Simultaneous unilateral central retinal vein occlusion and branch retinal artery occlusion after Coronavirus Disease 2019 (COVID-19) mRNA vaccine / Oclusão unilateral simultânea da veia retiniana central e artéria retiniana ramificada após vacina mRNA COVID-19

ABSTRACT A 51-year-old non-obese woman presented with a one-week history of progressive blurry vision within the inferior visual field of her left eye. Her only relevant past medical history was long-standing hypothyroidism and recent vaccination against Coronavirus Disease 2019 (COVID-19) with an mRNA vaccine 12 days before the onset of symptoms. At examination, the anterior segment was unremarkable, but the retinal fundus revealed a central retinal vein occlusion associated with a branch retinal artery occlusion of the superior temporal branch in her left eye. Ancillary tests to rule out thrombophilia, hyperviscosity, hypercoagulability, or inflammation were negative. Ultrasound tests were also negative for a cardiac or carotid origin of the branch retinal artery occlusion. At two-month follow-up, no new retinal vascular occlusive events were observed. Although the best-corrected visual acuity at presentation was 8/10 in the left eye, the final best-corrected visual acuity remained 3/10.

RESUMO Uma mulher de 51 anos, não obesa, apresentou história de uma semana de visão embaçada progressiva no campo visual inferior do olho esquerdo. Seu único histórico médico anterior relevante era hipotireoidismo de longa data e uma recente vacinação contra a Doença de Coronavírus 2019 (COVID-19), com vacina de mRNA, 12 dias antes do início dos sintomas. O exame mostrou segmento anterior normal, mas o fundo da retina revelou uma oclusão da veia central da retina associada a uma oclusão de ramo arterial da retina do ramo temporal superior no olho esquerdo. Testes auxiliares para descartar trombofilia, hiperviscosidade, hipercoagulabilidade ou inflamação apresentaram resultados negativos. Testes de ultrassom também foram negativos quanto a uma origem cardíaca ou da carótida da oclusão do ramo da artéria da retina. Após dois meses de acompanhamento, nenhum novo evento vascular oclusivo retiniano foi observado. Embora, a acuidade visual melhor corrigida na apresentação tenha sido de 8/10 no olho esquerdo, a acuidade visual final melhor corrigida permaneceu em 3/10.

Paracoccidoidomicosis: Reporte de 4 casos

La paracoccidioidomicosis (PCM) es una infección causada por hongos patógenos humanos del género Paracoccidioides. Es una micosis sistémica que puede afectar cualquier órgano. Se describen con este reporte cuatro casos de paracoccidioidomicosis con diferentes presentaciones clínicas, tiempo de evolución, con afectación mucocutánea, pulmonar, glándulas suprarrenales, sistema nervioso entre otros, principalmente en adultos varones de diferentes edades y profesiones, tanto inmunosuprimidos como inmunocompetentes, teniendo en común el contacto con el suelo. Se demuestra de esta manera la importancia de considerar esta patología ante una sospecha clínica de micosis sistémica para así realizar una confirmación temprana y tratamiento oportuno ya que presenta buena respuesta terapéutica antimicótica y mejoría clínica.

Paracoccidioidomycosis (PCM) is an infection caused by human pathogenic fungi of the genus Paracoccidioides. This report describes: 4 cases of paracoccidioidomycosis diagnosed with different clinical presentations, different times of evolution, with mucocutaneous, pulmonary, adrenal gland, and nervous system involvement, among others, mainly in male adults of different ages and professions, both immunosuppressed and immunocompetent, having in common contact with the ground. In this way, PCM is a systemic mycosis that can affect any organ and therefore the importance of considering this pathology when a diagnostic suspicion of systemic mycosis is presented in order to make an early diagnosis and timely treatment since it presents a good therapeutic response, antifungal and clinical improvement.

A COVID-19 perspective of Vogt–Koyanagi–Harada disease

Vogt–Koyanagi–Harada (VKH) disease, a bilateral granulomatous panuveitis associated with multisystem involvement, is a T-cell-mediated autoimmune disorder in which cytotoxic T-cell target melanocytes in genetically susceptible individuals. Recently, there has been an increase in literature on the new onset of uveitis and reactivation of previously diagnosed cases of uveitis following Covid-19 vaccinations. It has been postulated that Covid-19 vaccines can lead to an immunomodulatory change resulting in an autoimmune phenomenon in the recipients. VKH following COVID-19 infection was reported in four patients and a total of 46 patients developing VKH or VKH-like disease following COVID-19 vaccinations. There are reports of four patients who had been recovering or recovered from VKH after receiving the first dosage of the vaccine and developed worsening of ocular inflammation after receiving the second dose of the vaccine.

Cuerpos jóvenes y control de territorios en el triángulo del huachicol / Youth bodies and control of territories in the Huachicol triangle / Corpos jovens e controle de territórios no triângulo Huachicol

Resumen (analítico) Esta es una investigación antropológica con metodología etnográfica que muestra las dinámicas de violencia que buscan controlar los cuerpos jóvenes y sus territorios, provocando miedo y muerte en el llamado "triángulo del huachicol" en Guanajuato, México. Se analiza la experiencia de siete jóvenes sobrevivientes de un evento de ejecuciones donde asesinaron a dos de sus amigos. Los hallazgos evidencian que los cuerpos de los jóvenes están siendo disputados por los distintos poderes de los grupos del crimen organizado y por las fuerzas armadas del Estado mexicano. Las conclusiones explican que dichos jóvenes están vinculándose de forma cotidiana a efectos de lo que autores han llamado necropolítica ante un sistemático juvenicidio.

Abstract (analytical) This is an anthropological investigation that uses an ethnographic methodology to enquire about the dynamics of violence that control young bodies and their territories, producing fear and death in the so-called "Huachicol Triangle" in Guanajuato, Mexico. The experiences of 7 young survivors of an execution event in which two of their friends were murdered is analyzed. The findings show that control over the bodies of young people in this region are being disputed by different organized crime groups and the Armed Forces of the Mexican State. The conclusions identify that these young people are subject to necropolitical forces on a daily basis due to the systematic extermination of young people that occurs in this zone.

Resumo (analítico) Esta é uma investigação antropológica com metodologia etnográfica, que mostra as dinâmicas de violência que buscam controlar os corpos jovens e seus territórios, causando medo e morte no chamado "triângulo huachicol" em Guanajuato, México. É analisada a experiência de 7 jovens sobreviventes de um evento de execução onde dois de seus amigos foram assassinados. Os resultados mostram que os corpos dos jovens estão sendo disputados pelos diferentes poderes dos grupos do crime organizado e pelas forças armadas do Estado mexicano. As conclusões explicam que esses jovens estão ligados diariamente para fins do que os autores chamaram de necropolítica diante de um assassinato sistemático de jovens.

Percepción sobre informe médico telefónico a familiares de pacientes ingresados por COVID-19 en salas de observación de emergencias de un hospital terciario: estudio transversal / Perception on phone medical report to family members of patients admitted by COVID-19 to emergency observation rooms of a tertiary hospital: A cross-sectional study

Introducción El informe médico sobre el estado de salud del paciente ingresado a los servicios de emergencia se ha modificado, debido al necesario distanciamiento por la epidemia de COVID-19. Por esto, es importante conocer la percepción que tienen los familiares informados sobre el reporte médico telefónico implementado. Objetivo Determinar la percepción de los parientes sobre la atención de pacientes internados por COVID-19, a través del informe médico telefónico entregado a las familias en el servicio de emergencia de un hospital terciario del Seguro Social de Salud (EsSalud), Lima, Perú. Métodos Estudio transversal observacional, mediante encuesta a familiares de pacientes con COVID-19 ingresados durante los meses de julio y agosto del año 2020. Se usó como base la "Encuesta de satisfacción de usuario externo del Ministerio de Salud" adaptada a esta realidad, no habiéndose realizado ningún trabajo similar a este en forma previa. Se consideraron las dimensiones información, respeto al usuario, eficacia, accesibilidad, oportunidad, seguridad y satisfacción global. Se seleccionó la muestra para poblaciones finitas de 2936 familiares, obteniéndose 347 encuestas de 641 llamadas realizadas. Se les llamó telefónicamente y, previa aceptación, se les envió la encuesta vía en formato . Recibida la encuesta, se procedió a su análisis mediante técnicas de estadística descriptiva. Resultados Se realizaron 641 llamadas telefónicas con una tasa de respuesta de 54,1% obteniéndose 347 encuestas. La edad promedio fue de 40,12 años (desviación estándar de 11,93), de los cuales 61,4% era del sexo femenino y 38% estaban casados. El 65,1% de los entrevistados tenía educación superior. Dentro de los distritos de procedencia, Chorrillos tuvo más encuestados con 10,1%. El 42,4% de los encuestados fueron hijos de los pacientes internados, 17,3% fueron cónyuges y el 85% no era personal de salud. Las dimensiones con percepción de acuerdo fueron: información 88,8%, respeto de usuario 82,1%, eficacia 70,3%; accesibilidad 75,8%; oportunidad 79,0% y seguridad 87,9%. La satisfacción global obtuvo un 73,2% de acuerdo. Conclusiones La información médica telefónica entregada a los familiares de pacientes internados por COVID-19 en las salas de emergencia, encontró una satisfacción global de 73,2% de acuerdo. La información médica telefónica es una alternativa importante para mejorar la calidad de atención durante la epidemia por COVID-19.

Introduction Medical reports of patients admitted to the emergency services has been modified due to the social distancing needed in the COVID-19 epidemic. For this reason, it is essential to know the family members' perceptions about telephone medical reports. Objective To determine the perception of care by family members of patients hospitalized due to COVID-19 on telephone medical reports in a tertiary hospital's emergency room in Lima, Peru. Methods A non-experimental cross-sectional study, through a survey of family members of patients with COVID-19 admitted during July and August 2020. The "External user satisfaction survey of the Ministry of Health" adapted to this setting was used due to the absence of similar studies. Information, respect for the user, efficiency, accessibility, suitability, security, and overall satisfaction were considered. The sample size for finite populations was selected from 2 936 family members, obtaining 347 surveys from 641 calls. Relatives were called by phone, and after acceptance, the survey was sent to them via WhatsApp in Google Forms format. Once the survey was received, it was analyzed using descriptive statistical techniques. Results We made 641 telephone calls with a response rate of 54.1%, obtaining 347 surveys. The mean age was 40.12 years (standard deviation: 11.93 years), with 61.4% of females and 38.0% married. We found that 65.1% received higher education and that Chorrillos was the most prevalent district (10.1%). Moreover, 42.4% of those surveyed were children of hospitalized patients, 17.3% were spouses, and 85% were not health personnel. We found a high level of agreement in overall satisfaction (73.2%) and in most dimensions, including information (88.8%), respect for the user (82.1%), efficiency (70.3%), accessibility (75.8%), suitability (79.0%), and security (87.9%). Conclusion The telephone medical reports to relatives of patients hospitalized due to COVID-19 in the emergency room found an overall satisfaction of 73.2% . Telephone medical reports are essential alternatives to improve the quality of care during the COVID-19 epidemic.

Manejo anestésico de una gestante con síndrome de Morquio / Anesthetic Management for a pregnant woman with Morquio syndrome Sobre los autores:

Introducción: El síndrome de Morquio es una enfermedad hereditaria autosómica recesiva con distintos grados de afectación al metabolismo de los glúcidos, lo que genera incapacidad para romper los enlaces de las cadenas largas de glucosamiglicanos, esto provoca acumulación de mucopolisacáridos en distintos tejidos del cuerpo humano. Objetivo: Describir el manejo anestésico de una gestante con síndrome de Morquio. Presentación del caso: Gestante primigesta de 30 años de edad, de raza negra, de 103 cm de estatura y 33 Kg de peso. Acude a consulta preoperatoria por presentar embarazo a término, baja talla y se realizó interrupción del embarazo por vía alta. Se procede a la valoración preanestésica donde se recoge antecedentes de enfermedad genética e ingreso previo por presentar cifras elevadas de tensión arterial. La paciente padecía de alergia a la dipirona. Conclusiones: Los pacientes con mucopolisacaridosis tienen una alta incidencia de dificultad para la ventilación y la intubación endotraqueal asociada con insuficiencia cardiopulmonar. La afectación de la columna presenta dificultades adicionales para los anestesiólogos. Cualquier cirugía electiva requiere una evaluación preoperatoria de los factores de riesgo anestesiológicos y la disponibilidad de un espectro de equipos para el manejo de las vías respiratorias. La anestesia debe ser realizada por un equipo con experiencia en el manejo de la vía aérea(AU)

Introduction: Morquio syndrome is an autosomal recessive hereditary disease that affects, to different extents, carbohydrate metabolism, which obstructs the ability to break bonds of long chains of glycosaminoglycans, causing mucopolysaccharides accumulation in different tissues of the human body. Objective: To describe the anesthetic management of a pregnant woman with Morquio syndrome. Case presentation: This is the case of a 30-year-old primigravid pregnant woman, of black skin, 103 cm of height and 33 kg of weight. She came for preoperative consultation because she was pregnant at term and had low body size; the pregnancy was terminated through the abdominal route. A preanesthetic assessment was performed, which permitted to observe a history of genetic disease and previous admission for high blood pressure. The patient was allergic to dipyrone. Conclusions: Among patients with mucopolysaccharidosis, there is a high incidence of difficulty for ventilation and endotracheal intubation associated with cardiopulmonary insufficiency. Spinal involvement represents additional difficulties for anesthesiologists. Any elective surgery requires preoperative assessment of anesthesiologic risk factors and the availability of a spectrum of airway management equipment. Anesthetic managment should be performed by a team experienced in airway management(AU)

Afrontando la tercera ola de COVID-19 en el departamento de emergencia del Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú, 2021

Perú ha sido uno de los países más afectados por la pandemia de COVID-19. Luego de haber sufrido dos olas epidémicas devastadoras, el departamento de emergencia del Hospital Nacional Edgardo Rebagliati Martins mantuvo como reto la preparación, de forma constante y dinámica, para afrontar una tercera ola que ya azotó a muchos países del mundo. Para esto, el departamento se preparó en todos los ámbitos para contribuir a la reducción del impacto de la enfermedad, garantizando no solo la calidad en la atención, sino también la seguridad del personal de salud, modulando la carga laboral y mental generada por la sobredemanda de la pandemia. De esta manera, el departamento estuvo mejor preparado cuando ocurrió la tercera ola. En conclusión, la preparación constante y dinámica es fundamental para afrontar el aumento de casos; así como también, garantizar la seguridad y bienestar del personal de salud.

Peru has been one of the countries most affected by the COVID-19 pandemic. After having suffered two devastating epidemic waves, the emergency department of the Edgardo Rebagliati Martins National Hospital maintained the challenge of constantly and dynamically preparing to face a third wave that has already hit many countries around the world. For this, the department prepared itself in all areas, to contribute to reducing the impact of the disease, guaranteeing not only the quality of care, but also the safety of health personnel, modulating the work and mental load generated by the pandemic over-demand. In this way, the department was better prepared when the third wave occurred. In conclusion, constant and dynamic preparation is essential to face the increase in cases; as well as to guarantee the safety and well- being of health personnel.

Early discharge for patients with benign pleural effusions using a Wayne catheter (pigtail) chest drain - analysis of safety, complications, and quality of life / Alta precoce para pacientes com derrames pleurais benignos em uso de dreno pleural de Wayne (pigtail) - análise de segurança, complicações e qualidade de vida

ABSTRACT Objective: to assess safety, efficacy and quality of life in patients with benign pleural effusions undergong pleural drainage with Wayne pleural catheter (DW) in an outpatient setting. Method: this is a prospective study, in which 47 patients were evaluated between July 2017 and October 2018. Patients with non-malignant pleural effusions underwent pleural drainage with clinical evolution compatible with outpatient care were included. Patients who underwent drainage due to other conditions and patients were excluded. Results: after catheter placement, the mean length of hospital stay was 3.14 (± 3.85) days, and 21 patients (44.68%) were discharged within 24 hours. The mean time with the catheter was 12.63 (± 7.37) days. The analysis of the pleural fluid was transudate in 87.3% of cases and exudate in 12.3%. The causes of pleural effusion were heart failure (72.3%), renal failure (19.1%), liver failure (6.3%) and pneumonia (8.5%). The quality of life, analyzed according to the parameters of the questionnaire SF 36, showed low average values when compared to other studies. Analyzing each descriptor, the average was greater only in the limitation related to physical aspects. In the other descriptors, the results were similar, but smaller. Conclusion: the outpatient use of pleural catheters of the Wayne type (pigtail) proved to be feasible, safe and with a low associated infection rate. This is a viable option for selected patients.

RESUMO Objetivo: avaliar a segurança, a eficácia, as complicações e a qualidade de vida da alta precoce e acompanhamento ambulatorial de pacientes com derrames pleurais benignos submetidos à drenagem pleural com dreno de Wayne (DW). Método: estudo prospectivo, em que foram avaliados 47 pacientes entre julho de 2017 e outubro de 2018. Foram incluídos os pacientes com derrames pleurais não malignos, submetidos a drenagem pleural com evolução clínica compatível com o cuidado ambulatorial. Foram excluídos os pacientes submetidos a drenagem por outras afecções. Resultados: após a drenagem, a média do tempo de internação dos pacientes foi de 3,14 (±3,85) dias, sendo que 21 pacientes (44,68%) tiveram alta em até 24 horas após a drenagem. O tempo médio de permanência com o dreno foi de 12,63 (±7,37) dias. A análise do líquido pleural mostrou tratar-se de transudato em 87,3% dos casos e de exsudato em 12,3%. Dentre as causas do derrame pleural, destacaram-se insuficiência cardíaca (72,3%), insuficiência renal (19,1%), hepatopatias (6,3%) e pneumonias (8,5%). A qualidade de vida, analisada segundo os parâmetros do questionário SF 36, teve valores médios baixos, principalmente em relação a outros estudos. Na análise de cada descritor, a média apresentou-se maior somente na limitação por aspectos físicos. Nos demais descritores, os resultados foram semelhantes, mas menores. Conclusão: o uso ambulatorial de cateteres pleurais do tipo Wayne (pigtail) mostrou-se factível, seguro e com baixa taxa de infecções associadas. Trata-se de opção viável para pacientes selecionados.

Características clínicas de los primeros 60 pacientes con SARS CoV-2 internados en el Hospital Nacional periodo junio-agosto 2020

RESUMEN Introducción: las manifestaciones clínicas del SARS CoV-2 se caracterizan por varios síntomas como fiebre, tos, disnea, mialgia, fatiga, diarrea y trastorno del olfato/gusto, como también existen casos asintomáticos. Objetivos: determinar las características clínicas: datos demográficos, síntomas mas frecuentes, comorbilidades y evolución, de los primeros 60 pacientes con SARS CoV-2 internados en el Hospital Nacional (Itauguá, Paraguay) en el periodo junio-agosto, 2020. Metodología: estudio observacional descriptivo prospectivo, no probabilístico de casos consecutivos. Se incluyó a pacientes varones y mujeres, mayores de 18 años de edad, portadores de SARS CoV-2, internados en el Hospital Nacional en el periodo junio-agosto, 2020. Se midieron variables clínicas y sociodemográficas. Se respetaron los aspectos éticos. Resultados: se incluyeron 60 pacientes con edad media 44±16 años y siendo 52% del sexo masculino, en su mayoría procedentes del Departamento Central. Entre los síntomas predominó la disnea (27%). La comorbilidad más frecuente fue la obesidad (40%). La mortalidad de los pacientes internados fue 5%. Conclusión: en la muestra predominaron los adultos jóvenes y del sexo masculino (52%). El síntoma más frecuente fue la disnea (27%) y la comorbilidad prevaleciente fue la obesidad (40%). La mortalidad fue 5%.

ABSTRACT Introduction: The clinical manifestations of SARS CoV-2 are characterized by several symptoms such as fever, cough, dyspnea, myalgia, fatigue, diarrhea and smell / taste disorders, as well as asymptomatic cases. Objectives: To determine the clinical characteristics of the first 60 patients with SARS CoV-2 admitted to the National Hospital (Itauguá, Paraguay) in the period June-August, 2020. Methodology: Prospective, non-probabilistic, descriptive observational study of consecutive cases. Male and female patients, over 18 years of age, carriers of SARS CoV-2, admitted to the National Hospital in the period June-August, 2020 were included. Clinical and sociodemographic variables were measured. Ethical aspects were respected. Results: Sixty patients with a mean age of 44 ± 16 years were included and 52% of them were male, mostly from the Central Department. Among the symptoms, dyspnea (27%) predominated. The most frequent comorbidity was obesity (40%). Mortality in hospitalized patients was 5%. Conclusion: In this sample young adults and males (52%) predominated. The most frequent symptom was dyspnea (27%), the prevailing comorbidity was obesity (40%) and mortality was 5%.

Efecto de la educación comunitaria para control integrado del Triatoma Dimidiata (Hemiptera: Reduviidae) / EEffect of community education in an integrate control for Triatoma dimidiata (Hemiptera: Reduviidae) / EEffect of community education in an integrate control for Triatoma dimidiata (Hemiptera: Reduviidae)

Introduction: The Mesoamerican endemic specieTriatoma dimidiata is the main vector of Chagas disease in Central America, after the elimination of an introduced vector Rhodnius prolixus. The traditional method of vector control using insecticides results in reinfestation. An integrated Ecohealth approach, including education, house improvements and domestic animal management was shown effective for long-term control ofT. dimidiata, and it was applied in several villages in Guatemala. Objective: To evaluate the changes in community practices after an Ecohealth intervention in La Prensa, Olopa Chiquimula. Methods: Through three surveys, we measured risk factors associated withT. dimidiatainfestation, the infestation index, blood sources of T. dimidiata, the presence of Trypanosoma cruzi were analyzed using PCR. Statistics analysis included Wilcoxon signed-rank tests, Mc-Nemar test, Chi-square test and Fisher exact test to compare the surveys. Results: Over the years, risk factors associated with the presence of T. dimidiata and population density of the vector were observed. We found a decrease in consumption of human blood and the parasite in the vector population. However, we found the consumption of bird blood meal increased Conclusions: Our results provide evidence that an ecohealth approach for an endemic Chagas vector has impact on reducing vector-human contact, possibly by influencing people's behavior. Increasing the community knowledge about these risk factors can be an effective strategy to further reduce the risk of house reinfestation and Chagas transmission(AU)

Introducción: La especie endémica mesoamericana Triatoma dimidiata es el vector principal de la enfermedad de Chagas en América Central, después de la eliminación de un vector introducido Rhodnius prolixus. El método tradicional de control de vectores que utiliza insecticidas resulta en reinfestación. Se demostró que un enfoque integrado de ecosalud, que incluye la educación, mejorías en el hogar y manejo de animales domésticos, es efectivo para el control a largo plazo del T. dimidiata, y se aplicó en varias aldeas de Guatemala. Objetivo: evaluar los cambios en las prácticas comunitarias después de una intervención de ecosalud en La Prensa, Olopa Chiquimula. Métodos: a través de tres encuestas, se midieron los factores de riesgo asociados con la infestación de T. dimidiata, el índice de infestación, las fuentes sanguíneas de T. dimidiata y la presencia de Trypanosoma cruzi. Estas encuestas se analizaron mediante PCR. El análisis estadístico incluyó pruebas de Wilcoxon de rango con signo, la prueba de Mc-Nemar, la prueba de Chi-cuadrado y la prueba exacta de Fisher para comparar las encuestas. Resultados: A lo largo de los años, se observaron factores de riesgo asociados con la presencia de T. dimidiata y la densidad de población del vector. Encontramos una disminución del parásito en la población de vectores y en el consumo de sangre humana. Sin embargo, encontramos que aumentó el consumo de harina de sangre de aves. Conclusiones: Nuestros resultados proporcionan evidencia de que un enfoque de ecosalud para un vector de Chagas endémico impacta en la reducción del contacto vector-humano, posiblemente al influir en el comportamiento de las personas. Aumentar el conocimiento de la comunidad sobre estos factores de riesgo puede ser una estrategia efectiva para reducir aun más el riesgo de reinfestación en la casa y la transmisión de Chagas(AU)

Calidad de vida en estudiantes universitarios con sobrepeso y obesidad: Diferencias por sexo / Quality of life in university students with overweight and obesity: Differences by sex

Introducción: El objetivo de este artículo es dar a conocer la relación entre la calidad de vida, el sobrepeso y la obesidad, así como comparar si existen diferencias significativas por sexo. Método: Se utilizó el cuestionario de salud SF-36v2, que mide la salud funcional y el bienestar a partir de ocho dimensiones: función física, rol físico, dolor corporal, salud general, vitalidad, función social, rol emocional y salud mental. El tipo de investigación es cuantitativa con un diseño prospectivo, transversal y observacional. Las técnicas estadísticas que se utilizaron para el análisis de la información fueron el coeficiente de correlación de Pearson y la prueba t para muestras independientes. Para la magnitud del efecto se utilizó la d de Cohen. La muestra se seleccionó a partir del muestreo no probabilístico por conveniencia; el total de participantes fue de 320. Resultados: Se encontraron diferencias estadísticas significativas en dos de las dimensiones, con un tamaño del efecto pequeño, menor a una desviación estándar. Conclusión: Las mujeres sienten más energía y vitalidad que los hombres, éstos algunas veces se ven más afectados por los problemas de salud física o emocional que interfieren en su vida social.

Introduction: The objective of this article is to show the relation between the quality of life, overweight and obesity, and to compare if there are significant differences by gender. Methodology: The SF-36v2 questionnaire was used to measure the functional health and wellness from eight dimensions: physical function, physical role, body pain, general health, vitality, social function, emotional role and mental health. The study is quantitative with a traversal, observational and prospective design. The statistical techniques that were used to the data analysis was the Pearson relation coefficient and the t test to independent samples. The d of Cohen was used to obtain the magnitude of the effect. The sample was selected from a non-probabilistic sample by convenience; the total of participants was of 320. Results: Significant statistic differences were found in two of the dimensions, with a small magnitude of the effect, less than a standard deviation. Conclusion: Women feel more energy and vitality than men, whom sometimes are more affected by the physical or emotional health problems that interfere in their social life.

Pneumostomia: uma proposta operatória para o tratamento do enfisema pulmonar difuso grave / Pneumostomy: an operative proposal for the treatment of severe diffuse pulmonary emphysema

RESUMO Objetivo: avaliar uma nova técnica operatória para o tratamento do enfisema pulmonar avançado. Métodos: análise prospectiva de nove pacientes portadores de enfisema pulmonar grave, submetidos à pneumostomia. O procedimento foi realizado sob anestesia local, na parede torácica anterior, linha hemiclavicular, no segundo espaço intercostal, através de toracotomia anterior de 5cm para acesso ao lobo superior, cujo segmento anterior foi pinçado e fixado à pleura parietal. Realizada pneumotomia com eletrocautério e inserção romba de dispositivo (dreno) intrapulmonar. Para avaliação do procedimento, foram realizados os seguintes exames: testes de função pulmonar, exames de imagens, teste da caminhada de seis minutos e questionários de qualidade de vida, medidos todos no pré-operatório e 30 dias após o procedimento. Resultados: não houve mortes relacionadas ao procedimento. Exames de imagens mostraram diminuição do volume pulmonar. A função pulmonar mostrou significante redução do volume residual. O teste de caminhada de seis minutos mostrou um aumento na distância percorrida no pós-operatório. Houve melhora significante da qualidade de vida, demonstrada por meio dos seguintes questionários: Medical Outcomes Study 36 Item Short - Form Health Survey (SF-36), Saint-George Respiratory Questionnaire (SGRQ), Medical Research Council scale (MRC) e Eastern Cooperative Oncology Group Performance status (ECOG). Conclusão: a técnica proposta é viável, segura, de fácil realização e manutenção.

ABSTRACT Objective: to evaluate a new operative technique for the treatment of advanced pulmonary emphysema. Methods: we conducted a prospective analysis of nine patients with severe pulmonary emphysema submitted to pneumostomy. The procedure was performed under local anesthesia, in the anterior thoracic wall, hemiclavicular line, in the second intercostal space, through an anterior thoracotomy of 5cm for access to the upper lobe, whose anterior segment was pinched and fixed to the parietal pleura. We carried out the pneumostomy with electrocautery and blunt insertion of an intrapulmonary drain. To assess the procedure, we performed pulmonary function tests, imaging tests, six-minute walk test, and applied quality of life questionnaires, all measured preoperatively and 30 days after the procedure. Results: no deaths occurred related to the procedure. Imaging studies showed a decrease in lung volume. The pulmonary function showed a significant reduction in the residual volume. The six-minute walk test showed an increase in the distance covered in the postoperative period. There was significant improvement of the quality of life as demonstrated through questionnaires Medical Outcomes Study 36 Item Short-Form Health Survey (SF-36), Saint-George Respiratory Questionnaire (SGRQ), Medical Research Council scale (MRC), and Eastern Cooperative Oncology Group Performance status (ECOG). Conclusion: the proposed technique is feasible, safe, easy to perform and to maintain.

Características sociodemográficas y perfil de consumo de tabaco y drogas en estudiantes de dos universidades de México / Tobacco and drugs consumption in students from two universities in Mexico

Resumen Introducción El consumo de tabaco es la primera causa prevenible de muerte prematura y enfermedad en todo el mundo; asimismo el uso y abuso de drogas constituye un grave problema de salud pública y de altos costos de atención a la salud. Se aborda el consumo de tabaco y drogas, desde el punto de vista epidemiológico y en materia de salud pública, así como los factores sociodemográficos que influyen en la adicción a ellos. Objetivo Describir las características socio-demográficas y de consumo de tabaco y droga en estudiantes universitarios de Yucatán y Coahuila. Material y métodos Encuesta transversal que incluyó 412 universitarios de Yucatán y 344 de Coahuila. Se utilizó estadística descriptiva para las variables numéricas y frecuencias para las cualitativas, estadística inferencial para las coincidencias y diferencias. Resultados La media de edad fue mayor para los estudiantes de Yucatán así como predominio de los hombres, la media de consumidores de tabaco dentro de las personas de su red fue mayor para Coahuila siendo las diferencias estadísticamente significativas p<0.05, no así para las personas de la red respecto al consumo de drogas. Conclusiones El consumo de tabaco en ambos estados fue mayor al esperado para su región, las fumadoras activas estuvieron por encima del promedio nacional, los dos estados se ubicaron arriba del promedio nacional respecto a consumo de drogas y Coahuila por encima del promedio mundial. Se propone un trabajo conjunto para evaluar los spots publicitarios transmitidos en los medios de comunicación y evitar su incorporación al mercado como bienes de consumo.

Abstract Introduction Tobacco consumption is the leading cause of premature preventable death and disease worldwide, as well the drug use and abuse is a serious public health problem and health care high costs. The tobacco and drugs consumption is addressed from the epidemiologic and public health point of view, also the socio-demographic factors influencing addiction to them Objetive Describe the sociodemographic and tobacco and drugs consumption characteristics among college students from Yucatan and Coahuila Materials and methods Cross sectional survey that included 412 college students from Yucatan and 344 from Coahuila. Descriptive statistics were used for the numeric variables, frequencies for the qualitative, inferential statistics for the similarities and differences. Results The mean of the age was higher for Yucatan students and men predominated, the mean of the tobacco consumers within people from their social network was higher for Coahuila being the differences statistically significant p<0.05, not so for the people from their network regarding to drugs consumption Conclusions The tobacco consumption in both states was higher than expected for the region, the active female smokers were above the national mean, the two states were above the national mean regarding to drugs use and Coahuila above the world mean. Joint work is proposed to evaluate the advertising spots broadcast in the media and avoid its incorporation to the market as consumer goods.

Perfil epidemiológico y molecular de Rickettsiosis en localidades de frontera peruana / Epidemiological and molecular profile of Rickettsiosis in peruvian border locations

RESUMEN Objetivos. Determinar circulación de rickettsias durante los años 2010 al 2011 en localidades fronterizas de cuatroregiones del Perú, y sus características clínicas epidemiológicas y moleculares. Materiales y métodos. Estudio transversal realizado en Tumbes, Tacna, Madre de Dios y Loreto. Se obtuvo datos clínicos epidemiológicos y muestras de sangre total para cultivo y para ensayo de inmunofluorescencia indirecta (IFI). Fue utilizado ADN extraído de cultivos de leucocitos y de ectoparásitos, aquellos genes específicos para rickettsias que amplificaron exitosamente fueron secuenciados y analizados. Resultados. El 33,8% de los encuestados portaba anticuerpos a rickettsias; en Loreto 21,7%, en Madre de Dios 33,0%, en Tacna 48,2% y en Tumbes 33,3%, encontrándose seropositividad en más del 40% de aislamientos confirmados por IFI. Las pruebas moleculares evidenciaron la presencia de Rickettsia felis en Ctenocephalides felis de perros y gatos de Tacna y una especie recientemente reportada para Latinoamérica: Candidatus Rickettsia asemboensis en pulgas Ctenocephalides felis de gatos y perros de Loreto y Madre de Dios. De la población estudiada, el 81,4% informó antecedentes de contacto con ectoparásitos, el 22,6% eran asintomáticos y el 27,8% habitaban viviendas sin agua ni desagüe, con piso de tierra. Conclusiones. Evidencias serológicas y moleculares confirman la circulación de rickettsias en las localidades fronterizas estudiadas, con predisponentes epidemiológicos, demostrándose presencia de dos especies: Rickettsia felis y Candidatus Rickettsia asemboensis, las que representarían una amenaza potencial para la salud de los pobladores.

ABSTRACT Objectives. To determine the circulation of Rickettsia in the years 2010 and 2011 in border locations in four regions ofPeru and their clinical epidemiological and molecular characteristics. Materials and Methods. A cross-sectional study was carried out in Tumbes, Tacna, Madre de Dios, and Loreto. Whole blood samples were obtained from participants for culture and indirect immunofluorescence (IIF) testing. The DNA taken from leukocytes and ectoparasite cultures was used, and those genes detected for Rickettsia that were successfully amplified were sequenced and analyzed. Results. A total of 33.8% of those surveyed carried Rickettsia antibodies (21.7% in Loreto, 33.0% in Madre de Dios, 48.2% in Tacna, and 33.3% in Tumbes). Seropositivity was confirmed with IIF in over 40% of isolates. Molecular tests showed the presence of Rickettsia felis in Ctenocephalides felis of dogs and cats in Tacna and a recently reported species for Latin America, Candidatus Rickettsia asemboensis, in fleas of cats and dogs in Loreto, Madre de Dios, and Tacna. Of the population studied, 81.4% reported a history of contact with ectoparasites, 22.6% were asymptomatic, and 27.8% lived in earthen-floored homes without water or drainage. Conclusions. Serological and molecular evidence confirms the circulation of Rickettsia in the border locations studied, with predisposing epidemiological factors. Tests confirm the presence of two species, Rickettsia felis and Candidatus Rickettsia asemboensis, which represent a potential threat to the health of the inhabitants.

¿Es completo el reporte de los estudios observacionales publicados en la Revista Colombiana de Anestesiología? estudio de corte transversal / Assessing the completeness of reporting of observational studies in Colombian Journal of Anesthesiology. Cross sectional study

Introduction: The STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology), consisting of 22 points, was published in 2007 with the aim of improving the reporting of observational research. Objective: To determine the completeness of reporting of observational studies published in the Colombian Journal of Anaesthesiology between 2000 and 2013 using STROBE. Methods: Cross-sectional study. The units of analysis were observational studies published in Colombian Journal of Anesthesiology between 2000 (volume 28) and 2013 (volume 41). Of the randomly selected studies, 40% were included. The primary outcome was the completeness of the report of each study. Using two groups, the researchers applied the STROBE statement independently, supported by an arbitrator. Descriptive analyses, time series analyses and multiple linear regression analyses were used. Results: Overall, 55 studies were identified and 22 (40%) were randomly chosen. The median overall completeness according to STROBE was 57%, 95% CI (48-66%). Items with higher completeness in the reports were the Title and Introduction (89% each), followed by Methods 53%, Results 50%, and Discussion 58%. There were no significant differences between before and after the publication of STROBE. Conclusion: The completeness of reporting of observational studies in the Colombian Journal of Anaesthesiology is close to 60%, according to results worldwide. No change was found as a result of the publication of the STROBE Statement in 2007.

Introducción: La declaración STROBE (Strenghtening the Reporting of Observational Studies in Epidemiology) se publicó en el 2007 con el objetivo de mejorar el reporte de la investigación de tipo observacional, consta de 22 puntos. Objetivo: Determinar la completitud del reporte de estudios observacionales publicados en la Revista Colombiana de Anestesiología entre el aüo 2000 al 2013 mediante STROBE. Métodos: Estudio observacional de corte transversal. La unidad de análisis fueron los estudios observacionales publicados en la Revista Colombiana de Anestesiología desde el ano 2000 (volumen 28) hasta el ano 2013 (volumen 41). Se incluyó un 40% del total de estudios seleccionados aleatoriamente. El desenlace primario fue la completitud del reporte de cada estudio. Mediante dos grupos, los investigadores aplicaron la declaración STROBE de forma independiente con el apoyo de un árbitro. Se utilizó análisis descriptivo, análisis de series temporales y regresión lineal múltiple. Resultados: Se identificaron 55 estudios y se escogieron al azar 22 (40%). La mediana de completitud global de STROBE fue de 57% IC95% (48%-66%). Los ítems con mayor completitud de los reportes fueron en el título y la introducción (89% cada uno), métodos: 53%, Resultados 50%, discusión 58%. No se encontró diferencias significativas entre el periodo pre y post publicación de STROBE. Conclusión: La completitud del reporte de los estudio observacionales de la Revista Colombiana de Anestesiología es cercana al 60%, acorde con resultados a nivel mundial. No presentó cambios con la publicación de la declaración STROBE en el 2007.

Psychological model of ART adherence behaviors in persons living with HIV/AIDS in Mexico: a structural equation analysis

ABSTRACT OBJECTIVE The objective of this study has been to test the ability of variables of a psychological model to predict antiretroviral therapy medication adherence behavior. METHODS We have conducted a cross-sectional study among 172 persons living with HIV/AIDS (PLWHA), who completed four self-administered assessments: 1) the Psychological Variables and Adherence Behaviors Questionnaire, 2) the Stress-Related Situation Scale to assess the variable of Personality, 3) The Zung Depression Scale, and 4) the Duke-UNC Functional Social Support Questionnaire. Structural equation modeling was used to construct a model to predict medication adherence behaviors. RESULTS Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. CONCLUSIONS The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.

El metabolismo de la glucosa en pacientes con hipertensión arterial / Glucose metabolism in hypertension patients

Thiazide diuretics (TD) are recommended as first-line therapy in uncomplicated hypertension by several professional organizations. However, they also may pose a risk of glucose metabolism abnormalities in certain individuals. Early studies showed TD cause a small increase in fasting glucose. These effects may be related to exacerbation of insulin resistance as insulin blood levels increased. It could be postulated that long-term use may result in a higher risk of developing diabetes. This was not seen in the Systolic Hypertension in the Elderly study which used low doses of chlorthalidone but an increase in the odds of developing diabetes was demonstrated for chlorthalidone in comparison to lisinopril or amlodipine in the ALLHAT study. Nonetheless, in ALLHAT there was no increased risk of adverse cardiovascular outcomes. In addition, use of chlorthalidone in the ALLHAT study in patients with pre-existing diabetes maintained the same advantage in lower stroke rate versus lisinopril and lower heart failure rate versus amlodipine or lisinopril. Other factors that may play a role in thiazide-induced glucose elevation are potassium levels and weight. In a meta-analysis of 59 trials a correlation existed for lower potassium levels and higher fasting glucose. pidemiological studies suggest that elevated BMI and the level of pre-thiazide fasting glucose predict glucose elevation and new onset diabetes after thiazide therapy. Patients with a BMI over 32.3 kg/m2 had a 6.5% risk of developing diabetes. Whether co-administration of a thiazide diuretic with other classes of antihypertensives modulates the glucose alteration remains unknown. Studies suggest combination with valsartan may reduce the effect perhaps by conserving potassium. Practical implications of these observations would suggest reserving thiazide diuretics to later stages in treatment for patients who are obese, particularly if they have fasting blood glucoses in the pre-diabetic range. However, for the majority of patients thiazide diuretics remain an excellent choice given their long track record of safety and beneficial long-term cardiovascular outcomes

Los diuréticos tiazídicos (DT) se recomiendan como tratamiento de primera línea para la hipertensión no complicada, por varias organizaciones profesionales. Sin embargo, también pueden suponer un riesgo de alteraciones del metabolismo de la glucosa en ciertos individuos. Los primeros estudios mostraron que los DT causan un pequeño aumento de la glucemia en ayunas. Estos efectos pueden estar relacionados con la exacerbación de la resistencia a la insulina y los niveles de insulina plasmáticos están incrementados. Se podría postular que el uso a largo plazo puede resultar en un mayor riesgo de presentar diabetes. Esto no se observó en el estudio Systolic Hypertension in the Elderly, realizado con adultos mayores que utilizaban bajas dosis de clortalidona; sin embargo, un aumento en las probabilidades de contraer diabetes fue demostrado por el uso de clortalidona en comparación con lisinopril y amlodipina en el estudio ALLHAT. No obstante, en el ALLHAT no hubo mayor riesgo de eventos cardiovasculares adversos. Además, el uso de clortalidona en el estudio ALLHAT en pacientes con diabetes preexistente mantuvo la misma ventaja en la baja tasa de accidentes cerebrovasculares, en comparación con lisinopril, y la menor tasa de paro cardíaco, en comparación con amlodipina o lisinopril. Otros factores que pueden desempeñar un papel en la elevación de la glucosa inducida por tiazidas son los niveles de potasio y el peso del paciente. En un metanálisis de 59 ensayos se encontró una correlación entre los niveles de potasio más bajos y los niveles más elevados de glucemia en ayunas. Los estudios epidemiológicos sugieren que el índice de masa corporal (IMC) elevado y el nivel de la glucemia previo al tratamiento con tiazidas pueden predecir la elevación de la glucosa y la diabetes de nueva aparición después de la terapia con tiazidas. Los pacientes con un IMC superior a 32.3 kg/m2 tenían un riesgo de 6.5% de presentar diabetes. Se desconoce aún si la administración de un diurético tiazídico con otras clases de antihipertensivos modula la alteración de la glucosa. Los estudios sugieren que la combinación con valsartán puede reducir el efecto, quizá mediante la conservación del potasio. Las repercusiones prácticas de estas observaciones sugieren reservar los diuréticos tiazídicos para etapas posteriores del tratamiento para los pacientes que son obesos, sobre todo si han presentado glucemia en ayunas en el rango de prediabetes. Sin embargo, para la mayoría de los pacientes, los diuréticos tiazídicos siguen siendo una excelente opción dado su largo historial de seguridad y los resultados cardiovasculares beneficiosos a largo plazo