102ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)EN ESTE NMERO:CURRENT ISSUE: Avoidable mortality of scientific manuscripts Bio-anthropology and paleopathology of the SO10-IX muisca mummy Determination of the prevalence of hemoglobin S, C, D, GPractices and beliefs about exclusive breastfeeding Nephritic syndrome associated to skin infection, hepatitis A and pneumoniae-mail: comedica@univalle.edu.co colombiamedica@gmail.com colombiamedica@yahoo.comhttp://colombiamedica.univalle.edu.co E-ISSN-1657-9534Vol. 41 N 2, 2010, Abril-Junio103ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)UNIVERSIDADDELVALLEFACULTADDESALUD REVISTA COLOMBIA MDICARECTOR IVN ENRIQUE RAMOSDECANA LILIANA ARIASEDITOR EN JEFE JULIN ALBERTO HERRERA, MD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIAEDITORES ASISTENTES LUIS EDUARDO BRAVO, MD, MSC, UNIVERSIDAD DEL VALLE, CALI, COLOMBIAADOLFO CONTRERAS, OD, PHD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIAMAURICIO PALACIOS, MD, MSC, UNIVERSIDAD DEL VALLE, CALI, COLOMBIACORRECTOR DE ESTILO-INGLS ALBERT ORTIZ, MD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIACORRECTOR DE ESTILO-ESPAOL PABLO BARRETO, MD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIA2010 Universidad del Valle, Facultad de SaludColomb Med. 2009; 41: 103-95104ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)COMIT CIENTFICORODRIGO CIFUENTES, MD, PHD, UNIVERSIDAD LIBRE, CALI, COLOMBIARAL CUERO, PHD, TEXAS A & M UNIVERSITY SYSTEM, PRAIRIE VIEW, USARODRIGO GUERRERO, DRPH, VALLE EN PAZ, CALI, COLOMBIAOSCAR ROJAS, MD, MSP, FUNDACIN FUNCOMA, CALI, COLOMBIAJAIRO A. PALTA, BSC, MSC, PHD, DSC, CSIRO, PERTH, AUSTRALIAFERNANDO RONDN, BSC, PHD, UNIVERSIDAD INDUSTRIAL DE SANTANDER, BUCARAMANGALIGIA DE SALAZAR, PHD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIAARMANDO SARDI, MD, PHD, ST. AGNES HEALTH CARE, BALTIMORE, USAANDRS VILLAVECES, MD, PHD, UNIVERSIDAD DE CAROLINA DEL NORTE, CHAPEL HILL, USACOMITEDITORIALIVN A. ARENAS, MD, PHD, CENTRE HOSPITALIER DE L'UNIVERSITE DE MONTREAL, QUEBEC, CANADA IGNACIO BRICEO, MD, PHD, PONTIFICIA UNIVERSIDAD JAVERIANA, BOGOT, COLOMBIAEDELMIRA CASTILLO, PHD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIAPELAYO CORREA, MD, VANDERBILT UNIVERSITY, NASHVILLE, USA IVETH JIMENA GONZLEZ, MD, PHD, UNIVERSITY OF LAUSANNE, SWITZERLANDFABIN MNDEZ, MD, PHD, UNIVERSIDAD DEL VALLE, CALI, COLOMBIARICARDO PALACIOS, MD, PHD, ESCOLA PAULISTA DE MEDICINA, SO PAULO, BRASILHERNN PIMIENTA, MSC, UNIVERSIDAD DEL VALLE, CALI, COLOMBIACARLOS ALFONSO REYES, MD, PHD, UNIVERSITY TEXAS MEDICAL BRANCH, GALVESTON, USA MANUEL RUIZ-GARCA, PHD, PONTIFICIA UNIVERSIDAD JAVERIANA, BOGOT, COLOMBIA105ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)Direccin: Facultad de Salud, Universidad del Valle Apartado areo 8025 Telefax (57-2) 558-1939Cali, Colombiae-mail: comedica@univalle.edu.co colombiamedica@gmail.comcolombiamedica@yahoo.comhttp://colombiamedica.univalle.edu.coISSN0120-8322ISSN On Line 1657-9534Los artculos publicados en Colombia Mdica son indexados o resumidos por: ISI Web of KnowledgeScience Citation Index Expanded; ndice Nacional de Publicaciones Seriadas Cientficas y TecnolgicasColombianas 2006-2008 ( PUBLINDEX); EMBASE: The Excerpta Medica database for biomedical andpharmacological information; InterRed-Salud Iniciativa de Acceso a la Investigacin ( HINARI) dirigidapor la OMS; Scientific Electronic Library on Line ( SciELO-Colombia); Literatura Latinoamericana y delCaribe en Ciencias de la Salud ( LILACS); Directory of Open Access Journals ( DOAJ); Red de RevistasCientficas de Amrica Latina y el Caribe, Espaa y Portugal, Ciencias Sociales y Humanidades ( RedALyC); ndice Mexicano de Revistas Biomdicas Latinoamericanas ( IMBIOMED); ndice de RevistasLatinoamericanas en Ciencias ( PERIODICA) de la Hemeroteca Latinoamericana, HELA; CommonwealthAgriculture Bureau ( CAB Abstracts), Bases de datos pertenecientes a CABI-Publishing: AgBiotechNet-Abstracts Databse, Nutrition and Food Sciences Database, Animal Science Database; Index CopernicusInternational; Bioline International; EBSCO Informationn Services-MedicLatina; ULRICHS PeriodicalsDirectory; ndice Scopus; International Committee of Medical Journal Editors ( ICMJE); World Associationof Medical Editors (WAME); Sistema Regional de Informacin en Lnea para Revistas Cientficas deAmrica Latina, el Caribe, Espaa y Portugal ( LATINDEX); Biblioteca Virtual en Salud-Biblioteca Virtualpara la Vigilancia en Salud Pblica de Colombia ( BVS-VSP Col); Free Medical Journals; The ColoradoAlliance of Research Libraries; New Jour, Electronic Journals & Newsletters.106ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)CONTENIDO / CONTENTSEDITORIAL108 Avoidable mortality of scientific manuscripts110 Mortalidad evitable de manuscritos cientficosMAURICIO PALACIOSARTCULOS ORIGINALES / ORIGINAL ARTICLES112 Bio-anthropology and paleopathology of the SO10-IX Muisca mummy from Stivanorte, Boyac,ColombiaBioantropologa y paleopatologa de la momia muisca SO10-IX de Stivanorte, Boyac,ColombiaABEL FERNANDO MARTINEZ, BERNARDO FRANCISCO MELNDEZ, FRED GUSTAVO MANRIQUE121 Inflammatory response in Colombian children with severe protein-energy malnutrition beforeand after nutritional interventionRespuesta inflamatoria en nios colombianos con desnutricin grave antes y despus deltratamiento nutricionalCLAUDIA VELSQUEZ, CAROLINA NAVARRO, CSAR MUOZ, NGEL GONZLEZ129 Revisin documental de los productos naturales legalmente autorizados para su mercadeo enColombiaDocumental revision of the natural products authorized for marketing in ColombiaHELLEN ASTRID GUEVARA, PILAR ESTER LUENGAS, GIOVANNY GARAVITO141 Determination of the prevalence of hemoglobin S, C, D, and G in neonates from Buenaventura,ColombiaDeterminacin de la prevalencia de la hemoglobina S, C, D y G en recin nacidos deBuenaventura, ColombiaMATILDE DE BERNAL, ANDRS COLLAZOS, RUBN DARO BONILLA, EDNA PATRICIA TASCN148 Human papillomavirus (HPV) detected in restored plasma DNA from women diagnosed with pre-invasive lesions and invasive cervical cancerDeteccin del virus del papiloma humano (VPH) en ADN de plasma restaurado de mujeres enquienes se diagnosticaron lesiones pre-invasivas y cncer cervical invasivoYAZMN ROCO ARIAS, EDWARD FABIN CARRILLO, FABIO ANCZAR ARISTIZBAL155 Enzyme-linked immunosorbent assay of phenolic glycolipid-I in patients with Hansens diseaseInmunoensayo ligado a enzimas (ELISA) a glicolpido fenlico -1 en pacientes con enfermedadde HansenLUIS HERNANDO MORENO, ALBERTO ALZATE107ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)161 Practices and beliefs about exclusive breastfeeding by women living in Commune 5 in Cali,ColombiaCreencias y prcticas sobre la lactancia materna exclusiva de mujeres residentes en Comuna 5de CaliLUZMILA HERNNDEZ, MARTHA LUCA VSQUEZCASO DE INTERS / CASE REPORTS171 Nephritic syndrome associated to skin infection, hepatitis A, and pneumonia: a case reportSndrome nefrtico asociado con infeccin cutnea, hepatitis A y neumona: informe de un casoEMIL JULIO BARRIOS, GUSTAVO ADOLFO GUERRERO176 Bee sting of the cornea. Case reportPicadura de abeja en la crnea. Informe de un casoMAURICIO VLEZ, GLORIA I. SALAZAR, PATRICIA MONSALVEREVISIN DE TEMAS / REVIEW ARTICLES179 Essential aspects and practical implications of sexual identityAspectos fundamentales e implicaciones prcticas de la identidad sexualADALBERTO CAMPO-ARIASEDUCACIN MDICA / MEDICAL EDUCATION186 Importancia de la medicina basada en la evidencia para la prctica clnicaImportance of evidence-based medicine to clinical practiceXAVIER BONFILL,PABLO SCHAPIRA194 CORRESPONDENCIA / CORRESPONDENCE108ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)EDITORIALAVOIDABLEMORTALITYOFSCIENTIFICMANUSCRIPTS2010 Universidad del Valle, Facultad de SaludColomb Med. 2010; 41: 108-9Colombia Mdicapublishes64%oftheoriginalresearch articles submitted to editorial process, whichhighlights the rigor of the editorial review system; whileat the same time, generating a reflection on the causesfor rejecting material submitted for publication as aninput for the Journals collaborators.ThereviewofthefileofarticlesrejectedbytheJournal leads us to arbitrarily discriminating the causesfor rejecting scientific documents into two groups: Afirst group we will call lost causes, which centers onthe lack of ethical evaluation, research design flaws, andplagiarism. And the second group, manuscripts withavoidablerejection,whichincludesdeficienciesinfollowing the editorial guidelines for authors, inadequatewriting, and delays by authors in submitting answers toobservationsraisedduringaninitialevaluation.Documents classifying in the latter group could have hadanopportunitywithabitofjointeffortbetweentheauthorsandtheeditorialboard;andinallcases,bycorrectingerrorsandseekingsupportfrom,amongothers, expert consultants, these could, potentially, berevived by submitting them to a journal with a lowerimpact than that in which they were rejected.Among the reasons for the lost causes, we find thatfaults in the structure of institutional research take upconsiderable space. Institutions considering scientificproduction as one of their assets, must invest on theconformation and growth of an ethics committee onresearchthatreasonablyprovidesresearcherswithsocial, environmental, and ethical reflection elements toenrich research proposals. With bioethics foundations,Colombian and international norms do not consider otherformsofethicalevaluationoftheprojects,and;consequently,neitherdoestheEditorialCommittee.Furthermore, anyone seeking to conduct clinical trialsmust register the entity in any of the international databases that permit inputting the protocols for clinical testsand obtaining the registry required by scientific journals1.Thisfirstsupportfostersaninstitutionalresearchenvironment and allows researchers to promote theirproposals and results among scientific circles.Design flaws may be considered the most disturbingcauses of rejection, because there is no way of fixing anill-conceived project and because these flaws expresslack of knowledge of the state-of-the-art on the topic oron the research methodology. The poor definition orabsence of a hypothesis and an objective, inadequatesamplesize,vulnerablevariablesofthemeasuringsystem, among others, seriously hinder the researchproduct.Plagiarismhasnoeditorialsolutionandwarrantsdiscussion on another occasion.Continuing with the second group, deficient adherencetoguidelinesleadstoavoidablerejectionofthemanuscript being edited. The selection of the journal towhich the manuscript is submitted means the authoraccepts the instructions defined by the editorial boardandconsidersthatthejournalhastheexperiencetosuitably judge the work presented. Generally, authorsguidelines are rigid and particular for each publication2;hence,itisidealtodecideonthejournalinwhichpublication is sought and draft the manuscript based onits instructions. Writing the text and then seeking thejournalinwhichtopublishcreatesconflictbetweensome researchers and the journal; it also places burdenon the editorial process, which leads to suspension duetoasimplematterofform.Alongwiththeafore-mentioned, some manuscripts may meet the Editorsstandard of quality, but the Editor -bearing in mind theneeds of the readers, the types of topics the journal isinterested in publishing, and the scientific relevance withrespect to other topics- may return the document whenthe topics are excessively specialized or very tangentialwith respect to the journals habitual contents3.Abandonment by the authors of their work duringany of the editorial phases should not occur. Elaboratinga manuscript to be submitted for publication requirestime; nevertheless, accepting or discussing evaluatingpeerobservationsandsendingacorrectedversionrequiresdedication,proportionallysmaller,whencompared to the initial effort. Editorial processes containa high degree of critique and this should not offend theauthors; there is also no limit number of versions whenwe are seeking for the best possible document. A useful109ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)attitude for this editorial phase is to delegate, from theverybeginning,aleaderresponsibleinfollowingthedocumentsprogress;thenaturalchoicehereistheauthor who wrote the manuscript to maintain the styleand for said individual to coordinate the changes madewith the other collaborators. The editorial board willalways be available to address questions or discuss anyaspectoftheelaborationofthefinaldraftofthedocument.Deficiencies in composition are part of the naturalcourse of learning how to write. Higher education isfocused on the student understanding a written text, noton the student drafting such and formation processes inthisaspectforresearchersinthefieldofhealtharealmostnonexistent.Writingrequiresamentoranddedicatedpractice.Forthisreason,wewillsuggestconsulting the work of Cassany4 an expert guide onwriting construction.Lastly, there are virtues that avoid editorial mortality.Recognizing oneself as an imperfect writer promotesthe practice of reviewing our texts amongst peers, evenamong those not involved in the issue; if they understandwhat we write, we are improving. We should rememberthat the worst manuscript is the one we never get towriteandthatonlythosewhohaveneverwrittenscientific articles have never had a manuscript rejected.MauricioPalacios,MD,MScAssistantProfessor,UniversidaddelValleAssistantEditor,Colombia MdicaJournalREFERENCES1. Palacios M, RamrezJH. El registro de ensayos clnicos y elfenmeno de las investigaciones Ya que. Colomb Med. 2007;38: 5-6.2. Elizondo-RiveraRL,Bosques-PadillaFJ.Cmoescribirunartculo cientfico: cmo lograr que su investigacin sea publi-cada. Rev Gastroenterol Mex. 2007; 72: 113-6.3. BoschA,AlfonsoF,BermejoJ.Whywasourmanuscriptrejected? Rev Esp Cardiol. 2002; 55: 782-3.4. Cassany D. Afilar el lapicero. Gua de redaccin para profe-sionales.Barcelona: Anagrama; 2007.110ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)EDITORIALMORTALIDADEVITABLEDEMANUSCRITOSCIENTFICOS2010 Universidad del Valle, Facultad de Salud Colomb Med. 2010; 41: 110-11Colombia Mdica publica 64% de los artculos deinvestigaciones originales enviados a proceso editorial,locualresaltalarigurosidaddelsistemaderevisineditorialyalavez,debegenerarreflexinsobrelascausas del rechazo del material remitido para publica-cin como insumo para sus colaboradores.La revisin del archivo de artculos rechazados porla Revista me lleva a discriminar, arbitrariamente, losmotivos para no publicar los documentos cientficos endos grupos:Enelprimero,quedenominarprdidasinsal-vables, se destacan la falta de evaluacin tica, losproblemas de diseo de la investigacin y el plagio.Yelsegundogrupo,manuscritosconrechazoevitable, incluye las deficiencias en el seguimiento delas instrucciones de la revista, la redaccin inadecuaday los retrasos de los autores para someter las observa-ciones de una evaluacin inicial. Los documentos eneste ltimo grupo pudieron tener una oportunidad conalgo de esfuerzo conjunto entre los autores y el cuerpoeditorial; y en todo caso, con la correccin de errores yel apoyo en otros asesores expertos,podran revivirsesi los envan a una revista de impacto menor.Entrelascausasdelasprdidasinsalvables,lasfallasenlaestructuradeinvestigacininstitucionalocupan un lugar sobresaliente. La institucin que con-sidera la produccin cientfica como uno de sus activosdebe invertir en conformar y enriquecer un comit detica en investigacin que razonablemente le aporte alinvestigador elementos de reflexin tica, social y am-biental para enriquecer la propuesta de investigacin.Con fundamentacin biotica, las normas colombianase internacionales no consideran otras formas de evalua-cinticadelosproyectosy,enconsecuencia,elComit Editorial de Colombia Mdica tampoco.Adems, quienes proyecten realizar ensayos clni-cos deben inscribir la entidad en alguna de las bases dedatos internacionales que permita ingresar los protoco-los de estudios clnicos y obtener el registro que exigenlas revistas cientficas1. Este primer apoyo genera unambiente institucional de investigacin y permite a losinvestigadores promocionar sus propuestas y resulta-dos al medio cientfico.Esposibleconsiderarlasdeficienciasdediseocomo las causasms preocupantes de rechazo porqueno hay manera de arreglar un proyecto mal concebidoy expresan las carencias en el conocimiento del estadodel arte del tema o de la metodologa de investigacin.Lapocadefinicinoausenciadeunahiptesisyunobjetivo, los tamaos inadecuados de las muestras, elsistemademedicindevariablesvulnerables,entreotros, lesionan gravemente el producto de investigacin.El plagio no tiene solucin editorial y merece que sediscuta en otra oportunidad.Para continuar con el segundo grupo, el deficienteseguimiento de las instrucciones conduce a un rechazoevitable del artculo en edicin. Elegir la revista a la quese somete un manuscrito, significa que el autor aceptalas instrucciones definidas por el cuerpo editorial y queconsidera que la revista tiene la experiencia para juzgaradecuadamente su trabajo. Casi siempre las instruccio-nes a los autores son rgidas y particulares para cadapublicacin2; ante esto, es ideal decidir la revista en laque se desea publicar y con base en sus instruccionesredactar el manuscrito. Escribir el texto y luego buscaruna revista para publicarlo genera conflicto en algunosinvestigadoresconlarevistaydesgastaelprocesoeditorial, pues lleva a suspenderlo por una simple cues-tin de forma. A la par de lo anterior, algunos manuscri-tos pueden ser de calidad para el editor, pero como stetiene en cuenta las necesidades de sus lectores, el tipodetemasqueleinteresapublicarylaimportanciacientfica relacionada con otros aspectos, puede devol-ver el documento cuando los temas son excesivamenteespecializados o muy tangenciales al contenido conven-cional de la revista3.El abandono de los autores a su obra en alguna de lasfases editoriales no debera suceder. Elaborar un manus-crito para someterlo a publicacin, requiere mucho esfuer-zo y tiempo adicionales; sin embargo, aceptar o discutirlas observaciones de los pares evaluadores y enviar unaversincorregida,necesitaciertadedicacin,propor-cionalmente menor, si se compara con el primer esfuerzo.Los procesos editoriales contienen un gran componente111ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)de crtica y este concepto no debera ofender a los autores,pues tampoco hay lmite de versiones cuando lo que sepretende es presentar el trabajo de la mejor manera posible.Unaactitudtilparaestafasedelaedicinesdelegardesde el principio un lder responsable del seguimiento delartculo; lo natural es considerar al autor que redact elmanuscrito para mantener el estilo y que ste coordine consus colaboradores los cambios que se deben hacer. Esbueno que el autor principal (si hay ms de uno) sepa quesiemprepuedecontarconelcuerpoeditorialparasusconsultas o discutir cualquier aspecto en la elaboracin deuna versin final.Lasdeficienciaspararedactarsonpartedelcursonatural de aprender a escribir. La educacin superior seenfoca en que el estudiante comprenda un texto, no que locompongaylaformacinenesteaspectoparalosinvestigadores del rea de la salud es casi nula. Escribirrequiere un mentor, ojal con bastante prctica. Por estemotivo aconsejo a los interesados que consulten la obra deCassany4, un gua experto en construir escritura.Por ltimo, existen virtudes que evitan la mortalidadeditorial. Reconocerse como escritor imperfecto pro-mueve la solicitud de examinar los textos entre pares, eincluso entre los profanos en el tema; si entienden lo quese ha escrito, sin duda hay mejora. Es bueno recordarque el peor manuscrito es aquel que nunca se escribe yslo aquellos que no han escrito artculos cientficos, sonquienes no han tenido alguna vez un manuscrito recha-zado.MauricioPalacios,MD,MScProfesorAsistente,UniversidaddelValleEditor Asistente,Colombia MdicaREFERENCIAS1. Palacios M, RamrezJH. El registro de ensayos clnicos y elfenmeno de las investigaciones Ya que. Colomb Med. 2007;38: 5-6.2. Elizondo-RiveraRL,Bosques-PadillaFJ.Cmoescribirunartculo cientfico: cmo lograr que su investigacin sea publi-cada. Rev Gastroenterol Mex. 2007; 72: 113-6.3. BoschA,AlfonsoF,BermejoJ.Whywasourmanuscriptrejected? Rev Esp Cardiol. 2002; 55: 782-3.4. Cassany D. Afilar el lapicero. Gua de redaccin para profe-sionales.Barcelona: Anagrama; 2007.112ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)Bio-anthropology and paleopathology of the SO10-IX Muisca mummyfrom Stivanorte, Boyac, ColombiaABEL FERNANDO MARTINEZ , MD, MSC1, BERNARDO FRANCISCO MELNDEZ , MD, MSC2,FRED GUSTAVO MANRIQUE, RN, PHD3SUMMARYI ntroduction: The practice of artificial mummification of human corpses in America was common to most Andean pre-Hispanic societies to which the Muiscas belonged.Objective: bio-anthropologically and paleopathologically characterize the SO10-IX mummy.Materials and methods: Case and field history graphic study with invasive and non-invasive techniques.Results: Pre-Hispanic individual from the 14th century, male, 25 to 30 years of age. Macroscopic dental and osseouscharacteristics suggest it fitting the American Indian pattern. Evident absence of lower left member and right thigh, and thevertebral column reveals marked angular kyphosis, a pre-vertebral abscess in spindle shape, a lesion of vertebrate bodies T7and T8, compatible with tuberculous spondylitis known as Potts disease. Also noted is the good state of the dentoalveolarcomplex.Conclusions: For the first time, there is evidence of tuberculosis, in pre-Hispanic times, in a Muisca mummy from theAndean plateau (high plains). Due to the multidisciplinary approach, the historical, geographic, paleopathologic, bio-anthropologic, cultural, and chronological contexts of the mummy were reconstructed, granting importance to this nationalheritage asset. Two facial reconstruction studies are proposed, preservation and manipulation, and a genetic analysis toconfirm the presence of Mycobacterium tuberculosis DNA. The ritual position of mummification caused difficulties in thestudy and measurement techniques.Keywords: Paleopathology; Physical anthropology; Spondylitis; Mycobacterium tuberculosis; Colombia;Mummy Muisca pre-Hispanic.Bioantropologa y paleopatologa de la momia muisca SO10-I X de Stivanorte, Boyac, ColombiaRESUMENI ntroduccin: La prctica de la momificacin artificial de cuerpos humanos en Amrica, fue comn a la mayora de lassociedades prehispnicas andinas, a las que pertenecen los muiscas.Objetivo: Caracterizar bioantropolgica y paleopatolgicamente la momia S010-IX.Materiales y mtodos: Estudio historiogrfico de campo y de caso, con uso de tcnicas invasivas y no invasivas.Resultados: Individuo prehispnico, del siglo XIV, sexo masculino, de 25-30 aos de edad. Las caractersticas macroscpicasdentales y seas sugieren que pertenece al patrn indgena americano. Presenta ausencia de miembro inferior izquierdo y musloderecho. En la columna vertebral se observa una marcada cifosis angular, restos de un absceso prevertebral en forma de huso,una lesin de los cuerpos vertebrales T7 y T8, compatibles con una espondilitis tuberculosa conocida como Mal de Pott.Presenta un buen estado del complejo dentoalveolar.Conclusiones: Por primera vez se presenta evidencia de la existencia de tuberculosis, en poca prehispnica, en unamomia muisca del altiplano. Gracias al enfoque multidisciplinario se reconstruy el contexto histrico, geogrfico,1. Associate Professor, School of Medicine, Universidad Pedaggica y Tecnolgica de Colombia, Tunja, Colombia.e-mail: abel.martinez@uptc.edu.co2. Auxiliar Professor, School of Medicine, Universidad Pedaggica y Tecnolgica de Colombia, Tunja, Colombia.e-mail: bernardo.melendez@uptc.edu.co3. Associate Professor, School ofNursing,Universidad Pedaggica y Tecnolgica de Colombia, Tunja, and UniversidadNacional de Colombia, Bogot, DC, Colombia. e-mail: fred.manrique@uptc.edu.coReceived for publication July 16, 2009Accepted for publication January 26, 20102010 Universidad del Valle, Facultad de Salud Colomb Med. 2010; 41: 112-20113ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)paleopatolgico, bioantropolgico, cultural y cronolgico dela momia, dndole la importancia a este bien patrimonial de lanacin. Se proponen estudios de reconstruccin facial, pre-servacin y manejo, y un anlisis gentico para confirmar lapresencia de ADN de Mycobacterium tuberculosis. La posi-cin ritual de la momificacin, dificult el estudio y lastcnicas de medicin.Palabras clave: Paleopatologa; Antropologa fsica;Espondilitis; Mycobacterium tuberculosis; Colombia;Momia muisca prehispnica.In the field of human biology, paleopathology studiestheillnessesaffectinghumansinthepast1andbio-archaeology permits discovering anthropometric charac-teristics, population of descent, age, and sex. Interest inthis historical project stems from more than the curiosityto decipher the past, it comes about from the conceptionof the present as a movement and of the need to find thelaws and sense of this movement2.The study of ancient human remains permits knowinghow or why these individuals died, as well as providingvaluableinformationabouttheirlives,bio-culturaladaptations, and their diseases, which like tuberculosis,still prevail.The practice of artificial mummification of humanbodies in America was a common characteristic in mostAndeanpre-Hispanicsocieties,belongingtodiverseethnic groups that occupied, during different historicalmoments, the territories corresponding to what is nowColombia, Per, Chile, Bolivia, Argentina, and Ecuador.In South America, mummification was a much morecommonpractice,althoughitisregisteredinsomeregions of Meso-America and the southern territory ofthe United States.Muiscas,Guanes,Chitareros,andLaches,fourimportant pre-Hispanic indigenous ethnic groups fromthe Chibcha linguistic group inhabited the eastern Andesof the territory that is now Colombia. Their presence isarchaeologically registered after the occupation of EarlyAgro Potters or Ironsmiths, until the Spanish conquestand colonization, which had to be equally encounteredby the four population groups that had occupied theEastern Mountain range of the Colombian Andes fornearlyeightcenturies,conductingmummificationpractices.Mummiesarealinkbetweenhumanbiologyandcultural practices, making their study a relevant field ofresearch3. Dating of this ritualistic human practice inSouth America goes back over 7,000 years, that is, twomillenniapriortowhentheancientEgyptiansbeganthinking of mummification practices. The Chinchorropeoples, a culture from the Atacama desert, in northernChile, practiced elaborate conservation methods of theirdead4.As a cultural practice, artificial mummification is thecomplex preservation of the corpse due to mortuaryrituals, which include an important additional expense ofenergybysociety,specializingthepreparationandtreatmentofcadaversformummification.Energyinvestment in mortuary practices indicates the status ofthedeceased,itreflectstheinterestinmaintainingcertain prestige by the social group to which the deceasedbelongs5.Artificial mummification in Colombia is registeredvia radiocarbon from the 5th to the 17th centuries AC.6,7ItwasessentiallypracticedintheEasternAndes,inareas occupied by Muisca, Lache, Guane, and Chitareroethnic groups. There are 70 mummies documented inColombia, 54 belonging to the Chibcha macro group(Muiscas, Guanes, Chitareros, and Laches) who sharecharacteristics in the mummification process, and 16from the Yuko group from the Perij mountain range5.CrdenasArroyoexplainsthatmummieshavebeenfound in Chiscas, Gachantiv, Iguaque, Leiva, Moniquir,Muzo,Socot,Sogamoso,Boavita,Tasco,Tpaga,Tunja, and Pisba in Boyac; Suesca, Gachancip, andUbat in Cundinamarca; Santanderes in Ocaa, Silos,La Belleza, Bucaramanga, and Los Santos. Mummifi-cation was also practiced in the departments of Valle delCauca and Cauca8.The Eliecer Silva Celis Archaeological Museum atUniversidadPedaggicayTecnolgicadeColombia(UPTC)inSogamosokeepsamummyidentifiedasSO10-IX in the inventory of the Colombian Institute ofAnthropologyandHistory[InstitutoColombianodeAntropologa e Historia (ICANH)] since 1962, withoutregisteringanycontextualinformationregardingthespecific site of its finding, the general state, associatedelements, surroundings, funerary trousseau, or relatedarchaeological material. There is also no knowledge ofany study done on the mummy in the last 48 years, until2004 when the Group on the History of Health in Boyac(Grupo de Historia de la Salud en Boyac, UPTC), andthe Museum of History of Medicine (Museo de Historia114ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)delaMedicina)begantheresearchprojectBio-anthropological and Paleopathological Characterizationof the SO10-IX mummy from the Elicer Silva CelisArchaeological Museum in Sogamoso. This article isan advance on the initial results of the study mentioned.The aim of this article is to present the results of thecontext, C14 dating, and the bio-anthropological andpaleopathologicalcharacterizationoftheSO10-IXmummy.MATERIALSANDMETHODSAhistorygraphicstudywasconductedthroughinterviews of Elicer Silva Celis and of family membersof Abraham Lpez, who brought the mummy to theArcheological Museum in Sogamoso, as well as throughdocumentary revision, field visits, and research.Thecasestudyemployedinvasivemethods(C14,histopathologicalmethods)andnon-invasivemethods(anthropometry, description of the dentoalveolar complex,imaging studies) from a multidisciplinary perspective.TheprojectwasapprovedandauthorizedbytheResearch and Extension Center [Centro de Investiga-cinyExtensin(CIES)]oftheFacultyofHealthSciences at UPTC and by the ICANH for the study ofosseous remains.NON-INVASIVEMETHODSDeterminationofsex.TheAcsadi-Nemeskeriarthroscopic method was used, as well as the metricmethodofthewidthofthesacralbaseandwingaccording to Kimura9. The evaluation of cranial featureswas done through observation of the three-dimensionalreconstruction of the cranium and the face carried outvia computerized axial tomography.Determinationofage.Thesequenceofdentalwear was evaluated by using the Murphy diagram as areference; for the estimation of age, evaluation systemswere used through the wear of the molar occlusal faces,proposed by Miles and Brothwell, along with the closingof the ossification centers9. The oral cavity was observedunder direct vision with a mouth mirror and through X-rays (peryapical and coronal), this whole process withthe difficulties implied in the observation of a mummifiedindividual.Determination of height. The Genovese formula10for Meso-American Indians was used for tibial lengthand the Krogman-Iscan formula9 for Mongoloid maleswas used for the humerus, radius, cubitus, tibia, andfibulalengths.Intakingthemeasurements,ametrictape was used and the maximum lengths of the bonesmentioned were calculated by approximation, bearing inmind that it was impossible to disarticulate the bones anduse the osteometric table.Determinationofpopulationdescent.Themummys descent was established through bibliographicrevision, textile characterization, classical methods ofphysical anthropology, and field exploration of the pro-bable site of the finding and geographic coordinates.Descriptionofthedentoalveolarcomplex.WeregisteredthedentalchartelaboratedbytheBio-anthropology Laboratory at the Archaeological Museumin UPTC in Tunja, inventoried the type of dentition, teethpresent and missing, presence of dental plaque; registryof the pathological profile using cavities and fistulas asindicators and, finally, establishing the partial odontometryof anterior teeth11. We collected a simple of the materialfoundinthelowerrightretromolargap,whichwasmicroscopically observed and subjected to toxicologicalexaminationforalkaloidsandcarbohydrates;thisexamination was done by the Technical InvestigationsCorps [Cuerpo Tcnico de Investigacin (CTI)].I maging studies. Simple X-ray studies were done(cranium, thorax, pelvis, long bones, dental, spinal cord,hands, and foot), periapical X-rays; computerized axialtomography (simple tomography and three-dimensionalreconstruction of the thorax, cranium, face, and spinalcord).INVASIVE METHODSHaving been licensed and authorized by the ICANH,we obtained a simple from the 12th left rib. Thereafter,1 g of the material was sent for C14 analysis throughAccelerator Mass Spectrometry (AMS), after cleaningand purifying the simple through the HCL method at theTandem Laboratory in Uppsala University in Sweden.Thistechniqueislessdestructive,faster,andmoreproductive than the traditional technique. The traditionalmethod measures the radiation emitted by carbon-14;while AMS measures the number of carbon-14 atomspresent in the sample.TheRuffertechniquewasusedforthehisto-115ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)pathological identification12. Biopsies were taken of thelung pleura, muscle, skin, and hair. These were labeledand placed in mixture of ethyl alcohol at 48%, water, andbuffered formaldehyde at 5%, where they were kept fora week. They were set in formaldehyde at 10% for oneday and the routine histological process was conductedwith alcohol dehydration and paraffin inclusion. Crosscutswere stained with hematoxylin and eosin, and mountedonplatestobeobservedwithconventionallightmicroscopy.Data analysis. For analysis and discussion of theresults,ameetingofexpertswasheld(geneticist,orthopedist, radiologist, neuro-surgeon, anthropologists,medicine historians, paleopathologist, microbiologist,odontologists, textile designer, entomologist, forensictechnicians, artists, and photographer) to discuss thefindings and reach conclusions.Multidisciplinary work team. The work was donewith the participation of the authors and of the followingmembers from the Research Group of the History ofHealthinBoyacatUPTC;BibianaBernal;SandraBello Rosas; Mara Eugenia Bohrquez; Andrs OtloraCascante; Gisela Bernal Devia; Martha Liliana lvarezA; Paola Gamboa Gamboa, and Derly Judasy Daz.RESULTSThe mummy is part of the Elicer Silva Celis collectionof the Archaeological Museum in Sogamoso. It wasloanedtotheMuseumoftheHistoryofMedicine(Museo de Historia de la Medicina) of the Faculty ofHealth Sciences at UPTC in 2003 for the ExpositionMuisca Medicine.The mummy had been in the museums warehouse,referenced and coming from Gmeza, according to themuseumsregistryandtotheICANH.Duringthepreparation for the exposition, a paper was found withthe inscription: mommy from Sativanorte, contributionof Mr. Abraham Lpez vila in 1962.In interview to Silva Celis, there was no precision onthedataofthecontext,orthefinding;SilvaCelisrepeatedlyinsistedthatthiswasafemalemummybecause of the shape of the cranium, without furnishingfurther data.Through interviews with Lpezs family membersand filed visits, it was established that the mummy wasfound by children somewhere within the limits of themunicipalities of Sativasur, Sativanorte, and Socot in1962, on the western margin of the median basin of theChicamocha River. It had a cone-shaped hat tied to thehands with a cotton twine; it remained outdoors for eightmonths; it was covered by a blanket strip and two stripsof fine blanket in the anterior part of the ribs. We wereunable to establish the exact location of the mummysfinding, because of the rugged terrain in the region andbecause of the lack of specialized equipment.General morphoscopic description. Themummyisunwrappedinflexion,simulatingthefetalposition(Figure 1), missing the upper left limb, with partial lossoftherightlowerlimb,conservingthelegandfoot.There is loss of skin and soft tissue to the bone at thepelvis and the abdominal region. The upper limbs areflexed, the hands are interlaced and tied with a cottonlace; they are placed on the right side of the head. Thereis loss of skin and soft tissue in both upper limbs, in someregions to the bone. Three fragments of cotton blanketsaccompany the mummy.The body shows evidence of perforations caused bycadaveric fauna, predominantly on the left hemi-trunk.Figure 1. Right side view mummy SO10-IX(Luis Antonio Buitrago)116ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)Remains of coleoptera were identified and classified as:Class: Insect; Order: Coleoptera; Sub-order: Polyphaga;Super-family:Scarabaeoidea;Family:Melolonthidae;Subfamily: Melolonthinae; Genus:Ancognatha sp cf,Phylllophaga spcf.Inside the thoracic cavity, remains of the left lungwere identified. Within the abdominal cavity, remains ofthe peritoneum were evident, without possible macros-copic identification of any specific organ.ANATOMICDESCRIPTIONHead. The cranium is symmetric dolichocephalicwith size proportional to the rest of the body and noevidence of deformation. It abducted to the left. For themost part, there is good state of preservation of softtissue and even skin, with loss of these to the bone in theleft chin region and at the left fronto-temporal junction.Some small zones still preserve fine, straight black hairin the frontal and occipital parts with signs suggestingthat has been cut.The left auricular pavilion is strapped towards thefront, obstructing the entrance orifice of the ear canal;the right auricular pavilion is in anatomic position with aperforation on the lobe. There is cotton inside the earcanal and inside the nostrils. On the right chin, maxillary,and malar region there are skin marks, corresponding tothe type of pattern found on the blankets accompanyingthe mummy.Trunk. There is marked increase of dorsal kyphosis(Figure 2). Perforations are present in the left dorsalregion, attributable to taphonomic damage and to damagecaused by cadaveric fauna.On the anterior thoracic wall there is loss of softtissue on the right side, from the union of the manubriumwith the body of the sternum, continuing caudal-like andstemming from the sterna union with the second rib onthe left side. Such permits visualizing the interior of thethoracic cavity, which reveals ribs, muscles, vertebrae,and the much descended left lung, which shows a zonewith multiple miliar-like punctate nodules.At the seventh thoracic vertebrate, in front of theanterior face of its vertebral body, we can observe theremainsofapre-vertebralabscessinspindleform,measuring 6 x 4 x 3 cm. Marked asymmetry is noted inthe trajectory followed by the ribs on the left side inrelation to the abscess described. The remaining verte-bral bodies do not show signs of anomalies.Angular kyphosis, the deviation of the ribs, miliary-type lesions on the lung, and the presence of the pre-Figure 2. Left side view mummy SO10-IX angularkyphosis (Luis Antonio Buitrago)Figura 3. Pre-vertebral abscess in spindle form.Mummy SO10-IX (Luis Antonio Buitrago)117ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)vertebral abscess suggest the diagnosis of a tuberculousspondylitis or Potts disease (Figure 3).Abdomen. There is total loss of soft tissue on theanterior wall of the abdomen, permitting a view of theinnerabdominalcavitywheresomeremainsoftheperitoneum are identified.Pelvis. The pelvis lacks soft tissue, preserving smallportionsofsuchatiliaccrestlevelwherethereisevidence of marks corresponding to the texture of theaccompanying blankets. The left pubis shows loss of thedescending limb.Extremities. The right leg and foot are preserved;these are tied with a sisal rope at the pelvic waistline.The foot conserves soft tissue and skin, with the lattershowing dark tonality in comparison to the appearanceof the rest of the body; while the leg reveals a loss of skinand soft tissue to the bone. The upper limbs are flexedwith the hands on the right side of the head, joined at thepalms with fingers interlaced and tied with a dyed cottonlace.Skin and muscles. Whitish 1-mm diameter friablesphericaladhesionswerenoted,suggestingfungalcontamination.BASICIDENTIFICATIONQUATRAINSex.Viacraniumevaluation(glabella,mastoids,external occipital protuberance, supra-orbital arch, frontalinclination, orbit shape) and the general aspect of themandible, features visible through TAC three-dimensio-nal reconstruction, we obtained a weighted score of 1.4indicative of male sex.Through direct observation of the pelvis (greater sciaticnotch,sub-pubicangle,obturatorforamen,iliacfossa,acetabulum, greater and lesser pelvises), we obtained aweightedscoreof1.54indicativeofamaleindividual.Through direct observation of the sacrum, we obtained a55.55 index that places the mummy as male sex.Age. The mummy shows dental wear correspondingto Murphys state of dental use number 4, which in theBrothwell age assignment corresponds to an adult indi-vidual from 25 to 35 years of age and through the Milesmethod indicates an individual from 20 to 24 years ofage.ConsultationwithexpertsfromtheBiologicalAnthropology Group at Universidad Nacional deCo-lombia permitted establishing the age between 30 + 5years, from the observation of ossification centers.Height. The height obtained was 163.53 (IC 160.73-166.33) cm with the Genovese method; and with theKrogman-Iscan method, the average was 165.95 cm(DE 2.37).Ancestry and descent.Themummypresentsthedental formula consisting of 2 incisors, 1 canine, 2 pre-molars, and 3 molars completely erupted and in occlusionline corresponding to a young adult individual. Within thenon-metric dental features, we noted blade morphologyon the palatine surface grade 2 of 6 from the tables bytheArizonaStateUniversityonthesuperiorlateralincisors; while the reduction in the lateral incisor waszero, characteristic of American indigenous groups -indicating a Mongoloid origin.Descriptionofthedentoalveolarcomplex.Nofistulaewereobservedcompatiblewithinfectiousprocesses; the height of the alveolar bone in the premolarand molar zone was normal. The inferior incisors reveala 6-mm loss of osseous height, compatible with localizedperiodontal disease. There are no cavities, dental enamelhypoplasia, erosions, or abfraction lesions, which revealsa good state of oral health. In samples taken from theretromolar space, it was possible to identify vegetableremains of diatoms and algae; the toxicological examwas negative for alkaloids and positive for carbohydrates.Imaging studies. These describe the most significantfindingsfromaseriesofimagingstudies,withoutmentioning the X-ray numbering due to the impossibilityofreproducingalloftheminthiswork.Themostremarkable aspect of the radiological study is localizedat the mid level of the vertebral column. There is loss ofintervertebralspacebetweenvertebraeT7andT8.Selectiveosteolisisisidentifiedonthebodyoftheseventhdorsalvertebra,leadingtothecollapseandwedging of T7 causing marked spinal angulation (Figure4).The posterior arches of the 7th and 8th left ribs haveabnormaltrajectoriescausedbythelossofthecostovertebraljointduetothedestructionoftheT7body. In T8, on the superior part of the body, there isevidence of a linear fracture, of oblique stroke, withoutdisplacement and with signs of periosteal reaction. It isclear that the tissues better withstanding the passage oftime are the osseous structures and they are, in fact, theones that can be radiologically described in the mummy.However, some of these structures like the spinal cordreveal osteopenia, present to a lesser degree in structures118ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)Figure 4. Lateral thoraco-lumbar column X-ray ofthe SO10-IX mummy (Luis Antonio Buitrago)of the cranium.No other images are observed suggesting articulardegenerative and/or traumatic lesions of the spinal cord.Intheintercranialtomographyofthecranium,itispossible to observe intracranial laminar structures withthe same density as the cortical bone extending from thecuts at the base to the highest. These structures couldcorrespond to calcified meninges.Both the simple X-ray and the tomography showpunctate calcifications approximately 2 mm in diameteron the apex of the left lung.INVASIVE METHODSCarbon-14.Itwasestablishedthatthemummydates to the year 1335 + 35 AC, pre-Hispanic Era, 202years prior to the Spanish arrival in Muisca territory.Histopathological description. Upon verifying thestate of hydration of the samples, no changes were notedon the first day. Minimal changes were observed on thethird and fourth days, and on the seventh day a state ofhydrationwasevidencedsimilartothetissuesetinformaldehyde. The histopathological samples showedmuscular tissue and denatured collagen without evidenceofepithelium.Throughthesampletakenfromthethoracic cavity, we identified pleura in the presence ofcollagen and a simple flat epithelium of discontinuouscoating. The visceral tissue was completely autolyzedwith no identification of cell cytoplasm.DISCUSSIONThis is the first ever bio-anthropological characte-rization of a Muisca mummy in Boyac. This work wasaccomplished with the aid of a multidisciplinary team,updating and correcting the ICAHN registry concerningthe anthropological and pathological description, sex,age, place of finding, ethnics, textile description, andcarbon-14 dating; leaving evidence for future studies onmummified human remains.Interviews and field visits provided important know-ledge to determine climatic, social, cultural, and geographicvariables considered important in the analysis of Muiscaritual contexts.In light of the results, the individual studied was mostlikely important within the social group. Evidence suggestsdisability due to illness with motor limitation that musthave required care by the community13. The likelihoodofthisbeingaShamanritualfigureintheMuiscasociety is evident through the perforation on the ear lobe,the cone-shaped hat, the very act of the mummification,theposition,thefunerarytrousseau,andthroughitscontext.For the Muiscas, mummies were a cult object and anexample of valor. Historians indicate that they belongedto very important individuals, chiefs or sheiks, to whomtribute,homage,andreverencewasoffered,whenmummifiedafterdeath;drapedinfine,hand-paintedcottonblanketsandbedeckedwithrichandvariedadornments of fine gold. For their communities, mummiescontinuedaliveandperformedaritual,political,andsocial role. The mummification practice continued afterthe Conquest, as shown by Laches mummies with ovineskin7, animals introduced by the Spaniards.Chronicler Friar Pedro Simn, states that the Muiscaspracticed evisceration, employing vegetable resins to119ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)embalm the corpse, which they would then drape incotton blankets and deposited with ritualistic offeringsinto a cave. Other times, the corpse would be dried byfire and smoke and deposited into a hut14.In the 16th century, Friar Esteban de Asencio wrotethat the viscera were removed from a chief in Bogotand that he was then embalmed with a balm powderhut that after eight hours would make the fats and bloodexpire from the human body leaving it as myrrh. Thecorpseswerepreservedthroughingredients15,16.Likewise, Herodotus17, 25 centuries ago, claims that theEgyptians spiced their mummies treating them withsalt and spices.Theremainsofthefuneraldepositelaboratedincotton and its textile characteristics reaffirm its Muiscaorigin.Thepresenceofcadavericfaunainsidethemummy is associated to fauna belonging to Sogamosoand not to Stivanorte; an indicator of probable contami-nation in the warehouse of the Sogamoso archaeologicalmuseum and suggesting inadequate conservation. Thissituation gave origin to a new project in 2006 on theconservation of mummies by the Casa Marqus de SanJorgeMuseumandtheSogamosoArchaeologicalMuseum.For the first time, tuberculous spondylitis (Pottsdisease)isdocumentedinapre-HispanicMuiscamummy, in a high-ranking Muisca individual, ratifyingthe existence of this chronic infectious disease in thesedentaryagriculturalpopulationofpre-HispanicAmerica, especially in the Andean high plains18;thuscomplementing the work of Romero19, Etxeberria20, andSotomayor21 carried out in a Guane mummy.Allthemethodsemployedtodeterminethesexconfirmed the mummy as male, contrary to that statedby Silva Celis during the interview. The Miles methodunderestimated the age of the mummy, because it ismainly indicated for adults under 30 years of age, giventhat as wear is increased its level of precision is minor10.The research group on Archaeology and History atUPTC evidences that the archaeological population ofTunja reveals average height of 152.7 +3.6cm.forwomen and 159.7 +3.1 cm. for men22. The height of themummy is above the measurement calculatedregard-less of the method.TheAMSmethodforC14resultedlessinvasivegiventhatitpermitsanalysiswithsamples20timessmaller than the standard, leaving evidence of remainsfortheirconservationandfuturestudies.Thepre-Hispanic dating through carbon-14 corresponds to thatfound by other authors, placing it in Colombia from the5th to the 18th century AC6,7.The process of facial reconstruction of the mummywas begun in two and three dimensions from a three-dimensionalmodelofthecraniumviatomography,photography, and direct measurement for the purpose ofpresenting-forthefirsttime-thefaceofaMuiscashaman.Using current research techniques will permit con-ductingstudiestoprovethepresenceoftobaccometabolites,scopolamine,andcocainthehairandtextiles. Furthermore, it is possible to determine sometraces of the nutritional state and presence of parasitosisin the mummy.The lesion suggesting Potts disease, anatomicallyand radiologically, added to pre-Hispanic dating, motivatefurther research with DNA identification andMyco-baceriumtypingofthetuberculosiscomplex.Addi-tionally, we must stress the importance of these types ofstudiesonthecollectionsofhumanremainsinourcountry, according to Legislation 1185 of 2008.Conflict of interest. None of the authors has conflictsof interest related to this study.REFERENCES1. JaramilloC,GuhlF,GmezM,YocktengR,VallejoG.Hallazgo de Trypanosoma cruzi en momias de ms de 4.000aos de antigedad. Rev Med. 2000; 22: 53-8.2. Zuleta E. Conferencias sobre historia econmica de Colombia.Bogot, DC: Hombre nuevo; 1964.3. Rodrguez M, Crdenas-Arroyo F. Historia de las investigacio-nes en momias. In: Rodrguez MC (ed.). Studies on ancientmummies and burial archaeology. Bogot, DC: FundacinErigai, Instituto Canario de Bioantropologa, Universidad delos Andes; 2001. p. 13.4. Langman J. Mudos testigos del desierto. Prcticas mortuoriasde la civilizacin Chinchorra del rea del desierto de Atacamaen Chile. Americas (Spanish edition). 2001; 53: 1-4.5. ValverdeAM.Anlisisfuncionaldelamomificacinprehispnica, el caso del altiplano cundi-boyacense. Bogot,DC: Universidad de los Andes; 2002.6. Crdenas-Arroyo F. La momificacin indgena en Colombia.Bol Museo del Oro. 1989; 25: 120-3.7. Sotomayor HA, Correal G. Las calaveras enmascaradas de lasmomias Yuko-Yukpa (motilones). Rev Acad Colomb Cienc.2003; 27: 5-14.8. Crdenas-Arroyo F. Bioantropologa del pasado. Innovaciny Ciencia. 1993; 11: 52-9.120ColombiaMdica Vol. 41 N 2, 2010 (Abril-Junio)9. Krogman W, Iscan M. The human skeleton in forensic medici-ne. Springfield: Charles C. Thomas; 1986.10. Genovs S. La proporcionalidad entre los huesos largos y surelacin con la estatura en restos mesoamericanos.Mxico,D.F: Instituto de Investigaciones Histricas, UNAM; 1966.11. Lozano-Ruiz M. Estudio del desgaste a nivel microscpico delosdientesanterioresdeloshomnidosdelyacimientopleistocnico de Sima de los Huesos (Sierra de Atapuerca,Burgos). Tarragona: Universitat Rovira i Virgili; 2005.12. Ruffer M. Note on the presence of Bilharzia haematobia inEgyptian mummies of the Twentieth Dynasty (1250-1000B.C.). BMJ. 1910; 1: 16.13. Otlora-CascanteAR.Caracterizacinbioantropolgicadeuna momia prehispnica: implicaciones metodolgicas desde laantropologa biolgica. Rev Salud Hist Sanid. 2006; 1: 20-5.14. Simn FP. Noticias historiales de las conquistas de tierra firmeenlasIndiasOccidentales.Bogot,DC:BibliotecaBancoPopular; 1981.15. Silva-Celis E. Estudios sobre la cultura chibcha. Tunja: Aca-demia Boyacense de Historia; 2005.16. Pradilla H, Villate G, Ortiz F. Arqueologa del Cercado Grandede los Santuarios. Bol Museo del Oro. 1992; 32: 21-148.17. Herodoto. Los nueve libros de la historia. Bogot, DC: OvejaNegra; 1983.18. Rodrguez JV. Las enfermedades en las condiciones de vidaprehispnica de Colombia. Bogot: Universidad Nacional deColombia; 2006.19. Romero W. Estudio bioantropolgico de las momias del MuseoArqueolgico Marqus de San Jorge. Antropologa. Bogot,DC: Fondo de Promocin de la Cultura del Banco Popular,Universidad Nacional de Colombia; 1997.20. EtxeberriaF,RomeroW,HerrastiL.Cifosisangulardelacolumna vertebral: identificacin del Mal de Pott en una momiaGuane prehispnica de Colombia. Chungara. 2000; 32: 41-8.21. Sotomayor HA, Burgos J, Arango M. Demostracin de tuber-culosisenunamomiaprehispnicacolombianaporlaribotipificacindelADNdeMycobacteriumtuberculosis.Biomedica. 2004; 24 (supl): 18-26.22. Rodrguez JV. Laantropologaforenseenlaidentificacinhumana.Bogot,DC:UniversidadNacionaldeColombia;2004.121Colombia Mdica Vol. 41 N 2, 2010 (Abril-Junio) 2010 Universidad del Valle, Facultad de Salud Colomb Med. 2010; 41: 121-8Inflammatory response in Colombian children with severe protein-energymalnutrition before and after nutritional intervention*CLAUDIA VELSQUEZ, MSC1, CAROLINA NAVARRO, BACTERIOL2,CSAR MUOZ, MSC3, NGEL GONZLEZ, PHSC 4SUMMARYAim: To evaluate the changes in C-reactive protein and pro-inflammatory cytokines in severely malnourished children,before nutritional intervention and at the moment of restoring appetite.Methodology: To assess changes in inflammatory mediators, 20 severely malnourished children under 5 years of age, 10with kwashiorkor and 10 with marasmus were studied. Hemoglobin, total serum proteins, albumin, ferritin, transferrin,ceruloplasmin, C-reactive protein and pro-inflammatory cytokines (IL-8, IL-1, IL-6,IL-10,TNF-, and IL-12p70) were determined.Results: Upon hospital admission, the mean values of C-reactive protein in kwashiorkor and marasmus patients (16.319.0mg/L and 23.127.9 mg/l, respectively) indicated an inflammatory response process with no difference between both groups(p=1.0). Total protein, albumin, transferrin and ceruloplasmin in children with kwashiorkor were significantly lower than inmarasmic children (p=0.003, p=0.007, p=0.035, p=0.007, respectively). All cytokines, except IL-12p70, showed significantlyhigher concentrations in kwashiorkor than in marasmic children. After the stabilization phase, concentrations of C-reactiveprotein decreased significantly in both groups and albumin increased to normal values, but cytokines remained high.Conclusion: These results show that malnourished children are able to synthesize C-reactive protein in response to aninfectious process. Additionally, higher levels of pro-inflammatory cytokines and depletion of albumin in children withkwashiorkor suggest that these inflammatory mediators could be critical biomarkers during clinical phases of kwashiorkor.Keywords: Malnutrition; Marasmus; Kwashiorkor; Cytokines; C-reactive protein; Inflammatory response.Respuesta inflamatoria en nios colombianos con desnutricin grave antes y despus del tratamiento nutricionalRESUMENObjetivo: Evaluar los cambios en la concentracin de protena C reactiva y citocinas pro-inflamatorias en nios condesnutricin aguda grave antes del tratamiento nutricional y al recuperar el apetito.Metodologa:Seevaluen20niosmenoresde5aoscondesnutricinagudagrave,10conmarasmoy10conkwashiorkor, el cambio en la respuesta inflamatoria mediante la concentracin de ferritina, transferrina, protenas totales,albmina, ceruloplasmina, protena C reactiva y citocinas pro-inflamatorias (IL-8, IL-1, IL-6,IL-10,TNF- y IL-12p70).Resultados: Al momento de la admisin, la concentracin promedio de protena C reactiva en nios con kwashiorkor ymarasmo (16.319.0 mg/l y 23.127.9 mg/l, respectivamente) indicaron un proceso inflamatorio activo en ambos grupos (p=1.0).Lasprotenastotales,laalbmina,latransferrinaylaceruloplasminafueronsignificativamentemenoresenniosconkwashiorkor que en nios con marasmo (p=0.003, p=0.007, p=0.035, p=0.007, respectivamente). Todas las citocinas, exceptola IL-12p70, mostraron una concentracin significativamente mayor en nios con kwashiorkor que en marasmticos. Despusde la fase de estabilizacin la concentracin de protena C reactiva disminuy de manera significativa en ambos grupos y la* No external funding was sought for this study. Resources were obtained from the 2009-2010 sustainability program ofUniversidad de Antioquia.1. Food Research and Human Nutrition Group, Full Professor, Universidad de Antioquia, Medelln, Colombia.e-mail: claudia.velasquez@siu.udea.edu.co2. School of Microbiology, Universidad de Antioquia, Medelln, Colombia. e-mail: nabecaro@gmail.com3. Medical and Experimental Mycology Group, Corporacin para Investigaciones Biolgicas (CIB), Medelln, Colombia.e-mail: cmunoz@cib.org.co4. Professor, School of Microbiology, Universidad de Antioquia. Medical and Experimental Mycology Group, Corporacinpara Investigaciones Biolgicas (CIB). e-mail: agonzalezm@cib.org.coReceived for publication October 27, 2009Accepted for publication January 23, 2010122Colombia Mdica Vol. 41 N 2, 2010 (Abril-Junio)albminaaumentaconcentracionesnormales,perolascitocinas permanecieron altas.Conclusin:EstosresultadosmuestranquelosniosdesnutridosgravessoncapacesdesintetizarprotenasdefaseagudacomolaprotenaCreactivaenrespuestaaunproceso infeccioso. Adicionalmente, las mayores concentra-ciones de citocinas pro-inflamatorias y la mayor deplecin dealbmina ocurrida en nios con kwashiorkor sugieren queesosmediadoresinflamatoriospuedenserbiomarcadorescrticos durante las fases clnicas del kwashiorkor.Palabras clave: Desnutricin; Marasmo; Kwashiorkor;Citocinas; Protena C reactiva; Respuesta inflamatoria.Between10and20%ofthechildrenworldwidesuffer protein-energy malnutrition (PEM). Despite greatadvances in the prevention and treatment of malnutrition,Colombiareportedin2005,aprevalenceof1.2%ofacute malnutrition-quite similar to that reported in 2000(0.8%),indicatingthatthisproblempersistsinsomemarginalized areas of our country1.Duringmalnutrition,thereisdeteriorationoftheimmune response with serious compromise of lymphoidtissues and cellular immunity2,3. Additionally, a decreaseis observed in the proportion of TCD4/TCD8 lympho-cytes with a ratio under 0.8, comparable to immuno-deficiencystages4.Along with the deterioration of the immune response,PEMalsomodifiestheacute-phaseinflammatoryresponse, in part, by alterations in the production andactivity of inflammatory mediators, including cytokinesand acute-phase proteins. The findings published oninvitrocytokineproductionbyperipheralbloodmononuclearcells(PBMC)fromchildrenwithPEMare limited and generally show a decline in the ability ofthese PBMC to produce cytokines such as interleukin(IL)-1,IL-6,IL-8,andtumornecrosisfactoralpha(TNF-), which mediate or modulate the acute-phaseresponse5,6.Otherstudieshaveshownthatseverelymalnourished children have decreased capacity to pro-duce Th1 cytokines such as IL-2 and IFN-; on the otherhand, they present augmented ability to produce Th2cytokines including IL-4 and IL-5, indicating that PEMcould diminish the Th1/Th2 ratio7.In contrast to results found in cellular studies, childrenwith PEM and infections are able to maintain similarblood concentrations (plasma levels) of IL-1, IL-6 andTNF- compared to controls. The study reported thatthe concentration of pro-inflammatory cytokines washigher in plasma of malnourished children than in healthyindividuals, and higher in children with kwashiorkor thanin marasmic children. Nonetheless, it is interesting thatchildrenwithsevereacutemalnutritionandwithaconcurrent infection are able to maintain the serum pro-inflammatory cytokines at adequate levels8.Researchers have shown that even under the mostsevere forms of malnutrition, children are able to increasethe blood concentration of acute-phase proteins, such asC-reactive protein (CRP) at expense of production ofcirculating proteins, including albumin and transferrin9.CRP protein is synthesized in the liver and modulated bypro-inflammatorycytokinessuchasIL-1,IL-6,andTNF-. Its increase reflects the spread of infectious orinflammatory stage and its decrease represents clinicalimprovement, as well as the effectiveness of a therapeuticintervention. It is known that increase synthesis of CRPis lower in malnourished than in eutrophic children andeven lower in children with kwashiorkor than those withmarasmus10.TheUnidadVidaInfantilattheFranciscoValderrama Hospital, under advice from Universidadde Antioquia, addresses issues of severely malnourishedchildren (with marasmus or kwashiorkor) in the area ofUrab,Colombia.Thedeteriorationoftheimmunesystem and high incidences of coexisting infections arewidelydocumentedinthesechildren11.Nutritionalinterventions were performed by following World HealthOrganization(WHO)guidelines12.Theseguidelinessuggest the onset of nutritional repletion and supple-mentation with iron approximately 5 days after admission,i.e., when appetite is restored. This suggestion has beencontroversial because some research has shown that atthis time, malnourished children present some infectionprocessesandhavedetectableconcentrationsofironfree in the serum that induces oxidative stress andedema, which could complicate their recovery13.In the present work, we determined the concentrationof total protein, albumin, hemoglobin, ferritin, transferrin,ceruloplasmin, CRP and the pro-inflammatory cytokinesIL-1, IL-6, IL-8, IL-10, TNF-, and IL-12 in children withseverely acute malnutrition. This study was initiated uponhospital admission (phase 1, before implementing nutritionalinterventions), and we assessed the changes in the con-centration of inflammatory mediators after appetite wasrestored and before supplementation with iron (phase 2).123Colombia Mdica Vol. 41 N 2, 2010 (Abril-Junio)MATERIALS AND METHODSSubjects.Childrenunderfiveyearsofagewithseverelyacutemalnutritionwithmarasmusorkwashiorkor were enrolled in this study. According tothe Colombian Ministry of Health, research was classifiedas minimal risk. The procedures applied to children inthe study were considered ideal for their recovery assuggestedbyWHO.Thechildrensparentsgrantedconsenttoparticipateintheresearchonavoluntarybasis.TheprojectreceivedapprovalbytheCentralCommittee of Bioethics at Universidad de Antioquia.In order to determine the individuals number for thisstudy, the PRIMER program (PRIMER OF BIOSTA-TISTICS:THEPROGRAMByStantonA.Glantz.Copyrigth1992byMcGraw-Hill.Inc.Version3.02)was used including the following criteria: a power of90%andanalphaerrorof0.05%.Additionally,wedefinedIL-6asamainparametertocomparethegroups, we used the study by Dulguer et al.8 as a model,where IL-6 serum levels were determined among childrenwith severely acute malnutrition and eutrophic individuals(the differences were 11.99.3 pg/ml). The applicationof this formula determined a minimum childrens numberof 10 to be included per group.Inclusionandexclusioncriteria.Childrenwithseverelyacutemalnutritionwithorwithoutapparentinfection and with or without anemia were involved inthis study. Malnutrition was classified according to theWHO protocol: marasmus, when the child presented aratio of weight/height (W/H) below -3DS without ede-ma; and kwashiorkor, when they presented edema atleast malleolus bilateral independent of the W/H. Weexcludedchildrenwithedemasecondarytokidney,heart, liver, and endocrine diseases, as well as childrenwho needed transfusion for anemia and children withsevere dehydration.Before starting the nutritional therapy (at hospitaladmission), inflammatory mediators were measured intheseraof2groupsofchildrenwithseverelyacutemalnutrition: kwashiorkor and marasmus. This valuewasconsideredthebaseline(phase1).Later,whenchildrenwithmalnutritionregainedappetite,wereconsidered stable and before supplementation with iron(phase2),theconcentrationofvariableswasagainmeasured, and changes between the two phases wereassessed.In phase 1, we made determinations, including totalanddifferentialbloodcellcounts,urinalysisandparasitological examination of smear blood to investigatethe presence of malaria, and chest X-rays were done,amongothers.Totalblood(5mL)wascollectedtodeterminetotalprotein,albumin,transferrin,ferritin,hemoglobin, ceruloplasmin, cytokines and CRP.METHODSDiagnosisofassociateddiseases.Atrainedphysician identified clinical signs of infection such asfever,somnolence,hypoglycemia,hypothermiaandspecific signs of each disease. A measurement of CRP>8 mg/l was considered an infection marker. Anemiadiagnosis was made with concentration of hemoglobinbelow 11 g/dl.Anthropometricalmeasurements.Theweightofthe children was taken daily by using a mechanical scale(Health Meter ), with 10-g sensitivity; children wereweighed without clothes. Because of the age and healthstatus, the childrens height was measured in the supineposition. All children were weighed and measured withthesameanthropometricparametersandbytrainednurses. Each anthropometric measure was performedthreetimes,andwhenthedifferencebetweendataexceeded 10 g in the case of weight, and 2 mm in thelength, mean values were reported.Nutritional therapy. Immediately after each childwas evaluated and after collecting blood samples, thenutritionaltreatmentwasofferedinitiallyeverytwohours. According to the protocol, we started with theF75formulacontaining75kcal/100mland0.9gofproteinper100ml.Whenachildshowedrestoredappetite, approximately 5 days after hospital admissionandbeforesupplementationwithironanewbloodsample was collected to evaluate the variables a secondtime (phase 2).Medical treatment. The protocol recommends thatall children with severely acute malnutrition must betreatedwithantibiotics,consideringeveryseverelymalnourishedchildasinfectedalthoughnotoftenpresenting signs of infection. Thus, children in this studywere treated with ampicillin and/or amikacin. In somecases, and depending on the disease diagnosed, as wellasitsseverityandevolution,thephysicianusedtheantibiotic for each specific case. Parasites were treated124Colombia Mdica Vol. 41 N 2, 2010 (Abril-Junio)inchildrenovertwoyearsofagevia100mgofmebendazol; using pyrantel pamoate in children undertwo years of age.Clinicalevolution.Onadailybasis,aphysicianevaluated the infection course, appetite, and weight ofchildren.Appetiterestorationwasconsideredwhenmalnourished children were able to consume more than130 ml/kg/day of the F75 formula for two days. Whenitwasfoundthatthechildregainedappetite,beforesupplementation with iron, a blood sample was orderedto reassess transferrin, ferritin, ceruloplasmin, CRP, andcytokines;thiswasconsideredphase2oftheinves-tigation.Biochemicalassessment.Hemoglobinwasdetermined by the cyanmethemoglobin method, ferritinby micro-particle enzyme immunosorbent assay (MEIA);C-reactiveproteinbyturbidimetrycommercialCRPassay (Biosystems); transferrin by turbidimetry assay;ceruloplasminquantificationwasdonebyusingnephelometryArray.Theserumwasstoredat-70Cuntil use.Pro-inflammatorycytokinesdetermination.Measurement of pro-inflammatory cytokines IL-8, IL-1, IL-6, IL-10, TNF-, IL-12p70 was done in serum byusing a commercial Human Inflammation Kit (BDCytometricBeadArray)andusingflowcytometry,adheringtomanufacturersrecommendationsandasdescribedelsewhere14.Statistical analysis.The assessment was normalizedby using the Kolmogorov-Smirnov test. The longitudinalanalysis was performed by using ANOVA of repeatedmeasures. The frequency analysis was done with theFreeman Halton test. The correlation between variableswas performed with the Pearson Correlation or SpearmanRho tests. Statistical probability of p