Sobre la hepatitis aguda grave de etiología desconocida: la situación en México / About severe acute hepatitis of unknown etiology: the situation in Mexico

Introducción: en México, las hepatitis virales son de notificación epidemiológica obligatoria, pero no existe un sistema especial de vigilancia. La información disponible se limita a la distribución por edad y sexo. Ante la alerta de casos de hepatitis aguda grave de etiología desconocida, en la Unión Europea el Consejo Nacional de Vigilancia Epidemiológica (CONAVE) alertó al Sistema Nacional de Salud (SNS) para la atención y vigilancia de estos casos. Desarrollo: la hipótesis más convincente sobre la etiología está relacionada con una respuesta inmunitaria exacerbada que es mediada por superantígenos relacionados con la proteína espiga del SARS-CoV-2, activados por una infección por adenovirus que desencadena una respuesta de linfocitos T que provoca apoptosis de hepatocitos. Con base en la presentación clínica (niños menores de 16 años, con diarrea, dolor abdominal, ictericia, vómito e hipertransaminasemia) se han diseñado definiciones operacionales para su identificación y notificación al Sistema Nacional de Vigilancia Epidemiológica (SINAVE). Hasta junio del 2022, se han identificado 56 casos en México. Conclusiones: este brote de hepatitis representa un reto para el SINAVE. Es necesario incluir la identificación de adenovirus en el algoritmo diagnóstico de enfermedad respiratoria viral, implementar un sistema especial de vigilancia epidemiológica de hepatitis virales y sensibilizar a los profesionales sanitarios en el tema.

Introduction: In Mexico viral hepatitis requires mandatory epidemiological notification, but there is no special surveillance system. Available information is limited to distribution of cases by age and sex. Given the alert of cases of severe acute hepatitis of unknown etiology in the European Union, the National Council for Epidemiological Surveillance (Consejo Nacional de Vigilancia Epidemiológica) alerted the entire National Health System to care for and monitor these cases in Mexico. Development: The most convincing hypothesis is an exacerbated immune response mediated by superantigens related to the spike protein of SARS-CoV-2, activated by adenovirus infection that ends in a response of T lymphocytes that causes apoptosis of hepatocytes. Based on clinical presentation (children under 16 years of age, with diarrhoea, abdominal pain, jaundice, vomiting and increase in transaminases) the operational case definitions have been designed for their timely identification and notification to the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica). Until June 2022, 56 cases have been identified in Mexico. Conclusions: This hepatitis outbreak represents a challenge for the National System of Epidemiological Surveillance. It is necessary to include the identification of adenovirus in the diagnostic algorithm for viral respiratory disease, to implement a special epidemiological surveillance system for viral hepatitis, and to sensitize health professionals on this subject.

Cisplatin-induced azoospermia and testicular damage ameliorated by adipose-derived mesenchymal stem cells

BACKGROUND: The testes are highly susceptible to the adverse effects of chemotherapy and radiation at all stages of life. Exposure to these threats mainly occurs during cancer treatment and as an occupational hazard in radiation centers. The present study investigated the regenerative ability of adipose-derived mesenchymal stem cells (ADMSCs) against the adverse effects of cisplatin on the structure and function of the testes. METHODS: New Zealand white rabbits (N = 15) were divided into three groups of five: a negative control group (no treatment), a cisplatin group (single dose of cisplatin into each testis followed three days later by a PBS injection), and a cisplatin + ADMSCs group (cisplatin injection followed three days later by an ADMSC injection). On day 45 post-treatment, serum testosterone levels were evaluated, and the testes and epididymis were collected for histology, oxidative stress examination, and epididymal sperm analysis. RESULTS: Cisplatin caused damage to the testicular tissue and decreased serum testosterone levels, epididymal sperm counts, and oxidants. An antioxidant imbalance was detected due to increasing malondialdehyde (MDA) and reduced glutathione (GSH) levels in testicular tissue. The ADMSC-treated group displayed a moderate epididymal sperm count, adequate antioxidant protection, suitable hormone levels, and enhanced testicular tissue morphology. CONCLUSIONS: ADMSCs treatment repaired damaged testicular tissue, enhanced biochemical parameters, and modified pathological changes caused by cisplatin.

Synchronous Endometrioid Endometrial and Serous Ovarian Carcinoma: A double gynecologic jeopardy / Philippine Journal of Obstetrics and Gynecology

@#Synchronous malignant tumors are two primary tumors diagnosed at the same time during surgery. A postmenopausal, nulligravid, presented with vaginal bleeding. Ultrasound revealed an endometrial and right ovarian mass, both with nonbenign features. Cancer Antigen 125 and Human Epididymis Protein 4 were elevated. She underwent extrafascial hysterectomy with bilateral salpingo-oophorectomy with the frozen section of the endometrium and right ovary, followed by complete surgical staging. Histopathology report was endometrioid endometrial carcinoma and high-grade serous ovarian carcinoma. The endometrial and ovarian tissues tested positive for vimentin and Wilm's Tumor 1 (WT1), respectively, suggesting both are primary independent tumors. The pelvic lymph nodes and recto-sigmoid lymph nodes tested positive for vimentin and negative for WT1, suggesting endometrial tumor metastasis. The final diagnosis is synchronous endometrioid endometrial carcinoma Stage IIIC1 and high-grade serous ovarian carcinoma Stage IA, right ovary.

Catalizando cambios sociales y bioculturales sobre el cáncer. Diseño de acciones transdisciplinarias contra la pandemia / Catalyzing biocultural and social changes about cancer. Design of transdisciplinary actions against the pandemic

RESUMEN Objetivo Diseñar y analizar una experiencia de formación y organización transdisciplinaria sobre el cáncer, en la que expertos de múltiples disciplinas y actores con diferentes horizontes convergen en un diagnóstico y un panorama de intervención en múltiples escalas. Método Se diseñó e implementó un diplomado de 140 horas con más de 60 ponentes y 50 actores relevantes en torno al cáncer. Se llevó a cabo un taller transversal de 20 horas, usando como mediación las metodologías del diseño para la transición, que proponen estrategias para la construcción de diagnósticos e intervenciones en problemáticas complejas y conflictivas. Resultados Se logró construir un mapa de actores, preocupaciones, conflictos, causas-raíces, escenarios ideales y modelos potenciales de intervención con base en un trabajo colegiado. Se generaron recursos visuales que funcionan como mapas y estructuras donde se ubican los factores bioculturales que facilitan o impiden la efectiva implementación de estrategias de intervención. Las infografías y tablas funcionaron como mediaciones transdisciplinarias en tanto que posibilitaron que el espacio político (múltiples actores) fuera también un espacio pedagógico (múltiples epistemologías) situado en un contexto económico y ecológico concreto (interdependencia material de actores y ambientes). Conclusión Con la metodología del diseño para la transición se logró catalizar un trabajo transdisciplinario entre expertos y actores sociales en torno al cáncer. A través de las mediaciones visuales como mapas, infografías y tablas, se logró sintetizar y usar un diagnóstico compartido y avanzar así en intervenciones más incluyentes que reconozcan la complejidad biocultural de esta pandemia.(AU)

ABSTRACT Objective Design and analyze a transdisciplinary training and organization experience on cancer, where experts from multiple disciplines and actors with different horizons converge on a diagnosis and intervention horizon on multiple scales. Method A 140-hour diploma course with more than 60 speakers and 50 relevant actors around cancer was designed and implemented. A 20-hour transversal workshop was developed, using the Design for Transition methods as mediation of collaborative strategies for the construction of diagnoses and interventions in complex and conflict situations. Results It was possible to build a series of maps with a common view of stakeholders, concerns, conflicts, root causes, ideal scenarios and potential models of intervention, based on diverse participant's input. The visual resources generated were able to function as guides and structures that made possible the identification of biocultural factors that facilitate or impede implementation of strategies and interventions. Infographic material functioned as transdisciplinary mediations that enabled a diverse political (multiple-actors) and pedagogical (multiple-epistemologies) space to act upon an economic and ecological context (material interdependence of actors and environments). Conclusion The Design for Transition methodology catalized transdisciplinary work by enabling cancer experts and social actors interactions. Through visual mediations such as maps, infographics and tables, it was possible to synthesize and use a shared diagnosis and thus advance towards more inclusive interventions that recognize the biocultural complexity of this pandemic.(AU)

Aging, Resilience and Vulnerability of Selected Faculty and Staff (55 years old and above) in an Academic Community in the Philippines

Introduction@#A demographic shift towards population aging is evident worldwide. This presents challenges particularly to low-income and middle-income countries like the Philippines. Understanding perceptions of aging, resilience, vulnerability, and gender identity will help prepare the health care system and social services in addressing the needs of the Filipino older population. @*Objective@#To describe gender identity, perceptions of active aging, successful aging, resilience, and vulnerability among faculty and staff (working, retired) in an academic community in the Philippines.@*Methods@#Survey and focus group discussions were conducted among working and retired faculty and staff aged 55 years old and above. @*Results, Analysis, and Discussion@#Almost all respondents had the same gender identity as their biological sex. There were differences in the respondents’ perceptions of active aging and successful aging and in their sources of strength and worries. Compared with retired respondents more working respondents believed that active aging meant being strong and physically active or being involved in sports. Female respondents thought that being socially active in their community and church was indicative of active aging. In contrast, male respondents equated being physically healthy with active aging. More working respondents and females (than retired and male respondents) thought that successful aging meant participating in community-based activities. In terms of vulnerability, differences were noted in the respondents’ sources of strength and worries. In general, retired respondents and female respondents said they got their strength from their grandchildren and from their religion. In contrast, working respondents and male respondents relied on their families for strength. It was also noteworthy that more retired respondents did not have any old agerelated worries compared with working respondents. Female respondents worried about their families while male respondents worried about death. Subjective nuances of being an older working or a retired employee in an academic community surfaced in the FGDs. The importance of context was evident in shaping the informants’ perceptions of active aging and frailty, and in their sources of worries and happiness. Overall, this paper adds to the body of knowledge about aging in the Philippines by studying a group of older Filipinos in an academic community. It showed that particular aspects of Filipino culture such as gender roles, religion, and close family ties permeate one’s life until he or she reaches old age. The results can help academic communities in policy formulation and program development to ensure that their older employees — throughout their life course — can adequately address vulnerability and resiliency needs to achieve active and successful aging.

What do non-ophthalmic health professionals know about retinoblastoma: a survey in Saudi Arabia

Background: The aim of the study is to estimate the level of knowledge about retinoblastoma (Rb) and its determinants among non-ophthalmic health professionals of Qassim region of Saudi Arabia.Methods: This cross-sectional survey was held in 2016 in primary health centres (PHC) and general hospitals in the study area. In addition to demography like age, gender, education, place of work, participants replied to five questions related to Rb with close-ended questions to respond. They were matched to the expert group's answers to estimate the level of knowledge.Results: One hundred and fifty-two non-ophthalmic doctors participated in the survey. The excellent grade of knowledge of Rb was in 66 [43.3% (95% confidence interval 35.5-51.3)] of participants. Very poor level of knowledge was noted in 13 [8.6% (95% CI 4.1-13.0)] participants. Male gender (P = 0.02) and physician category (P = 0.02) were significantly associated with the excellent grade of Rb related knowledge. The participant’s response by type of questions varied significantly (P<0.001).Conclusions: More than half of the non-ophthalmic health professionals had less than desired knowledge about Rb. Health education about Rb to health professionals could be gender sensitive and based on the type of profession. Increasing the awareness about retinoblastoma among non-ophthalmic health professional is important.

Prevención de hemorragias en el posoperatorio temprano de cirugía bariátrica: Papel de la vitamina K / Prevention of hemorrhage in the early postoperative period of bariatric surgery: Role of vitamin K

Introducción: la cirugía bariátrica es el tratamiento más eficaz para la obesidad mórbida. La hemorragia se presenta en el 0,5-5% de las pacientes. La preparación prequirúrgica con dieta líquida y el uso de antibióticos para Helicobacter pylori podría alterar el metabolismo de la vitamina K y asociarse a hemorragia. Objetivo: describir el comportamiento de la concentración de protrombina (basal = B-PT y prequirúrgica = preQ-PT) en estos pacientes. Material y métodos: se realizó un estudio de cohorte prospectivo donde se comparó la concentración de B-PT (15-180 días previos a la cirugía) y la preQ-PT (24 horas previas a la cirugía). Resultados: se incluyeron 194 pacientes, de los cuales el 72% (n = 139) fueron mujeres, de entre 19 y 69 años, con BMI (IMC) 45 (33 a 58) y pérdida de peso prequirúrgica del 7% (-2 a 17). El promedio de B-PT fue 91,9% (DE 9,529), el promedio de la preQ-PT fue 81,1% (DE 10,760); descendió un 10,8% (p < 0,001). No hubo diferencias significativas cuando se comparó el comportamiento en la preQ-PT entre los diferentes subgrupos (uso de antibióticos para Helicobacter pylori, de acuerdo con la pérdida de peso y en relación con la suplementación de vitamina K); sin embargo, siempre se detectó descenso de la preQ-PT. No hubo ninguna complicación hemorrágica (necesidad de transfusiones o reoperación); tampoco hubo muerte por hemorragias ni eventos tromboembólicos. Conclusión: realizar dosaje de protrombina 24 horas antes de la cirugía bariátrica permite detectar alteraciones iatrogénicas de la coagulación inducidas por la dieta y el uso de antibióticos.

Background: bariatric surgery is the most efficient treatment for morbid obesity. Bleeding occurs in 0.5-5% of patients. Pre-surgical preparation with liquid diet and the use of antibiotics for Helicobacter pylori could alter the metabolism of vitamin K and be associated with hemorrhage. Objective: to describe the behavior of the concentration of Prothrombin (basal = B-PT and pre-surgical = preQ-PT) in these patients. Material and methods: a prospective cohort study comparing B-PT concentration (15-180 days prior to surgery) and preQ-PT (24 h prior to surgery) was performed. Results: a total of 194 patients were included in the study, with 72% (n = 139) women aged 19-69 years, BMI 45 (33 to 58) and preoperative weight loss of 7% (-2 to 17). The media B-PT was 91.9% (SD 9.529), the media pre-PT was 81.1% (SD 10.760); declined 10.8% (p <0.001). There was no significant difference when comparing the behavior in the preQ-PT among different subgroups (use of antibiotics for Helicobacter pylori, according to weight loss and in relation to vitamin K supplementation), however, there was always a decrease of the preQ-PT. There were no bleeding complications (need for transfusions or re-intervetion), nor was there death for bleeding or thromboembolic events. Conclusion: prothrombin measurement 24 hours before bariatric surgery allows the detection of iatrogenic coagulation alterations induced by diet and the use of antibiotics.

Challenges in research and management of hepatitis E virus infection in Cuba, Mexico, and Uruguay / Retos en la investigación y el tratamiento de la infección por el virus de la hepatitis E en Cuba, México y Uruguay / Desafios em pesquisa e tratamento da infecção pelo vírus da hepatite E em Cuba, ­México e ­Uruguai

ABSTRACT The symposium "Epidemiology of Hepatitis E virus (HEV) Infection and Associated Immune Response" was held at the Universidad de Guadalajara, Mexico, on 14 June 2017, to define the status of research on HEV infection in three countries in Latin America and the Caribbean (LAC)—Cuba, Mexico, and Uruguay—compared to the situation in Germany. Scientists identified specific research gaps in understanding HEV transmission and the resulting impact on development of disease in the three abovementioned LAC countries. Specific recommendations for implementing standardized serologic and molecular diagnostic methods and epidemiologic, basic, and applied research aimed to develop prevention and handling strategies for this infection, along with the associated comorbidities in the three LAC countries, were also discussed. Given similar demographic, sanitary, and economic conditions in other LAC countries that could predispose them to be at high risk for HEV transmission and infection, these research gaps and recommendations might apply to the entire LAC region. This report was ­prepared by meeting participants based on 1) symposium presentations, 2) literature reviews, and 3) group discussions.

RESUMEN El 14 de junio del 2017 se realizó en la Universidad de Guadalajara (México) un simposio sobre las características epidemiológicas de la infección por el virus de la hepatitis E (VHE) y la respuesta inmunitaria asociada. El objetivo fue definir el estado de las investigaciones sobre la infección por el VHE en tres países de América Latina y el Caribe —Cuba, México y Uruguay— en comparación con la situación en Alemania. Los científicos señalaron que para comprender la transmisión del VHE y la consiguiente repercusión en el avance de la infección en estos tres países latinoamericanos aún faltan investigaciones sobre ciertos temas específicos. También analizaron recomendaciones concretas para poner en práctica métodos estandarizados de diagnóstico serológico y molecular, y realizar investigaciones epidemiológicas, básicas y aplicadas a fin de elaborar estrategias de prevención y tratamiento de esta infección y las comorbilidades asociadas en los tres países antes mencionados. Considerando que otros países de América Latina y el Caribe presentan condiciones demográficas, sanitarias y económicas similares que podrían implicar una predisposición a un riesgo alto de transmisión del VHE y de infección por este virus, este análisis sobre las brechas y recomendaciones en el ámbito de la investigación podría aplicarse en toda la subregión. El presente informe fue elaborado por los participantes del simposio sobre la base de: 1) presentaciones del simposio; 2) revisiones bibliográficas; y 3) debates en grupos.

RESUMO O simpósio Epidemiologia da infecção pelo vírus da hepatite E (HEV) e ­resposta imune associada foi realizado na Universidade de Guadalajara, no México, em 14 de junho de 2017, para determinar a situação da pesquisa em HEV em três países da América Latina e Caribe (ALC) - Cuba, México e Uruguai - em comparação à Alemanha. Os especialistas identificaram lacunas específicas nas pesquisas no que se refere ao entendimento da transmissão do HEV e ao impacto resultante do surgimento da doença nos três países da ALC mencionados. Também foram debatidas recomendações aos três países da ALC, especificamente implementar métodos sorológicos e moleculares padronizados de diagnóstico e realizar pesquisa epidemiológica, básica e aplicada visando elaborar estratégias de prevenção e de enfrentamento da infecção e das comorbidades associadas. Diante da semelhança das condições demográficas, econômicas e de saúde que poderia predispor outros países da ALC a um maior risco de transmissão e infecção de HEV, as lacunas em pesquisa e recomendações provavelmente se aplicam à toda a Região da ALC. Este relatório foi preparado pelos participantes do encontro embasado nas apresentações do simpósio, revisão da literatura científica e discussões em grupo.

High Prevalence of ITPA Alleles Associated with Ribavirin-Induced Hemolytic Anemia Among Mexican Population

ABSTRACT Background. The prevalence of two functional polymorphisms (rs1127354 and rs7270101) of the inosine triphosphatase (ITPA) gene associated with ribavirin-induced hemolytic anemia (RIHA) during antiviral therapy for hepatitis C virus (HCV) infection varies by ethnicity. In Mexico, the distribution of these polymorphisms among Native Amerindians (NA) and admixed population (Mestizos) is unknown. This study aimed to determine the prevalence of the ITPA polymorphisms among healthy NA and Mestizos, as well as in HCV patients from West Mexico. Material and methods. In a cross-sectional study, 600 unrelated subjects (322 Mestizos, 100 NA, and 178 treatment-naïve, HCV-infected Mestizos patients) were enrolled. A medical history was registered. ITPA genotype was determined by Real-Time PCR. Fst-values and genetic relatedness between study and reference populations were assessed. Results. The frequency of the risk genotypes rs1127354CC and rs7270101AA was higher among NA (98-100%) than in Mestizos (87-92.9%), (p < 0.05). The NA presented the highest prevalence of the rs1127354CC genotype reported worldwide. The Fst-values revealed a genetic relatedness among Mexican NA, South Americans and African populations (p > 0.05). The frequency of the predicted risk for RIHA was higher among NA (98%) than in Mestizos (80.5%) and HCV-infected patients (81.5%) (p < 0 .01). The CC/AA alleles were associated with lower values of total bilirubin, aspartate/alanine aminotransferases, and aspartate-to-platelet-ratio-index score among HCV-patients. Conclusion. A high prevalence of the ITPA polymorphisms associated with RIHA was found in Mexican NA. These polymorphisms could be a useful tool for evaluating potential adverse effects and the risk or benefit of antiviral therapy in Mexicans and other admixed populations.

Morphological and Radiological Studies on the Skull of the Nile Crocodile (Crocodylus Niloticus).

Background and Aim: Present study provides with more anatomical information on the structure and form of the bones forming the cranium of the Nile crocodile helps in understanding the interpretation of X ray images and surgical affection of the crocodile heads. Materials and Methods: The present study was conducted on six heads of the Nile crocodile (Crocodylus niloticus). The heads were removed from their bodies and prepared by hot water maceration technique. The bones of the skull were studied separately and identified by using a specific acrylic color for each bone. Results: The cranium of the crocodile composed of the cranial bones and the facial bones. The crocodile had four paired paranasal sinuses; the antorbital, the vomerine bullar, the pterygopalatine bullar and the pterygoid sinuses. The mandible of crocodile formed from six fused bones (articular, angular, suprangular, coronoid, splenial and dentary). The X ray images were applied for identifying the paranasal sinuses which their contribution to the morphological organization of the head. Conclusion: this results show a bony variation between the crocodile, mammals and also the birds that paves the way to the comparative anatomical and radiological studies.

In Situ hybridization and light and electron microscopes of cervical squamous cell carcinoma infected with human Papillomavirus

Aim of the work-In Egypt cervical carcinoma is ranked as a number 6 of all malignant tumors. There is growing evidence that the human papillomavirus [HPV] is associated with the development of cervical cancer

Patients and Methods-The present study hunted HPV in Egyptian biopsies of cervical cancer by using in situ hybridization [ISH] technique .Light microscopy and ultra-structural features accompanied by squamous cell carcinoma [SCC] of the cervix were monitored

Results-The ultra structural study revealed viral particles in some epithelial cell nuclei and cytoplasm in the moderately-differentiated squamous cell carcinoma. These were suggested to be Herpes Simplex Virus [HSV]

Conclusion-The potential relation between HPV and HSV in the incidence of Cervical Squamous Cell Carcinoma is discussed

High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

Studies on the prevalence of infection with hepatitis B virus (HBV) among children are scarce in Latin American countries, especially in Mexico. This study was aimed to investigate the prevalence of HBV infection, occult hepatitis B infection (OBI) and HBV genotypes among children with clinical hepatitis. In total, 215 children with clinical hepatitis were evaluated for HBV infection. HBV serological markers and HBV DNA were analysed. OBI diagnosis and HBV genotyping was performed. HBV infection was found in 11.2% of children with clinical hepatitis. Among these HBV DNA positive-infected children, OBI was identified in 87.5% (n = 21/24) of the cases and 12.5% (n = 3/24) were positive for both HBV DNA and hepatitis B surface antigen. OBI was more frequent among children who had not been vaccinated against hepatitis B (p < 0.05) than in those who had been vaccinated. HBV genotype H was prevalent in 71% of the children followed by genotype G (8%) and genotype A (4%). In conclusion, OBI is common among Mexican children with clinical hepatitis and is associated with HBV genotype H. The results show the importance of the molecular diagnosis of HBV infection in Mexican paediatric patients with clinical hepatitis and emphasise the necessity of reinforcing hepatitis B vaccination in children.

Conocimientos, actitudes y prácticas sobre los exámenes utilizados en la detección temprana del cáncer de próstata en hombres de dos comunas de Medellín / Knowledge, attitudes and practices about the exams applied in the early prostate cancer screening among men in two suburbs in Medellín

OBJETIVO: identificar los conocimientos, actitudes y prácticas acerca de los exámenes utilizados en la detección temprana del cáncer de próstata en hombres de dos comunas de Medellín. METODOLOGÍA: estudio de corte transversal realizado mediante muestreo probabilístico estratificado. Se aplicó una encuesta dirigida de 38 preguntas. En el análisis descriptivo se utilizaron porcentajes; en el bivariado se calculó la razón de prevalencias y el intervalo de confianza al 95%, con un valor de significancia de p < 0,05. RESULTADOS: se realizaron 83 encuestas en 14 clubes de vida de las comunas dos y cuatro de Medellín. El 68,7% de los participantes presentaron conocimientos adecuados; el 43,4%, actitudes adecuadas; y el 38,6%, prácticas adecuadas. Se observó que la posibilidad de que los hombres tuvieran actitudes adecuadas con conocimientos adecuados fue de 1,9 veces (IC 95% = 1,4-2,7) que en los hombres con conocimientos inadecuados. Además, la posibilidad de que los hombres presentaran prácticas adecuadas con actitudes adecuadas fue de 0,8 veces (IC 95% = 1,2-2,7) más que en los hombres con actitudes inadecuadas. DISCUSIÓN: es necesario fortalecer las intervenciones en prevención del cáncer de próstata en los hombres más pobres y vulnerables, los cuales presentan menos posibilidad de contar con conocimientos, actitudes y prácticas adecuadas.

OBJECTIVE: to identify the knowledge, attitudes, and practices associated with the exams used for early prostate cancer screening among men living in two suburbs in Medellín. METHODOLOGY: a cross-sectional study conducted using a stratified probability sampling and a guided survey with 38 questions. Percentages were used for the descriptive analysis. Likewise, the prevalence ratio and the confidence interval at 95% with a significance value of p < 0.05 were calculated in the bivariate analysis. RESULTS: eighty-three surveys were conducted in 14 life clubs (social organizations of elderly people) in suburbs 2 and 4 of Medellín. The results showed that 68.7% of participants had adequate knowledge, 43.4% an appropriate attitude, and 38.6% adequate practices. It was observed that men with the adequate knowledge were10.9 times (IC 95% = 1.4-2.7) likely to also have an adequate attitude compared to those with inadequate knowledge. Similarly, men with adequate attitude were 0.8 times (IC 95% = 1.2-2.7) more likely to also have adequate practices compared to men with an inadequate attitude. DISCUSSION: It is necessary to strengthen the interventions aiming to prevent prostate cancer among the poorest and most vulnerable men, since they are less likely to have adequate knowledge, attitude, and practices.

Epidemiología de las hepatitis virales en México / Epidemiology of viral hepatitis in Mexico

Las hepatitis virales son una de las causas principales de daño hepático en México. En este estudio se analiza el estado actual de las hepatitis virales en México. La Secretaría de Salud informa un total de 192 588 casos de hepatitis virales entre 2000 y 2007. De éstos, 79 por ciento corresponden aVHA, 3.3 por ciento aVHB, 6 por ciento a VHC y 11.7 por ciento a casos sin agente etiológico descrito. No obstante, el VHB se podría estar subdiagnosticando, ya que hay zonas de alta endemia en poblaciones indígenas, existen limitaciones en la sensibilidad y especificidad de las pruebas inmunológicas y podría ser común la hepatitis B oculta. ElVHE podría ser uno de los agentes etiológicos de aquellos casos que carecen de un agente etiológico conocido. Se proponen estrategias específicas para el control de las hepatitis virales tendientes a disminuir el número de casos.

The main etiology of liver disease in Mexico is alcohol and viral hepatitis. The aim of the present study was to analyze the current epidemiology of viral hepatitis in Mexico. From 2000 to 2007 the Ministry of Health reported 192 588 cases of hepatitis, 79 percent HAV, 3.3 percent HBV, 6 percent HCV, and 12 percent without a specific etiologic factor. Due to high endemic areas for HBV infection in native Mexican population, limitations in the diagnostic sensitivity and specificity of the serological immunoassays used to date and presence of occult hepatitis B in the country, the real prevalence of HBV infection could be even higher than HCV in Mexico. Hepatitis E virus in cirrhotic patients and in porcine farms could at least partially explain the cases of hepatitis that are diagnosed without a specific etiologic agent. Specific strategies to establish control regulations against viral hepatitis infections in Mexico are proposed.

Proyecto institucional para la educación médica continua en investigación clínica / Continuing medical education: A clinical research institutional project

En la Argentina, educar en investigación clínica consiste principalmente en cursos teóricos. En países desarrollados existen programas que generan el entorno propicio para un aprendizaje práctico y continuo. En el 2006, en el Servicio de Clínica Médica del Hospital Italiano de Buenos Aires se creó el Área de Investigación en Medicina Interna para formar profesionales capaces de participar en todas las etapas de la investigación clínica. El propósito de este estudio es describir el área y su impacto en la educación en investigación en medicina interna durante el período 2006-2008. El proyecto cuenta con un programa de capacitación en investigación clínica para residentes y otro de perfeccionamiento para becarios. Además de becas, asesoramiento en proyectos, ateneos sobre investigación clínica y registros de enfermedades prevalentes en medicina interna. Participan el 33% (6/18) de los clínicos de internación, se encuentran en formación 3 becarios y 7 monitores de investigación. 25 residentes pasaron por el programa de capacitación, completaron una propuesta de investigación 19 (76%). Se hicieron 59 presentaciones en congresos. Se encuentran en proceso de publicación 6 artículos originales y 2 en revisión por comités editoriales. De un cuestionario de evaluación del área, el 76% (35/46) considera que ha adquirido nuevas habilidades, y 93% (44/47) refiere que las utiliza en la práctica diaria. El 100% (47/47) considera que ha recibido orientación adecuada. El 97% (45/46) considera que sus ideas han sido respetadas. La implementación del área de investigación logró aumentar la capacitación y producción científica en investigación clínica independiente.

In Argentina, education in clinical investigation is based on courses with theoric content. In developed countries programs with ongoing and practical content exist, generating the proper context to learn. In 2006, the Hospital Italiano de Buenos Aires (HIBA) created an area to train physicians, Research Area in Internal Medicine, and enable them to participate in every step of the clinical investigation process. The objective of this study is to describe this teaching area and its impact on the investigation in Internal Medicine in the HIBA, in the period 2006-2008. This area counts with fellow positions and provides training in Clinical Investigation for rotating residents. It has different activities including lectures, project counseling and 3 ongoing Institutional Registers for prevalent medical problems, 33% (6/18) of Intern staff are currently participating, with 3 fellows and 7 monitors for the Registers; 25 residents rotated in the area and generated their own research projects. 59 posters were presented in local and international congresses. Currently 6 original articles are in process of publication and 2 in peer review evaluation. A survey was carried out to evaluate the area where 76% (35/46) of the participants believed that they have acquired new skills; with 93% (44/47) using these knowledges in their every day practice. A 100% thought that they were adequately oriented in their projects, their ideas being fully respected (97%) (45/46). The inclusion of the Research Area in Internal Medicine improved the knowledge of the process of clinical Investigation and increased independent scientific production.

Factors associated with hospitalization for type2 diabetic patients at a teaching hospital in Saudi Arabia

Increasing prevalence of diabetes all over the world intensifies the demand for health care services, and particularly for inpatient care. The present study aims at identifying factors associated with hospitalization for patients with type 2 diabetes mellitus at a teaching hospital in Saudi Arabia. To achieve the objectives of the study, comparison was made between hospitalized and non-hospitalized type 2 diabetic patients using a retrospective case-control design. Four categories of factors namely, socio-demographic, outpatient clinic, clinical and quality indicators were investigated to elicit their relation with hospitalization among type 2 diabetes patients. Univariate analysis and stepwise multiple regression analysis were employed. Hospitalization was found to be independently associated with male gender, frequent visitors of outpatient clinics other than diabetes clinic, patients with nephropathy and patients with HbA1c >/= 7%. Limited number of cases and controls received the recommended ambulatory care for diabetes patients as evidenced by the marked low level of process of care indicators for diabetes patients. Conclusions and recommendations: Hospitalization was related to a limited number of factors many of which require better ambulatory care at outpatient clinics of the study hospital. It was recommended to continuously monitor the identified significant variables using the hospital electronic medical record system in order to target those patients at high risk for hospitalization

Riverine Communities and Waterborne Diseases in South Eastern Nigeria

Waterborne diseases (WBDs) have continued to be a major health threat to people living in many underdeveloped countries due to absence of basic infrastructure, especially water and health care facilities. In this study we report the findings of an investigation into waterborne diseases amongst the riverine communities in Anambra State, South Eastern Nigeria. A survey of 1200 heads of household using a questionnaire and 600 hospital records were reviewed. A major concern of the study was to identify socio-economic and cultural factors that drive the epidemiology of such diseases. Findings revealed significant differences in the prevalence of waterborne diseases within and between the communities, implicating education levels of the head of household, occupation, and source of water used. The study recommends the provision of community health education through trained community health workers and provision of functional and accessible health care services as a primary means of combating water borne diseases.

Nurses' perception toward hallmarks of the professional nursing practice environment

Are characteristics of the practice setting that best support professional nursing practice and allow baccalaureate and higher degree nurses to practice to their full potential, and assist nursing students educated at the baccalaureate level and above to make the best decision regarding where to practice following graduation. This study aimed to assess Hallmarks of the Professional Nursing Practice Environment as perceived by Bachelor Undergraduate Nursing students, Nurse Interns and nursing staff working/training at Main University hospital, Alexandria University, and conducted at Alexandria Main University hospital, on 336 nurse students, interns and staff nurses from those meeting the inclusion criteria and were available during data collection period. "Hallmarks of the professional nursing practice envtronment questionnaire developed by American Association of Colleges of Nursing [AACN 2001] was used to collect data. The study main findings were that the subjects' perception for Hallmarks of the professional nursing practice environment was below the acceptable level, however, above the average. Nurse Interns tended to have significantly higher perception for all hallmarks; while staff nurses as well as nurse students tended to have the lowest one. Age and years of experience of the staff nurses were found to be not affecting nurses' perception. Diploma nurses were found to perceive hallmarks more significantly as compared to bachelor nurses, Finally, the overall perception of staff nurses working in special care units was high in comparison to those working in the general wards

Revisión de Tema: Nemátodos intestinales de importancia médica en Colombia ¿un problema resuelto? / intestinal nematodes of medical importance in Colombia: a solved problem?

Las enteroparasitosis, en general, constituyen un gran problema de salud pública en el mundo. De éstas, las nematodosis figuran entre las más destacadas en Colombia. Debido a que estos parásitos pueden ingresar al organismo por vía oral o por la piel, los hábitos higiénico-sanitarios deficientes, entre ellos el fecalismo, facilitan su transmisión y conservación.Entre las nematodosis más prevalentes en nuestro país tenemos aquéllas causadas por Ascaris lumbricoides, Trichuris trichiura (tricocéfalo), uncinarias (Necator americanus y Ancylostoma duodenale) y Strongyloides stercoralis. Cuando la carga de dichos parásitos es considerablemente alta o se acompaña de alteraciones en las defensas del hospedero, se pueden producir complicaciones que comprometen seriamente la salud del paciente.En la actualidad se sabe que el control farmacológico de estas nematodosis es efectivo y seguro. No obstante, sin autocuidado y mantenimiento sostenible de buenas condiciones higiénico-sanitarias, no es posible su erradicación.Por lo anterior, esta revisión dirigida al personal de la salud, especialmente a los médicos generales, discutirá los aspectos más relevantes de estas nematodosis y de sus complicaciones, haciendo énfasis en su biología, fisiopatología, manifestaciones clínicas, diagnóstico, tratamiento y algunos datos epidemiológicos.

Abstract Intestinal parasites, in general, constitute a great worldwide, public health problem. Of them, nematodes are among the most outstanding in Colombia. Because these parasites can enter into the organism either by ingestion or through the skin, faulty hygienic-sanitary habits facilitate their transmission and conservation. Among nematodosis the more frequent in Colombia are those caused by Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), hookworms (Necator americanus and Ancylostoma duodenale) and Strongyloides stercoralis. When the burden of these parasites is considerably high and/or is accompanied by alterations in host defenses, complications can take place that seriously affect health. Presently it is known that pharmacological control of these nematodosis is effective and safe. Nevertheless, without selfcare, and maintenance of good hygienic-sanitary conditions, their eradication will not be feasible. This review of outstanding aspects of nematodosis, with emphasis on their biology, physiopathology, clinical manifestations, diagnosis, treatment, and some epidemiologic data, intends to update physicians as a basis for adequate management of this problem.

Theory-practice gap: leadership concept among undergraduate baccalaureate nurse's students

This study aimed to determine leadership concept among Bachelor nursing student and identify how much theory is matched with real practice. This study included 121 students who were interviewed before/after graduation then at the end of the internship to identify concepts in relation to the deciding, relating, influencing and facilitating activities in the leadership process. The results of this study revealed that there was a significant difference among students' concept before the internship year and after the internship in relation to the deciding, relating, influencing and facilitating activities in the leadership process. From the present study, it can be concluded that it is amended now more than any time before to develop a link between education and practice to get nurses' students who can be accredited to be good qualified nurse