Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Epidemiological-clinical characteristics and results of appendiceal plastron management in adult patients from a reference hospital in Peru / Características epidemiológico-clínicas y resultados del manejo de plastrón apendicular en pacientes adultos de un hospital de referencia del Perú

Introduction: Appendicular plastron is considered a progressive form of acute appendicitis, with a national prevalence of 2-10%. Currently management is often controversial. It is that from this context, it seeks to promote studies that can elucidate the variables associated with the management of this condition. Objective: to determine the epidemiological-clinical characteristics associated with the results of the management of the appendiceal plastron in adult patients in a reference hospital in Peru. Methods: Non-experimental study, with a quantitative approach, observational, analytical and cross-sectional design, whose sample consisted of 100 patients with a diagnosis of appendicular plastron. The data collection sheet was applied as an instrument. Likewise, a Poisson regression model was used to respond to the objectives. Results: The multivariate analysis showed that alcohol consumption (p<0.05 RPa=1.12), nausea and vomiting (p<0.05, RPa=1.48), diarrhea (p<0.05; RPa=1.08), duration of symptoms before admission between 3 and 5 days (p<0.05; RPa=1.09), appendiceal mass (p<0.05, RPa=1.18) and bandemia (p<0.05, RPa=1.12) were significantly associated with unsuccessful management results of the appendiceal plastron. Conclusion: There are epidemiological and clinical characteristics associated with the results of the management of the appendicular plastron.

Introducción: El plastrón apendicular se considera una forma progresiva de apendicitis aguda, teniendo una prevalencia a nivel nacional de 2-10%. Actualmente el manejo suele ser controversial. Ante lo expuesto, se busca promover estudios que puedan dilucidar las variables asociadas al manejo de esta condición. Objetivo: determinar las características epidemiológico-clínicas asociadas a los resultados del manejo del plastrón apendicular en pacientes adultos en un hospital de referencia del Perú. Métodos: Estudio no experimental, de enfoque cuantitativo, diseño observacional, analítico y transversal, cuya muestra estuvo conformada por 100 pacientes con diagnóstico de plastrón apendicular. Se aplicó como instrumento la ficha de recolección de datos. Asimismo, se utilizo un modelo de regresión de Poisson para responder a los objetivos. Resultados: El análisis multivariado evidenció que el consumo de alcohol (p<0.05 RPa=1.12), las náuseas y vómitos (p<0.05, RPa=1.48), diarrea (p<0.05; RPa=1.08), duración de síntomas antes del ingreso entre 3 y 5 días (p<0.05; RPa=1.09), masa apendicular (p<0.05, RPa=1.18) y bandemia (p<0.05, RPa=1.12) se asociaron significativamente a resultados de manejo no exitosos de plastrón apendicular. Conclusión: Existe características epidemiológicas y clínicas asociadas a resultados del manejo de plastrón apendicular.

Colelitíase sintomática como apresentação de colangite esclerosante primária na infância - série de casos e revisão de literatura / Symptomatic cholelithiasis as the presentation of pediatric primary sclerosing cholangitis - case series and literature review

ABSTRACT BACKGROUND: Primary sclerosing cholangitis (PSC) is a rare hepatobiliary disorder, whose etiology remains not fully elucidated. Given how rare PSC is in childhood, until the recent publication of a multicenter international collaboration, even data on its characteristics and natural history were scarce. Symptomatic cholelithiasis has not been previously reported as the presentation of PSC. OBJECTIVE: The aim of this study was the diagnosis of PSC following the initial unusual presentation with symptomatic cholelithiasis, that followed an atypical clinical course that could not be explained by cholelithiasis alone. A literature review was also conducted. METHODS: We conducted a retrospective chart review of three patients, who were diagnosed and/or followed at the Clinics Hospital, University of Campinas - Sao Paulo/ Brazil, between 2014 and 2020. Data analyzed included gender, age of presentation, past medical history, imaging findings, laboratory results, endoscopic evaluation, response to medical therapy and follow-up. RESULTS: Age at time of presentation with cholelithiasis varied from 10 to 12 years. In two of the cases reported, a more subacute onset of symptoms preceded the episode of cholelithiasis. Two patients were managed with cholecystectomy, not followed by any surgical complications, one patient was managed conservatively. Percutaneous liver biopsy was performed in all three cases, showing histological findings compatible with PSC. Associated inflammatory bowel disease (IBD) was not seen in any of the patients. The patients have been followed for a mean time of 3.4 years. CONCLUSION: PSC and cholelithiasis are both rare in the pediatric population. This study reports on symptomatic cholelithiasis as a presentation of PSC and raises the importance of suspecting an underlying hepatobiliary disorder in children with cholelithiasis without any known predisposing factors and/or that follow an atypical clinical course for cholelithiasis alone.

RESUMO CONTEXTO: A colangite esclerosante primária (CEP) é uma doença hepatobiliar rara, cuja etiologia ainda não está totalmente elucidada. Dada a raridade do CEP na infância, até a recente publicação de uma colaboração multicêntrica internacional, mesmo dados sobre suas características e história natural eram escassos. A colelitíase sintomática não foi relatada anteriormente como a apresentação inicial de CEP na infância. OBJETIVO: O objetivo deste estudo foi o diagnóstico de CEP após a apresentação inicial incomum com colelitíase sintomática, que seguiu um curso clínico atípico que não poderia ser explicado apenas pela colelitíase. Também foi realizada uma revisão da literatura. MÉTODOS: Foi realizada uma revisão retrospectiva dos prontuários de três pacientes, que foram diagnosticados e/ou acompanhados no Hospital das Clínicas da Universidade Estadual de Campinas - São Paulo / Brasil, entre 2014 e 2020. Os dados analisados incluíram sexo, idade de apresentação, história médica pregressa, achados de imagem, resultados laboratoriais, avaliação endoscópica, resposta à terapia médica e acompanhamento. RESULTADOS: A idade no momento da apresentação da colelitíase variou de 10 a 12 anos. Em dois dos casos relatados, um início mais subagudo dos sintomas precedeu o episódio de colelitíase. Dois pacientes foram tratados com colecistectomia, não seguida de qualquer complicação cirúrgica, e um paciente foi tratado de forma conservadora. Biópsia hepática percutânea foi realizada em todos os três casos, mostrando achados histológicos compatíveis com CEP. Doença inflamatória intestinal associada não foi observada em nenhum dos pacientes. Os pacientes foram acompanhados por um tempo médio de 3,4 anos. CONCLUSÃO: CEP e colelitíase são raras na população pediátrica. Este estudo relata a colelitíase sintomática como uma apresentação de CEP e levanta a importância da suspeita de doença hepatobiliar subjacente em crianças com colelitíase sem quaisquer fatores predisponentes conhecidos e/ou que seguem um curso clínico atípico.

Vivir con dolor crónico desde la experiencia de adultos mayores con enfermedades crónico degenerativas / Living with cronic pain from the experience of older adults with chronic degenerative diseases

INTRODUCCIÓN: Ser adulto mayor conlleva a cambios físicos, psicológicos y sociales que se ven aún más afectados por comorbilidades como las enfermedades crónicas y el dolor. El propósito es interpretar las experiencias de vivir con dolor de los adultos mayores con enfermedades crónico-degenerativas. METODOLOGÍA: Diseño cualitativo de tipo fenomenológico, recolectado mediante un muestreo intencional a través de una entrevista semi estructurada, en la cual se seleccionó a la población adulta mayor con una patología crónico-degenerativa que haya experimentado dolor crónico; se analizaron los datos con el proceso cognitivo de Janice Morse, hasta llegar a la saturación de la información. Participaron 8 personas entre los 66 y 72 años, habiendo siete mujeres y un hombre. RESULTADOS: Se encontraron cuatro categorías: 1. El desgaste de vivir con dolor; 2. Cotidianidad del vivir con dolor; 3. Alternativas para aliviar el dolor, y 4. Afectación en el entorno social. CONCLUSIÓN: Ser adulto mayor trae muchos cambios en todas las esferas de la vida, sin embargo, el padecer una enfermedad crónica acelera toda esta transición, viéndose afectados la salud mental, físico y social, adaptando esta situación a su cotidianidad, buscando a su vez medios alternos que mitiguen o disminuya el dolor.

INTRODUCTION: Being an older adult leads to physical, psychological, and social changes that are further affected by comorbidities such as chronic diseases and pain. The purpose is to interpret the experiences of living in pain of older adults with chronic-degenerative diseases. METHOD: Qualitative phenomenological research, recollected by an intentional sampling through a semi-structured interview in which was selected the adult population with a chronic-degenerative pathology that have experienced an state of chronic pain. The data was analyzed with the cognitive process of Janice Morse and reached to a saturation of 8 participants. There were 8 participants between the ages of 66 and 72, with seven women and one man. RESULTS: Four categories were found: 1. Wearing of living with pain; 2. Daily Living with Pain; 3. Alternatives for Pain Relief, and 4. Social Affectation. CONCLUSION: Being an older adult brings many changes in all spheres of life, however, suffering from a chronic disease accelerates this whole transition, being affected mental, physical and social health, adapting this situation to its daily life, seeking in turn alternate means to mitigate or decrease pain.

Conformación de póntico E en sector anterior / Pontic E conformation at anterior sector

El póntico E es una alternativa de tratamiento para la pérdida prematura dental, este tipo de póntico fue publicado por primera vez en 2014 por Robert P. Korman. El diseño del póntico permite ofrecer predictibilidad en cuanto a soporte y mantenimiento de la arquitectura gingival, también promueve que el tejido vestibular migre coronalmente sobre el póntico, creando un surco gingival. Se recibió a una paciente que presentaba fragmento radicular del diente 21 y ausencia del diente 12, reborde residual atrófico (clase I según Seibert). Como plan de tratamiento, se realizó la extracción atraumática del fragmento radicular del diente 21 para retardar el colapso del reborde alveolar y se colocó injerto de tejido conectivo en la zona del diente 12 para corregir el defecto clase I de Seibert, se realizó la conformación de los nichos gingivales con electrobisturí en conjunto con la prótesis provisional y la preparación de los dientes pilares para la recepción y rehabilitación con pónticos E. Se colocó una prótesis fija de cinco unidades (dientes 13 al 23) en material núcleo de Zr y estratificada con cerámica (AU)

Pontic E is an alternative treatment for premature dental loss, this type of pontic was published for the first time in 2014 by Robert P. Korman. The design of the pontic allows to offer predictability in terms of support and maintenance of the gingival architecture, it also promotes that the vestibular tissue migrates coronally over the pontic, creating a gingival groove. A patient was received who presented a radicular fragment of tooth 21 and absence of tooth 12, atrophic residual ridge (class I according to Seibert). As a treatment plan, atraumatic extraction of the root fragment of tooth 21 was performed to delay the collapse of the alveolar ridge and connective tissue graft was placed in the area of tooth 12 to correct Seibert's class I defect, conformation was performed of the gingival niches with electrocautery in conjunction with the provisional prosthesis and the preparation of the abutment teeth for the reception and rehabilitation with pontics E. A fixed prosthesis of five units was placed (teeth from 13 to 23) of Zr core material and stratified with ceramic (AU)

Diego Rivera, the history of medicine in Mexico: peopled demand for better health, mural in 1953 still current / Diego Rivera: la historia de la medicina en México: el pueblo en demanda de salud, mural de 1953 aún vigente

Abstract: Although public health and social medicine have a long history in Latin America going back to Co lonial times, their relevance has ebbed and flowed as a result of the development of a variety of social and political movements. The Mexican Revolution accelerated implementation of public health po licies in Mexico and resulted in the creation of the Mexican Institute of Social Security to serve the health and social security needs of the country's population. Construction of the Hospital La Raza and its embellishment by the mural paintings of Diego Rivera and David Alfaro Siqueiros correspon ded to the heyday of public health ideas in Mexico. This is clearly reflected in Rivera's mural painting from 1953, The History of Medicine in Mexico: People's Demand for Better Health. The left side of the painting, representing the history of modern medicine in Mexico, exemplifies the tensions between individuals and social groups demanding the fruits of modern medicine and public health, and en trenched bureaucracy and private interests resisting their demands. Rivera's artistry illustrates this tension by depicting urban social groups and a family with a pregnant mother and children reques ting medical attention on one side of the main panel, facing condescending physicians, bureaucrats and upper society gentlemen and ladies on the other side. The importance of social movements to the development of public health policies illustrated by Rivera in 1953 continues to be relevant in Latin America today where increasing millions still lack the benefits of health care and social security.

El clima laboral desde las percepciones del profesional de enfermería de instituciones hospitalarias públicas de Corrientes capital / The work environment from the perceptions of the nursing professional of public hospitals in Corrientes capital

El clima laboral no es otra cosa que el medio en el que se desarrolla el trabajo cotidiano. La calidad de éste influye directamente en la satisfacción de los trabajadores y por ende en la productividad; se encuentra íntimamente relacionado con el manejo social de los directivos, las ventajas y desventajas del liderazgo, comportamientos de los trabajadores, manera de trabajar y de relacionarse, los recursos materiales que se utilizan y las características propias de la actividad que desarrollan. Como objetivo se propuso describir las percepciones sobre el clima laboral que tienen los profesionales de enfermería de planta permanente de los hospitales públicos Escuela "Gral. José Francisco de San Martín", "Juan Ramón Vidal" y Pediátrico "Juan Pablo II", de Corrientes Capital, a través de un estudio cuantitativo, descriptivo, observacional y transversal realizado de Agosto a Octubre de 2018. Se diseñó una encuesta para la medición de las variables en las que incluían tres dimensiones, de la organización y el puesto de trabajo, los datos sociodemográficos y el entorno y condiciones laborales. La población total en estudio comprendió a 145, del cual se extrajo un tamaño muestral de los tres conglomerados de 123. Los resultados permitieron indagar las diferentes percepciones sobre clima laboral identificando las características relacionadas con los estilos de liderazgo preponderante, las habilidades comunicacionales entre pares y otros, disponibilidad de recursos y condiciones del espacio en que se desenvuelven y las expectativas personales. Se detectaron condiciones satisfactorias respecto a factores que influyen y determinan aspectos positivos para un entorno laboral saludable como el estilo de liderazgo democrático reconocido por la mayoría; así también como opiniones positivas respecto a la confiabilidad de la información impartida por sus superiores. Sin embargo algunos determinantes resultaron desfavorables para un buen clima laboral como los recursos materiales insuficientes, distorsiones comunicativas e inconvenientes en las relaciones interpersonales. Las dimensiones estudiadas permitieron detectar puntos débiles sobre los cuales se hace imprescindible reforzar y acompañar al trabajador. El conocimiento del clima laboral en las diferentes instituciones de salud pública proporcionó información acerca de los procesos que determinan los comportamientos organizacionales, permitiendo describir actitudes y conductas de los miembros y conformación de la estructura institucional. Así también destacar características favorables a fin de promover políticas organizacionales para su afianzamiento y consolidación

SUMMARY The working environment is nothing other than the medium in which daily work is carried out. The quality of this directly affects the satisfaction of workers and productivity; it is closely related to the social management of managers, the advantages and disadvantages of leadership, the behavior of workers, the way of working and the relationship, the resources used and the characteristics of the corresponding activity. What is the objective of describing the perceptions about the work climate that the nursing professionals of the permanent plant of public hospitals have? José Francisco de San Martín "," Juan Ramón Vidal "and Pediatric" Juan Pablo II ", of Corrientes Capital, through a quantitative, descriptive, observational and transversal study carried out from August to October 2018. A survey was designed to measure the variables that include the dimensions, the organization and the job, the sociodemographic data and the environment and working conditions. The total population in the study comprised 145, from which a sample size of the three conglomerates of 123 was extracted.The results allowed the different perceptions about the work climate identifying the characteristics related to the predominant styles of leadership, the communication skills between peers and others, the availability of resources and the conditions of the space in which they develop and personal expectations. Satisfactory conditions were detected regarding factors that influence and determine positive aspects for a work environment such as the style of democratic leadership recognized by the majority; As well as positive opinions regarding the reliability of the information imparted by their superiors. However, some determinants were unfavorable for a good working environment as insufficient resources, communicative distortions and inconveniences in interpersonal relationships. The dimensions studied allowed to detect the weak points on which it is essential and accompany the worker. The knowledge of the work environment in the different health institutions provided information about the processes that determine the organizational behaviors, the descriptors and behaviors of the members and the conformation of the institutional structure. Also highlight favorable characteristics in order to promote organizational policies for its consolidation and consolidation

RESUMO O ambiente de trabalho nada mais é do que o meio em que o trabalho diário é realizado. A qualidade disso afeta diretamente a satisfação dos trabalhadores e, portanto, a produtividade; Ele está intimamente relacionado com a gestão social dos gestores, as vantagens e desvantagens de comportamentos de liderança dos trabalhadores, maneira de trabalhar e se relacionar, recursos materiais são utilizados e as características das atividades realizadas. Como objetivo, foi proposto descrever as percepções sobre o clima de trabalho que os profissionais de enfermagem permanente dos hospitais públicos possuem. "Gral. José Francisco de San Martin "" Juan Ramón Vidal "e Pediátrica" Juan Pablo II", Corrientes Capital, através de um estudo quantitativo, descritivo, observacional transversal realizado de agosto a outubro 2018. Uma pesquisa foi desenvolvida para medir as variáveis em que eles incluíam três dimensões, a organização e o trabalho, os dados sociodemográficos e o ambiente e condições de trabalho. A população total em estudo compreendeu 145, dos quais foi extraído um tamanho de amostra dos três conglomerados de 123. Os resultados permitiram investigar as diferentes percepções do ambiente de trabalho, identificando as características relacionadas com os estilos predominantes de liderança, habilidades de comunicação entre pares e outros, disponibilidade de recursos e condições de espaço em que vivem e expectativas pessoais. Foram detectadas condições satisfatórias quanto aos fatores que influenciam e determinam aspectos positivos para um ambiente de trabalho saudável, como o estilo de liderança democrática reconhecido pela maioria; bem como opiniões positivas sobre a confiabilidade das informações transmitidas por seus superiores. No entanto, alguns determinantes foram desfavoráveis para um bom ambiente de trabalho, como recursos materiais insuficientes, distorções de comunicação e inconveniências nas relações interpessoais. As dimensões estudadas permitiram detectar pontos fracos sobre os quais é essencial reforçar e acompanhar o trabalhador. O conhecimento do ambiente de trabalho nas diferentes instituições de saúde pública forneceu informações sobre os processos que determinam os comportamentos organizacionais, permitindo descrever as atitudes e comportamentos dos membros e a conformação da estrutura institucional. Destacar também características favoráveis para promover políticas organizacionais para sua consolidação e consolidação

Parásitos gastrointestinales de aves silvestres en un ecosistema ribereño urbano tropical en Heredia, Costa Rica / Gastrointestinal parasites of wild birds in a tropical riverine urban ecosystem in Heredia, Costa Rica

Resumen En las zonas urbanas, los ríos brindan diversos servicios ecosistémicos, entre ellos, funcionan como corredores biológicos interurbanos, permitiendo a las aves trasladarse y refugiarse en medio de la ciudad. Sin embargo, los altos niveles de contaminación las exponen, e incluso al ser humano, a diversos problemas de salud. De aquí la importancia de realizar diagnósticos ambientales que permitan identificar alteraciones y mitigarlos de forma oportuna. En este estudió se da un primer diagnóstico de la situación parasitaria de las aves silvestres del río Pirro ubicado en un entorno urbano, fragmentado y con altos niveles de contaminación superficial del agua. El muestreo se llevó a cabo en la parte alta y media del río Pirro en Heredia, Costa Rica. Se utilizaron redes de niebla para la captura de las aves, y se les realizó un examen objetivo general (EOG) para revisar su estado de nutrición e hidratación, así como su estado físico; además, se recolectaron muestras de heces para la caracterización de los parásitos gastrointestinales (PGI). Este procedimiento se realizó a 158 aves, correspondientes a 30 especies, se identificaron tres grupos de estos: protozoarios, nematodos y cestodos. Los porcentajes de infección más altos estuvieron representados por los coccidios, con 97.6 %, seguido de los nematodos y cestodos con un 2.4 %. Dentro del grupo de los coccidios se logró identificar: Eimeria spp., Isospora spp., en los nemátodos: a nivel de grupo Strongylida y a nivel de género: Capillaria spp. Y para los céstodos: Choanotaenia spp. El EOG resultó de regular a bueno en todos los individuos capturados sin embargo, mediante el modelo de regresión lineal general (General Lineal Model) se identificó que la cavidad oral de las aves y el estado del plumaje, podrían ser las variables más relacionadas con el porcentaje de infección por parásitos gastrointestinales, esto debido a que la cavidad oral es la vía principal de ingesta para el ave, así como el estado del plumaje evidencia su vigor.

Abstract In urban ecosystems, rivers provide various ecosystem services, among them, serving as interurban biological corridor, allowing birds to move and shelter in the middle of the city. However, high levels of pollution expose them, and even humans, to several health problems. Hence the importance of performing environmental diagnoses that allows to identify alterations and mitigate them in a timely manner. This study provides a first diagnosis of the parasitic situation of wild birds along the Pirro river which is located in an urban environment, fragmented and with high levels of surface water pollution. The sampling was carried out at the upper and middle part of the Pirro river in Heredia, Costa Rica. Mist-nets were used to capture the birds, and a general objective exam (GOE) was conducted in order to evaluate their nutritional and hydration state, as well as their physical state. In addition, stool samples were collected in order to characterize the gastrointestinal parasites (GPI). This procedure was carried out on 158 birds, belonging to 30 species, three PGI groups were identified: protozoa, nematodes and cestodes. The highest percentages of infection were represented by coccidia, with 97.6 %, followed by nematodes and cestodes with 2.4 %. Within the group of coccidios, it was possible to identify Eimeria spp., Isospora spp., in the nematodes: at the Strongylida group level and at the Capillaria spp., and for the cestodes: Choanotaenia spp. GOE resulted regular-to-good in all individuals captured, however, a general linear model was used to identify that the oral cavity and the state of the plumage could be the more linked variables with the percentage of infection by gastrointestinal parasites in birds, due to the fact that the oral cavity is the bird's main route of ingestion, as well as the state of the plumage shows its vigor. Rev. Biol. Trop. 66(2): 788-798. Epub 2018 June 01.

Relación entre segregación y convivencia escolar en escuela públicas chilenas / Relationship between segregation and school climate in Chilean schools with high scores PISA 2009

La educación chilena es altamente segregadora, lo que dificulta la construcción de sociedades cohesionadas y democráticas. La investigación corresponde a un diseño mixto, secuencial y bietápico que indagó la relación entre segregación (selección y nivel socioeconómico) y calidad de la convivencia escolar, tomando como muestra las 200 escuelas PISA 2009. Los resultados evidencian peores ambientes escolares en las escuelas municipales, de niveles socioeconómicos bajos y no selectivos, donde los estudiantes se sienten estigmatizados y discriminados por variables académicas, familiares y políticas. Se discute la necesidad de revisar la política educativa que incentiva la competencia entre escuelas por rendimiento académico y formar en educación cívica para avanzar hacia escuelas más integradas y con ello a sociedades más justas y democráticas.

Chilean education is highly segregated, making it difficult to construct cohesive and democratic societies. Through a mixed-method sequential design we explored the relationship between segregation (selection and socioeconomic level) and quality of school climate, taking as example the 200 Chilean schools who participated in the PISA 2009 test. The results evidence worst school environments in public, non-selective and low socioeconomic status schools, where students feel stigmatized and discriminated by academic, social, family and political variables. We discuss the need to revise the education policy that encourages competition among schools for academic performance and training in civics to move towards more integrated schools and more democratic societies.

Impacto en la salud mental de la (del) enfermera (o) que otorga cuidados en situaciones estresantes / Impact on nurses mental health giving care in stressful situations

La(el) Enfermera(o) tiene como principal característica la Gestión del Cuidado, es decir conservar la vida asegurando la satisfacción de las necesidades y es reconocida como el único cuidador permanente en el proceso asistencial. Las afecciones de salud mental en las(los) Enfermeras(os) están apareciendo fuertemente en la actualidad, donde destaca el estrés a la salud física, mental y emocional e incluso puede llevar a la depresión y ansiedad. Objetivo: Determinar el impacto en la salud mental de Enfermeras(os) que trabajan en situaciones estresantes en centros asistenciales de mediana y alta complejidad, públicos y privados. Material y método: Estudio no experimental, transversal, descriptivo realizado a 70 Enfermeras(os) que trabajan en Unidades de Paciente Crítico y Oncológico en la ciudad de Antofagasta, Chile, a través de un instrumento autoadministrado, escala "Nursing Stress Scale". Resultados: De las 34 situaciones estresantes aplicadas, el 48.5% de las/los Enfermeras(os) obtuvieron puntaje mayor a 34 puntos, siendo los de mayor frecuencia: observar el sufrimiento del usuario 68,2%; realizar procedimientos que suponen experiencias dolorosas al usuario 57,6%; tener que realizar tareas no relacionadas con la Enfermería 56,1% e insuficiente personal para cubrir adecuadamente el trabajo de la unidad 53%. Conclusión: El 48.5% de las(los) Enfermeras(os) generan algún grado de estrés, ya que otorgar cuidados en situaciones estresantes provoca impacto en la salud mental, viéndose afectados principalmente los ambientes psicológico, social y finalmente el ambiente físico.

The Nurse have as main characteristic the "Care Management", understood as preserving life ensuring satisfaction of needs and is recognized as the only permanent caregiver in the care process. The mental health conditions in the Nurses are emerging strongly today, which highlights the stress to physical, mental and emotional health and may even lead to depression and anxiety. This research aims to determine the impact on the mental health of Nurses working in stressful situations in public and private, medium and high complexity health centers; with a non-experimental, cross-sectional study conducted at 70 Nurses working in Critical and Oncology Units patient in the city of Antofagasta, Chile, through a self-administered instrument, the scale "Nursing Stress Scale". From the 34 stressors applied, 48.5% of the nurses obtained the highest score 34 points, with the highest frequency: observe the user suffering 68.2%; perform procedures involving painful experiences users 57.6% ; have to perform non- nursing work 56.1% and insufficient staff to adequately cover the work of the unit 53%. Conclusion: So 48.5% of the nurses generate some degree of stress as they provide care in stressful situations resulting impact on mental health, looking mainly affected the psychological and social environment, and finally the physical environment.

Cutis laxa en una lactante / Cutis laxa in an infant

Se describe el caso clínico de una lactante de 18 meses de edad, quien fue atendida en la consulta externa del Hospital Oftalmológico "Amistad Argelia-Cuba" de la Wilaya de Djelfa en la República Democrática y Popular de Argelia, por caída de los párpados. En el examen físico se observó facies tosca, piel laxa, arrugada, caída e hiperextensible, con grandes pliegues, así como aspecto de envejecimiento, blefarocalasia y ectropion. No se detectaron alteraciones musculoesqueléticas, hernia inguinal o umbilical, ni otras manifestaciones gastrointestinales, genitourinarias o cardiorrespiratorias. Por las características clínicas se concluyó que la paciente presentaba cutis laxa.

The clinical case of an infant aged 18 months is described, who was attended in the Outpatient Department from "Amistad Argelia-Cuba" Ophthalmology Hospital of the Wilaya of Djelfa in the People's Democratic Republic of Algeria due to eyelid drooping. On physical examination coarse facies, hiperextensible and sagging, wrinkled lax skin with large folds were observed, as well as aging appearance, blepharochalasis and ectropion. There were not musculoskeletal changes, groin or umbilical hernia, or other gastrointestinal, genitourinary or cardiopulmonary manifestations. Taking into account clinical characteristics it was concluded that the patient presented with cutis laxa.

Urban vegetation change after a hundred years in a tropical city (San José de Costa Rica)

Urban vegetation is of key importance because a large proportion of the human population lives in cities. Nevertheless, urban vegetation is understudied outside central Europe and particularly, little is known about the flora of tropical Asian, African and Latin American cities. We present an estimate of how the vegetation has changed in the city of San José, Costa Rica, after about one century, with the repeat photography technique (based on a collection of 19th and early 20th century photographs by José Fidel Tristán and others) and with data from the Costa Rican National Herbarium. We found little vegetation change in the landscape of San José during the 20th century, where a total of 95 families and 458 species were collected in the late 19th and early 20th century. The families with most species were Asteraceae, Fabaceae, Poaceae, Lamiaceae, Euphorbiaceae, Solanaceae, Cyperaceae, Acanthaceae, Malvaceae, Piperaceae and Verbenaceae. Similar results have been found in Europe, where the number of plant species often is stable for long periods even when the individual species vary. Rev. Biol. Trop. 58 (4): 1367-1386. Epub 2010 December 01.

La vegetación urbana es de vital importancia ya que una proporción importante de la población humana vive en ciudades. Sin embargo, esta vegetación es poco estudiada fuera del centro de Europa y se sabe particularmente poco sobre la flora urbana de las ciudades tropicales de Asia, África y América Latina. Aquí presentamos una estimación de cómo ha cambiado la vegetación en la ciudad de San José, Costa Rica, durante un siglo, con la técnica de la fotografía repetida (sobre la base de una colección de fotografías del siglo XIX y principios del siglo XX hechas por José Fidel Tristán y otros) y con los datos del Herbario Nacional de Costa Rica. Encontramos pocos cambios en el paisaje de San José durante el siglo XX. En la ciudad se recolectaron 95 familias y 458 especies entre finales del siglo XIX y principios del XX. Las familias con más especies fueron Asteraceae, Fabaceae, Poaceae, Lamiaceae, Euphorbiaceae, Solanaceae, Cyperaceae, Acanthaceae, Malvaceae, Piperaceae y Verbenaceae. Los resultados son similares a los de Europa, donde el número de especies de plantas a menudo es estable durante largos períodos, aunque las especies individuales varíen.

Neurofibromatosis de von Recklinghausen en la niñez / Von Recklinghausen's neurofibromatosis in the childhood

Se presenta el caso clínico de una niña argelina de 7 años de edad, con exoftalmos del ojo derecho de 3 años de evolución, que acudió a la consulta externa del Hospital Oftalmológico Amistad Argelia-Cuba de la Willaya de Djelfa en la República Democrática y Popular de Argelia. En el examen físico se encontraron numerosas manchas de color café con leche diseminadas por todo el cuerpo y tumor exofítico palpebral del lado derecho; y en el oftalmológico especializado: nódulos de Lisch. Por medio de la tomografía axial computarizada de cráneo se comprobó un proceso tumoral intraocular y tumor palpebral derechos, que infiltraban los músculos oculomotores: oblicuo menor y externo derecho. Se concluyó que la paciente presentaba neurofibromatosis de von Recklinghausen.

The clinical case of a 7-year-old Algerian girl with 3 year-exophthalmos of the right eye is reported who went to the outpatient department of the Ophthalmology Hospital Amistad Argelia-Cuba from Wilaya de Djelfa in the Democratic and People's Republic of Algeria. On physical examination numerous coffee-and-milk spots spread throughout the body and lid exophytic tumor of the right side were found, and in the specialized ophthalmologic testing: Lisch nodules. Cranial computerized axial tomography revealed a right intraocular tumor process and right palpebral tumor infiltrating oculomotor muscles: inferior oblique and right external. It was concluded that the patient presented with von Recklinghausen's neurofibromatosis.

Estudio de reproducibilidad del examen de cuantificación de VIH-1 por la técnica Nuclisens HIV-1 QT en muestras de plasma de pacientes infectados con VIH-1 / Reproducibility of a quantification assay, nuclisens HIV-1 QT in HIV positive plasma samples

La cuantificación (carga viral) del virus de inmunodeficiencia humana (VIH) en los pacientes infectados por este agente ha demostrado ser un valioso examen para la predicción del progreso de la infección y el monitoreo de la respuesta al tratamiento antiviral. Se evaluó la reproducibilidad de la técnica Nuclisens HIV-1 QT, recientemente introducida en nuestro país, comparando diferentes volúmenes de plasma en 11 pacientes infectados con VIH. Cada muestra fue analizada al menos en duplicado, realizándose un total de 29 determinaciones. Se encontró una mayor reproducibilidad al utilizar un volumen inicial mayor o igual a 500 µl de plasma (precisión promedio de 0,18 log y un coeficiente de variación promedio de 20 por ciento). La variación intra e inter-ensayo fue de 0,19 y 0,07 log respectivamente. La buena reproducibilidad encontrada en este estudio, asociada a la facilidad de manipulación de esta metodología en un laboratorio de biología molecular, la hace altamente recomendable para su uso rutinario en el estudio de la carga viral de los pacientes con infección por VIH