. The demographic change has been profound but the velocity has been more important. The aging of population has serious implications for the country. These notable modifications in Colombian families raise challenges in all social fields. The demographic and epidemiological changes (structure and level of morbimortality) require a serious analysis, and easy explanations do not have to be accepted without repairs.

Colombia↗
PubMed2003

[Reference values for erythrocyte cholinesterase activity in the working population of Antioquia, Colombia, according to the Michel and EQM techniques].

OBJECTIVE: To establish reference values for erythrocyte cholinesterase (EC 3.1.1.7) activity for the active working population of two regions of the department of Antioquia, Colombia, that are located at different altitudes above sea level. METHODS: We took representative samples from populations of active working persons 18 to 59 years old from two regions in the department of Antioquia: (1) the Aburrá Valley (1 540 m above sea level) and (2) the near east of the department (2 150 m above sea level). We excluded workers who were using cholinesterase-inhibiting substances in their work or at home, those who had a disease that altered their cholinesterase levels, and those who said they were not in good health. We measured the erythrocyte cholinesterase activity using two methods: (1) the Michel method and (2) the EQM method (EQM Research, Cincinnati, Ohio, United States of America). We carried out the measurements with 827 people, 415 from the Aburrá Valley and 412 from the near east region. We compared proportions using the chi-square test and Fisher's exact test. We utilized the Student's t test for independent samples to compare two averages. To simultaneously compare three or more averages, analysis of variance was used, followed by the Newman-Keuls multiple-range test. When the variables were not normally distributed or when the variances were not homogeneous, Kruskal-Wallis nonparametric analysis of variance was used to compare the medians. Three computer software programs were used in the statistical analysis: SPSS 9.0, SGPlus 7.1, and Epi Info 6.04. In all the statistical tests the level of significance was set at P < 0.05. RESULTS: The average erythrocyte cholinesterase activity value that we found for the studied population by using the Michel method was 0.857 delta pH/hour (95% confidence interval (CI): 0.849 to 0.866), and the average value found through the EQM method was 35.21 U/g hemoglobin (95% CI: 34.82 to 35.60). With the Michel method: (1) the enzymatic activity differed significantly between the two regions, according to the Newman-Keuls test; (2) within each region, the enzymatic activity was significantly higher among males than among females, according to the Newman-Keuls test; and (3) in none of the region-sex strata was there a statistically significant influence of age on the enzymatic activity. Using the EQM method, there were no statistically significant differences by region, sex, or age group. CONCLUSIONS: The erythrocyte cholinesterase activity values found by the two analytical techniques were significantly higher than the values from outside Colombia that are now being used as reference values in the country, which poses both clinical and epidemiological problems. We recommend that the data from this study be adopted as the reference values in Colombia.

Adolescent↗
PubMed2003

[Onychomycosis by common non-dermatophyte moulds].

Between 1990 and 2000, The Medical Mycology Laboratory at University of Antioquia (Medellín, Colombia), attended 4621 patients, with nail dystrophies. We used the direct test and culture of nail samples for diagnostic purposes. This report includes 310 patients, 7% (310/4621), with positive cultures for the same non-dermathophyte fungi, in five or more places of inoculation. From the 310 positive cultures, 284 (92%) were positive in direct test. No characteristic morphology for any of the genera could be detected. Until 1989 we had an average of 9 cases per year and between 1990 and 2000 we found 28 cases per year (an increase of 211%). The implicated genera were: Fusarium 50%, Nattrassia 31%, Aspergillus and Dendrophoma 7% each, Penicillium and Scopulariopsis contributed with 2% each, and Acremonium was found in less of 1% of cases. The general prevalence of onychomycosis due to non-dermatophytic fungi was about 12,4% between 1990-2000. This report describes the main epidemiological characteristics found, comparing them with results from other authors, and defines the basic profile of affected patients: adults (31-40 years old) who use occlusive shoes (trainers) and practice sport, which predispose to hyperhydrosis and consequently to onychomycosis. The course of the disease takes in average 30 months in both sexes. The percentage of onychomycosis found was 62% for women and 38% for men.

Adult↗
PubMed2003

[Food and nutritional security in a risk area for malaria].

To explore some relationships between alimentary and nutritional security (SAN) and nutritional status in an endemic malaria community, applying qualitative and quantitative methods simultaneously. The study was descriptive and prospective. The population were all farming Afro-American families who live in the basin of the river Valle (Bahía Solano. Chocó, Colombia) that derived the base of their feeding of the agriculture. The SAN was measured from the monthly availability of foods and was classified in adequate and inadequate according to the available monthly caloric balance percentage. We determined the risk of acute malnutrition (indicative P/T), chronic (T/E), global (P/E) and risk of thinness (BMI). We sought for malarian cases. The official data of illness were revised. We applied surveys to know the morbidity and knowledge, attitudes and practices in malaria infections, 29% of homes had alimentary insecurity. There was protein deficit and iron of high availability, calcium and vitamin A in 100% of families. In children under 6 years old, we found 31% and 69%, in same order, with low P/T and T/E, while in the 6-10 year old children had 14% and 41%, respectively. In adolescents (11 to 17 years old) the risk of thinness was 15% and in adults 3%. There was not association between alimentary available and family nutritional status. These results suggest subclinics deficiencies of micronutrients.

Adolescent↗
PubMed2003

[Levels of plasma cholinesterase in Colombian working-class populations].

Levels of plasma cholinesterase in Colombian working-class populations Reference values for plasma cholinesterase (EC 3.1.1.8) are not available for Colombian populations. A representative sample of a working-class population was used to establish these values to provide reference data for use by the social security system. Two working-class populations were sampled from the Aburrá Valley (Aburrá) and eastern Antioquia (Oriente). Cholinesterase activity was measured in 827 workers, with ages spanning 18-49 years, 415 from Aburrá and 412 people from Oriente. Three methods were used to measure cholinesterase: Michel, EQM and Monotest The average values by Michel and EQM were not statistically different between regions (Michel: Aburrá, 1.11, and East, 1.13 deltas pH/hora; EQM: Aburrá, 2.55, and Oriente, 2.48 U/ml). By the Monotest, the enzyme average was statistically higher in Aburra than in Oriente (5,743 and 5,459 U/L respectively; p = 0 .012). By region and technique, men had significantly higher enzymatic levels than women. Within both regions and sexes, no statistically significant difference among the three aged groups was noted. Our obtained Colombian values differed significantly from foreign reference values: Michel and Monotest levels were higher and EQM levels were lower. For making clinical and epidemiologic decisions in Colombia related to these data, the values obtained for the Colombian populations are preferred over values derived from external sources.

Adolescent↗
PubMed2002

Resistance of Plamodium falciparum to antimalarial drugs in Zaragoza (Antioquia, Colombia), 1998.

Plasmodium falciparum sensitivity to chloroquine (CHL), amodiaquine (AMO) and sulfadoxine/pyrimethamine (SDX/PYR) was assessed in vivo and in vitro in a representative sample from the population of Zaragoza in El Bajo Cauca region (Antioquia-Colombia). There were 94 patients with P. falciparum evaluated. For the in vivo test the patients were followed by clinical examination and microscopy, during 7 days. The in vitro test was performed following the recommendations of the World Health Organization. The in vivo prevalence of resistance to CHL was 67%, to AMO 3% and to SDX/PYR 9%. The in vitro test showed sensitivity to all antimalarials evaluated. Concordance for CHL between the in vivo and in vitro tests was 33%. For AMO and SDX/PYR, the concordance was 100%. We conclude that a high percentage of patients are resistant to CHL (in vivo). A high rate of intestinal parasitism might explain in part, the differences observed between the in vivo and the in vitro results. Therefore, new policies and treatment regimens should be proposed for the treatment of the infection in the region. Nationwide studies assessing the degree of resistance are needed.

Adolescent↗