¿Está la virtud en el punto medio? La incertidumbre del CIN2 y el papel del VPH / Is virtue at the midpoint? The uncertainty of CIN2 and the role of HPV

Objetivo: La biopsia guiada por colposcopia (BGC) marca el manejo de la neoplasia intraepitelial cervical. El objetivo de este estudio fue evaluar la concordancia de los resultados entre la BGC y la escisión amplia de la zona de transformación (LLETZ, large loop excision of the transformation zone), y la utilidad del genotipado del virus del papiloma humano (VPH) para seleccionar a las pacientes con riesgo de lesión intraepitelial escamosa de alto grado/neoplasia intraepitelial cervical 3 (HSIL/CIN3). Método: Se compararon los resultados de la BGC y de la LLETZ, siendo esta última el método de referencia. Se evaluó la relación del genotipo del VPH con el diagnóstico final de HSIL/CIN3. Resultados: La precisión de la biopsia comparada con LLETZ fue del 61,4%. La tasa de concordancia fue del 64,4% para CIN1, del 31,4% para CIN2 y del 77,4% para CIN3. La tasa global de sobrediagnóstico fue del 18,68% y la de subdiagnóstico del 19,89%. En mujeres menores de 30 años, la concordancia fue del 62,79% (CIN1 65%, CIN2 39,58% y CIN3 73,08%), la tasa de sobrediagnóstico del 22,67% y la tasa de subdiagnóstico del 15,11%. La infección por VPH16 tuvo una odds ratio de 3,86 para el diagnóstico final de HSIL/CIN3+. Conclusiones: El diagnóstico de CIN2 por BGC parece insuficiente para seleccionar a las pacientes para tratamiento escisional, principalmente en mujeres jóvenes. El hallazgo de VPH16 es un factor de riesgo de HSIL/CIN3+ independientemente del resultado de la biopsia.

Objective: Colposcopy-guided biopsy (CGB) is a basic tool for the management of cervical intraepithelial neoplasia. The aim of this study is to evaluate the concordance of results between CGB and large loop excision of the transformation zone (LLETZ), and the usefulness of human papillomavirus (HPV) genotyping to select patients at risk of H-SIL/CIN3. Method: The results of colposcopy-guided biopsy and LLETZ were compared, with LLETZ being the gold standard. The relationship of HPV genotype to the final diagnosis of CIN3 was assessed. Results: The accuracy of CGB compared to LLETZ was 61.4%. The concordance rate was 64.4% for CIN1, 31.4% for CIN2 and 77.4% for CIN3. The overall overdiagnosis rate was 18.68% and underdiagnosis rate was 19.89%. In women under 30 years of age the concordance rate was 62.79% (CIN1 65%, CIN2 39.58% and CIN3 73.08%), and the rate of overdiagnosis and underdiagnosis was 22.67% and 15.11%, respectively. HPV16 infection had an odds ratio of 3.86 for the final diagnosis of CIN3+ and the result was significant regardless of the biopsy result. Conclusions: The CGB result as CIN2 is inaccurate and seems insufficient to select patients for excisional treatment, mainly in young women. HPV16 infection is a risk factor for CIN3+ regardless of the colposcopy-guided biopsy result.

Musicalidad y juego en la primera infancia: el andamiaje que el juego con las formas de la vitalidad provee al juego de ficción / Musicality and play in early childhood: the scaffolding that forms of vitality play provides to pretend play

Resumen El juego de ficción, aquel que comporta la creación de una situación imaginaria, ha sido un objeto de estudio privilegiado en la psicología del desarrollo y se ha señalado su rol en el desarrollo de funciones psicológicas complejas. Recientemente, gracias a la utilización de herramientas de análisis de las artes temporales, se ha documentado una nueva forma de juego, el juego con las formas de la vitalidad, cuyo foco es la repetición y variación de motivos sonoro-kinéticos de modo interactivo, en detrimento de cualquier contenido figurativo. Se ha observado que durante el tercer año de vida este tipo de juego se presenta de modo combinado con el juego de ficción y que en esos casos podría ser parte del andamiaje del desarrollo del juego de ficción. El objetivo del presente estudio fue realizar un microanálisis de los sonidos y movimientos de una escena de juego de ficción combinado con juego con las formas de la vitalidad de una niña de 1 año y 11 meses de edad, con el fin de conocer cómo se produce dicho andamiaje. Entre los resultados se destacan la presencia de sincronía interactiva basada en un pulso subyacente, la construcción de una mutualidad entre adulto e infante a partir de la calidad de los motivos compartidos, la ampliación del espacio de juego y el sostenimiento de la atención conjunta y la fluidez interactiva.

Abstract The pretend play, one that involves the creation of an imaginary situation, has been a privileged object of study in developmental psychology framed in the linguistic turn. Its important role in the development of complex psychological functions, such as language, theory of mind or narrative capacity, has been pointed out. In recent years, there has been a change in focus in the human sciences that has been dubbed the corporal turn: a re-focus on the analysis and conceptualization of bodily aspects that are at the base of various cognitive capacities. Thanks to the use of analysis tools typical of the temporal arts -such as music and dance- to the field of cognitive psychology, a new form of play has been documented in early childhood: the forms of vitality play. It recovers the idea of forms of vitality from Stern (2010), which refers to affects that cannot be reflected in the lexicon of Darwinian emotions. The forms of vitality are a Gestalt, an emergent property where movement, time, force, space and directionality/intentionality are integrated; they are a fundamental property of multimodal exchanges in the adult-baby dyad as well as of the experience, as spectator or performer, of non-figurative temporal arts such as dance and music. The forms of vitality play arise as a reconceptualization of the notion of musical play and is considered a reissue of early social play with a symmetrical participation of the child in the composition of play. It is defined as any pleasant or self-remunerative activity, in which motifs of movements and/or sounds are elaborated according to the repetition-variation form, at the expense of any figurative content. The forms of vitality play have been observed in the third year of the child's life and it has been pointed out that it can manifest in a simple way or in combination with the pretend play. Likewise, it was suggested that when the pretend play is presented in combination with the forms of vitality play, the latter could be scaffolding the pretend play, although how this happens has not been clearly specified. The objective of the present study is to carry out a microanalysis of the sounds and movements of a pretend play scene combined with forms of vitality play of a girl of 1 year and 11 months of age and an adult, in order to know how such scaffolding is produced. The sound envelope was analyzed in order to identify and describe the timing of the sounds. Regarding movement, specialized software was used to graph its trajectory and for the analysis of the expression of movements, the basic categories "Shape and Effort" of the Laban-Bartenieff system of movement analysis were used (Laban, 1971). The results indicate the presence of interactive synchrony based on an underlying pulse that sustains mutuality between the players and provides a temporal structure on which the synchrony of the self can be anchored. Furthermore, it allows the sharing of continuity and contrast in the quality of sounds and movements and thus provides the dyad with a primary level of understanding with non-mediated meanings; promotes the exploration of the play space and the expansion of the potential of the fictional scene; it favors the maintenance of joint attention and mutual understanding through ontogenetically pre-fiction semiotic mechanisms, which favor the interactive fluidity of play.

Caracterización microbiológica y molecular de la resistencia antimicrobiana de Escherichia coli uropatógenas de hospitales públicos peruanos / Microbiological and molecular characterization of antimicrobial resistance in uropathogenic Escherichia coli from peruvian public hospitals

RESUMEN Se caracterizó la resistencia antimicrobiana de 70 aislados de Escherichia coli obtenidos de pacientes con infección del tracto urinario (ITU) provenientes de ocho hospitales públicos en el Perú. Los perfiles de resistencia fueron identificados mediante el uso del sistema automatizado MicroScan®. Se utilizó una reacción en cadena de la polimerasa convencional para la detección de los genes bla TEM, bla CTX-M, bla SHV y bla PER. El 65,7% (46/70) de los aislados presentó un fenotipo multidrogorresistente y el 55,7% (39/70) fue identificado como productores de betalactamasas de espectro extendido. Se detectaron altos niveles de resistencia para ampicilina (77,1%), ciprofloxacina (74,3%), trimetoprim/sulfametoxazol (62,9%), cefepime (57,1%) y cefuroxima (57,1%). El gen bla TEM fue el más frecuente con un 31,4%, seguido por bla CTX-M (18,6%) y bla SHV (2,9%). Los resultados evidencian altos niveles de resistencia a antimicrobianos de importancia clínica en aislados de E. coli de pacientes con ITU en el Perú.

ABSTRACT We characterized the antimicrobial resistance of 70 Escherichia coli isolates obtained from patients with a urinary tract infection (UTI) from 8 public hospitals in Peru. Resistance profiles were identified using the automated MicroScan® system. A standard polymerase chain reaction was used for the detection of the bla TEM, bla CTX-M, bla SHV and bla PER genes. The 65.7% (46/70) of the isolates presented a multidrug-resistant phenotype and 55.7% (39/70) were extended-spectrum beta-lactamases producers. High levels of resistance were detected for ampicillin (77,1%), ciprofloxacin (74,3%), trimethoprim/sulfamethoxazole (62,9%), cefepime (57,1%), and cefuroxime (57,1%). The bla TEM gene was the most frequent (31,4%), followed by bla CTX-M (18,6%) and bla SHV (2,9%) genes. These results show high resistance levels to antimicrobials of clinical use in E. coli isolates from hospital UTI patients in Peru.

Caracterización microbiológica y molecular de la resistencia antimicrobiana de Escherichia coli uropatógenas de hospitales públicos peruanos / Microbiological and molecular characterization of antimicrobial resistance in uropathogenic Escherichia coli from peruvian public hospitals

RESUMEN Se caracterizó la resistencia antimicrobiana de 70 aislados de Escherichia coli obtenidos de pacientes con infección del tracto urinario (ITU) provenientes de ocho hospitales públicos en el Perú. Los perfiles de resistencia fueron identificados mediante el uso del sistema automatizado MicroScan®. Se utilizó una reacción en cadena de la polimerasa convencional para la detección de los genes bla TEM, bla CTX-M, bla SHV y bla PER. El 65,7% (46/70) de los aislados presentó un fenotipo multidrogorresistente y el 55,7% (39/70) fue identificado como productores de betalactamasas de espectro extendido. Se detectaron altos niveles de resistencia para ampicilina (77,1%), ciprofloxacina (74,3%), trimetoprim/sulfametoxazol (62,9%), cefepime (57,1%) y cefuroxima (57,1%). El gen bla TEM fue el más frecuente con un 31,4%, seguido por bla CTX-M (18,6%) y bla SHV (2,9%). Los resultados evidencian altos niveles de resistencia a antimicrobianos de importancia clínica en aislados de E. coli de pacientes con ITU en el Perú.

ABSTRACT We characterized the antimicrobial resistance of 70 Escherichia coli isolates obtained from patients with a urinary tract infection (UTI) from 8 public hospitals in Peru. Resistance profiles were identified using the automated MicroScan® system. A standard polymerase chain reaction was used for the detection of the bla TEM, bla CTX-M, bla SHV and bla PER genes. The 65.7% (46/70) of the isolates presented a multidrug-resistant phenotype and 55.7% (39/70) were extended-spectrum beta-lactamases producers. High levels of resistance were detected for ampicillin (77,1%), ciprofloxacin (74,3%), trimethoprim/sulfamethoxazole (62,9%), cefepime (57,1%), and cefuroxime (57,1%). The bla TEM gene was the most frequent (31,4%), followed by bla CTX-M (18,6%) and bla SHV (2,9%) genes. These results show high resistance levels to antimicrobials of clinical use in E. coli isolates from hospital UTI patients in Peru.

Contribuciones de las actividades de extensión académica en la formación de terapeutas ocupacionales, desde la perspectiva de los estudiantes / Contribuições das atividades de extensão acadêmica na formação de terapeutas ocupacionais, na perspectiva dos estudantes / Contributions of academic extension activities in the training of occupational therapists, from the students´ perspective

Resumen Introducción Este texto presenta la experiencia acumulada durante 10 años en las Jornadas de Terapia Ocupacional del Bio Bio en Chile, actividad de extensión académica y recreativa en la cual se tratan temas relevantes para la formación de terapeutas ocupacionales. Objetivo Analizar los principales aprendizajes y contribuciones a la formación profesional de las metodologías de enseñanza que se exponen en estas Jornadas, a través de la opinión de los estudiantes que han participado como asistentes. Método se desarrolla una sistematización, ya que esta metodología permite la reflexión crítica a partir de la experiencia vivida. La información se produce a través de entrevistas a 12 estudiantes. Se realiza análisis del contenido de temas predefinidos, que corresponden a pensamiento crítico, herramientas para la intervención y valores compartidos. Resultados El grupo de estudiantes valoran las metodologías de carácter práctico, participativas y dialogantes que permitan compartir opiniones y experiencias. Las herramientas que se adquieren corresponden a habilidades relacionales que facilitan el trato y manejo terapéutico. Los valores compartidos que los estudiantes identifican se encuentran presentes en las Jornadas incluyen la solidaridad, el respeto a la diversidad y la empatía. Conclusiones Las actividades de extensión académica enriquecen la formación profesional porque acerca a los estudiantes con la realidad social, fortalecen la identidad disciplinar y promoverían su formación ciudadana. Los desafíos de las actividades de extensión son generar transformaciones en las vidas cotidianas de los/as sujetos/as de intervención, y que éstos/as puedan participar activamente en los ajustes curriculares de los planes de estudios.

Resumo Introdução Este texto apresenta a experiência acumulada ao longo de 10 anos na Conferência de Bio Bio Terapia Ocupacional no Chile, uma atividade de extensão acadêmica e recreativa na qual são discutidos temas relevantes para a formação de terapeutas ocupacionais. Objetivo Analisar as principais aprendizagens e contribuições das metodologias de ensino expostas nestes Congressos para a formação profissional, através da opinião dos alunos que participaram como assistentes. Método desenvolveu-se uma sistematização, uma vez que esta metodologia permite a reflexão crítica a partir da experiência vivida. As informações foram produzidas por meio de entrevistas com 12 alunos e efetuada análise de conteúdo de temas predefinidos, que corresponderam ao pensamento crítico, ferramentas de intervenção e valores partilhados. Resultados O grupo de alunos valoriza as metodologias de carácter prático, participativo e dialógico que lhes permitem partilhar opiniões e experiências. As ferramentas adquiridas correspondem a habilidades relacionais que facilitam o tratamento e o manejo terapêutico. Os valores partilhados que os alunos identificaram presentes na Conferência incluem solidariedade, respeito pela diversidade e empatia. Conclusões As atividades de extensão acadêmica enriquecem a formação profissional, pois aproxima os alunos da realidade social, fortalece a identidade disciplinar e promove sua formação cidadã. Os desafios das atividades de extensão são gerar transformações no cotidiano dos sujeitos da intervenção e que eles possam participar ativamente das adequações curriculares dos planos de estudos.

Abstract Introduction This text shows the experience accumulated over 10 years in the Bio Bio Occupational Therapy Conference in Chile, an academic extension and recreational activity in which relevant topics for the training of occupational therapists are discussed. Objective To analyze the main learning and contributions to the professional training of the teaching methodologies that are exposed in this conference, through the opinion of the students who have participated as assistants. Method systematization is developed since this methodology allows critical reflection from the lived experience. The information is produced through interviews with 12 students. Analysis of the content of predefined topics is carried out, which correspond to critical thinking, tools for intervention, and shared values. Results The group of students values the methodologies of a practical, participatory, and dialogue nature that allow them to share opinions and experiences. The tools that are acquired correspond to relational skills that facilitate treatment and therapeutic management. The shared values that the students identify are present in the conference, including solidarity, respect for diversity, and empathy. Conclusions The academic extension activities enrich professional training because it brings students closer to social reality, strengthens disciplinary identity and promotes their citizenship training. The challenges of extension activities are to generate transformations in the daily lives of the intervention subjects, and that they can actively participate in the curricular adjustments of the study plans.

Carcinoma gástrico: revisión bibliográfica / Gastric Carcinoma: literature review

Resumen El carcinoma gástrico hoy en día es una de las principales causas de mortalidad a nivel mundial por neoplasias y especialmente en países como Costa Rica, que se cataloga como un país de alta incidencia. Existen múltiples factores de riesgo, siendo el primero y más importante la infección por Helicobacter pylori, que desencadena una cascada de diferentes lesiones, iniciando en atrofia gástrica, que puede llegar a finalizar en cáncer invasivo. Existen otros factores que pueden influir en un ambiente pro-carcinogénico tales como fumado, obesidad, la dieta, entre otros. Múltiples naciones han desarrollado diferentes guías de tamizaje para disminuir la mortalidad; sin embargo, en países con alta incidencia sigue siendo el estándar realizar estudios de imagen y endoscopia luego de determinada edad dependiendo de factores de riesgo.

Abstract Gastric carcinoma is nowadays one of the main causes of mortality worldwide due to neoplasms and especially in countries such as Costa Rica, which is classified as a high incidence country. There are multiple risk factors, starting with Helicobacter pylori infection being the most important one; after the infection a cascade with different lesions is triggered, first it begins with gastric atrophy and then eventually lead to an invasive cancer. There are other factors that can influence a pro-carcinogenic environment such as smoking, obesity, diet, among others. Multiple nations have developed different screening guidelines to reduce mortality, however in countries with high incidence it is still the gold-standard to perform imaging and endoscopy studies after a certain age and depending on risk factors.

Coartación de aorta / Coarctation of the Aorta

Resumen La coartación de aorta es una cardiopatía congénita con altas tasas de morbilidad y mortalidad, que usualmente es subdiagnosticada a pesar de la disponibilidad de herramientas diagnósticas. El grado de severidad de las manifestaciones clínicas de la coartación de aorta va a depender del grado de obstrucción, así como de la presencia de defectos cardiacos y lesiones extracardíacas asociados. En la población pediátrica la modalidad terapéutica mayormente utilizada es la reparación quirúrgica; mientras que la angioplastia con balón y la colocación de una endoprótesis son menos utilizadas en esta población, ya que asocian mayor riesgo de reestenosis con la consecuente reintervención, estas técnicas son principalmente utilizadas en pacientes mayores. A pesar del éxito en la reparación de la coartación de aorta, los pacientes deben continuar un seguimiento estrecho a largo plazo, que incluye mediciones de la presión arterial de manera periódica, así como estudios por imagen de la estructura cardíaca, debido a la aparición tardía de complicaciones cardiovasculares asociadas.

Abstract Coarctation of the aorta is a congenital heart disease with high rates of morbidity and mortality, which is usually underdiagnosed despite the availability of diagnostic tests. The degree of severity of the clinical manifestations of coarctation of the aorta will depend on the level of obstruction, as well as the presence of cardiac defects and associated extracardiac lesions. In the pediatric population the most used therapeutic modality is surgical correction; while balloon angioplasty and stent placement are less used in this population, since they are associated with a greater risk of restenosis with the subsequent reintervention; these techniques are mostly used in older patients. Despite the success in the repair of coarctation of the aorta, patients should continue a close long-term follow-up, which includes periodic blood pressure measurements, as well as imaging studies that assess the cardiac structure, due to the late onset of associated cardiovascular complications.

Riesgo de apendicitis complicada en el paciente diabético / Risk of complicated appendicitis in the diabetic patient

Resumen La apendicitis aguda es una de las causas quirúrgicas de dolor abdominal más frecuentes en el mundo. Se presenta en diversos grupos etarios y su presentación clínica puede variar de un grupo a otro. Además hay una variedad de patologías crónicas que pueden opacar la sintomatología usual de la enfermedad, entre ellas la diabetes mellitus. En las últimas décadas la incidencia de diabetes mellitus se ha elevado considerablemente por lo que es más común que un paciente diabético padezca de apendicitis. También, el retraso entre el inicio de los síntomas y el diagnóstico de apendicitis, es un factor de riesgo para el desarrollo de apendicitis aguda complicada. Por ende, es importante conocer tanto las complicaciones como el impacto que puede tener la diabetes mellitus sobre la presentación clínica típica de la apendicitis aguda, para de esta manera, realizar un diagnóstico temprano y preciso.

Abstract Acute Appendicitis is one of the most common surgical causes for abdominal pain in the world. It occurs in a variety of age groups and its clinical presentation vary from one group to another. Additionally, there are several chronic conditions that can blurry the usual symptomatology of the disease, among them diabetes mellitus. In the last decades the incidence of diabetes mellitus has increased considerably, therefore it is more common for a diabetic patient to suffer from appendicitis. Also the delay between the beginning of the symptoms and the diagnosis of appendicitis is a risk factor for the development of complicated acute appendicitis. Thus it is important to know the complications and the impact that diabetes mellitus can have over the clinical presentation of acute appendicitis, thereby an accurate diagnose can be made in the shortest time possible.

Enfermedad arterial periférica en miembros inferiores / Peripheral arterial disease in lower extremities

Resumen La Enfermedad arterial periférica se desarrolla por la obstrucción a nivel arterial. La resultante reducción en el flujo sanguíneo puede ser asintomática o producir síntomas de insuficiencia arterial como claudicación intermitente, dolor en reposo en el grupo muscular afectado, así como la presencia de diversos grados de pérdida tisular, como úlceras, siendo éste uno de los signos más evidentes de isquemia de la extremidad. Debido a que la mayoría de los casos de Enfermedad arterial periférica tiene como etiología la ateroesclerosis resultante de la acumulación de lípidos y material fibroso entre las capas de la pared arterial en miembros inferiores, el presente artículo se centra en esta etiología como causa de la Enfermedad arterial periférica en miembros inferiores.

Abstract Peripheral artery disease is developed for an arterial obstruction. The reduction in blood flow can be asymptomatic or produce symptoms of arterial insufficiency such as intermittent claudication or rest pain in the affected muscle group, as well as the presence of different degrees of tissue loss, such as ulcers, being one of the most obvious signs of ischemia in the limb. Because the majority of cases of peripheral artery disease are caused for the atherosclerosis resulted for the accumulation of lipids and fibrous material between the layers of the artery in the lower limbs, the present article is focus on this etiology as the cause of peripheral artery disease in lower extremity.

Oleanonic acid from Lippia lupulina (Verbenaceae) shows strong in vitro antileishmanial and antitrypanosomal activity / Ácido oleanônico isolado de Lippia lupulina (Verbenaceae) apresenta potentes atividades leishmanicida e tripanocida

Leishmaniasis and Chagas disease affect millions of people in tropical and subtropical regions. Drugs used currently to treat such diseases often present undesirable side effects and low efficiency. The aim of this work was to identify extracts and isolated compounds from the genus Lippia with leishmanicidal and trypanocidal activity. Fifteen extracts from different plant parts of Lippia species with partially known chemical compositions, four partition fractions, six compounds and a mixture of four interconverting flavanones previously isolated from Lippia salviaefolia and Lippia lupulina were assayed in vitro towards epimastigote forms of Trypanosoma cruzi and promastigote forms of Leishmania amazonensis. The root extract of L. lupulina had potent activity against T. cruzi and L. amazonensis (IC50 of 20.0 and 54.5 µg mL-1, respectively). The triterpenoid oleanonic acid showed the strongest activity against these protozoans (IC50 of 18.5 and 29.9 µM, respectively). Our results indicate that Lippia plants and their derivatives deserve further investigation in the search for new antiprotozoal drugs, particularly for the treatment of leishmaniasis and Chagas disease.

Leishmaniose e doença de Chagas afetam milhões de pessoas em regiões tropicais e subtropicais. As drogas atualmente usadas para tratar estas doenças frequentemente apresentam efeitos colaterais indesejáveis e baixa eficiência. Este trabalho teve como objetivo encontrar extratos, frações e compostos isolados de espécies do gênero Lippia com atividades leishmanicida e tripanocida. Quinze extratos de diferentes partes de plantas do gênero Lippia, com composições químicas parcialmente conhecidas, quatro frações de partição, seis substâncias e uma mistura de quatro flavanonas interconversíveis isolados de Lippia salviaefolia e Lippia lupulina foram testados, in vitro, frente a formas epimastigotas de Trypanosoma cruzi e promastigotas de Leishmania amazonensis. O extrato etanólico das raízes de L. lupulina apresentou atividade potente contra T. cruzi e L. amazonensis (IC50 de 20,0 e 54,5 µg mL-1, respectivamente), enquanto que o ácido oleanônico mostrou as atividades mais fortes contra estes protozoários, com IC50 de 18,5 e 29,9 µM, respectivamente. Estes resultados indicam que espécies do gênero Lippia e seus derivados merecem investigações adicionais na busca por novas terapias antiprotozoárias, especialmente para o tratamento de leishmaniose e doença de Chagas.

Trypanosoma cruzi strains from triatomine collected in Bahia and Rio Grande do Sul, Brazil / Trypanosoma cruzi isolado de triatomíneos coletados na Bahia e Rio Grande do Sul

OBJECTIVE Collection of triatomines in domestic, peridomestic and sylvatic environments in states of Bahia and Rio Grande do Sul, Northeastern and Southern Brazil respectively, and isolation of Trypanosoma cruzi strains. METHODS First, the captured triatomines were identified using insect identification keys, then their intestinal content was examined by abdominal compression, and the samples containing trypanosomatid forms were inoculated in LIT medium and Swiss mice. RESULTS Six triatomine species were collected in cities in Bahia, namely Panstrongylus geniculatus (01), Triatoma melanocephala (11), T. lenti (94), T. pseudomaculata (02), T. sherlocki (26) and T. sordida (460), and two in cities in Rio Grande do Sul, namely T. circummaculata (11) and T. rubrovaria (115). Out of the specimens examined, T. cruzi was isolated from 28 triatomine divided into four different species: T. melanocephala (one), T. lenti (one), T. rubrovaria (16) and T. sordida (10). Their index of natural infection by T. cruzi was 6.4%. CONCLUSIONS The isolation of T. cruzi strains from triatomines found in domestic and peridomestic areas shows the potential risk of transmission of Chagas disease in the studied cities. The maintenance of those T. cruzi strains in laboratory is intended to promote studies that facilitate the understanding of the parasite-vector-host relationship. .

OBJETIVO Isolar cepas de Trypanosoma cruzi em triatomíneos capturados nos ambientes domiciliar, peridomiciliar e silvestre da Bahia e do Rio Grande do Sul. MÉTODOS Os triatomíneos capturados nos estados da Bahia e Rio Grande do Sul foram identificados por meio de chaves entomológicas. O conteúdo intestinal foi examinado por compressão abdominal e as amostras que continham formas de Trypanosomatidae foram inoculadas em meio de cultura Liver Infusion Tryptose e em camundongos Swiss. RESULTADOS Foram identificadas seis espécies de triatomíneos nas coletas realizadas em municípios do Estado da Bahia: Panstrongylus geniculatus (01), Triatoma melanocephala (11), T. lenti (94), T. pseudomaculata (02), T. sherlocki (26) e T. sordida (460), e duas no Estado do Rio Grande do Sul: T. circummaculata (11) e T. rubrovaria (115). Dos exemplares examinados, T. cruzi foi isolado de 28 triatomíneos pertencentes a quatro espécies: T. melanocephala (uma), T. lenti (uma), T. rubrovaria (16) e T. sordida (10). O índice de infecção natural de triatomíneos por T. cruzi foi de 6,4%. CONCLUSÕES O isolamento de cepas de T. cruzi em triatomíneos encontrados no intra e peridomicílio reflete o potencial risco de transmissão da doença de Chagas nos municípios estudados. .

Socialização parental: adaptação ao Brasil da escala ESPA29 / Parental socialization: Brazilian adaptation of the ESPA29 Scale

O objetivo deste estudo foi analisar as propriedades psicométricas da versão em português brasileiro da escala de socialização parental ESPA29 (Musitu & García, 2001). Esta escala permite medir os estilos de socialização parental - autoritativo, autoritário, indulgente e negligente - através de duas dimensões independentes da conduta parental, extraídas do uso que os pais fazem das distintas práticas de socialização. Utilizando uma amostra de 2105 adolescentes brasileiros, com idades entre os 10 e os 18 anos, replicou-se a estrutura de dois fatores - Aceitação/Implicação e Severidade/Imposição - que compõem a escala, mediante a análise fatorial exploratória. Para completar o estudo de replicabilidade, levou-se a cabo a análise da estrutura ortogonal de Procusto, comprovando-se que a estrutura era invariante para o pai e para a mãe.

The objective of this study was to analyze the psychometric properties of the Brazilian version of the ESPA29 Parental Socialization Scale (Musitu & García, 2001). This scale allows measuring parental styles - authoritative, authoritarian, indulgent, and negligent - by means of two independent dimensions of parental conduct extracted from parents' use of different socialization practices. Using a sample of 2.105 Brazilian adolescents from 10 to 18 years old, the structure of two factors that define the scale - Acceptance/Implication and Strictness/Imposition - has been replicated using an exploratory factorial analysis. In order to complete a proper replication of the ESPA29 scale structure, the analysis of the orthogonal structure of Procrustes was carried out proving that the structure was invariant for the father as well as for the mother.

Cierre asistido con succión en heridas complejas de la pared del tórax / Vacuum assisted closure of complex wounds of the chest

Las heridas complejas e infectadas de la pared del tórax, aunque infrecuentes, representan un reto para el cirujano de tórax, especialmente cuando se asocian a compromiso de los órganos torácicos en pacientes con inestabilidad hemodinámica y desnutridos. El cierre asistido por succión en este tipo de heridas no es común y hasta ahora sólo se han reportado en la literatura pequeñas series de casos. Se presentan dos casos con el fin de ilustrar los aspectos clínicos y quirúrgicos de esta técnica de tratamiento.

Evaluación de los sistemas de salud: estudio multivariante del logro en salud en los países europeos / Evaluation of the health systems: multivariant study of the profit in health in the European countries

La mayoría de países del mundo dedica un alto porcentaje de su presupuesto al sistema sanitario, y este porcentaje crece año tras año. Cobrando así, cada vez más importancia la evaluación de los sistemas sanitarios y su desempeño. El objetivo de este estudio es determinar las principales variables socioeconómicas que influyen sobre la esperanza de vida ajustada por discapacidad (EVAD) en los países europeos. Se han tomado 16 variables de carácter social, económico, sanitario y medioambiental, para los periodos de 2003 y 2004 en 22 países europeos. La información de de las 15 variables explicativas ha sido trasformada mediante un análisis factorial. Con el análisis de regresión, se ha obtenido la relación entre la EVAD y el resto de variables explicativas. Por último se ha realizado una agrupación de los países mediante un análisis cluster.

The majority of the countries in the world dedicate a high percentage of their budget to their Health Care System. In addition, this percentage grows year by year. For that reason, theHealth Care evaluation and its repercussion in the improvement of the population health are very important. The aim of this paper is to determine the mean socioeconomic variables thatinfluence the healthy life expectancy in the european countries. Taking 16 variables of social, economic, sanitary and environmental character, for the periods 2003 and 2004 in 22 europeancontries. The information of the 15 variables is transformed by a factorial analysis. The relation between the variables and the healthy life expectancy by means of a regression analisys. And a classification of the countries is made using the analysis cluster.

Inmunogenicidad inducida por la vacuna antimeningocócica VA-MENGOC-BC® contra la cepa de N. meningitidis ATCC C11 en adolescentes después de 12 años de vacunados / Immunogenecity induced by the VA-MENGOC-BC® antimeningococcal vaccine against the ATCC C11 N. meningitidis strain in adolescents 12 years after being vaccinated

Se estudió la respuesta de anticuerpos inducida por la vacuna antimeningocócica cubana VA-MENGOC-BC® contra la cepa ATCC C11 mediante Ensayo Bactericida del Suero y ELISA, a 184 adolescentes de un Politécnico de Ciego de Ávila, que habían sido inmunizados en campañas masivas 12 años antes. Se realizaron extracciones de sangre antes de aplicar la primera dosis (T0), 4 semanas después de esta (T1) y 4 semanas después de la segunda dosis (T2). Después de 12 años de la vacunación, 25 por ciento de los adolescentes presentó títulos bactericidas ≥ 1:8 frente a la cepa evaluada. Por ELISA, 78 por ciento mostró una concentración de anticuerpos superior al límite de detección contra el polisacárido capsular del meningococo C. Los porcentajes de seroconversión posterior a la primera dosis fueron 59 por Ensayo Bactericida del Suero y 82 por ELISA. No hubo diferencias significativas (p> 0,05) entre los resultados obtenidos después de la primera y segunda dosis por ambos ensayos. La reinmunización con 2 dosis de la vacuna no provocó hiporrespuesta frente a la cepa ATCC C11 en este grupo de edad

Portadores de Neisseria meningitidis en niños de una escuela primaria

Se realizó, con la autorización de la Dirección Municipal de Educación, Dirección Municipal de Salud y el consentimiento informado de los padres, un estudio transversal descriptivo en 318 niños de la Escuela "Mártires del Corynthia"; con el propósito de conocer la prevalencia de portadores de meningococo en niños de edad escolar, determinar los marcadores epidemiológicos de las cepas aisladas y establecer la posible relación existente entre el portador y las variables como edad, sexo, antecedente de infección respiratoria aguda, hacinamiento, amigdalectomía, efecto inhibitorio de la flora acompañante y el estado secretor de antígenos ABH en la saliva. A todos, se les tomó exudado nasofaríngeo y una muestra de saliva. Además, los padres llenaron una encuesta donde se indagó sobre los factores de riesgo a investigar. Se detectó 6,9 % de portadores de meningococo y predominaron las cepas NA:NT:P1.NST:L3,7,9. Los factores de riesgo que dieron resultados estadísticamente significativos respecto a la condición de portador de Neisseria meningitidis fueron: edad, antecedente de infección respiratoria aguda y la presencia de Streptococcus pneumoniae y Neisseria lactamica de la flora bacteriana acompañante en la nasofaringe de los niños investigados.

A cross-sectional and descriptive study was conducted among 318 children from the "Mártires del Corynthia" Primary School under the authorization of the Municipal Division of Education and the informed consent of their parents aimed at knowing the prevalence of meningoccoco carriers in school children, determining the epidemiological markers of the isolated strains and establishing the possible relation existing between the carrier and variables, such as age, sex, acute respiratory infection history, hacinamiento, amigdalectomy, inhibitory effect of of the accompanying flora and the secretory state of ABH antigens in saliva. All of them underwent nasopharyngeal exudate and a saliva sample was taken. In adition, the paents were surveyed about the risks factors to be investigated. 6.9 % of meningoccoco carriers were found and the NA:NT:P1:NST:L3,7,9 strains predominated. The risk factors with statistically significant results regarding the condition of carrier Neisseria meningitidis carrier were age, acute respiratory infection history, and the presence of Streptococcus pneumoniae and Neisseria lactamica of the accompanying bacterial flora in the nasopharynx of the children under study.

Evaluation of four methods for detecting the beta-lactamase activity in Neisseria gonorrhoeae isolated in Cuba

Four methods (chromogenic, acidimetric, inhibition, and iodometric) for demonstration of the beta-lactamase production by 70 isolates of Neisseria gonorrhoeae, were evaluated in Cuba. There was 100 percent correlation between all beta-lactamase methods and the standardized penicillin dilution susceptibility test for penicillinase-non-producing N. gonorrhoeae. For penicillinase-producing N. gonorrhoeae strains, there was a perfect correlation between the chromogenic method and penicillin susceptibility testing, but one and two strains failed to give a positive result for beta-lactamase with the inhibition/acidimetric and the iodometric methods, respectively. There was a high concordance between the chromogenic method, considered as gold standard and the rest of penicillinase tests evaluated: Kappa Index (KI) = 0.98 for inhibition/acidimetric methods and KI = 0.97 for the iodometric method. The four methods evaluated were accurate, reproducible, easily readable, economical, and ease to use for screening primary isolates of N. gonorrhoeae in Cuba. We recommended the use of the inhibition method, when testing the penicillinase activity in gonococcal isolates in provincial and municipal reference laboratories.

Contribution to the laboratory diagnosis of human cryptosporidiosis

Human cryptosporidiosis is an infection caused by Cryptosporidium spp, a coccidial protozoan of emergencial pathogenicity and responsible for severe and prostrating watery diarrhea, mainly in immunocompromised patients. Smears of stools submitted to concentration and staining by carbol fuchsin technique has been used in our laboratory as a diagnostic procedure for cryptosporidiosis. The long time observing the smears in the microscope due to the small size of the forms and the low contrast of the staining led us to introduce some modifications in the original protocol for the acid-fast staining. The smears were treated with the carbol fuchsin solution for 3 minutes as recommended by LENNETTE et al., 1985 and the solution of the ethyl alcohol 70 percent-chloride acid 0.5 percent was used instead of the ethyl alcohol-sulfuric acid 5 percent recommended by HENRIKSEN & POHLENZ, 1981. Smears were treated with the discoloration solution for 2 minutes. These modifications promoted a better washing out of the excess of carbol fuchsin therefore increasing the dye efficiency. In such conditions, the visualization of protozoan oocysts on the slides examined became easier. They were observed by the contrast of their intense pink-reddish pigmentation against the blue background. It's worthwhile to emphasize that these modifications offer advantages when time and accuracy are concerned

Verificación del sexo en restos óseos humanos adultos según las características dentales y maxilares / Sex determination through dental and maxillary characteristics in human bony remains

El objetivo de este estudio fue verificar si las características morfológicas maxilares y dentales ayudan a diferenciar el sexo en los restos óseos de individuos adultos. Metodológicamente se clasificó como un estudio descriptivo exploratorio de diseño no experimental.El universo sobre el cual se llevó a cabo la investigación fueron restos óseos humanos de colombianos entre los 18 y 25 años de edad, disponibles en el Instituto de Medicina Legal de Bogotá. La muestra fue de 80 maxilares completamente dentados: 40 maxilares superiores y 40 mandíbulas. El muestreo fue de carácter intencional.

Avaliaçäo do emprego de soro humano no meio de Diamond para isolamento e manutençäo de cepas de Trichomonas vaginalis / Evaluation of the use of human serum in Diamond's Medium for the isolation and maintenance of Trichomonas vaginalis

O meio de Diamond vem sendo empregado para o cultivo do Trichomonas vaginalis, Trichomonas tenax e Pentatrichomonas hominis, em sua composiçäo utiliza-se soro de cavalo como fonte de enriquecimento. Neste trabalho, este soro foi substituído pelo soro humano, por facilidade na sua obtençäo em laboratórios de análises clínicas. Os meios de cultura, assim preparados, foram distribuídos em tubos com tampa de rosca, em alíquotas de 8 mL, e os repiques foram feitos a cada 5 dias. As cepas de Trichomonas vaginalis foram inoculadas concomitantemente em meios contendo soro de cavalo e soro humano; resultados satisfatórios foram obtidos no cultivo e manutençäo das cepas, e o número de parasitas dobrou no mesmo período quando foi usado soro humano. Esses dados mostram que o isolamento e a manutençäo desses flagelados podem ser realizados de maneira simples e rotineira nos laboratórios, possibilitando uma melhoria no diagnóstico dessa parasitose e facilidade na manutençäo de cepas para outros estudos.