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Dietary diversity in eight Latin American countries: results from ELANS study
(2020-06-10) Gómez Salas, Georgina; Fisberg, Regina Mara; Nogueria Previdelli, Agatha; Kovalskys, Irina; Fisberg, Mauro; Herrera Cuenca, Marianella; Cortés Sanabria, Lilia Yadira; Yépez García, Martha Cecilia; Pareja Torres, Rossina Gabriella; Rigotti, Attilio
Dietary diversity, define as the number of food items or food groups consumed over a given period of time measured at the household or individual level, is widely recognized as a key dimension of diet quality. This analysis investigated dietary diversity in eight Latin-American countries and its associations with sociodemographic and anthropometric parameters.
Data from the ELANS study conducted in eight Latin-American countries (Argentina, Brazil, Colombia, Costa Rica, Chile, Ecuador, Peru and Venezuela) were analyzed. The ELANS study interviewed 9,218 subjects living in the main cities in each country. Food intake were collected using two 24-hour dietary recalls, following the Multiple Pass Method. For calculation of diet diversity score, only the first 24-hour recall was analyzed. Dietary diversity was assessed at individual level. All food items reported to be consumed during the first 24-hour recall were classified into nine food groups: 1. Cereals, 2. White roots and tubers, 3. Vegetables, 4. Fruits, 5. Meat, poultry and offal, 6. Fish and seafood, 7. Eggs, 8. Pulses, legumes and nuts and 9. Milk and milk products. The selection of these groups was based on the Women's Dietary Diversity Score Projectfood groups classification. Consumption of at least 15 g of each food group was assigned 1 point or 0 points if consumption was less than 15 g. Thus, the score ranged from a minimum of 0 and a maximum of 9 points. Higher scores indicated higher diversity as more food groups were eaten. Analysis was performed by age group, gender, and socioeconomic level (SES) as well as anthropometric measurements.Mean diet diversity score (DDS) for the whole sample was 4.48 ± 1.16, ranging from 0 to 9 points. Men showed significant higher DDS. No difference was observed among age groups. Among countries, Ecuador and Peru showed the highest DDS, 4.88 ± 1.22 and 4.82 ± 1.12 points, respectively; while Argentina (4.20 ± 1.13) and Venezuela (4.27 ± 1.04) reported the lowest. We found a statistically significant trend (p < 0.001) to a higher DDS among those subjects in the high socio-economic level. Regarding anthropometric measurements, no differences were found in DDS among different nutritional status or based on waist and neck circumference measures.This study revealed that dietary diversity is limited among Latin American countries regardless of sex, age, socioeconomic level, and nutritional status. Nutritional interventions emphasizing the importance of maximizing dietary diversity should be encouraged to ensure optimum nutritional adequacy within the region
The contrasting effects of Bothrops lanceolatus and Bothrops atrox venom on procoagulant activity and thrombus stability under blood flow conditions
(2024-09-18) Radouani, Fatima; Jalta, Prisca; Rapon, Caroline; Lezin, Chloe; Branford, Chelsea; Florentin, Jonathan; Gutiérrez, José María; Resiere, Dabor; Neviere, Remi; Pierre Louis, Olivier
Background: Consumption coagulopathy and hemorrhagic syndrome are the typical features of Bothrops sp. snake envenoming. In contrast, B. lanceolatus envenoming can induce thrombotic complications. Our aim was to test whether crude B. lanceolatus and B. atrox venoms would display procoagulant activity and induce thrombus formation under flow conditions. Methods and Principal Findings: Fibrin formation in human plasma was observed for B. lanceolatus venom at 250–1000 ng/mL concentrations, which also induced clot formation in purified human fibrinogen, indicating thrombin-like activity. The degradation of fibrinogen confirmed the fibrinogenolytic activity of B. lanceolatus venom. B. lanceolatus venom displayed consistent thrombin-like and kallikrein-like activity increases in plasma conditions. The well-known procoagulant B. atrox venom activated plasmatic coagulation factors in vitro and induced firm thrombus formation under high shear rate conditions. In contrast, B. lanceolatus venom induced the formation of fragile thrombi that could not resist shear stress. Conclusions: Our results suggest that crude B. lanceolatus venom displays amidolytic activity and can activate the coagulation cascade, leading to prothrombin activation. B. lanceolatus venom induces the formation of an unstable thrombus under flow conditions, which can be prevented by the specific monovalent antivenom Bothrofav®.
Key contribution: Crude B. lanceolatus venom displays procoagulant activity and is able to activate coagulation factors in the plasma, independently of its enzymatic activity. Under flow conditions, B. lanceolatus venom elicits the formation of a thrombus that cannot resist shear stress, suggesting thrombus fragility. The specific monovalent antivenom Bothrofav® was able to prevent B. lanceolatus venom-induced thrombus formation.
Infectious complications following snakebite by Bothrops lanceolatus in Martinique: a case series
(2019-10-14) Resiere, Dabor; Mehdaoui, Hossein; Neviere, Remi; Olive, Claude; Severyns, Mathieu; Beaudoin, Adeline; Florentin, Jonathan; Brouste, Yannick; Banydeen, Rishika; Cabié, André; Mégarbane, Bruno; Gutiérrez, José María; Kallel, Hatem
Infections secondary to snakebite occur in a number of patients and are potentially life-threatening. Bothrops lanceolatus bites in Martinique average 30 cases per year and may result in severe thrombotic and infectious complications. We aimed to investigate the infectious complications related to B. lanceolatus bite. A retrospective single-center observational study over 7 years (2011–2018) was carried out, including all patients admitted to the hospital because of B. lanceolatus bite. One hundred seventy snake-bitten patients (121 males and 49 females) were included. Thirty-nine patients (23%) presented grade 3 or 4 envenoming. Twenty patients (12%) developed wound infections. The isolated bacteria were Aeromonas hydrophila (3 cases), Morganella morganii (two cases), group A Streptococcus, and group B Streptococcus (one case each). Patients were treated empirically with third-generation cephalosporin (or amoxicillin–clavulanate), aminoglycoside, and metronidazole combinations. Outcome was favorable in all patients. The main factor significantly associated with the occurrence of infection following snakebite was the severity of envenoming (P < 0.05). Our findings clearly point toward the frequent onset of infectious complications in B. lanceolatus–bitten patients presenting with grade 3 and 4 envenoming. Thus, based on the bacteria identified in the wounds, we suggest that empiric antibiotic therapy including third-generation cephalosporin should be administered to those patients on hospital admission.
Snakebite envenoming in French Guiana: assessment of the preclinical efficacy against the venom of Bothrops atrox of two polyspecific antivenoms
(2020-01-15) Resiere, Dabor; Villalta Arrieta, Mauren; Arias Oviedo, Ana Silvia; Kallel, Hatem; Nèviére, Rémi; Vidal, Nicolas; Mehdaoui, Hossein; Gutiérrez, José María
Snakebite envenoming is a relevant public health problem in French Guiana, and Bothrops atrox is responsible for the vast majority of envenomings in this overseas French territory. The preclinical efficacy of freeze-dried antivenoms manufactured in Costa Rica (Polival-ICP®) and Mexico (Antivipmyn Tri®) was assessed against the lethal, hemorrhagic, in vitro coagulant, and myotoxic effects of Bothrops atrox venom from French Guiana. Antivenoms differ in protein concentration and in the type of active principle (IgG and F (ab’)2, respectively). Polival-ICP® showed significantly higher neutralizing activity against lethal, hemorrhagic and in vitro coagulant activities of the venom. Antivenoms neutralized myotoxic effect to a similar extent. In the case of lethal activity, Antivipmyn Tri® did not neutralize the effect at the highest antivenom level tested (1 mg venom/mL antivenom).
Análisis retrospectivo tipo observacional de la relación entre el tiempo de administración antimicrobiano efectivo y la mortalidad en pacientes con hemocultivos positivos en mayores de 18 años en el Hospital San Juan de Dios en el primer trimestre del año 2025
(2026) Gómez Rojas, Juan Carlos; Ramírez Cardoce, Manuel; Mora Díaz, Mauricio
Objetivo: Analizar la relación entre el tiempo transcurrido, desde el registro de un hemocultivo positivo hasta la intervención terapéutica antimicrobiana efectiva y la mortalidad a los 7 y 30 días en pacientes mayores de 18 años hospitalizados en el Hospital San Juan de Dios durante el primer trimestre de 2025. Metodología: Se llevó a cabo un estudio observacional y retrospectivo de cohorte en un único centro. La muestra incluyó 158 episodios de bacteriemia confirmada, tras aplicar los criterios de inclusión y exclusión. Se analizaron variables demográficas, clínicas, microbiológicas y temporales. Para evaluar la asociación entre el tiempo de tratamiento y la mortalidad y evitar el sesgo de tiempo inmortal, en 148 episodios se empleó un análisis tipo landmark en puntos temporales preestablecidos (1, 3, 6, 12, 24, 48 y 72 horas), ajustado por comorbilidades según el índice de Charlson. Resultados: La cohorte presentó una mediana de edad de 60 años, con predominio masculino (58.2 %) y una alta carga de comorbilidad. Los microorganismos más frecuentes fueron E. coli (28.5 %) y S. aureus (25.9 %). La mortalidad global a los 7 y 30 días fue del 24.7 % y 36.1 %, respectivamente. La mediana de tiempo hasta el inicio de la terapia efectiva fue de 2.5 horas, con una diferencia significativa entre infecciones comunitarias (0 horas) y nosocomiales (11 horas); no se documentaron diferencias significativas entre jornadas laborales. El análisis Landmark demostró que el retraso en el inicio de la terapia efectiva mayor que 1 hora se asoció con un incremento drástico en la mortalidad a 30 días (OR ajustado 21.728; IC95 % 8.58–54.97; p < 0.001). Esta asociación se mantuvo significativa a las 3 horas (OR ajustado 9.067; p < 0.001) y a las 12 horas (OR ajustado 12.519; IC95 % 4.893–32.031; p < 0.001). No se encontró una asociación significativa con la mortalidad temprana a 7 días. Las bacteriemias por gramnegativos presentaron una ventana crítica más inmediata (<1 hora) en comparación con los grampositivos. Conclusiones: El tiempo transcurrido hasta la administración de un antimicrobiano efectivo constituye un predictor determinante de la mortalidad a 30 días, aunque no a los 7 días según la metodología empleada. Los retrasos, especialmente durante las primeras 12 horas, incrementan significativamente el riesgo de muerte. Se identifican brechas importantes en la oportunidad de tratamiento para las infecciones nosocomiales y aquellas causadas por gérmenes resistentes. Es necesaria la implementación de alertas tempranas y protocolos de respuesta rápida, en particular para bacilos gramnegativos.