Síndrome antifosfolípido y tumores cardiacos

Presentamos el caso de una paciente mujer de 31 años con antecedente de litiasis coraliforme bilateral. Ella inició la enfermedad un mes antes del ingreso con trombocitopenia y anemia hemolítica autoinmune. Fue diagnosticada con Síndrome de Evans, inicialmente tuvo marcadores de autoinmunidad negativos, finalmente presentó disnea progresiva y se le encontró 4 masas intracardiacas en aurícula derecha y marcadores positivos para síndrome antifosfolípido. A pesar de la anticoagulación y preparación para cirugía cardiaca, la paciente tuvo una muerte súbita.

We present the case of a 31-year-old female patient with a history of bilateral staghorn lithiasis, who started the disease one month before admission with thrombocytopenia and autoimmune hemolytic anemia. She was diagnosed with Evans Syndrome, initially she had negative autoimmunity markers, finally presented progressive dyspnea and 4 intracardiac masses were found in the right atrium and positive markers for antiphospholipid syndrome. Despite anticoagulation and preparation for cardiac surgery, she presented sudden death.

Leucoencefalopatía posterior reversible en pacientes trasplantados. Presentación clínica, radiológica y evolución / Posterior reversible encephalopathy syndrome in transplanted patients. Clinical features and imaging follow up

Resumen El síndrome de leucoencefalopatía posterior reversible (PRES) es un desorden neurológico agudo caracterizado por cefalea, alteración de la conciencia, convulsiones y alteraciones visuales, con imágenes de edema vasogénico reversible en regiones cerebrales posteriores. Nos propusimos describir una serie de casos de pacientes trasplantados que desarrollaron PRES, caracterizando su presentación, evolución clínica, imágenes y terapéutica. Se analizaron historias clínicas informatizadas desde enero 2009 hasta enero 2019. Se recabaron datos demográficos, antecedentes clínicos, motivos y días de internación, tiempos desde el trasplante a la presentación clínica y diagnóstico. Se evaluó la mejoría/resolución en estudios por imágenes y la supervivencia anual. Se identificaron 27 pacientes con PRES; 22 trasplantados de órgano sólido de 1647 totales (1.3%) y 5 de médula ósea de 617 totales (0.8%). La media de edad fue de 38.2 años (DS 19.5), 62.9% de sexo femenino, 59.2% (16) antes del año del trasplante. Las comorbilidades más frecuentes enfermedad renal (14; 51%) e hipertensión arterial (11; 40%). Se realizó tomografía axial computarizada (TAC) a 23 pacientes (85.1%), siendo patológica en 11 (47.8%), y resonancia magnética nuclear (RMN) a 25 (92.6%), mostrando patrón característico en 17 (62.9%), con mejoría/resolución antes del año en 20 (74%). El tratamiento fue sintomático, modificando la inmunosupresión. Se registraron 5 óbitos durante la internación y otros 3 antes del año, con una supervivencia anual del 70.3% (19). La población de trasplantados, en crecimiento en nuestro medio, es particularmente susceptible al PRES. Tanto su presentación en estudios por imágenes, como su comorbilidad, difieren de otras poblaciones.

Abstract Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder characterized by headache, encephalopathy, seizures and visual disturbances, with reversible vasogenic edema in posterior brain areas. The aim of this research was to describe a case series of transplanted patients who developed PRES, characterize their presentation, treatment, clinical and imaging evolution. Electronic medi cal records were analyzed from January 2009 to January 2019. Demographic data, clinical backgrounds, causes of admission, hospital length of stay and time from transplantation to PRES were collected. Image improvement/ resolution and annual survival were assessed. We identified 27 patients with PRES; 22 of 1647 total solid-organ transplant (1.3%) and 5 of 617 total bone marrow transplant (0.8%). The mean age at presentation was 38.2 years (SD 19.5), 62.9% female, 59.2% (16) before the year of transplantation. The most common comorbidities were kidney disease (14; 51%) and high blood pressure (11; 40%). Computed axial tomography (CT) was per formed in 23 patients (85.1%), with pathological findings in 11 (47.8%). Magnetic resonance imaging (MRI) of 25 (92.6%), showed a characteristic pattern in 17 (62.9%) with improvement/resolution before the year in 20 (74%). Treatment was symptomatic, modifying immunosuppression. Five deaths were recorded during hospital stay and another 3 before the year of admission, with an annual survival of 70.3% (19 patients). Organ transplant trend is growing in our region. These patients are particularly susceptible to PRES, with a different imaging presentation and comorbidities from other populations.

Evaluation of tissue repair using phytotherapeutic gel from Plectranthus neochilus, Schlechter (boldo-gambá) and Cnidoscolus quercifolius Pohl (favela) in Wistar rats / [Avaliação da reparação tecidual do gel fitoterápico de Plectranthus neochilus, Schlechter (Boldo-gambá) e Cnidoscolus quercifolius Pohl (Favela) em ratos Wistar]

The objective of this study was to investigate the effects of a gel formulation from the association of Plectranthus neochilus and Cnidoscolus quercifolius on tissue repair in cutaneous wounds in rats. A surgical wound was induced in 35 Wistar rats and treated according to group: G1 - commercial phytotherapeutic gel; G2 - Carbopol gel 1%; G3, 4, 5 - gel formulation from Boldo-gambá and Favela (FGBF) at 2.5%, 5%, and 10%, respectively. 1ml of the product was applied topically daily, for 14 days. Macroscopic evaluation of the wound showed inflammation, granulation, and epithelization in all groups. The FGBF 2.5% group showed greater angiogenic potential. There was a significant difference between the surgical area of the wounds treated with FGBF 2.5%, 5%, or 10% compared to the group with the commercial phytotherapeutic gel. On histomorphometry of the skin, there were reepithelization of the epidermis and superficial dermis, longitudinal collagen fibers, fibroblasts, and blood vessels, and in the deeper dermis, fibroblasts, transverse and longitudinal collagen fibers, blood vessels, and inflammatory cells. The 2.5% formulation had the greatest increase in fibroblast proliferation and most intense collagenization on day 14 of treatment.(AU)

Este trabalho objetivou investigar os efeitos de uma formulação em gel da associação da Plectranthus neochilus e da Cnidoscolus quercifolius no processo de reparação tecidual em feridas cutâneas de ratos. Foi induzida uma ferida cirúrgica em 35 ratos Wistar, sendo tratadas de acordo com os grupos: G1 - fitoterápico comercial; G2 - gel de carbopol 1%; G3, G4 e G5 - formulação gel boldo-gambá mais favela (FGBF) 2,5%, 5% e 10%, respectivamente. Aplicou-se 1mL do produto, via tópica, diariamente, durante 14 dias. Na avaliação macroscópica das feridas, verificou-se inflamação, granulação e epitelização em todos os grupos. O grupo FGBF 2,5% apresentou maior potencial angiogênico. Houve diferença significativa entre as áreas cirúrgicas das feridas tratadas com os FGBF 2,5%, 5% ou 10%, comparados ao grupo com o gel fitoterápico comercial. Na histomorfometria da pele, observou-se reepitelização da epiderme e da derme superficial, fibras colágenas longitudinais, fibroblastos e vasos sanguíneos e, na derme profunda, fibroblastos, fibras colágenas transversais e longitudinais, vasos sanguíneos e células inflamatórias. A formulação a 2,5% teve o maior aumento na proliferação de fibroblastos e mais intensa colagenização no dia 14 de tratamento.(AU)

O fort-da como limite da representatividade e da temporalização da experiência / Fort-da as the limit of representativeness and temporalization of experience / Fort-da como límite de representatividad y temporalización de la experiencia / Le fort-da comme limite de représentativité et du transitoire de l'expérience

O artigo resgata as perspectivas do brincar na teoria freudiana identificando dois modelos principais. O primeiro em que o brincar é compreendido a partir da teoria dos sonhos como realização de desejo, e o segundo, que surge em 1920, com o ensaio Além do princípio do prazer, quando ele é reposicionado ao lado dos sonhos traumáticos, das neuroses de guerra e da compulsão à repetição, às voltas com as questões do limite da representatividade e do colapso da temporalização da experiência. O fort-da inaugura, nesse contexto, uma perspectiva do brincar onde ele passa a ter uma função em si mesmo, quando apoia o sentido da experiência na materialidade, como ação disparadora do processo de simbolização.

The article rescues the prospects of playing in Freudian theory, identifying two main models. The first in which the game is based on the theory of the subjects as the realization of the desire, and the second, which appears in 1920, with the "Beyond the pleasure principle", when repositioned next to the traumatic dreams, neurosis of war and compulsion to repeat, dealing with the problems of the limit of representativeness and the collapse of the experience timing. Fort-da starts, in this context, a perspective of playing from which it begins to have a function in itself, at a time when it supports the sense of experience in materiality, as a triggering action to the symbolization process.

El artículo rescata las perspectivas del juego en la teoría freudiana, identificando dos modelos principales. El primero en el que se entiende el juego basado en la teoría de los sueños como realización de deseo, y el segundo, que aparece en 1920, con el ensayo "Más allá del principio del placer", cuando se repo-siciona junto a los sueños traumáticos, de las neurosis de guerra y la compulsión a repetir, lidiando con los problemas del límite de representatividad y el colapso de la temporalización de la experiencia. Fort-da inaugura, en este contexto, una perspectiva del juego donde este comienza a tener una función en sí mismo, en el momento en que apoya el sentido de la experiencia en la materialidad, como una acción desencadenante del proceso de simbolización.

L'article récupère les perspectives du jeu dans la théorie freudienne, identifiant deux modèles principaux. Le premier dans lequel on comprend le jeu comme l'accomplissement du désir, ayant pour base la théorie du rêve ; et le second, qui apparaît en 1920, dans l'essai « Au-delà du principe du plaisir ¼ , où il est repositionné à côté des rêves traumatisants, des névroses de la guerre et de la répétition, qui font face aux questions de la limite de représentativité et de l'effondrement du transitoire de l'expérience. Le fort-da inaugure, dans ce contexte, une perspective de jeu où il commence à avoir une fonction en soi, au moment où il soutient le sens de l'expérience dans la matérialité, comme une action qui déclenche le processus de symbolisation.

High seroprevalence and associated factors for visceral leishmaniasis in dogs in a transmission area of Paraíba state, Northeastern Brazil / Alta soroprevalência e fatores associados da leishmaniose visceral canina em área de transmissão do Estado da Paraíba, Nordeste do Brasil

Abstract Dogs have been implicated as main reservoirs for visceral leishmaniasis (VL) in urban areas. Therefore, studies on this species provide important data for public health. Thus, the objective of the present study was to ascertain the seroprevalence of canine VL (CVL) and the associated factors in the Brejo Paraibano microregion, northeastern Brazil. A total of 409 dogs were sampled from the eight municipalities of the microregion: Alagoa Grande, Alagoa Nova, Areia, Bananeiras, Borborema, Matinhas, Pilões and Serraria. The diagnosis of CVL was made using an enzyme-linked immunosorbent assay (ELISA S7®), through which the prevalence observed was 29.3%. By robust Poisson regression analysis two factors were associated with seroprevalence: illiterate/incomplete elementary owner's education level (prevalence ratio = 1.57; 95% CI = 1.05-2.34; p-value = 0.027) and tick infestation (prevalence ratio = 1.82; 95% CI = 1.27-2.61; p-value = 0.001). It is concluded that the seroprevalence of CVL in the Brejo Paraibano microregion is high. The factors associated with seroprevalence indicated the importance to develop socioeducational actions on the population, and the finding that tick infestation was associated with seroprevalence shows that there is a need for investigation regarding the role of ticks in the epidemiology of CVL.

Resumo Os cães são apontados como principais reservatórios da leishmaniose visceral (LV) em áreas urbanas. Portanto, estudos com essa espécie fornecem dados importantes para a saúde pública. Assim, o objetivo do presente estudo foi determinar a soroprevalência da leishmaniose visceral canina (LVC) e os fatores associados na microrregião do Brejo Paraibano, Nordeste do Brasil. Foram amostrados 409 cães dos oito municípios da microrregião: Alagoa Grande, Alagoa Nova, Areia, Bananeiras, Borborema, Matinhas, Pilões e Serraria. O diagnóstico de LVC foi realizado com o ensaio imunoenzimático (kit ELISA S7®), no qual a prevalência observada foi de 29,3%. Pela análise de regressão de Poisson robusta, dois fatores foram associados à soroprevalência: proprietário analfabeto ou com ensino fundamental incompleto (razão de prevalência = 1,57; IC 95% = 1,05-2,34; p-valor = 0,027) e infestação de carrapatos (razão de prevalência = 1,82; IC 95% = 1,27-2,61; p-valor = 0,001). Conclui-se que a soroprevalência da LVC na microrregião Brejo Paraibano é alta. Os fatores associados à soroprevalência indicaram a importância do desenvolvimento de ações socioeducativas na população, e a associação da infestação de carrapatos com a soroprevalência mostra que há necessidade de investigação sobre o papel dos carrapatos na epidemiologia da LVC.

Compromiso pulmonar en pacientes hospitalizados con infección por el virus de inmunodeficiencia humana en el Hospital Pablo Tobón Uribe (Medellín, Colombia) / Pulmonary compromise in inpatients with human immunodeficiency virus infection at Pablo Tobón Uribe Hospital, Medellín, Colombia

Más de la mitad de los pacientes con infección por virus de inmunodeficiencia humana (VIH) pueden tener compromiso pulmonar en el transcurso de su vida. Este puede ser multicausal y las infecciones oportunistas son las principales, sin embargo, las causas no infecciosas no son menos importantes. Objetivo: Describir las características del compromiso pulmonar en pacientes hospitalizados con infección por VIH. Metodología: Estudio descriptivo observacional. Resultados: Se incluyó a 63 pacientes, el 85,7% fueron hombres. La edad promedio fue 40,6 ± 12 años. El 21,4% tuvieron antecedente de promiscuidad sexual y 28,6% fueron hombres con sexo con hombres. Se identificó tabaquismo en 60,3%, alcoholismo en 52,4% y consumo de drogas en 20,6%. El 23,8% tuvo historia de tuberculosis. Al ingreso, el 79,4% tenía sida, el recuento promedio de CD4 fue 138,5 ± 17,7 células/mm3 y el 49,2% tenía CD4 < 100 células/mm3. Las principales comorbilidades fueron: enfermedad neoplásica 20,6%, diarrea crónica 19%, EPOC 6,3% y diabetes mellitus 3,2%. Los principales síntomas al ingreso fueron: respiratorios 66,7%, gastrointestinales 47,6% y neurológicos 34,9%. Los principales oportunistas documentados fueron Mycobacterium spp, H. capsulatum y P. jirovecii. El sarcoma de Kaposi, la enfermedad lifoproliferativa y la EPOC fueron causas de compromiso no infeccioso. Los principales hallazgos radiográficos fueron: infiltrados intersticiales (42,9%), compromiso pleural (23,8%) y lesiones cavitarias (7,9%). El compromiso multilobar fue evidente en el 15,9%. Las principales complicaciones fueron falla respiratoria, disfunción orgánica múltiple y falla renal aguda. El 19% requirió ingreso a UCI y, de estos, el 83,3% necesitó ventilación mecánica. La estancia hospitalariapromedio fue de 18 ± 20 días y la mortalidad del 17,5%. Discusión: Las infecciones por oportunistas son las principales causas de compromiso pulmonar y, dentro de estas, las causadas por micobacterias. Puede ocurrir más de una infección oportunista simultáneamente, pero en nuestra población fueron infrecuentes. Las causas noinfecciosas también son importantes.

More than a half of patients with HIV infection have pulmonary involvement throug-hout their lives. Opportunistic infections are the main cause; however, many patients havenoninfectious pulmonary involvement. Objective: To describe the characteristics of pulmonary involvement in inpatients with HIVinfection.Methods: Descriptive observational study. Results: A total of 63 patients were included, and 85.7% were men. The average age was40.6 ± 12 years. Some 21.4% had a history of sexual promiscuity and 28.6% were men whohad sex with men. Smoking was found in 60.3%, alcoholism in 52.4% and drug abuse in 20.6%.A tuberculosis history was documented in 23.8% of patients. At admission, 79.4% had AIDS, themean CD4 count was 138.5 ± 17.7 cells/mm3and 49.2% had CD4 counts < 100 cells/mm3. Majorcomorbidities included neoplastic disease in 20.6%, chronic diarrhea in 19%, COPD in 6.3% anddiabetes in 3.2%. Major opportunistic agents were Mycobacterium spp, H. capsulatum and P.jirovecii. Kaposi's sarcoma, lymphoproliferative disease and COPD were causes of noninfectiouspulmonary involvement. The main radiographic findings included interstitial infiltrates in 42.9%,pleural involvement in 23.8%, alveolar infiltrates in 7.9% and cavitary lesions in 7.9%. Multilobarcompromise was evident in 15.9% of the patients. The major complications were respiratoryfailure, multiple organ dysfunction and acute renal failure. Some 19% required care in the ICUand 83.3% of these required mechanical ventilation. The mean stay was 18 ± 20 days and themortality was 17.5%. Discussion: Opportunistic infections are the main causes of lung involvement and mycobacterialdiseases were most frequent. Mycobacterial diseases can occur simultaneously with an oppor-tunistic infection, but in our series this was infrequent. Non-infectious diseases are importantbut are less common.

Coinfección por virus de inmunodeficiencia humana y micobacterias en un hospital universitario de alta complejidad en Colombia / Co-infection with human immunodeficiency virus and mycobacteria in a tertiary referral hospital in Colombia

Antecedentes: La coinfección por virus de inmunodeficiencia humana (VIH) y micobacterias tiene un efecto dual; el riesgo de enfermedad extrapulmonar y diseminada por micobacterias se incrementa y la progresión de la enfermedad VIH se acelera. La tuberculosis (TB) es la entidad que más amenaza la vida en estos pacientes. Metodología: Estudio observacional, descriptivo, retrospectivo. Objetivo: Determinar las características epidemiológicas, clínicas y el perfil de resistencia en los pacientes con coinfección VIH y micobacterias. Resultados: De 159 pacientes con diagnóstico de infección por VIH, 44 (27,7%) tenían coinfección por micobacterias. La edad promedio fue de 36,7 años ± 11,3. El 86% fueron hombres. Al ingreso 66% tenía síndrome de inmunodeficiencia adquirida (SIDA), 20% historia de TB y 11% historia de otras enfermedades de transmisión sexual. El 50% tenía linfocitos T CD4 <50/mm³. Las principales comorbilidades fueron neoplasias hematológicas 11%, insuficiencia cardiaca 4,5% y enfermedad linfoproliferativa 4,5%. La incidencia anual fue de 4,6%. Las formas diseminadas fueron el 54% de los casos. Se identificó M. tuberculosisen 77,3%, micobacterias no tuberculosas (MNT) en 18,3% y en el 4,5% no fue posible establecerla especie. El 2,5% de los aislamientos de M. tuberculosis fueron multifarmacorresistentes (TB-MDR) y en 18,2% se identificó resistencia a un solo fármaco o resistencia combinada. En el 54%de los pacientes se documentó compromiso pulmonar. La letalidad fue del 9,1%. Conclusión: En nuestros pacientes, la infección por M. tuberculosis es la más frecuente y es llamativa la alta prevalencia de resistencia al menos a un fármaco y la TB-MDR. Las infecciones por MNT son cada vez más frecuentes. Las formas diseminadas y extrapulmonares son muy importantes. La incidencia anual es alta.

Background: Co-infection with the human inmunodeficiency virus (HIV) and mycobacteria hasa synergistic effect; the risk of extrapulmonary and disseminated mycobacterium disease isincreased and the progression of HIV disease is accelerated. Tuberculosis (TB) is the entity thatis most life threatening to these patients. Methodology: Observational, descriptive and retrospective study. Objective: To determine the epidemiological and clinical characteristics and the resistanceprofile in patients coinfected with HIV and mycobacteria. Results: Of 159 patients diagnosed with HIV, 44 (27.7%) patients were co-infected with myco-bacteria. The average age was 36.7 years ± 11.3. Some 86% were men. At admission, 66% hadacquired immune deficiency syndrome (AIDS), 20% a history of TB and 11% a history of othersexually transmitted diseases. A total of 50% reported a count of CD4 lymphocytes less than50 cells/mm 3 . Major comorbidities were haematological malignancies in 11%, heart failure in4.5%, and lymphoproliferative disease in 4.5%. The annual incidence was 4.6%. Disseminatedforms were found in 54% of cases. M. tuberculosis was identified in 77.3%, non-tuberculousmycobacteria (NTM) in 18.3% and in 4.5%, it was not possible to establish the species. Some2.5% of isolates of M. tuberculosis were multidrug-resistant (MDR-TB) and 18.2% were resistantto a single drug or had combined resistance. There was documented pulmonary involvement In54% of patients. Mortality was 9.1%. Conclusion: In our patients, infection with M. tuberculosis was the most common and the highprevalence of resistance to at least one drug and MDR-TB was striking. NTM infections are becoming more common. The extra-pulmonary and disseminated forms are common, and annual incidence is high.

Migração cranial de diferentes volumes de iobitridol, administrados pela via epidural lombossacra, em coelhos / Cranial spread of different volumes of iobitridol, administered by epidural lumbosacral route, in rabbits

Com o objetivo de avaliar a migração cranial de diferentes volumes de iobitridol, administrado por via epidural lombossacra, bem como as possíveis alterações decorrentes dessa administração, foram utilizados 12 coelhos, sem raça definida, com 1,0±0,5 anos de idade e pesando 2,4±0,4 kg. Os animais foram anestesiados com xilazina (5 mg/kg) e cetamina (20 mg/kg), por via intramuscular, 15 minutos antes da punção lombossacra. Foram compostos dois grupos: grupo 1 (G1), onde foi administrado iobitridol, no volume de 0,33 mL/kg; e grupo 2 (G2), 0,22 mL/kg. Avaliaram-se as frequências cardíaca (FC) e respiratória (f), a duração da onda P, do intervalo PR, do complexo QRS e do intervalo QT, a saturação de oxihemoglobina (SPO2) e a temperatura retal (TR), antes da epidurografia e a cada 10 minutos após, durante 60 minutos. Também foram analisadas a migração cranial do iobitridol e a ataxia produzida. A FC, f e TR reduziram e a duração do intervalo QT aumentou após a anestesia em ambos os grupos. As durações do intervalo PR e do complexo QRS aumentaram no G1. O limite cranial da migração do meio de contraste variou entre a 4а vértebra lombar e a 8а vértebra torácica no G1 e entre a 5а vértebra lombar e a 11а vértebra torácica no G2. A ataxia foi moderada em ambos os grupos. Conclui-se que a administração do iobitridol pela via epidural lombossacra, associada à anestesia dissociativa com xilazina-cetamina, e nos volumes utilizados e sob as condições de estudo, causa alterações toleráveis nos parâmetros avaliados em coelhos hígidos, e quando utilizado neste modelo animal não causa sinais de neurotoxicidade.

In order to evaluate the cranial spread of different volumes of iobitridol, by epidural lumbosacral route, 12 mongrel rabbits, 1.0±0.5 years old, weighing 2.4±0.4 kg were used. The animals were anesthetized with xylazine (5 mg/kg) and ketamine (20 mg/kg) intramuscularly, 15 minutes before of the lumbosacral puncture. Two groups were formed: iobitridol was administered at a volume of 0.33 mL/kg in the group 1 (G1) and at 0.22 mL/kg in the group 2 (G2). The heart (HR) and respiratory rates (f), duration of P-wave, PR interval, QRS complex and QT interval, oxyhemoglobin saturation (OS) and rectal temperature (RT) were evaluated, before epidurography and every 10 minutes after, for 60 minutes. The cranial spread of iobitridol and the ataxia produced were also analyzed. FC, f and RT reduced and duration of QT interval increased after anesthesia in both groups. The duration of PR interval and QRS complex increased in G1. The cranial limit of the migration of the contrast medium varied between the 4th lumbar vertebra and the 8th thoracic vertebra in G1 and between the 5th lumbar vertebra and the 11th thoracic vertebra in G2. Ataxia was moderate in both groups. It is concluded that the administration of iobitridol by the lumbosacral epidural route, associated with dissociative anesthesia with xylazine-ketamine, and in the volumes used and under the study conditions, causes tolerable changes in the parameters evaluated in healthy rabbits, and when used in this animal model there is no signs of neurotoxicity

Bacteremia por Staphylococcus coagulasa negativo con concentración inhibitoria mínima para vancomicina ≥ 2 / Coagulase-negative Staphylococcus bacteremia with Vancomycin minimum inhibitory concentrations ≥ 2

Introducción: La bacteremia por Staphylococcus coagulasa negativo (SCN) es una infección que actualmente genera significativa morbimortalidad dado el tipo de pacientes a los que afecta y el cambio en el perfil de susceptibilidad a los antibióticos. Objetivo: Describir características de los pacientes con aislamientos de SCN en sangre con CIM para vancomicina ≥2. Metodología: Estudio observacional descriptivo en pacientes hospitalizados ≥ 15 años. Resultados: De 130 aislamientos, 38 (29,23%) tenían CIM para vancomicina ≥ 2. La mediana de edad fue de 54 años y la razón hombre:mujer, de 1,37:1. Las especies más frecuentes fueron: S. epidermidis (71,1%), S. haemolyticus (13,2%) y S. hominis (7,9%). El 44,7% tenían antecedentes de inmunosupresión, siendo las más importantes: neoplasias (28,9%), enfermedad reumatológica (5,2%) y VIH (2,6%). El 81,5% tenían accesos vasculares, el 97,3% antecedente de hospitalización previa y el 60,5% habían requerido manejo en la UCI. El 81,4% tuvieron exposición previa a antibióticos, y los más utilizados fueron: betalactámicos (78,9%) y vancomicina (50%). En el 2,6% se documentó endocarditis infecciosa. De los aislamientos de SCN con CIM para vancomicina ≥2 µg/ml, el 26,3% fueron sensibles a meticilina. Los principales tratamientos recibidos fueron: daptomicina (31,5%), vancomicina (21%), linezolid (15,7%) y betalactámicos (10,5%). Se utilizó terapia combinada en el 10,5%. La mortalidad general fue del 15,8%, y la mortalidad atribuible, del 33,3%. Conclusión: Un porcentaje considerable de aislamientos tenían heterorresistencia para vancomicina. La bacteremia estuvo asociada con accesos vasculares, hospitalizaciones previas, tratamientos en cuidado intensivo y exposición previa a antibióticos. La inmunosupresión es la comorbilidad más importante, y la mortalidad es significativa.

Introduction: Currently, coagulase-negative Staphylococcus (CNS) bacteremia is an infection that leads to significant morbidity and mortality given the type of patients affected and the recent changes in antimicrobial susceptibility. Objective: To describe the characteristics of patients with CNS blood isolates with vancomycin MIC ≥ 2. Methodology: Descriptive observational study on hospitalised patients ≥ 2 15 years of age. Results: Of 130 isolates, 38 (29,23%) contained vancomycin MIC ≥ 2. The median age was 54 years and the male:female ratio was 1.37:1. The most frequent species were S. epidermidis (71.1%), S. haemolyticus (13.2%) and S. hominis (7.9%). Some 44.7% of patients had a history of immunosuppression, including: neoplasms (28.9%), rheumatologic disease (5.2%) and HIV (2.6%). Some 81,5% had vascular access; 97.3% had previous hospitalisations and 60.5% had required intensive care. A total of 81.4% of the patients had prior exposure to antibiotics and the most commonly used were beta-lactams (78.9%) and vancomycin (50%). Infective endocarditis was documented in 2.6%. Of the CNS isolates with vancomycin MIC ≥ 2, 26.3% were sensitive to methicillin. The main treatments received were: daptomycin (31.5%), vancomycin (21%), linezolid (15.7%) and betalactams (10.5%). Combined therapy was performed in 10.5%. The overall mortality was 15.8% and attributable mortality was 33.3%. Conclusion: A significant proportion of isolates were hetero-resistant to vancomycin. The bacteremia was associated with vascular access, previous hospitalisations, intensive care treatments and prior antibiotic exposure. Immunosuppression is the most important comorbidity and mortality is significant.

Experiencia clínica con infecciones causadas por Klebsiella pneumoniae productora de carbapenemasa, en una institución de enseñanza universitaria en Medellín, Colombia / Clinical experience with infections caused by carbapenemase-producing Klebsiella pneumoniae in a tertiary care teaching institution in Medellin, Colombia

Antecedentes: Las infecciones por Klebsiella pneumoniae productora de carbapenemasa (KPC) son un problema de salud pública mundial. Desde 2008 nuestra institución experimenta casos endémicos de infecciones por KPC posteriores a un brote cuyo caso índice fue un paciente de Israel admitido para trasplante hepático. Objetivo: Describir características clínicas y mortalidad en pacientes hospitalizados con infecciones nosocomiales por KPC. Métodos: Estudio observacional retrospectivo, descriptivo. Resultados: Un total de 52 pacientes fueron incluidos, la edad media fue 45,7 ± 27 años, 65,4% fueron hombres. Uso de inmunosupresores, cirugía gastrointestinal, hepatopatía crónica y trasplante de órgano sólido fueron las comorbilidades importantes. El 100% recibió antibióticos antes de la infección por KPC. Las principales infecciones fueron bacteriemia (30,7%), infección intraabdominal (23,1%) y neumonía (17,3%). El tratamiento fue dirigido por antibiograma en 50,7%. Tigeciclina fue administrada en el 51,9% y colistina en el 32,7%, ambas en terapia combinada con otros antibióticos. En el 15,4% se utilizó tigeciclina más colistina. La duración del tratamiento fue 15,7 ± 7,5 días. El 51,9% desarrolló bacteriemia y falla renal aguda y el 76,9% requirió atención en UCI. La mortalidad fue 48,1% y fue significativamente mayor en pacientes con bacteriemia vs. sin bacteriemia (74,1 vs. 20%; p = 0,01). No hubo diferencias significativas en mortalidad cuando se comparó uso de tigeciclina vs. colistina (45 vs. 52%; p = 0,609). Conclusión: La inmunosupresión, cirugía gastrointestinal, tratamiento previo con antibióticos y estancia en UCI son factores importantes para la infección por KPC. La mortalidad es alta a pesar de la terapia dirigida, especialmente en pacientes con bacteriemia.

Background: Carbapenemase-producing Klebsiella pneumoniae (KPC) infections are a worldwide public health problem. Since 2008, our institution has experienced endemic cases of KPC infection after an outbreak whose index case was a patient from Israel admitted for liver transplantation. Objective: To describe the clinical characteristics and mortality of inpatients with nosocomial KPC infections. Methods: Retrospective, descriptive observational study. Results: A total of 52 patients were included, with an average age of 45.7 ± 27 years; 65.4% were men. Use of immunosuppressants, gastrointestinal surgery, chronic liver disease and solid organ transplantation were significant comorbidities. All the patients had received antibiotics before the KPC infection. The primary infections were bacteraemia (30.7%), intra-abdominal infections (23.1%) and pneumonia (17.3%). Treatment was directed by antibiogram in 50.7% of cases. Tigecycline was administered in 51.9% of cases and colistin in 32.7%, both in combination therapy with other antibiotics. Colistin plus tigecycline was used in 15.4% of cases. The treatment duration was 15.7 ± 7.5 days, with 51.9% of patients developing bacteraemia and acute renal failure and 76.9% requiring ICU care. Mortality was 48.1% and was significantly higher in the patients with bacteraemia compared with those without (74.1 vs. 20%, respectively, p = 0.01). There were no significant differences in mortality between tigecycline and colistin use (45 vs. 52%, respectively, p = 0.609). Conclusion: Immunosuppression, gastrointestinal surgery, previous treatment with antibiotics and ICU stay are important factors for infection with KPC. Mortality is high despite targeted therapy, particularly in patients with bacteraemia.

Infección por VIH posterior a exposición ocupacional de riesgo biológico en trabajadores de la salud / HIV infection after biohazard occupational exposure to HIV in health care

Se describe el caso de una mujer auxiliar de enfermería quien sufrió accidente de riesgo biológico luego de punción con aguja, al canalizar una vena periférica. La auxiliar de enfermería era residente en área rural y fue atendida en urgencias de su hospital local. El origen de la exposición (fuente) fue positivo para VIH y negativo para VHB y VHC. La trabajadora de la salud accidentada fue negativa para VIH, VHB y VHC y no recibió profilaxis antirretroviral (ARV) postexposición y luego fue remitida a nuestra institución. Este es el primer reporte en Colombia de seroconversión al VIH luego de exposición ocupacional.

We report a postexposure HIV infection in a woman nursing assistant, resident in rural area. She suffered biohazard exposure after needlestick incident during channeling of peripheral vein. She was attended at their local hospital emergency room. The serostatus on the patient's exposure source (source) was HIV positive and negative for HBV and HCV. The health worker was negative for HIV, HBV and HCV and she did not receive antiretroviral (ARV) prophylaxis at the initial consultation. Thereafter she was referred to our institution. This is the first report of HIV infection after occupational exposure in Colombia.

Revisão das Propriedades Medicinais de Cajanus cajanna Doença Falciforme / Review of Medicinal Cajanus cajan of properties in Sickle Cell Disease

RESUMO Este artigo descreve a ocorrência, características botânicas, fitoquímicas e a composição nutricional do feijão guandu [Cajanus cajan (L.) Millsp], e sua relação no processo de inibição da falcização na doença falciforme, um distúrbio genético que acomete as hemácias, gerando hemólise e anemia crônica. Dois constituintes químicos estariam mais relacionados aos efeitos inibitórios na falcização de células falciformes: L-fenilalanina e o ácido p-hidroxibenzóico. Estudos químico-biológicos detalhados com o feijão guandu no Brasil poderão esclarecer melhor os mecanismos pelos quais ocorre a inibição da falcização das hemácias e a diminuição do estresse oxidativo, ajudando no tratamento de pessoas com DF.

ABSTRACT This article describes the occurrence, botanical characteristics, phytochemical and nutritional composition of pigeonpea [Cajanus cajan (L.) Millsp], and their relationship in the process inhibition of sickling in sickle cell disease (SCD), a genetic disorder that affects red blood cells, causing hemolysis and chronic anemia. Two chemical components would be related to the inhibitory effect on sickling of sickle cells: the L-phenylalanine and the p- hydroxybenzoic acid. In Brazil, detailed studies with pigeonpea chemical-biological may clarify the mechanisms by which the inhibition of sickling of red blood cells occurs, reducing oxidative stress and thus helping treating people affected by this disease.

Características clínicas, factores de riesgo y perfil de susceptibilidad de las infecciones por micobacterias documentadas por cultivo, en un hospital universitario de alta complejidad en Medellín (Colombia) / Clinical features, risk factors and susceptibility profile of mycobacterial infections documented by culture in a university hospital of high complexity in Medellin (Colombia)

Introduction: Tuberculosis (TB) remains an entity of high prevalence and mortality worldwide. The rising drug resistance is a public health problem. Besides, non-tuberculosis mycobacterial (NTM) infections are described with increasing frequency in areas of high prevalence of TB. Objectives: To determine epidemiological, clinical and microbiological characteristics of mycobacterial infections documented by culture. Materials and Methods: An observational, descriptive study in hospitalized patients. Results: M. tuberculosis complex was identified in 90,9% of 187 patients; 9,1% had NTM, 64% were male and the mean age was 40 years (range 1-88 years). The main co-morbidities were HIV / AIDS (23.5%), use of corticosteroids (13.3%) and chronic kidney disease (9.6%). Clinical forms were pulmonary (56.6%), extra-pulmonary (23.9%) and disseminated (19.2 The most common extra-pulmonary compromise was nodal (7.4%) and gastrointestinal (7%). 10.6% of M. tuberculosis were multi-drugresistant (MDR) and 2.12% had extended drug resistance (XDR). Mycobacterium avium andM. abscessus were the most frequent NTM. Overall mortality was 10%. Conclusions: In our study immune suppression is the main risk factor for extrapulmonary and disseminated disease. Resistance, MDR and XDR is higher in inpatients with TB. MNT infections are not uncommon in our country.

Introducción: Tuberculosis (TBC) es aún una entidad de alta prevalencia y mortalidad en el mundo. La resistencia ascendente a fármacos es un problema de salud pública. Además se describen con mayor frecuencia infecciones por micobacterias no tuberculosas (MNT) en áreas de alta prevalencia de TBC. Objetivos: Determinar características epidemiológicas, clínicas y microbiológicas de las infecciones por micobacterias documentadas por cultivo. Materiales y Métodos: Estudio observacional, descriptivo, en pacientes hospitalizados. Resultados: De 187 pacientes, en 90,9% se identificó complejo M. tuberculosis y en 9,1% MNT; 64% fueron hombres. Edad promedio 40 años (rango 1-88 años). Las principales co-morbilidades fueron infección por VIH/SIDA (23,5%), uso de corticoesteroides (13,3%) y enfermedad renal crónica (9,6%). Las formas clínicas fueron pulmonares (56,6%), extra-pulmonares (23,9%) y diseminadas (19,2%). El compromiso extra-pulmonar más frecuente fue ganglionar (7,4%) y gastrointestinal (7%). En M. tuberculosis 10,6% fueron multidrogoresistentes (MDR) y 2,12% con resistencia extendida (XDR). Mycobacterium avium y M. abscessus fueron las MNT más frecuentes. La mortalidad general fue 10%. Conclusiones: Inmuno-supresión es el principal factor de riesgo para enfermedad extrapulmonar y/o diseminada y la resistencia a fármacos en pacientes hospitalizados con TBC es llamativa, con mayor incidencia de MDR y XDR. Las infecciones por MNT no son infrecuentes en nuestro medio.

Accidentes ocupacionales de riesgo biológico en Antioquia, Colombia. Enero de 2010 a diciembre de 2011 / Biohazard occupational exposure in Antioquia, Colombia; January 2010 to December 2011

Antecedentes: Los accidentes ocupacionales de riesgo biológico tienen como mayor riesgo postexposición la seroconversión para el virus de la inmunodeficiencia humana (VIH) y virus de la hepatitis C (VHC) y B (VHB). En la literatura latinoamericana aún faltan estudios que aporten información al respecto. Objetivo: Describir las características epidemiológicas de los accidentes ocupacionales de riesgo biológico. Metodología: Estudio descriptivo longitudinal. Resultados: Se describen 231 episodios de riesgo biológico. La mediana de edad fue 30 años. Un 65,8% fueron mujeres. Las principales actividades laborales fueron: auxiliares de enfermería (22,9%), aseo hospitalario (16,5%), estudiantes (14,3%), recolección de basuras (5,2%) y médicos (4,8%). El mecanismo del accidente fue: punción (77%), herida cortante (11,3%) y contacto con mucosas (9,1%). En 24% la fuente fue conocida y de estas fueron positivas para VIH un 62,5%, para VHB un 3,5% y para VHC un 5,3%. Recibieron profilaxis postexposición (PPE) un 75,8% de los 231. Entre los expuestos a fuente VIH positiva, recibieron PPE biconjugada 85,1% y terapia triple 14,8% De los que recibieron profilaxis, 40% presentaron reacciones adversas, siendo las gastrointestinales (77,1%) y las neurológicas (45,7%) las más frecuentes. Al ingreso, un 67,1% tenían anticuerpos protectores para VHB. Durante el seguimiento se confirmó una seroconversión postexposición para VIH. Conclusión: El riesgo de adquirir infecciones postexposición ocupacional es una realidad en nuestro medio; se debe hacer énfasis en estrategias de prevención de exposición, introyectar la cultura del reporte y el manejo adecuado de la profilaxis postexposición.

Background: Occupational biohazard exposure can increase the risk of postexposure seroconversion of human immunodeficiency virus (HIV) and hepatitis C (HCV) and B virus (HBV). In Latin America, the literature lack of studies on this topic. Objective: To describe the epidemiological characteristics of occupational biohazard exposure. Methodology: A descriptive, longitudinal study. Results: A total of 231 episodes of biological risk exposure are described. The median age was 30 years, and 65.8% were women. The major occupational activities were: nursing assistants 22.9%, hospital cleaning 16.5%, students 14.3%, garbage collection 5.2% and physicians 4.8%. The mechanisms of the accidents were: needle stick 77%, cutting wound 11.3% and contact with mucous membranes 9.1%. In 24% the source was known and of these, 62.5% were positive for HIV 3.5% for HBV and 5.3% for HCV. A total of 75.8% of the 231 received postexposure prophylaxis (PEP). In those exposed to an HIV-positive source, 85.1% received a two-drug conjugate for PPE, and 14.8% received triple therapy. Of those who received prophylaxis, 40% reported adverse events with being the most frequent the gastrointestinal (77.1%) and neurological (45.7%). At admission, 67.1% had protective antibodies to HBV. During program monitoring, HIV seroconversion was confirmed in one patient. Conclusion: The risk of acquiring occupational infections postexposure is a reality in our country. This emphasizes the importance of exposure prevention strategies, introjecting the reporting culture and proper management of postexposure prophylaxis.

Eletroacupuntura para tratamento de hipotensão induzida por isofluorano em cavalos / Electroacupuncture treatment for isoflurane induced hypotension in horses

Objetivou-se avaliar a eficiência do tratamento da hipotensão arterial com eletroacupuntura comparativamente à dobutamina em equinos. Foram avaliados seis cavalos adultos, saudáveis, mantidos em anestesia inalatória, com isofluorano, em ventilação mecânica. Após a estabilização da anestesia, foi induzida hipotensão arterial, através do incremento da concentração do isofluorano, iniciando-se um dos tratamentos: DOB: dobutamina (1,5µg kg-1 min-1, infusão contínua intravenosa); EA: estímulo elétrico no acuponto pericárdio 6 (PC6), bilateralmente; SHAM: estímulo elétrico em ponto falso de acupuntura. Foram mensurados: frequência cardíaca (FC), pressão arterial média (PAM), temperatura retal (T), concentração final expirada de isofluorano (ETiso), variáveis hemogasométricas, concentração sérica de aspartato aminotransferase (AST) e creatina fosfoquinase (CK), tempo e qualidade da recuperação pós-anestésica. Houve incremento na PAM de 50%, 36,6% e 7,5% nos tratamentos DOB, EA e SHAM, respectivamente. Não houve diferença entre os grupos nas variáveis hemogasométricas, FC, T, ETiso, CK, AST, tempo e qualidade de recuperação pós-anestésica. Conclui-se que o tratamento com dobutamina foi mais efetivo para o tratamento da hipotensão em cavalos sob anestesia inalatória quando comparado ao estímulo elétrico do acuponto PC6 ou ponto falso de acupuntura...

This study aimed to evaluate the efficacy of electroacupuncture compared to the dobutamine treatment of hypotension in equines. Six adult horses were maintained in isoflurane anesthesia with mechanical ventilation. After anesthesia was established, the isoflurane concentration was raised until hypotension was achieved. After that the animals were treated with a constant rate of 1.5mg kg -1min-1 intravenous dobutamine (DOB), electroacupunture to pericardium 6 (PC-6) acupoint (EA) and false point treatment (SHAM). Heart rate (HH), median arterial blood pressure (MAP), rectal temperature (T), isoflurane end-tidal concentration, arterial blood gases, creatine kinase (CK), aspartate transaminase (AST), recovery time and quality of recovery were investigated. The MAP increased 50%, 36.5% and 7.5%% in DOB, EA and SHAM treatments, respectively. HH, T, arterial blood gases, CK, AST, recovery time and quality of recovery did not differ among treatments. It was concluded that the dobutamine treatment was more effective than EA and SHAM treatments for the reversion of isoflurane induced hypotension in horses...

A campanha #foraricardoteixeira no Twitter: interações sociais e debate público a respeito do esporte / The campaign #foraricardoteixeira on Twitter: social interactions and public debate about sport / La campaña #foraricardoteixeira en el Twitter: interacciones sociales y debate público a respeto del deporte

Em 2011 ganhou espaço na mídia um movimento que se iniciou no Twitter e que reivindicava a saída do então presidente da Confederação Brasileira de Futebol (CBF). O episódio demonstrava o poder que a mobilização popular assumia nas Redes Sociais. A partir dessa temática, realizamos uma pesquisa com o objetivo de investigar como são os debates públicos sobre fatos esportivos na Rede Social Twitter, a partir de um estudo de caso da campanha "Fora Ricardo Teixeira". Para tal, analisamos 725 postagens textuais do Twitter e acompanhamos a campanha por seis meses. Constatamos que, para protestar, os participantes debatem entre si, divulgam opiniões pessoais e informações da mídia que não são presentes nos meios televisivos, além de abordarem a temática esportiva de modo amplo e crítico.

In the year 2011 there was a lot of mentions in the media about a movement initiated in Twitter which claimed the president of the Brazilian Soccer Confederation (CBF). The episode showed the power that a popular mobilization is getting on the social network. From this thematic we did a research with the objective of investigating how the public discussions about sport facts are on the social network denominated Twitter, starting with a case study of the campaign "Out Ricardo Teixeira". We analyzed 725 text posts from Twitter and we spent 6 months monitoring the campaign. We are seeing that to protest, people involved keep discussions with others in the group, share personal opinions and information that are not available on the television. In addition, we have seen the sportive thematic being approached in a large and critical way.

En 2011 tuvo espacio en los multimedios un movimiento que empezó en el Twitter y que reivindicaba la salida del presidente, a la época, de la Conferedação Brasileira de Futebol. El acontecimiento demostraba el poder que la movilización popular asumía en las Redes Sociales. A partir de esa temática realizamos una investigación con el objetivo de descubrir como son los debates públicos a respeto de acontecimientos deportivos en la Red Social Twitter, a partir de un estudio de la campaña "Fora Ricardo Teixeira". Para ello analizamos 725 postajes textuales del Twitter y acompañamos la campaña por seis meses. Constatamos que para hacer la protesta, los participantes debaten entre sí, divulgan puntos de vista personales y informaciones obtenidas a partir de los multimedios y que no son presentes en la media televisiva, además de abordaren la temática deportiva de modo amplio y crítico.

Fibromialgia en el distrito de Lambayeque: un estudio preliminar / Fibromyalgia syndrome in Lambayeque District: a preliminary study

Objetivo. Determinar la frecuencia del síndrome de fibromialgia en el distrito de Lambayeque y validar localmente los tests de Zung para ansiedad y depresión. Material y métodos. Estudio descriptivo, trasversal y prospectivo; muestreo aleatorio, estratificado, bietápico. El distrito de Lambayeque fue dividido en cinco zonas arbitrarias para el muestreo. Ocho alumnos de la Escuela de Medicina fueron capacitados en la aplicación de los criterios del American College of Rheumathology de 1990 para el diagnóstico de fibromialgia. Se aplicó los tests de Zung de depresión y ansiedad y una ficha de recolección de datos para diagnóstico de Fibromialgia. Resultados. Se entrevistó a 94 personas. El promedio de edad fue de 37,3 ± 12,3 años; hubo 74 mujeres (78,7%). El valor de los coeficientes de Alfa de Cronbach para los tests de depresión y ansiedad de Zung fueron de 0,71 y 0,73. Se identificó cuatro pacientes con fibromialgia (4,2%), cuatro con síndrome depresivo (4,2%) y nueve de síndrome ansioso (9,7%). Conclusión. La frecuencia de fibromialgia en el distrito de Lambayeque fue relativamente común y los test de Zung para depresión y ansiedad tuvieron validez y confiabilidad aceptables en dicha población.

Objective. To determine the frequency of the fibromyalgia syndrome in Lambayeque and to validate the Zung Test for Depression and Anxiety in these city. Material and methods. A descriptive, transversal and prospective study was done, with randomized, bietapic and stratified sampling. The district of Lambayeque was divided into five arbitrary areas for sampling. Eight medical students were trained in the application of the criteria of the American College of Rheumathology of 1990 and the Zung tests for Depression and Anxiety. Results. Ninety-four people were interviewed; the average age was 37,3 ± 12,3 year-old; there were 74 (78,7%) women and 20 (21,3%) men. The CronbachÆs alpha coefficient values were 0,71 y 0,73 for depression and anxiety. There were four with fibromyalgia (4,2%), four patients with depressive syndrome (4,2%) and nine cases of anxiety (9,7%). Conclusion. Fibromyalgia is a relatively common entity in the Lambayeque district and the Zung tests for depression and anxiety had an acceptable reliability and validity for that population.

Nivel de conocimientos, actitudes y prácticas en relación al test de papanicolaou en mujeres del distrito de Chiclayo - 2010 / Level of knowledges, attitudes and practices of pap test in women of Chiclayo during 2010

Evaluar el nivel de conocimientos, actitudes y prácticas en relación al test de Papanicolaou en mujeres de 20 a 45 años. Diseño descriptivo, transversal; se entrevistaron 116 mujeres, 44,8 % tuvieron nivel alto de conocimientos, 47,4% actitud favorable y 38,8%, nivel de prácticas correcto. En las mujeres con actitud desfavorable con respecto al PAP se halló 5,6 veces más probabilidades de solamente haber concluido estudios en el colegio: OR: 5,6 (IC95%: 2,2-15,23 p< 0,05). El motivo más frecuente por el que no se habrían realizado el test, fue por falta de tiempo.(AU)

To evaluate the level of knowledge, attitudes and practices regarding the Papanicolau test in women from 20 to 45 years from Chiclayo during 2010. Descriptive, cross-sectional, prospective study; 116 women were interviewed. The mean age was 33,5 ± 7,6 years; 44,8% had a high level of knowledge, 47,4% had favorable attitudes and 38,8% good practices. The odds of the women with unfavorable attitude toward PAP was 5,6 of only having concluded the school studies: OR:5,6 (IC: 2,2-15,23 p < 0,05). Conclusions: The levels of knowledge, attitudes and practices are low in this population; an association was found between level of attitudes and educational level; the main reason why women have not performed PAP was lack of time.(AU)