Recurrent dermatofibrosarcoma protuberans of the breast: A case report and review of literature

Dermatofibrosarcoma protuberans (DFSP) is a rare and low-grade sarcoma of fibroblast origin with a tendency to invade and recur locally. The most common sites of origin of DFSP are the head, neck, and extremities. However, DFSP breast has also been reported. It infiltrates surrounding subcutaneous tissue and fascia, with an incidence of <2% for lung metastases. Surgery being the main modality of the treatment, literature has shown that radiation therapy also plays an important role to improve local control in case of recurrent tumors. In this article, we will be discussing one such rare case of DFSP in a recurrent setting and the role of radiation therapy.

The nonsynaptic plasticity in Parkinson's disease: Insights from an animal model

Abstract Background The 6-OHDA nigro-striatal lesion model has already been related to disorders in the excitability and synchronicity of neural networks and variation in the expression of transmembrane proteins that control intra and extracellular ionic concentrations, such as cation-chloride cotransporters (NKCC1 and KCC2) and Na+/K+-ATPase and, also, to the glial proliferation after injury. All these non-synaptic mechanisms have already been related to neuronal injury and hyper-synchronism processes. Objective The main objective of this study is to verify whether mechanisms not directly related to synaptic neurotransmission could be involved in the modulation of nigrostriatal pathways. Methods Male Wistar rats, 3 months old, were submitted to a unilateral injection of 24 µg of 6-OHDA, in the striatum (n= 8). The animals in the Control group (n= 8) were submitted to the same protocol, with the replacement of 6-OHDA by 0.9% saline. The analysis by optical densitometry was performed to quantify the immunoreactivity intensity of GFAP, NKCC1, KCC2, Na+/K+-ATPase, TH and Cx36. Results The 6-OHDA induced lesions in the striatum, were not followed by changes in the expression cation-chloride cotransporters and Na+/K+-ATPase, but with astrocytic reactivity in the lesioned and adjacent regions of the nigrostriatal. Moreover, the dopaminergic degeneration caused by 6-OHDA is followed by changes in the expression of connexin-36. Conclusions The use of the GJ blockers directly along the nigrostriatal pathways to control PD motor symptoms is conjectured. Electrophysiology of the striatum and the substantia nigra, to verify changes in neuronal synchronism, comparing brain slices of control animals and experimental models of PD, is needed.

Universal adhesives applied to deep dentin with different bonding treatments / Adhesivos universales aplicados a dentina profunda con diferentes tratamientos de unión

ABSTRACT Eighth-generation adhesives may be applied with total etch, selective-etch or self-conditioning, and serve as primers for non-dental substrates. Aim: To determine the bonding characteristics of universal adhesives applied to the deep pulp wall with different strategies, by means of shear bond strength and laser microscopy. Materials and Method: Cavities 4 mm deep and maximum width were carved in 36 extracted molars. Nine groups were formed according to dental substrate treatment and adhesives, as follows: Total-etch: group 1-Monobond 7 self-etch, group 2-One coat 7 universal, and group 3-Single bond universal; Adamantine etch: group 4-Monobond 7 self-etch, group 5-One coat 7 universal, and group 6-Single bond universal; Self-conditioning: group 7-Monobond 7 self-etch, group 8-One coat 7 universal, and group 9-Single bond universal. Molars were filled following the manufacturer's instructions. Three specimens per group (27 altogether) were used to determine shear bond strength using a universal testing machine, while layer thicknesses were measured on the remaining specimens using microscope images and Olympus LEXT 3D Software. Analysis of variance was used to compare data. Results: Mean (standard deviation) bond strength in megapascals (MPa) was: group 1: 7.06±3.01; group 2: 10.74±4.36; group 3: 8.20±3.92; group 4: 7.41±2.23; group 5: 6.84±1.50; group 6: 5.86±2.10; group 7: 5.83±1.94; group 8: 7.14±2.37; group 9: 8.06±3.51. Bond strength was higher (p=0.049) for total-etch (8.61±3.96) than for selective etch (6.71±1.98) and self-conditioning (6.91±2.68). No significant difference was found among the three adhesives (p=0.205). Adhesive layer in micrometers (μm) was total-etch 8.71±4.93, selective etch 5.49±1.70 and self-conditioning 6.27±3.01, with no significant difference. Conclusions: There were significant differences among bonding strategies, with the highest values for total-etch. No significant difference was observed between self-conditioning and selective etch. No significant difference was found among the adhesives, which all behaved similarly. The greatest adhesive layer thicknesses were recorded in the total-etch group, with no significant difference among the various adhesive approaches.

RESUMEN Los adhesivos universales de octava generación pueden ser aplicados con diferentes estrategias de unión: grabado total, grabado selectivo o autoacondicionamiento. Además, imprimen sustratos no dentales. Objetivo: Determinar las caracteristicas de unión de adhesivos universales con diferentes estrategias en pared pulpar profunda mediante resistencia adhesiva al corte y microscopía laser. Materiales y Método: En 36 molares se tallaron cavidades de 4 mm de profundidad y ancho máximo. Se dividieron en 9 grupos según tratamientos y adhesivos. Grabado total: grupo 1-Monobond 7 self-etching, grupo 2-One coat 7 universal y grupo 3-Single bond universal; Grabado selectivo: grupo 4-Monobond 7 self-etching; grupo 5-One coat 7 universal y grupo 6-Single bond universal y Autoacondicionamiento: grupo 7-Monobond 7 self-etching; grupo 8-One coat 7 universal y grupo 9-Single bond universal. Las obturaciones se realizaron siguiendo las instrucciones del fabricante. La resistencia adhesiva al corte se determinó utilizando una máquina de ensayo universal sobre 27 especímenes mientras que los restantes fueron empleados para evaluar los espesores de la capa generado sobre imágenes obtenidas con microscopía y con el software Olympus LEXT 3D. Se ultilizó análisis de varianza. Resultados: Resistencia adhesiva en megapascal (MPa) media (desviación estándar): grupo 1: 7,06±3,01; grupo 2: 10,74±4,36; grupo 3: 8,20±3,92; grupo 4: 7,41±2,23; grupo 5: 6,84±1,50; grupo 6: 5,86±2,10; grupo 7: 5,83±1,94; grupo 8: 7,14±2,37; grupo 9: 8,06±3,51. Grabado total (8,61±3,96) registró los valores mayores (p=0,049) en comparación a grabado selectivo (6,71±1,98) y autoacondicionamiento (6,91±2,68). Los adhesivos no tuvieron diferencias significativas (p=0,205). Capa adhesiva en μm: Grabado total (8,71±4,93); grabado selectivo (5,49±1,70) y autoacondicionamiento (6,27±3,01) sin diferencias significativas (p=0,073). Conclusiones: Las estrategias de unión mostraron diferencias significativas; los valores más altos se obtuvieron con grabado total y entre autoacondicionamiento y grabado selectivo no hubo significancia. Los adhesivos evidenciaron comportamientos similares sin registrar diferencias significativas. Los mayores espesores de capa fueron con grabado total sin diferencias significativas entre las técnicas.

Negative association between 25-hydroxyvitamin D and inflammatory markers in rheumatologic diseases / Asociación negativa entre 25-hidroxi vitamina D y los marcadores inflamatorios en enfermedades reumatológicas

Objective: The main purpose of this study was to evaluate serum 25-hydroxyvitamin D (25OHD) levels and its association with in"ammatory markers in patients with rheumatologic diseases (RD). Methods: A cross-sectional study in 154 women with RD (rheumatoid arthritis, spondyloarthritis and other connective tissue diseases) and 112 healthy individuals as a control group (CG) was carried out. Results: No differences in serum and urine calcium, serum phosphate, and urinary deoxypyridinoline were found. RD group had lower 25OHD and higher PTH compared to CG. RD group had higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to CG. The overall mean level of 25OHD (ng/ml) was 26.3±12.0 in the CG and 19.4±6.8 in the RD group (p<0.0001). Moreover, CG had lower percentage of individuals with 25OHD de!ciency compared to RD (29.9% vs 53.2%). The femoral neck BMD was signi!cantly lower in postmenopausal RD women compared to CG. 25OHD levels signi!cantly correlated with ESR and CRP as in"ammatory markers. Age, BMI, presence of RD, and CRP were signi!cantly and negatively associated with 25OHD levels through linear regression analysis. According to univariate logistic regression analysis for 25OHD deficiency (<20 ng/ml), a significant and negative association with BMI, presence of RD, ESR and CRP were found. Conclusion: Patients with RD had lower 25OHD levels than controls and the presence of a RD increases by 2.66 the risk of vitamin D de!ciency. In addition, 25OHD has a negative correlation with ESR and CRP as in"ammatory markers. (AU)

Objetivo El objetivo principal de este estudio fue evaluar los niveles séricos de 25-hidroxivitamina D (25OHD) y su asociación con marcadores inflamatorios en enfermedades reumatológicas. Materiales y métodos: Se realizó un estudio transversal en 154 mujeres con enfermedades reumatológicas (artritis reumatoide, espondiloartritis y otras enfermedades del tejido conectivo) y 112 individuos sanos como grupo control (GC). Resultados: No se encontraron diferencias en el calcio sérico y urinario, el fosfato sérico y la desoxipiridinolina urinaria entre el GC y los sujetos con enfermedades reumatológicas. El grupo de pacientes con enfermedades reumatológicas tenía 25OHD más bajo y PTH más alto en comparación con el GC. Asimismo, el grupo de individuos con enfermedades reumatológicas tenía proteína C reactiva (PCR) y velocidad de eritrosedimentación (VES) más altas en comparación con el GC. El nivel de 25OHD (ng/ml) fue 26,3±12,0 en el GC y 19,4±6,8 en el grupo con enfermedades reumatológicas (p<0,0001). Además, el GC presentó un porcentaje menor de deficiencia de 25OHD en comparación con el grupo con enfermedades reumatológicas (29,9% vs 53,2%). La DMO del cuello femoral fue significativamente menor en las mujeres posmenopáusicas con enfermedades reumatológicas en comparación con el GC. La 25OHD correlacionó significativamente con la VES y la PCR como marcadores inflamatorios. El análisis de regresión lineal mostró que la edad, el IMC, la presencia de una enfermedad reumatológica y la PCR se asociaron significativa y negativamente con los niveles de 25OHD. Mientras que el análisis de regresión logística univariada mostró que la deficiencia de 25OHD (<20 ng/ml), se asoció significativa y negativamente con el IMC, la presencia de una enfermedad reumatológica, la VES y los niveles de PCR. Conclusiones: Los pacientes con enfermedades reumatológicas tenían niveles de 25OHD más bajos que los controles y la presencia de una enfermedad reumatológica aumenta en 2.66 el riesgo de deficiencia de vitamina D. Además, la 25OHD mostró correlación negativa con la VES y la PCR como marcadores inflamatorios. (AU)

Díadas de cuidado y competencia para cuidar al alta hospitalaria en un hospital de Bogotá / Dayds of care and competition to care for hospital discharge in a Bogotá hospital / Diades de cuidado e competência para cuidar da alta hospitalar em um hospital de Bogotá

Introducción. Con frecuencia las personas con enfermedades crónicas requieren un cuidado especial en su hogar, siendo en este contexto fundamental la competencia de cuidado. Objetivo. Identificar las características y asociaciones del cuidado informal y de la competencia para cuidar de la díada cuidador-persona con enfermedad crónica, durante el alta hospitalaria en un hospital de alta complejidad de Bogotá ­ 2016. Metodología. Estudio cuantitativo­descriptivo, transversal-analítico; en la medición se usó la encuesta de caracterización de la díada: cuidador-persona con enfermedad crónica, y el instrumento de competencia de cuidado en el hogar, versión abreviada CUIDAR. Resultados. Participaron 97 díadas. Los cuidadores eran, en su mayoría, mujeres (79,4%) con edad promedio de 43,7 (±15,5) años, con una trayectoria como cuidadores en promedio de 4,3 años. Las personas con enfermedad crónica eran mayormente mujeres (67,0%), con edad promedio de 64,3 años, y con antecedentes patológicos de diabetes mellitus (55,7%) e hipertensión arterial (48,5%). Cuidadores perciben sentir carga (61,9%) y pacientes ser una carga (57,7%); las díadas perciben mínima satisfacción con el apoyo recibido y están más familiarizadas con el uso del teléfono y televisión. La competencia para cuidar fue valorada como alta por el cuidador (44,8 puntos promedio). Dimensiones de la competencia de cuidado se asociaron (p<0,05) con escolaridad, compromiso religioso, carga percibida, edad del paciente, entre otros aspectos. Conclusiones. Las díadas de cuidado cuentan con características relacionadas con el nivel de competencia para el cuidado, estas son de importancia en la estructuración de intervenciones para mejorar el bienestar de los cuidadores.

Introduction. People with chronic diseases often require special care in their home, being in this fun- damental context the competence of care. Objective. Identify the characteristics and associations of informal care and competition to take care of the "Caregiver-Person" dyads with chronic illness during hospital discharge in a high complexity hospital in Bogotá - 2016. Methodology. Quantitative - descriptive, analytical cross-sectional study, using the "Characterization survey of the Caregiver-Person dyad with chronic disease" and the instrument of "Home care compe- tence - abbreviated version CUIDAR-" Results. 97 days participated. Caregivers were mostly women (79,4%) with an average age of 43,7 years old and have been caregivers in average 4,3 years. The people with chronic disease were mostly women (67,0%) with an average age of 64,3 years old and with a pathological history of diabetes mellitus (55,7%) and high blood pressure (48,5%). Caregivers perceive feeling a burden (61,9%) and patients being a burden (57,7%), dyads perceive minimal satisfaction with the support received, and they are more familiar with the use of phone and television. The competence to care was rated as high by the caregiver (44,8 points average). Dimensions of care competence were associated (p <0,05) with schooling, religious commitment, perceived burden, patient age, among other aspects. Conclusions. Caregiver-Person dyads have characteristics related to the level of competence for care, these are being of importance in structuring interventions to improve the well-being of caregivers.

Introdução. As pessoas com doenças crônicas frequentemente necessitam de cuidados especiais em seu domicílio, sendo neste contexto fundamental a competência de cuidar. Objetivo. Identificar as características e associações de atenção informal e competição para cuidar das díades "Cuidador-Pessoa" com doença crônica durante a alta hospitalar em um hospital de alta complexidade em Bogotá - 2016. Metodologia. Estudo quantitativo - descritivo, analítico, transversal, utilizando o "Levantamento de caracterização da díade Cuidador-Pessoa com doença crônica" e o instrumento "Competência em assistência domiciliar - versão abreviada CUIDAR-" Resultados. 97 dias participaram. Os cuidadores eram em sua maioria mulheres (79,4%), com idade média de 43,7 anos e cuidadores em média 4,3 anos. As pessoas com doença crônica eram majorita- riamente mulheres (67,0%), com idade média de 64,3 anos e história patológica de diabetes mellitus (55,7%) e hipertensão arterial (48,5%). Os cuidadores percebem sentir um fardo (61,9%) e os pacien- tes um fardo (57,7%), as díades percebem uma satisfação mínima com o apoio recebido e estão mais familiarizados com o uso de telefone e televisão. A competência para cuidar foi classificada como alta pelo cuidador (44,8 pontos em média). As dimensões da competência assistencial foram associadas (p <0,05) à escolaridade, comprometimento religioso, carga percebida, idade do paciente, entre outros aspectos. Conclusões. os dias de atendimento têm características relacionadas ao nível de competência para o cuidado, sendo de importância na estruturação de intervenções para melhorar o bem-estar dos cuidadores.

Factores asociados a estancia prolongada en una población de pacientes con exacerbación de Enfermedad Pulmonar Obstructiva Crónica en un hospital de referencia del Nororiente Colombiano / Factors Associated with a Prolonged Hospital Length of Stay in a Population of Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in a Reference Hospital in Northeastern Colombia

La estancia hospitalaria prolongada durante un episodio de exacerbación en Enfermedad Pulmonar Obstructiva Crónica representa una condición que aumenta el riesgo de complicaciones médicas asociadas. Objetivo: El objetivo de este estudio fue determinar los factores asociados a una estancia hospitalaria prolongada en exacerbaciones de Enfermedad Pulmonar Obstructiva Crónica, a través de un modelo de predicción. Materiales y métodos: En un estudio de tipo corte transversal recopilamos los datos de los registros médicos en un hospital localizado en la región oriente de Colombia, entre los años 2012-2014. Se realizó análisis descriptivo, bivariado y multivariado Resultados: Un total de 212 pacientes fueron incluidos en este estudio, 61.32% presentaron estancia hospitalaria prolongada. Encontramos asociación estadística significativa entre estancia hospitalaria prolongada y las variables independientes producto del análisis bivariado: disnea (OR: 2.87 p = 0.04), fiebre (OR: 2; p = 0.02), oxígeno hospitalario (OR: 2.34, p = 0.003), anticolinérgicos hospitalarios (OR: 2.91, p = 0.002), antibiótico hospitalario (OR: 2.25, p = 0.004), segmentados (OR: 1.02, p= 0.01) y linfocitos (OR: 0.95, p = 0.003). El modelo predictivo tenía un valor de p de 0.4950 en el análisis de bondad (prueba de Pearson) y un valor de p de 0.2689 en el test de bondad de ajuste (prueba de Hosmer-Lemeshow) indicando adecuado ajuste. Además, el modelo presentó un área bajo la curva de 0.6588. Conclusiones: Nuestro modelo de predicción incluyo las variables: edad, anticolinérgicos y segmentados, por su asociación significativa. Tiene adecuado ajuste y con un buen patrón de predicción.

Factors Associated with a Prolonged Hospital Length of Stay in a Population of Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in a Reference Hospital in Northeastern Colombia / Factores asociados a estancia prolongada en una población de pacientes con exacerbación de Enfermedad Pulmonar Obstructiva Crónica en un hospital de referencia del Nororiente Colombiano

A prolonged hospital length of stay during an episode of exacerbation of chronic obstructive pulmonary disease is a condition that increases the risk of suffering associated medical complications. Objective: The objective of this study was to determine the factors associated with a prolonged hospital length of stay in exacerbations of chronic obstructive pulmonary disease through a prediction model. Materials and Methods: In a cross-sectional study we gathered the data of the medical records of a hospital located in the Eastern region of Colombia, between years 2012 and 2014. We carried out a descriptive, bivariate and multivariate analysis. Results: A total of 212 patients were included in this study. 61.32% showed a prolonged hospital length of stay. We found a significant statistical association between the prolonged hospital stay and the independent variables of the bivariate analysis: dyspnea (OR [Odds Ratio]: 2.87 p = 0.04), fever (OR: 2; p = 0.02), inpatient oxygen (OR: 2.34, p = 0.003), inpatient anticholinergics (OR: 2.91, p = 0.002), inpatient antibiotic (OR: 2.25, p= 0.004), segs (OR: 1.02, p= 0.01) and lymphocytes (OR: 0.95, p = 0.003). The predictive model had a p value of 0.4950 in the analysis of goodness (Pearson Test) and a p value of 0.2689 in the goodness of fit test (Hosmer-Lemeshow Test), indicating an adequate fit. Also, the model showed an area under the curve of 0.6588. Conclusions: Our prediction model included the following variables: age, anticholinergics and segs, for their significant association. It has an adequate fit and a good pattern of prediction.

Effectiveness of chronic hepatitis C treatment with direct-acting antivirals in the Public Health System in Brazil

ABSTRACT Introduction Chronic hepatitis C virus infection is one of the major causes of cirrhosis, hepatocellular carcinoma and liver transplantation. Treatment using direct-acting antivirals has revolutionized the treatment of hepatitis C virus, increasing long-term prognosis after cure. The goal of the present study was to evaluate the effectiveness of direct-acting antivirals in a Public Health System in southern Brazil. Methods A retrospective study evaluated all patients with chronic hepatitis C virus infection who underwent treatment at one center of the Public Health Department of the State of Rio Grande do Sul - Brazil, according to the Brazilian Clinical Protocol and Therapeutic Guidelines. The effectiveness was assessed in terms sustained virological response 12 weeks after the end of treatment. Results A total of 1002 patients who were treated for chronic hepatitis C virus infection were evaluated. The mean age was 58.6 years, 557 patients (55.6%) were male and 550 (54.9%) were cirrhotic. Overall sustained virological response was observed in 936 (93.4%) patients. There was a difference in sustained virological response rate varied according to sex, 91.6% in men and 95.7% in women (p= 0.009), length of treatment in genotype 1, 92.7% with 12 weeks and 99.1 with 24 weeks (p= 0.040), and genotype, 94.7% in genotype 1, 91.7% in genotype 2, and 91.4% in genotype 3 (p= 0.047). Conclusion The treatment of chronic hepatitis C virus infection for genotypes 1, 2 or 3 with the therapeutic regimens established by the Brazilian guidelines showed high rates of SVR, even in cirrhotic patients.

Emigrants' Stories of Foreign Aid and their Reasons for Emigration: Guatemalans on the Move / Historias de migrantes y sus razones para la emigración: guatemaltecos en movimiento

Abstract This single instrumental case study was designed to learn about emigrants' reasons for emigrating, situated within the challenges and available opportunities in their home country of Guatemala. Eight emigrants (two women and six men) were interviewed to better understand their personal experiences and to examine the role of the United States Agency for International Development (USAID) investments, Central American Free Trade Agreement (CAFTA), and Guatemala's domestic conditions and development in participants' decisions to emigrate to the U.S. The study was guided by the following central questions: (1) How do emigrants explain their reasons for leaving? (2) What motivates emigration in Guatemala's domestic conditions? (3) And how are these reasons related to U.S. policies, if at all? Data were drawn from multiple sources. The literature on Guatemala's history, and current USAID investments and impacts provides an understanding of the present context in Guatemala for emigration, and interviews with emigrants in the U.S. and Guatemala provide data on personal experiences with emigration. Primary findings were that significant economic hardship and lack of opportunity motivated emigrants' decisions to go to the U.S. All participants, except for one, had received no development aid, and for the one who had received aid, it did not factor into his decision to emigrate. Half of the participants indicated that they would not have emigrated if development programs had offered educational opportunities and jobs.

Resumen Este estudio instrumental de caso único está diseñado para conocer los motivos que tienen los migrantes para emigrar, en el marco de los desafíos y las oportunidades existentes en Guatemala, su país de procedencia. Se entrevistó a ocho emigrantes (dos mujeres y seis hombres) para comprender mejor sus experiencias personales y también para analizar el papel que tienen la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID, por sus siglas en inglés), el Tratado de Libre Comercio entre Estados Unidos y Centroamérica (CAFTA, por sus siglas en inglés) y las condiciones internas de Guatemala en las decisiones que tomaron los participantes de emigrar a los EE.UU. El estudio estuvo guiado por las siguientes preguntas centrales: (1) ¿Cómo explican los emigrantes sus razones para salir de su país? (2) ¿De qué manera las condiciones internas de Guatemala motivan la emigración? (3) Y ¿de qué manera se relacionan estas razones con las políticas de los EE. UU., si están relacionadas? Los datos se obtuvieron de varias fuentes. Las publicaciones sobre la historia de Guatemala y las inversiones e impactos actuales del USAID ayudan a comprender el contexto que existe en Guatemala por el que ocurre la emigración, asimismo, las entrevistas con los emigrantes en los EE.UU. y Guatemala proporcionan datos sobre las experiencias personales en cuanto a la emigración. Los principales resultados obtenidos fueron que las grandes dificultades económicas y la falta de oportunidades fueron las razones por las que los emigrantes decidieron irse a los EE.UU. Ninguno de los participantes, salvo uno de ellos, recibió asistencia y esta no influyó en la decisión de emigrar de dicha persona. La mitad de los participantes indicó que no hubiese emigrado si los programas de desarrollo les hubieran ofrecido oportunidades educativas y laborales.

Factores asociados con la presencia de secuelas fibrocavitarias torácicas en pacientes con antecedente de tuberculosis pulmonar del Hospital Universitario de Santander, Bucaramanga, Colombia / Factors associated with the presence of thoracic fibrocavitary sequelae in patients with a history of pulmonary tuberculosis from Hospital Universitario de Santander, Bucaramanga, Colombia

Objetivo: Determinar las variables relacionadas con el desarrollo de secuelas fibrocavitarias torácicas en pacientes con antecedente de tuberculosis pulmonar en Santander. Métodos: Cohorte retrospectiva de 141 pacientes con diagnóstico previo de tuberculosis, captados mediante muestreo no probabilístico de casos consecutivos en consulta de neumología (Hospital Universitario de Santander). Se realizó un análisis descriptivo, bivariado y multivariado a las variables recolectadas de las historias clínicas. Resultados: El 66% de los pacientes pertenecían al sexo masculino, con una edad promedio de 52 ± 16,91 años, evidenciando un tiempo promedio desde el contagio hasta el momento de la captación de 69 meses y un antecedente de tabaquismo del 46%. El 68% referían tos y se realizó fibrobroncoscopia al 41%. El 89% mostraron algún tipo de secuelas, distribuidas así: Torácicas parenquimatosas 88%, Pleurales 30%, Vías respiratorias 45%, Mediastinales 38% y Vasculares 5%. Fueron variables asociadas a la presencia de alguna secuela la edad del paciente; el tiempo mayor a 17 meses desde el diagnóstico de tuberculosis; la edad de diagnóstico de tuberculosis; la confirmación diagnóstica de tuberculosis por fibrobroncoscopia y síntomas como disnea, cianosis y tos. Discusión: El presente estudio estableció la prevalencia de secuelas de tuberculosis en el 88,65% de los sujetos con tuberculosis curada en Bucaramanga, Santander, Colombia. Es el primer estudio en la región en el que se evaluaron factores asociados con el desarrollo de secuelas de tuberculosis, encontrando como factor importante el uso de fibrobroncoscopia como método diagnóstico.

Factors associated with the presence of thoracic fibrocavitary sequelae in patients with a history of pulmonary tuberculosis from Hospital Universitario de Santander, Bucaramanga, Colombia

Objective: To determine the variables associated with the development of thoracic fibrocavitary sequelae in patients with a history of pulmonary tuberculosis in Santander. Methods: A retrospective cohort of 141 patients previously diagnosed with tuberculosis, recruited using non-probability consecutive sampling at pneumology consultations (Hospital Universitario de Santander). A descriptive, bivariate and multivariate analysis was performed with all the variables collected from the medical records. Results: Sixty-six percent of the patients were males, with an average age of 52+/-16.91 years, evidencing an average time span of 69 months from the moment of the infection to the moment they were recruited, and a history of tobacco use of 46%. Sixty-eight percent stated they had cough and a fibrobronchoscopy was performed in 41%. Eighty-nine percent exhibited some type of sequelae, classified as follows: Parenchymal thoracic 88%, pleural 30%, respiratory tract 45%, mediastinal 38% and vascular 5%. The variables associated with the presence of a sequela were the age of the patient; a period of time exceeding 17 months since the moment of the tuberculosis diagnosis; the age of diagnosis; the diagnostic confirmation of tuberculosis by fibrobronchoscopy and symptoms such as dyspnea, cyanosis and cough. Discussion: This study establishes the incidence of tuberculosis sequelae in 88.65% of the subjects with tuberculosis treated in Bucaramanga, Santander, Colombia. It is the first study in the region evaluating the factors associated with the development of tuberculosis sequelae, in which the use of fibrobronchoscopies as a diagnostic method was found to be an important factor.

Obtención de goma de semillas de algarroba (Prosopis alba) y su utilización en formulaciones alimenticias / Obtaining carob seed gum (Prosopis alba), and its use in food formulations

Introducción: Las semillas de algarroba son fuente de gomas. Estas son adicionadas a una variedad de productos como espesante, estabilizante o saborizante. El objetivo del presente trabajo fue extraer goma de las semillas de algarrobo, variedad local, y utilizarlos en la formulación de sopa deshidratada y polvo para preparar postre. Materiales y Método: Se trabajó con vainas de Prosopis alba, la goma se obtuvo por Métodos: Químico alcalino (MQ) y Mecánico en Seco (MM). Se formuló sopa de arveja deshidratada y polvo para preparar postre sabor dulce de leche. Se trabajó a 3 concentraciones de goma; para sopa rehidratada lista para consumo a valores de 0,15; 0,20 y 0,30%, que según método utilizado se denominaron MQ0,15; MQ0,20; MQ0,30 y MM0,15; MM0,20; MM0,30; en postre listos para consumo a 0,50; 0,75 y 1,00%, designándose como MQ0,50; MQ0,75; MQ1,00 y MM0,50; MM0,75; MM1,00. En los productos se determinó viscosidad , sinéresis, preferencia y aceptabilidad (Tablas Newell y MacFarlane). Resultados: El rendimiento de las vainas a goma fue de 1,91% (MA) y 6,85% (MM), mientras el aprovechamiento de semillas a goma fue 76,66% y 46,21% para MQ y MM respectivamente. La viscosidad fue mayor en los productos formulados con goma extraída por MQ, siendo de 893,75 cP y 793,75 cP para sopa de arveja MQ0,30 y MM0,30 y de 1966,25 cP y 1519,37 cP para postres MQ0,50 y MM0,50 respectivamente.No se observó sinéresis en los productos. Se prefirió las sopas formuladas con mayor concentración de goma y postres con la menor, los productos tuvieron una aceptabilidad del 89% y 94% respectivamente. Conclusión: Fue factible la obtención de goma por diferentes métodos, lográndose mayor rendimiento de goma y mejor efecto sobre la viscosidad con goma obtenida por MQ.La incorporación de goma en formulaciones alimentarias permitió obtener productos con características sensorialmente aceptables.

Percepción en paciente y familia de la seguridad de la atención hospitalaria de en un Hospital Universitario / Perception of patients and families on the safety ofhospital care at a university hospital

ResumenObjetivo general: Describir la percepción de paciente y familia sobre la seguridad de la atención sanitaria brindada en un Hospital Universitario colombiano de alta complejidad durante su proceso de hospitalización.MetodologíaEstudio cuantitativo con abordaje descriptivo-transversal y muestreo estratificado no aleatorizado, con una muestra de 276 participantes de los servicios de hospitalización y urgencias; la recolección de datos se hizo con el cuestionario "Percepción de seguridad de la atención en salud en el ámbito hospitalario".ResultadosLas dimensiones indagadas fueron: 1. Información recibida por los pacientes con 88.8% de acuerdo; 2. Calidad en la atención en salud recibida con 88.2% de acuerdo; 3. El 97.2% no identificaron Eventos Adversos; 4. El 99,64% no identificaron incidentes en la atención de salud; y 5. Sensación de seguridad percibida en el 88,77% como segura y en el 4,35% como ligeramente segura. Discusión y conclusionesSe encontró una alta percepción positiva de la seguridad en la atención de salud brindada y baja cantidad de eventos adversos e incidentes, el comportamiento de los resultados fue en general similar entre las 3 categorías de participantes (paciente y cuidador, paciente únicamente y cuidador familiar únicamente) y por servicios participantes. Lo anterior muestra la importancia de implementar y mantener estrategias institucionales que van desde policitas, programas, procedimientos y actividades específicas en los servicios para que el paciente y su familia se sientan seguros frente a su situación de salud y tratamiento

AbstractObjective: To describe the patients and families ́ perception on the safety of health care provided at a highly complex Colombian University Hospital during the hospitalization process.Methodology: It was used a quantitative study with descriptive-transversal approach and non-randomized stratified sampling, with a sample of 276 participants from the hospitalization and emergency services. The data collection was done with the questionnaire "Perception of safety of health care in the hospital setting".Results: The dimensions investigated were: 1. Information received by patients with 88.8% of agreement; 2. Quality in health care received with 88.2% of agreement; 3. 97.2% did not identify adverse events; 4. 99.64% did not identify incidents in health care; and 5. Feeling of safety perceived by 88.77% as safe and at 4.35% as slightly safe.Discussion and conclusions: It was found a high positive perception of safety in health care provided and low number of adverse events and incidents. The behavior of the results was generally similar among the 3 categories of participants (patient and caregiver, patient only and family caregiver only) and by participating services. This shows the importance of implementing and maintaining institutional strategies that go from policies, programs, procedures and specific activities in the services so that patients and their families feel safe in front of their health situation and treatment

Processamento auditivo: marcadores de tempo por habilidade auditiva / Auditory processing: time markers for hearing ability

Caracterizar o tempo de aquisição de cada habilidade auditiva trabalhada em crianças diagnosticadas com Distúrbio do Processamento Auditivo Central, em idade escolar, a partir de um programa de intervenção fonoaudiológica pré-estabelecido, com duração máxima de 20 sessões. Metodologia: foram selecionados, para a intervenção fonoaudiológica, 8 indivíduos na faixa etária de sete a nove anos, em idade escolar, de uma escola pública e que completasse, no mínimo, 16 sessões de terapia, ou, ainda, aquele que atingisse os objetivos propostos (adequação das habilidades) em menor número de sessões. Para cada sessão, que ocorreu semanalmente, com duração de 40 minutos, foi realizado registro cursivo do desempenho da criança, para cada uma das habilidades trabalhadas (localização, discriminação, reconhecimento, figura-fundo/fechamento, compreensão e memória). Posteriormente, foi realizada análise do conteúdo descritivo por semelhança entre as habilidades. No registro, foi assinalada a sessão considerada como término da atividade, isto é, a aquisição da habilidade. Resultados: o número de sessões realizadas pelos indivíduos do estudo variou de 10 a 20 sessões, sendo que o tempo médio de sessões para a aquisição de cada habilidade auditiva trabalhada oscilou entre três e 16 sessões. Conclusões: foi possível observar adequação das habilidades auditivas em todos os indivíduos do estudo, com variação de tempo para cada habilidade trabalhada. Estudos com maior casuística são fundamentais para que se alcancem marcadores de tempo para aquisição de habilidades auditivas, nesse segmento populacional...

To characterize the acquisition time of each hearing ability worked with children diagnosed with Disturbance of Central Auditory Processing, school age, from a speech therapy program pre-established, which lasted 20 sessions. Methods: participated in speech therapy 8 patients aged seven to nine years, school age, in a public school. For the analysis of the dataset as a criterion for participation, the individual who completed at least 16 sessions of therapy, or one that reached the proposed objectives (adequacy of skills) in fewer sessions. For each session, which occurred weekly, lasting 40 minutes each, was conducted cursive record the child’s performance for each of the skills worked (location, discrimination, recognition, figure-ground/closing, comprehension e memory).Subsequently, we performed a descriptive content analysis of similarity between the skills. In the recordwas marked session considered the end of the activity, that is, the acquisition of skill. Results: the number of sessions held by the study subjects ranged from 10 to 20 sessions and the average length of sessions for each skill acquisition of auditory worked varied from three to 16 sessions. Conclusion: it was possible to observe adequacy in auditory skills in all subjects of the group, with a range of time worked for each skill. Studies with larger samples are essential to achieve time markers for the acquisition of auditory skills in this population segment...

Asociación entre factores ambientales y pautas de crianza con el Índice de Masa Corporal de preescolares de hogares infantiles de Floridablanca, Colombia / Relationship between environmental factors and child rearing practices on body mass index of preschool children residents of children's homes from Floridablanca, Colombia

The association of environmental factors and child rearing practices with body mass index z-score (BMIZ) in children residents of Children's Homes from Floridablanca, Colombia was studied. A random sample of 176 preschool children aged 3-6 years was weighed and measured, their parents or caregiver were also measured and they answered a survey. The generalized linear model showed that BMIZ increased significantly with children's age (β=0.02), children's sex (male β=0.27), mother's occupation (homemaker β=0.29), mother's overweight (β=0.20), person who accompanies children while they eat (relatives β=0,49; anyone or non-relative β=0.40), person who cooks (grandmother β=0.55), adequate time spent on eating by children (β=0.54), and overeating (0.51). BMIZ decreased significantly with mother's occupation (looking for a job or student β=-0.43), maternal history of hypertension (β=-0.26), motivation to eat (β=-0.59) and pressure to eat (β=-0.55).

El objetivo del estudio fue determinar la asociación de factores ambientales y estilos de crianza con el puntaje z del Indice de Masa Corporal (IMCZ) en preescolares de los Hogares Infantiles de Floridablanca, Colombia. Una muestra aleatoria de 176 preescolares de 3 a 6 años fueron medidos y pesados; sus padres o cuidadores fueron medidos y respondieron una encuesta. El modelo lineal generalizado mostró que el IMCZ aumenta significativamente con la edad (β=0,02) y sexo del preescolar (masculino β=0,27), ocupación (ama de casa β=0,29) y sobrepeso de la madre (β=0,20), persona que lo acompaña mientras come (familiares β=0,49; ninguno o no familiares β=0,40), persona que prepara los alimentos (abuela β=0,55), comer en un tiempo adecuado (β=0,54), y comer demasiado (0,51). El IMCZ disminuye significativamente con la ocupación de la madre (buscando trabajo o estudianteβ=-0,43), antecedentes de hipertensión arterial maternos (β=-0,26), motivación para comer (β=-0,59), y presión para comer (β=-0,55).

Implementación de la estrategia "Atención Limpia es Atención Segura" en un hospital de tercer nivel en Medellín, Colombia / Implementation of the strategy "Clean Care is Safer Care" in a third level hospital in Medellín, Colombia

Introduction: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). Aim: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). Methods: Quasi-experimental before-after study. Results: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. Discussion: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. Conclusions: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.

Introducción: La higiene de manos es una medida costo-efectiva para prevenir las infecciones asociadas a la atención de salud (IAAS). Para mejorar el cumplimiento se recomienda implementar estrategias multimodales como "atención limpia es atención segura" de la OMS. Objetivo: Estimar el efecto de la estrategia multimodal en cinco unidades de un hospital de tercer nivel en Medellín, Colombia (2008-2010). Métodos: Estudio cuasi-experimental antes y después. Resultados: El cumplimiento general con la higiene de manos aumentó de forma significativa en el período posterior a la implementación (82 a 89%, p = 0,007). El puntaje de conocimientos aumentó entre los dos períodos de tiempo (Mediana = 26, RIC = 22-28 vs Mediana = 30, RIC = 26-32; p = 0,001). El consumo de alcohol aumentó de 10,5 litros a 58,1 litros por 1.000 pacientes/día [razón de incidencias (RI) = 2,39; 95% CI = 1,99; 2,88]. Las tasas mensuales de IAAS no mostraron variaciones [RI = 0,90; 95% CI = 0,71; 1,13]. Discusión: Este estudio demuestra que la implementación de una estrategia multimodal para la higiene de manos aumenta significativamente el cumplimiento con esta medida, independientemente del tipo de trabajador y el servicio hospitalario. Conclusión: Con la estrategia multimodal se aumentó significativamente el cumplimiento con la higiene de manos.

Salmonella Yeerongpilly in a Chinese Owl (Columba livia domestica) in Jamaica.

Salmonella infection in bird species in Jamaica was studied. This revealed that very low prevalence of salmonellosis was found (0.32 %). Salmonella Yeerongpilly (newly reported in the country) was isolated from a bird collected at a bird aviary. This study showed that there was the presence of this Salmonella serovar in a Chinese owl (Columba livia domestica) in Jamaica. There were not published reports from Caribbean Islands of the presence of this serovar. Salmonella Yeerongpilly belongs to serogroup E1 and by molecular serotyping random amplification of polymorphic DNA (RAPD) fingerprinting belongs to A20, B17 and C21. This strain was isolated in Queensland Australia in the 1960s before the successful Salmonella eradication campaign. This study suggests that a larger investigation in pet birds as Salmonella carriers should be carried out in Jamaica. Mandatory screening or quarantine of birds entering the country should be institutionalized.

A DNA Vaccine versus Attenuated Vaccine to Protect against Salmonella Infection in Chickens.

The aim of this study was to vaccinate layer hen chickens against Salmonella infection. Two vaccines were assessed for efficacy and safety: a DNA vaccine containing Salmonella genomic DNA encapsulated in a liposome as a vector and a live attenuated Salmonella vaccine comprising 5 attenuated Salmonella serovars that were attenuated using indigenous plant extracts such as garlic and onion. The results showed that both vaccines had a high protection capacity, preventing Salmonella infection after challenge with a wild type of SalmonellaTyphimurium. Hyper-immune eggs inhibited the growth of Salmonella spp in vitro in immunized chickens. ELISA demonstrated the specific antibody production to LPS of S. Typhimurium. Post-mortem studies confirmed the presence of salmonellosis in the control group but not in immunized chickens with either vaccine. This study shows that Poultry salmonellosis can be prevented by the use of prophylactic DNA or live-attenuated vaccines (LAV).

Seroprevalence of Anti-HIV Antibodies in Women with Abnormal Pap Smears in Jamaica.

The Human Papilloma Virus (HPV) and Human Immunodeficiency Virus (HIV) are both sexually transmitted infections, which have impacted the prevalence of cervical dysplasia and cancer in women. Infections with one of these viruses can facilitate infection with the other. In Jamaica cervical cancer is seen in 27.5 per 100, 000 women making it the second leading cause of cancer death in this population only to breast cancer as a cause of death in women with cancer. Our study investigates the seroprevalence of anti-HIV antibodies in women with abnormal pap smears in Jamaica to determine the influence of HIV on cervical dysplasia. Only patients with positive confirmatory tests were classified as HIV positive. Enzyme-Linked Immunosorbent Assay (ELISA) was used for screening while the Western blot was used for confirmation. Sero-prevalence of anti-HIV antibodies in women with abnormal pap smears was 0.85%. The preliminary results of HIV seroprevalence in women with abnormal pap smears may be low in Jamaica because of the success of the HIV/AIDS programme. A larger study can be done in the future and be representative of the Jamaica population, since the present study has as a limitation a smaller number of controls in comparison to cases. The findings reported do not support the hypothesis that HPV infection facilitates HIV infection in the studied population. It is the first study of its class reported in the Caribbean. It has been postulated that HPV infections may account for the cervical dysplasia despite the low prevalence of HIV association in the women with abnormal pap smears and that persistent HPV and to a lesser extent the HIV is responsible for the prevalence of abnormal pap smears in Jamaica. A limitation of the study was that the control group was smaller than that expected for 3 million’s population but a larger study can be done in the future.

Association between ABO Blood Type and Cervical Dysplasia/Carcinoma in Jamaican Women.

Cervical cancer is one of the leading causes of death from cancer among women worldwide and is the most common female cancer in developing countries. In Jamaica, at 27.5 per 100, 000 it is second only to breast cancer as a cause of cancer death in women. Several studies have suggested an association between blood type A and cervical dysplasia/cancer. The aim of this study was to determine whether presence of cervical dysplasia/cancer is associated with blood type A in Jamaican women. Blood was collected from 319 women, 234 cases (abnormal Pap smears) and 85 controls (normal Pap smears). Blood type was determined by the determination of isoagglutinins (anti-A and anti-B). The frequency of types A, B, AB and O in the controls and cases was similar to the Jamaican population. There was a slightly association between blood group O and cervical dysplasia/ carcinoma in Jamaican women when compared with others blood groups. Cervical dysplasia/ carcinoma was strongly associated to the number of sexual partners, number of biological fathers, number of children and the use of hormonal contraceptive.