Hepatic alveolar echinococcosis simulating metastatic malignancy

ABSTRACT Echinococcosis is a parasitic disease caused by infection with tiny tapeworms of the genus Echinococcus. Echinococcosis is classified as either cystic echinococcosis or alveolar echinococcosis. The common form is a zoonosis from goats and sheep that tends to cause liver lesions. The larval stage of Echinococcus multilocularis causes alveolar echinococcosis/alveolar hydatid disease. It is a zoonosis with field mice and tundra voles as intermediate and wild carnivores like foxes and wolves as definitive hosts. This zoonosis is highly uncommon compared to the other form known as cystic echinococcosis but poses a great human threat if untreated. We report the case of a young man who was working in the Kashmir Valley, North India, and presented with jaundice and right upper quadrant abdominal pain. Computed tomography revealed a large solid-cystic intrahepatic lesion measuring 125x118x123 mm, suggestive of a malignant tumor with central necrosis. A liver biopsy showed necrosis with PAS-positive membranes morphologically consistent with echinococcosis. Alveolar echinococcosis can present as a solid-cystic mass in the liver and can simulate metastatic malignancy.

Desempenho do Escore SHARPEN e do Índice de Comorbidade de Charlson para Predição de Mortalidade durante a Internação Hospitalar e após a Alta na Endocardite Infecciosa / Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis

Resumo Fundamento O SHARPEN foi o primeiro escore desenvolvido especificamente para a predição de mortalidade hospitalar em pacientes com endocardite infecciosa (EI), independentemente da realização de cirurgia cardíaca. Objetivos Analisar a capacidade do escore SHARPEN na predição de mortalidade hospitalar e mortalidade após a alta e compará-la à do Índice de Comorbidade de Charlson (ICC). Métodos Estudo retrospectivo do tipo coorte incluindo internações por EI (segundo os critérios de Duke modificados) entre 2000 e 2016. A área sob a curva ROC (AUC-ROC) foi calculada para avaliar a capacidade preditiva. Curvas de Kaplan-Meier e regressão de Cox foram realizadas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados Estudamos 179 internações hospitalares. A mortalidade hospitalar foi 22,3%; 68 (38,0%) foram submetidos à cirurgia cardíaca. Os escores SHARPEN e ICC (mediana e intervalo interquartil) foram, respectivamente, 9(7-11) e 3(2-6). O escore SHARPEN mostrou melhor predição de mortalidade hospitalar em comparação ao ICC nos pacientes não operados (AUC-ROC 0,77 vs. 0,62, p = 0,003); não foi observada diferença no grupo total (p=0,26) ou nos pacientes operados (p=0,41). Escore SHARPEN >10 na admissão foi associado a uma menor sobrevida hospitalar no grupo total (HR 3,87; p < 0,001), nos pacientes não operados (HR 3,46; p = 0,006) e de pacientes operados (HR 6,86; p < 0,001) patients. ICC > 3 na admissão foi associada a pior sobrevida hospitalar nos grupos total (HR 3,0; p = 0,002), de pacientes operados (HR 5,57; p = 0,005), mas não nos pacientes não operados (HR 2,13; p = 0,119). A sobrevida após a alta foi pior nos pacientes com SHARPEN > 10 (HR 3,11; p < 0,001) e ICC > 3 (HR 2,63; p < 0,001) na internação; contudo, não houve diferença na capacidade preditiva entre esses grupos. Conclusão O SHARPEN escore foi superior ao ICC na predição de mortalidade hospitalar nos pacientes não operados. Não houve diferença entre os escores quanto à mortalidade após a alta.

Abstract Background SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery. Objectives To analyze the ability of the SHARPEN score to predict in-hospital and post-discharge mortality and compare it with that of the Charlson comorbidity index (CCI). Methods Retrospective cohort study including definite IE (Duke modified criteria) admissions from 2000 to 2016. The area under the ROC curve (AUC-ROC) was calculated to assess predictive ability. Kaplan-Meier curves and Cox regression was performed. P-value < 0.05 was considered statistically significant. Results We studied 179 hospital admissions. In-hospital mortality was 22.3%; 68 (38.0%) had cardiac surgery. Median (interquartile range, IQR) SHARPEN and CCI scores were 9(7-11) and 3(2-6), respectively. SHARPEN had better in-hospital mortality prediction than CCI in non-operated patients (AUC-ROC 0.77 vs. 0.62, p = 0.003); there was no difference in overall (p = 0.26) and in operated patients (p = 0.41). SHARPEN > 10 at admission was associated with decreased in-hospital survival in the overall (HR 3.87; p < 0.001), in non-operated (HR 3.46; p = 0.006) and operated (HR 6.86; p < 0.001) patients. CCI > 3 at admission was associated with worse in-hospital survival in the overall (HR 3.0; p = 0.002), and in operated patients (HR 5.57; p = 0.005), but not in non-operated patients (HR 2.13; p = 0.119). Post-discharge survival was worse in patients with SHARPEN > 10 (HR 3.11; p < 0.001) and CCI > 3 (HR 2.63; p < 0.001) at admission; however, there was no difference in predictive ability between these groups. Conclusion SHARPEN was superior to CCI in predicting in-hospital mortality in non-operated patients. There was no difference between the scores regarding post-discharge mortality.

Patient care during interfacility transport:a narrative review of managing diverse disease states / 世界急诊医学杂志（英文）

BACKGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care.Therefore,appropriate and effi cient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient care.While medical adverse events may occur during the interfacility transfer process,there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.METHODS:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June 2022.Two reviewers independently screened the titles and abstracts for eligibility.Studies that were not in the English language and did not involve critically ill patients were excluded.RESULTS:The search identified 75 articles,and we included 48 studies for our narrative review.Most studies were observational studies.CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process,such as proning positioning for respiratory failure,extracorporeal membrane oxygenation(ECMO),obstetric emergencies,and hypertensive emergencies(aortic dissection and spontaneous intracranial hemorrhage).

Intervención educativa sobre cuidado espiritual para estudiantes de licenciatura en enfermería y obstetricia / Spiritual care educational intervention for undergraduate nursing and midwifery students

Para los estudiantes de enfermería es indispensable la formación en el cuidado espiritual para identificar y satisfacer las propias necesidades espirituales y las de las personas que cuidarán, la dimensión espiritual es inherente al ser humano, para abordarla se requieren conocimientos que lleven a la reflexión e interés en la atención desde una perspectiva integral.

For nursing students, training in spiritual care is essential to identify and satisfy their own spiritual needs and those of the people they will care for; the spiritual dimension is inherent to the human being, and to address it requires knowledge that leads to reflection and interest in care from an integral perspective.

Detección de anticuerpos tipo igg contra borrelia burgdorferi, y factores asociados a la enfermedad de lyme en población canina, de los municipios honda-Tolima, la mesa y Chia-Cundinamarca. detección de anticuerpos tipo igg contra borrelia burgdorferi en población canina / Detection of IgG-type antibodies against Borrelia Burgdorferi, and factors associated with Lyme disease in the canine population, of the municipalities Honda-Tolima, La Mesa and Chia-Cundinamarca

Borrelia burgdorferi, is the spirochete responsible for causing Lyme disease in man and different animals. Objective. Detect specific IgG type antibodies against Borrelia burgdorferi, in canines using the immunofluorescence technique and its correlation with other factors associated with Lyme disease. Methods. Blood was taken for IgG detection against Borrelia burgdorferi sl; Peripheral blood smear of the canines and hemolymph of the ticks to search for spirochetes with Wright staining and finally classification of the ticks using morphometric keys. Results. In the serological test, on average 69.0% of the canines sampled gave positive results in the different titrations. Bacterial structures were spirally visualized both in the peripheral blood of the canines and in the hemolymph of the ticks. The vector found was classified as Rhipicephalus sanguineus, until now not reported in the scientific literature as a carrier of Borrelia, nor associated with the disease.

Excursiones de glucosa en pacientes con diabetes mellitus tipo 2 tratados con vildagliptina más metformina Galvus Met®, versus glimepirida más metformina ­GLOBE­: Ensayo clínico aleatorizado / Glucose excursions in patients with type 2 diabetes mellitus treated with vildagliptin plus metformin Galvus Met®, versus glimepiride plus metformin -GLOBE-: Randomized clinical trial

Resumen Objetivos. La hemoglobina glicada podría sub-representar las fluctuaciones diarias de la glucemia. Se han propuesto múltiples técnicas para estudiar la variabilidad glucémica con el fin de conocer más claramente el control metabólico de la enfermedad. El objetivo de este estudio es comparar la variabilidad glucémica medida por MAGE y CONGA en el grupo de intervención y control; Además, comparar los resultados de variabilidad glucémica obtenidos antes y 12 semanas después del inicio del tratamiento en ambos grupos. Métodos. Ensayo clínico aleatorizado, multicéntrico, de etiqueta abierta, fase IV. Cuarenta sujetos aleatorizados para recibir vildagliptina más metformina1 o glimepirida más metformina por un periodo de 12 semanas. Se realizaron monitoreos continuos de glicemia antes y después del periodo de tratamiento utilizando dispositivos iPro2. Se compararon los resultados de variabilidad glucémica medida por MAGE, CONGA y DET. Se comparó el perfil de seguridad y tolerabilidad de las intervenciones. Resultados. El uso de GalvusMet® o glimepirida más metformina por 12 semanas en pacientes diabéticos con mal control glucémico se asoció con una reducción estadísticamente significativa de la variabilidad glucémica (Valor p Wilcoxon

AbstractObjectives. Glycosylated hemoglobin could under-represent daily fluctuations in bloodglucose. Multiple techniques have been proposed to study glycemic variability in order to better understand the metabolic control of the disease. The objective of this study is to compare the glycemic variability measured by MAGE and CONGA in the intervention and control group; In addition, compare the glycemic variability results obtained before and 12 weeks after the start of treatment in both groups. Methods. Phase IV, randomized, multicenter, open-label clinical trial.Forty subjects were randomized to receive vildagliptine plus metformin1 or glimepiride plus metformin for a period of 12 weeks. Continuous blood glucose monitoring was performed before and after the treatment period using iPro2 devices. The results of glycemic variability measured by MAGE, CONGA and DET were compared. The safety and tolerability profile of the interventions was compared. Results. The use of GalvusMet®ï¸ or glimepiride plus metformin for 12 weeks in diabetic patients with poorglycemic control was associated with a statistically significant reduction in glycemic variability (Wilcoxon p-value <0.005) and HbA1c (Wilcoxon p-value <0.005) in both groups;however, insufficient evidence was found to determine the superiority of the treatments. No differences were detected in the safety or tolerability profile of the drugs. Conclusions.The results of the study suggest that the evaluated treatment regimens are equivalent. Additional studies are required to determine the clinical significance of the results.

Análisis de estudios sobre psicofármacos en una IPS del departamento de Córdoba 2012-2020 / Analysis of studies of psychopharmacers in a IPS of the department of Córdoba 2012-2020

Resumen Introducción. Los psicofármacos son medicamentos utilizados en la práctica médica para tratar enfermedades mentales. Objetivo. Realizar un análisis comparando indicadores de consumo en la utilización de psicofármacos en una Institución de Salud mental en el Departamento de Córdoba- Colombia. Metodología. Estudio longitudinal, retrospectivo-transversal, estudio de utilización de medicamentos (EUM) para comparar indicadores de consumo como dosis diaria definida (DDD), número de envases, considerando el diagnóstico y variables sociodemográficas. Resultados. población de 3.089 pacientes, donde el 48% presento diagnóstico de trastorno mental y del comportamiento por consumo de sustancias psicoactivas, el 17% presentó trastorno afectivo bipolar y el 15% esquizofrenia paranoide, el 70% de sexo masculino y un 30% sexo femenino. Los medicamentos más consumidos fueron ácido valproico en cápsulas de 250mg, carbonato de litio en tabletas de 300mg y sertralina en tabletas de 50mg; mayor consumo lo obtuvieron los antidepresivos con 45,77%, seguido por antipsicóticos con 23,19% y por último los anticonvulsivantes con 22,39%. Conclusión.Se observó diferencias en la tendencia del aumento en el consumo de psicofármacos utilizando como indicadores de consumo la dosis diaria definida (DDD) 54versus número de envases en los años de estudio. Esta investigación difiere con los resultados a nivel nacional y departamental en el sentido de que la depresión y demás problemas de salud mental se encuentran en mayor incidencia en los hombres

Results.Population of 3,089 patients, where 48% presented a diagnosis of mental and behavioral disorder due to the use of psychoactive substances, 17% presented bipolar affective disorder and 15% paranoid schizophrenia, 70% male and 30% sex feminine. The most used medications were valproic acid in 250mg capsules, lithium carbonate in 300mg tablets and sertraline in 50mg tablets; The highest consumption was obtained by antidepressants with 45.77%, followed by antipsychotics with 23.19% and finally anticonvulsants with 22.39%. Conclusion.Differences were observed in the trend of the increase in the consumption of psychotropic drugs using as consumption indicators the defined daily dose (DDD) versus the number of containers in the years of study. This research differs from the results at the national and departmental levels in the sense that depression and other mental health problems are found to be more prevalent in men

Determinantes sociales de la falta de adherencia al tratamiento de la tuberculosis en migrantes venezolanos en Colombia, 2018-2019 / Social determinants of non adherence to tuberculosis treatment in venezuelan migrant population in Colombia, 2018-2019

Resumen Introducción. La falta de adherencia al tratamiento de la Tuberculosis (TB) por parte de la población migrante venezolana en Colombia, se ha convertido en un problema de salud pública. Esto se explica por un conjunto de barreras que impiden una adherencia terapéutica exitosa de estos pacientes que son importantes de reconocer. Objetivo. Identificar los Determinantes Sociales de la Salud (DSS) que impidieron la adherencia al tratamiento de la TB en la población migrante venezolana atendida durante el período 2018-2019 en la Subred Centro Oriente de la ciudad de Bogotá D.C. Metodología. Estudio cuantitativo descriptivo en la ciudad de Bogotá D.C., muestra no probabilística, compuesta por 19 migrantes venezolanos, 12 hombres y 7 mujeres, quienes fueron diagnosticados y notificados con TB pulmonar. Resultados. El acompañamiento y apoyo familiar inciden en una mayor probabilidad de adherencia al tratamiento; así mismo las variables de ocupación, afectación laboral y gastos extras, sorpresivamente como el desempleo mejoran la adherencia al tratamiento. Se infiere que la ausencia de vinculación laboral aumenta la disponibilidad de tiempo para acudir a las instituciones y recibir un tratamiento efectivo.

AbstractIntroduction. The lack of adherence to tuberculosis (TB) treatment by the Venezuelan migrant population in Colombia has become a public health problem. This is explained by a set of barriers that prevent the successful adherence of these patients, which are important to recognize. Objective. To identify the Social Determinants of Health (SDH) that prevented adherence to TB treatment in the Venezuelan migrant population attended during the period 2018-2019 in the Subred Centro Oriente of the city of Bogotá D.C. Methodology. Descriptive quantitative study in the city of Bogotá D.C., non-probabilistic sample, composed of 19 Venezuelan migrants, 12 men and 7 women, who were diagnosed and notified with pulmonary TB. Results. Accompaniment and family support have an impact on a greater probability of adherence to treatment; likewise, the variables of occupation, work involvement, and extra expenses, surprisingly, as well as unemployment, improve adherence to treatment. It is inferred that the absence of employment increases the availability of time to go to the institutions and receive effective treatment

Análisis temporal del covid-19 en Colombia: indicadores asociados y modelización / Temporal analysis of covid-19 in Colombia: associated indicators and modeling

AbstractIntroduction. This study shows statistical information regarding COVID-19 in Colombia up to this date (March 1-2022). Specifically, the daily, monthly and cumulative evolution of infections and deaths, correlated with the distribution of the population according to age and gender. Objective. Show statistical information about COVID-19 that allows help to plan and design, in future Pandemics, public health policy strategies in Colombia. Methods. Daily information since the official declaration of Pandemic in Colombia (March 16 ­ 2020) was obtained by the National Health Institute (INS) and was organized in a database in order to conduct respective analysis. This information was compared to similar studies obtained based on the bibliographical review. Results and Conclusions. Results and conclusions are similar to those found in the reference literature: most part of those dead by COVID-19 are of senior age and male gender. Regarding Case Fatality Rate (CFR), it notoriously increases with age. The most vulnerable population displays an average age of ≥ 52.8 years. The less vulnerable population are young persons under 30 years of age, but specifically, those within the age range of 10 and 20 years. Gompertz and Logistic models can mathematically simulate the evolution of deaths and the evolution of CFR according to age

ResumenIntroducción. Este estudio muestra información estadística sobre el COVID-19 en Colombia a la fecha (1 de marzo de 2022). Específicamente, la evolución diaria, mensual y acumulada de contagios y defunciones, correlacionada con la distribución de la población según edad y sexo. Objetivo. Mostrar información estadística sobre COVID-19 que permita ayudar a planificar y diseñar, en futuras Pandemias, estrategias de política de salud pública en Colombia. Metodología. La información diaria desde la declaratoria oficial de Pandemia en Colombia (16 de marzo de 2020) fue obtenida del Instituto Nacional de Salud (INS) y fue organizada en una base de datos para realizar los análisis respectivos. Esta información se comparó con estudios similares obtenidos a partir de revisión bibliográfica. Resultados y conclusiones. Los resultados y conclusiones son similares a los encontrados en la literatura de referencia: la mayor parte de los fallecidos por COVID-19 son de edad avanzada y sexo masculino. En cuanto a la tasa de letalidad (CFR), ésta aumenta notoriamente con la edad. La población más vulnerable presenta una edad promedio ≥ 52.8 años. La población menos vulnerable son los jóvenes menores de 30 años, pero específicamente, los que se encuentran en el rango de edad de 10 y 20 años. Los modelos Gompertz y Logistic pueden simular matemáticamente la evolución de las muertes y la evolución de la CFR según la edad.

Efecto del factor de crecimiento fibroblástico dos (FGF-2), en la reducción de la senescencia en células madre mesenquimales aisladas de gelatina de Wharton / Fibroblastic growth factor two (FGF-2), in reducing the senescent effect on mesenchymal stem cell isolated from Wharton ́s jelly

Resumen Introducción. Las células madre mesenquimales han generado interés en la ingeniería de tejidos, debido a sus propiedades proliferativas y capacidad de reparación de tejidos, sin embargo, para un trasplante exitoso, es necesario aumentar el número de células mediante un cultivo in-vitro. Durante este proceso la capacidad proliferativa disminuye, provocando cambios en la morfología y funcionalidad celular y afectando la viabilidad del cultivo, este estado se conoce como senescencia celular y como posibles causales, se ha considerado el estrés oxidativo y la falta de factores de crecimiento. Objetivos: Evaluar el efecto de FGF-2 sobre la senescencia de un cultivo de células madre mesenquimales aisladas de gelatina de Wharton y su papel en la regulación del estrés oxidativo. Metodología. Se añadieron dosis de 3,5 y 7,5 ng de FGF-2 al cultivo. Durante los pasajes 5 y 7, se estimó tanto la senescencia celular como la presencia de ROS (especies reactivas de oxígeno). Resultados.Se obtuvo en el pasaje 5, una diferencia significativa del 99,5% entre el control (+) con respecto a los tratamientos con FGF-2, sin embargo, en el pasaje 7 se observó un aumento en la producción de la enzima ß-galactosidasa y cambios morfológicos, confirmando un estado senescente en el cultivo en todos los tratamientos evaluados. Conclusión. Las dosis utilizadas en este estudio contribuyeron positivamente a disminuir el proceso senescente en el cultivo celular, además se determinó, que el FGF-2 puede prolongar el tiempo de cultivo, retardando parcialmente la concentración de especies reactivas de oxígeno

AbstractIntroduction. Mesenchymal stem cells have been generated interest in tissue engineering, due to their proliferative properties and tissue repair capacity, however, for a successful transplant process, it is necessary to increase the number of cells in a culture expansion process. During this process the proliferative capacity is limited, causing changes in cell morphology and functionality affecting the viability of the culture, this state is known as cell senescence. Oxidative stress and deregulation of growth factors are considered as reasons. Aims. To evaluate the effect of FGF-2 on the senescence of a mesenchymal stem cells culture isolated from Wharton ́s jelly and its role in the regulation of oxidative stress. Methodology: 3,5 and 7,5 ng doses of FGF-2 were added to the culture medium from passage 2, then the senescence of the culture was evaluated and the presence of reactive oxygen species was determined during passages 5 and 7. Results. We observed that in passage 5, there is a significant difference 99.5% between the control (+) concerning the FGF-2 treatments, however, in passage 7, an increase in the production of the enzyme ß-galactosidase was observed and changes in morphology such as: increase in size and elongated shape of the cell, confirming a senescent state on the culture in all the treatments evaluated. Conclusion. The doses used in this study contributed positively to decrease this process in a cell culture, also, the FGF- 2 can prolong the cultivation time, partially decreasing the concentration of reactive oxygen species

Seropositividad de Brucella abortus en ganado bovino de Aguazul- Casanare / Seropositivity of Brucella abortus in cattle from Aguazul- Casanare

Resumen Introducción. La Brucelosis bovina, es una enfermedad bacteriana e infecto contagiosa, causada por Brucella abortus. Se transmite a través de la ingestión de forrajes y aguas contaminadas con descargas vaginales infectadas, que conlleva a una patología del sistema reproductor en bovinos, que impactan la sanidad pecuaria y la economía de la agroindustria. Objetivo. Evaluar el comportamiento de la brucelosis bovina en el municipio de Aguazul, Casanare (Colombia) y los factores asociados al desarrollo de esta enfermedad. Metodología. Estudio descritptivo de 26.187 muestras de suero sanguíneo de ganado bovino evaluadas, que corresponden a 260 predios del municipio de Aguazul. Se empleó técnicas serológicascomo rosa de bengala, fluorescencia polarizada y ELISA competitiva para la evaluación de positividad a Brucella abortus y se evaluaron las pérdidas económicas asociadas a positividad en los ensayos de laboratorio. Resultados y conclusiones. La positividad a brucelosis bovina correspondió al 1%, que corresponde a hembras menores de 24 meses de edad y entre 37 a 48 meses y, machos entre los 57 a 68 meses de edad. Se sugiere consolidar esfuerzos en investigación para evaluar los factores que contribuyen a la seropositividad en el ganado y el riesgo para la propagación y mantenimiento de la enfermedad.

Abstract Introduction. Bovine brucellosis is a contagious bacterial and infectious disease caused by Brucella abortus. It is transmitted through the ingestion of forage and water contaminatedwith infected vaginal discharges, which leads to a pathology of the reproductive system inbovines, which impacts livestock health and the economy of agribusiness. Aim. To evaluatethe behavior of bovine brucellosis in the municipality of Aguazul, Casanare (Colombia) and the factors associated with the development of this disease. Methodology. Descriptive study of 26,187 bovine blood serum samples evaluated, corresponding to 260 farms in the municipality of Aguazul. Serological techniques such as rose bengal, polarized fluorescence, and competitive ELISA were used to evaluate positivity to Brucella abortus and the economic losses associated with positivity in laboratory tests were evaluated. Results and conclusions. The positivity to bovine brucellosis corresponded to 1%, which corresponds to females under 24 months of age and between 37 to 48 months and males between 57 to 68 months of age. It is suggested to consolidate research efforts to evaluate the factors that contribute to seropositivity in cattle and the risk for the spread and maintenance of the disease

Fisiopatología y alteraciones clínicas de la diabetes mellitus tipo 2: revisión de literatura / Physiopathology and clinical alterations of diabetes mellitus 2: literature review

Resumen La diabetes mellitus tipo 2 constituye una condición clínica debilitante, degenerativa y multifacética de alta prevalencia a nivel mundial. Dada la complejidad de su fisiopatología y las variadas opciones terapéuticas que existen esta enfermedad presenta un desafío para el médico general, se hace imperativo describir comprensiblemente esta patología para mejorar la resolutividad de ésta en atención primaria. Tras una búsqueda bibliográfica exhaustiva de 103 estudios publicados hasta el año 2010, se identificaron los aspectos más importantes tanto de la fisiología, fisiopatología, complicaciones y terapéuticas de esta patología. La resistencia a la insulina (RI) es una condición metabólica central en la etiopatogenia de esta patología donde se logra reconocer de manera clásica tanto la pérdida de la acción periférica de la insulina por parte de los diferentes tejidos, así como defectos en la secreción de insulina conllevando estados de hiperglucemia constantes asociados tanto a complicaciones agudas como crónicas caracterizadas por provocar disfunción y fallo en diferentes órganos. Es de conocimiento general que parte importante de los resultados en el manejo de esta patología se logran con cambios en el estilo de vida que van desde modificaciones en la dieta a cambios en el patrón de actividad física con pérdida de peso corporal. No obstante, existe a su vez una amplia gama de terapias farmacológicas orientadas a controlar estados hiperglucémicos ante la falla de la terapia no farmacológica. Dentro de este mismo contexto varias son las dianas y objetivos terapéuticos en el tratamiento del diabético tipo 2, sin embargo, todas confluyen en el control metabólico de los estados de hiperglucemia y la prevención de sus complicaciones.

Abstract Type 2 diabetes mellitus is a debilitating, degenerative and multifaceted clinical condition with a high prevalence worldwide. Given the complexity of its pathophysiology and the various therapeutic options that exist, this disease presents a challenge for the general practitioner, it is imperative to understand this pathology to improve its resolution in primary care. After an exhaustive bibliographic search of 103 studies published up to 2010, the most important aspects of both the physiology, pathophysiology, complications, and therapeutics of this pathology were identified. Insulin resistance (IR) is a central metabolic condition in the etiopathogenesis of this pathology. Classically it is possible to recognize both the loss of the peripheral action of insulin by the different tissues as well as defects in the secretion of insulin that leads to constant hyperglycemic states associated with both acute and chronic complications characterized by causing dysfunction and failure in different organs. It is generally known that an important part of the results in the management of this pathology are achieved with changes in lifestyle that range from modifications in diet to changes in the pattern of physical activity with loss of body weight. However, there also is a wide range of pharmacological therapies aimed at controlling hyperglycemic states in the event of the failure of non-pharmacological therapy. Within this same context, there are several therapeutic targets and objectives in the treatment of type 2 diabetics, however, they all converge in the metabolic control of hyperglycemic states and the prevention of their complications

Silenciamiento génico en insectos plaga que afectan la industria agrícola usando ARN de interferencia / Gene silencing in pest insects that affect the agricultural industry using interference RNA

Resumen Los insectos plaga, son especies de organismos vivos que en forma constante se encuentran en poblaciones altas, ocasionando daños económicos en los cultivos. Generalmente, suele tratarse de especies puntuales, por lo general, sólo una o dos, que pueden causar gran afectación económica en el sector de la agricultura. En las últimas 3 décadas se ha venido desarrollando el concepto de un proceso biológico, detectado en eucariotas ampliamente, mediante el que se pueden silenciar genes, a partir de ARN de doble cadena (ARNdc). Esta maquinaria se ha investigado para conocer su funcionamiento y buscar potenciales aplicaciones que podrían tener en el campo de la biotecnología. En varios estudios se encontró que el silenciamiento de genes se debe a las interacciones enzimáticas intracelulares citoplasmáticas con moléculas de ARN pequeñas (ARNsi), que actúan sobre el ARN mensajero (ARNm) intracelular, impidiendo que este se traduzca a proteína. Mediante este mecanismo se busca silenciar genes específicos en insectos plaga, que sean esenciales para que el insecto pueda vivir y de esa manera evitar la proliferación de la plaga. Este artículo recopila los estudios realizados acerca del ARN de interferencia, referidos al mecanismo genético de los insectos, como alternativa para su control.

AbstractPest insects are species of living organisms that are constantly found in high populations,causing economic crops damage. Generally, it tends to be specific species, usually onlyone or two, which can cause great economic damage in the agricultural sector. In thelast 3 decades, the concept of a biological process has been developed, widely detected in eukaryotes, by which genes can be silenced, from double-stranded RNA (dsRNA). This machinery has been investigated to understand its operation and to look for potential applications that it could have in the field of biotechnology. In several studies it was found that gene silencing is due to cytoplasmic intracellular enzymatic interactions with small RNA molecules (siRNA), which act on intracellular messenger RNA (mRNA), preventing it from translating a protein. Through this mechanism, the aim is to silence specific genes in pest insects, which are essential for the insect to live and thus prevent the proliferation of the pest. This article compiles the studies carried out on RNA interference, referring to the genetic mechanism of insects, as an alternative for its control.

Individual assistance plan: challenges to the construction of a life project while serving socio-educational measures / Plano individual de atendimento: desafios para construção do projeto de vida na medida socioeducativa

This article seeks to analyze the use of Plano Individual de Atendimento (Individual Assistance Plans) for the construction of the life projects of adolescents serving Medida Socioeducativa (Socio-Educational Measures) in an incarceration facility. Interviews were conducted with ten adolescents between the ages of 15 and 17, who were carrying out an Medida Socioeducativa of male incarceration, and document analysis was performed on their plans. The data were analyzed using thematic content analysis, from the categories "Elaboration of the Individual Assistance Plans", "What the PIA addressed" and "Objective of the Individual Assistance Plans" in the light of Vygotsky's cultural-historical psychology. The interviews and plans analyzed did not present sufficient information to identify the construction of the life project. The use of Individual Assistance Plans in socio-educational measures, allowing it to accomplish its planning and socio-educational function, remains challenging.

Este artigo tem como objetivo analisar a utilização do Plano Individual de Atendimento em uma unidade de medida socioeducativa de internação para construção do projeto de vida. Foram realizadas entrevistas individuais com dez adolescentes, com idades entre 15 e 17 anos em cumprimento de medida socioeducativa, em uma unidade de internação masculina, e uma pesquisa documental com os planos desses adolescentes. Os dados foram analisados com a Análise Temática de Conteúdo a partir das categorias Elaboração do Plano Individual de Atendimento. O que o Plano Individual de Atendimento abordou e Objetivo do Plano Individual de Atendimento à luz da perspectiva da Psicologia Histórico-Cultural de Vigotski. As entrevistas e planos analisados não apresentaram informações suficientes para identificação da construção do projeto de vida. A utilização do Plano Individual de Atendimento ainda é um desafio na medida socioeducativa, para que esta possa cumprir sua função de planejamento e assumir uma função socioeducativa.

Delays in HIV-1 infant polymerase chain reaction testing may leave children without confirmed diagnoses in the Western Cape province, South Africa

Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa.Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing.Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017­2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns.Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing.Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged.

Loss of an eye to mucormycosis following corticosteroid therapy for COVID-19

Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.

COVID-19 inductor del síndrome visual informático y sus afectaciones a las personas / COVID-19 inducer of computer visual syndrome and its effects on people

El objetivo de este artículo es analizar la literatura existente sobre el SVI y sus afectaciones a las personas producto por alta exposición a equipos electrónicos generados por la pandemia del COVID-19 El tipo de investigación es revisión de literatura, de diseño bibliográfico o documental; el método de investigación empleado fue el de revisión de literatura. La población estuvo constituida por 35 artículos y la muestra de 19 artículos en diversos idiomas, seleccionados de manera intencional de acuerdo a criterios de inclusión y exclusión previamente establecidos; las técnicas e instrumentos empleados para el recojo de información fueron el análisis documental, y el fichaje y la computadora respectivamente. Entre los principales resultados se tiene que el SVI tiene gran prevalencia en personas que tienen gran periodo de exposición a pantallas de dispositivos electrónicos, asimismo, vinculados a fallas en las condiciones ergonómicas en sus estaciones de trabajo o estudio. Se concluye, el promedio de prevalencia del SVI en los artículos revisados es de 73.2%, siendo el máximo 98.7% y el mínimo 50%, siendo más frecuente en mujeres; respecto a los síntomas más frecuente que se presentan se tienen: dolor en ojos, cansancio visual o visión borrosa, picazón, sequedad en los ojos, sensación de empeoramiento de la vista, lagrimeo y párpados pesados(AU)

The objective of this article is to analyze the existing literature on IVS and its effects on people as a result of high exposure to electronic equipment generated by the COVID-19 pandemic. The type of research is literature review, bibliographic or documentary design; the research method used was the literature review. The population consisted of 35 articles and the sample of 19 articles in various languages, intentionally selected according to previously established inclusion and exclusion criteria; the techniques and instruments used for the collection of information were the documentary analysis, and the signing and the computer respectively. Among the main results is that SVI has a high prevalence in people who have a long period of exposure to electronic device screens, also linked to failures in ergonomic conditions in their workstations or study. It is concluded that the average prevalence of SVI in the reviewed articles is 73.2%, the maximum being 98.7% and the minimum 50%, being more frequent in women; Regarding the most frequent symptoms that appear, there are: pain in the eyes, visual fatigue or blurred vision, itching, dry eyes, sensation of worsening of sight, tearing and heavy eyelids(AU)

Cardiopulmonary Resuscitation in Prone Position

Abstract Mechanical ventilation in prone position is an alternative strategy for patients with acute respiratory discomfort syndrome (ARDS) to improve oxygenation in situations when traditional ventilation modalities have failed. However, due to the significant increase in ARDS cases during the SARS-CoV-2 pandemic and the experimental therapeutic use of potentially arrhythmogenic drugs, cardiopulmonary resuscitation in this unusual position could be needed. Therefore, we will review the available scientific evidence of cardiopulmonary resuscitation in prone position.

Conocimientos, actitudes y prácticas de niñas y niños sobre educación sexual integral en ocho municipios de Colombia / Knowledge, attitudes and practices of girls and boys on comprehensive sexual education in eight municipalities of Colombia

Resumen Introducción: La educación integral para la sexualidad permite dotar a niñas/os y adolescentes de conocimientos basados en datos empíricos, habilidades, actitudes y valores que fortalecen sus procesos de empoderamiento para disfrutar del derecho a la salud, el bienestar y la dignidad humana; además, les permite comprender cómo proteger y velar por la garantía de sus derechos a lo largo de su vida. Objetivo: Describir los conocimientos, actitudes y prácticas en educación sexual integral de 6 645 niñas y niños escolarizados en ocho municipios priorizados de Colombia. Metodología: Ocho municipios fueron seleccionados según indicadores socio-demográficos, embarazo adolescente y violencia de género. Los criterios de inclusión fueron definidos: niñas/os escolarizados de entre nueve y 11 años de edad y con residencia habitual en el municipio. Una encuesta de Conocimientos, Actitudes y Prácticas fue diseñada, validada y aplicada para recolectar datos de 5 600 hogares, 50 instituciones educativas y 6 645 niñas/ os. Se realizó un análisis descriptivo de la muestra, profundizando en los datos obtenidos del cuestionario aplicado a niñas/os. Resultados: Se encontraron altos porcentajes de desacuerdo de violencia directa contra la mujer y validación de formas sutiles de violencia en las niñas/os. Los niños reciben más castigos físicos que las niñas. El término sexualidad es desconocido por la mayoría de niñas y niños, quienes creen conocerlo lo dialogan principalmente con su mamá y más del 20 % no lo hablan con nadie. Las niñas y niños participantes están iniciando relaciones sexuales a edades tempranas sin previa educación en sexualidad. Conclusiones: Las niñas y niños interiorizan y reafirman roles tradicionales de género y tienen percepciones erradas sobre la sexualidad, por lo cual, es necesario profundizar en el significado de sexualidad y sobre la violencia basada en género. Esto con el fin de desarrollar capacidades en la toma de decisiones, que influyan positivamente en sus proyectos de vida.

Abstract Introduction: Comprehensive sexuality education enables children and adolescents to be provided with knowledge based on empirical data, skills, attitudes, and values that strengthen their empowerment processes to enjoy their right to health, well-being, and human dignity. Additionally, it allows them to understand how to protect and guarantee their rights throughout their lives. Objective: To describe the knowledge, attitudes, and practices in comprehensive sexuality education of 6,645 school age children enrolled in eight prioritized municipalities in Colombia. Methods: Eight municipalities were selected according to its sociodemographic characteristics, and indicators of teenage pregnancy and gender-based violence. The inclusion criteria were: children going to school between nine and eleven years old and habitually residing in the municipality. A Knowledge, Attitudes and Practices survey was designed, validated and applied to 5,600 families, 50 schools and 6,645 children. A descriptive analysis of the sample obtained was carried out, delving into the data obtained from the children's survey. Results: High percentages of disagreement regarding direct violence against women were found in children's responses, as well as validation of subtle forms of violence. Boys received more physical punishment than girls. The term sexuality is unknown by the majority of surveyed boys and girls, those who believe to understand it have discussed it mainly with their mothers and more than 20% have not spoken about it with anyone. The participating boys and girls are initiating sexual relations at an early age without prior sexuality education. Conclusions: Girls and boys internalize and reaffirm traditional gender roles and have wrong perceptions about sexuality. That is why, to develop with them decision-making skills that will have positively influence in their life projects it is necessary to deepen the meaning of sexuality and gender-based violence.