Prevalencia de Dientamoeba fragilisy otros protozoários intestinales en porcinos de una granja en la región Andina de Colombia / Prevalence of Dientamoeba fragilis and other intestinal protozoa from a swine farm at the Andean region of Colombia

RESUMEN Dientamoeba fragilis es un protozoário que parasita el intestino grueso del hombre y animales domésticos. Hasta el momento, aún no son claros aspectos de su ciclo de vida, como el rango de hospedadores, reservorios, mecanismo de infección, entre otros. Se postula que el cerdo es un hospedador natural para este protozoario y que, debido a su cercanía con el humano, podría facilitar una transmisión zoonótica. En Colombia no existen a la fecha estudios sobre la presencia de D. fragilis en hospedadores animales, incluidos los cerdos, y los datos sobre la prevalencia de otros protozoarios intestinales en estos animales son escasos. El objetivo fue determinar la frecuencia de protozoarios intestinales, incluyendo D. fragilis, en cerdos de una granja tecnificada de una zona rural de Medellín (región Andina de Colombia). Se recolectaron muestras de materia fecal de 70 cerdos en etapa de preceba, que fueron evaluadas mediante examen directo, tinción tricrómica y Ziehl-Neelsen modificado. Se realizaron análisis univariados con medidas de frecuencia relativa y tendencia central y análisis bivariados para la exploración de factores de riesgo. Se detectó la presencia de D. fragilis en un 13% de las muestras y de otros parásitos como Entamoeba spp. (66%), Blastocystis spp. (64%), Balantioides coli (36%), Cryptosporidium spp. (36%), Iodamoeba butschlii (17%), coccidias (4%) y Giardia spp. (1,4%). En este primer reporte de D. fragilis en cerdos en Colombia se observó la alta prevalencia de otros protozoarios patógenos, lo que corrobora el papel de los cerdos como importantes reservorios de infecciones humanas. Estudios sobre la presencia de este protozoario tanto en cerdos como en el personal encargado de su manejo contribuirían al conocimiento sobre su dinámica de transmisión.

ABSTRACT Dientamoeba fragilis is a protozoan that parasitizes the large intestine of humans and domestic animals. To date, some aspects regarding D. fragilis life cycle, including hosts, reservoirs, infection mechanism, among others, are not yet clear. Swine are considered natural hosts for this protozoan, therefore their close contact with humans promotes its zoonotic transmission. In Colombia there are no studies on the presence of D. fragilis in animal hosts, including pigs, and data about other intestinal protozoa are scarce. The objective was to determine the prevalence of intestinal protozoan, including D. fragilis, in pigs raised in a farm from a rural area of Medellin (Andean region of Colombia). Fecal samples from 70 pigs in prefattening stage were collected. Direct fecal smear examination, trichrome and modified Ziehl-Neelsen stain were used in the study. Univariate analysis (frequency distribution and central tendency measures) and bivariate analysis were used to explore risk factors. Dientamoeba fragilis was found in 13% of the evaluated fecal samples. Other parasites detected included: Entamoeba spp. (66%), Blastocystis spp. (64%), Balantioides coli (36%), Cryptosporidium spp. (36%), Iodamoeba butschlii (17%), coccidias (4%), and Giardia spp. (1,4%). This is the first report of D. fragilis in swine in Colombia, and the high prevalence of other pathogen protozoa was also observed, which corroborates the role of pigs as important reservoirs for human infections. Studies focused on the evaluation of both swine and swine-exposed farm workers should be done in order to know the dynamics of transmission of this parasite.

Prevalencia de Fasciola hepatica y Paramphistomidae en bovinos de doble propósito en una hacienda del trópico bajo andino colombiano / Prevalence of Fasciola hepatica and Paramphistomidae in dual purpose cattle in a farm in the Colombian low Andean tropic

RESUMEN En muchos países la fasciolosis y la paramfistomosis representan un grave problema para la salud del sector pecuario. En Colombia hay registros de ambas distomatosis en bovinos, la mayoría en el trópico alto andino, las cuales generan pérdidas econômicas anuales cercanas a 40 000 000 000 COP. El objetivo de esta investigación fue determinar la prevalencia de fasciolosis y paramfistomosis en vacunos de la hacienda La Candelaria, Caucasia (Colombia), y la presencia de caracoles hospederos intermediarios. Para cumplirlo, se realizó un estudio descriptivo de corte transversal con muestreo no probabilístico por conveniencia. Se recolectaron heces de los animales y se hizo el diagnóstico mediante la técnica modificada de Dennis. Se establecieron las prevalencias de los digeneos de acuerdo con el sexo, peso, edad y raza. Se recolectaron caracoles dulciacuícolas en la zona estudiada y se identificaron por morfologia. Se analizaron 466 muestras fecales de 178 bovinos, de las razas Cebú (Bos indicus), BON (blanco orejinegro) y del cruce entre ellas. Se diagnosticaron F. hepatica y Paramphistomidae con prevalencias del 2,2% y 30,9%, respectivamente. En el 1,1% de los vacunos se diagnosticó coinfección. Ambas trematodosis prevalecieron en las hembras (p = 0,03). Se identificaron moluscos dulciacuícolas Ampullariidae, Physidae y Planorbidae sin estadios larvarios de digeneos. Se concluyó que los bovinos de doble propósito de la hacienda La Candelaria están expuestos a F. hepatica y Paramphistomidae, y, probablemente, se infectan en los predios de la hacienda. Paramphistomidae es más prevalente que F. hepatica, lo cual concuerda con lo descrito en algunos estudios realizados en hatos del trópico alto andino colombiano. Paramphistomidae se encontró en todos los grupos etarios.

ABSTRACT Fasciolosis and paramphistomosis are a major health problem for the livestock economy worldwide. In Colombia, both distomatosis are reported in cattle, particularly in high Andean tropics, with annual economic losses close to COP 40 billion. The goal of this study was to determine the prevalence of fasciolosis and paramphistomosis in cattle from La Candelaria farm, Caucasia (Colombia), and the presence of intermediate host snails. A descriptive cross-sectional study was carried out with non-probability convenience sampling. Stool samples were collected from the animals and the diagnosis was made using the modified Dennis technique. Digenea prevalence were determined according to sex, weight, age, and race. Freshwater snails were collected in the studied area and were identified by morphology. 400 and 66 fecal samples from 178 bovines of the Zebu (Bos indicus), BON (white-eared white) breeds and the cross between them were analyzed. Fasciola hepatica and Paramphistomidae were diagnosed with a prevalence of 2,2% and 30,9%, respectively. Coinfection was diagnosed in 1,1% of the cattle. Both trematodosis were most frequent in females (p = 0,03). Freshwater molluscs Ampullariidae, Physidae and Planorbidae without digenea larval stages were identified. It was concluded that dual-purpose cattle from La Candelaria farm are exposed to F. hepatica and Paramphistomidae and are probably infected on the farm grounds. Paramphistomidae was more prevalent than F. hepatica, which agrees with other studies in herds from the Colombian high Andean tropics. Paramphistomidae was found in all age groups.

Obstacles to compassion-giving among nursing and midwifery managers: an international study.

AIM: To explore nursing and midwifery managers' views regarding obstacles to compassion-giving across country cultures. BACKGROUND: The benefit of compassionate leadership is being advocated, but despite the fact that health care is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking. METHODS: Cross-sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers' responses on open-ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo. RESULTS: Three key themes related to compassion-giving obstacles emerged across countries: 1. related to the managers' personal characteristics and experiences; 2. system-related; and 3. staff-related. CONCLUSIONS: Obstacles to compassion-giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in health care is important. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers' practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organizational cultures and system-related obstacles to compassion-giving.

Consensus of the Iberoamerican Oculoplastic Society for diagnosis and management of facial dystonia. / Consenso de la Sociedad Iberoamericana de Oculoplástica para el diagnóstico y manejo de las distonías faciales.

OBJECTIVE: To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. MATERIAL AND METHODS: An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. CONCLUSIONS: Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease.

Malignant transformation of a conjunctival keratoacanthoma requiring enucleation.

PURPOSE: We report a rare case of rapid transformation of a conjunctival keratoacanthoma (KA) into a highly aggressive squamous cell carcinoma requiring enucleation. To our knowledge, this is the second such case reported in the literature. METHODS: Case report. RESULTS: A 73-year-old man presented with a recurrent conjunctival lesion in the right eye. A slit lamp examination revealed a hyperkeratotic lesion in the limbar conjunctiva adhered to deep planes but with no ocular involvement. An incisional biopsy was performed because an area of scleromalacia was observed underlying the lesion. Histological findings were consistent with conjunctival KA. One week later, a raised lesion was observed invading the anterior chamber. Histological examination of another excisional biopsy specimen indicated conjunctival squamous cell carcinoma. The right eye was enucleated. Histological analysis confirmed intraocular tumor invasion. Complete clinical remission was observed over one year of follow up. CONCLUSIONS: Although conjunctival keratoacanthoma is normally benign, it is important to correctly differentiate between KA and squamous cell carcinoma, and closely monitor the eye after surgery because of the rare possibility of recurrence or conversion to squamous cell carcinoma. Immunohistochemistry could help in the diagnosis and management of dubious cases.

Resolution of conjunctival melanoma with topical interferon alpha 2b in a patient with mitomycin C intolerance. / Resolución de un melanoma conjuntival con interferón tópico alfa 2b en un paciente con intolerancia a la mitomicina C.

OBJECTIVE: To describe the clinical and histological resolution of a case of an inexcisable conjunctival melanoma using topical interferon alpha 2b (INFα2b) in a patient with mitomycin C (MMC) intolerance. CASE REPORT: Conjunctival melanoma is a rare, but potentially sight- and life-threatening, tumour. In cases of multiple lesions, or when surgical excision is not possible, topical combination chemotherapy with MMC and INFα2b has been described as first line therapy. The case is presented of a 77 year-old woman with a multifocal conjunctival in situ melanoma, who was intolerant to initial treatment with MMC and was switched to long-term INFα2b therapy, with a good outcome. CONCLUSIONS: When topical MMC is given as chemotherapy treatment for primary acquired melanosis with atypia or in situ melanoma is not well tolerated, switching to INFα2b seems to be a good option. This approach could replace surgical management of pigmented tumours, especially the larger ones, with potential benefits that include less dependence on surgical margins. This report prompts a need for prospective studies designed to examine the role of INFα2b as primary treatment for heavily pigmented conjunctival tumours avoiding the ocular surface toxicity caused by MMC.

Application of botulinum toxin in Horner's muscle for the treatment of dry eye. / Aplicación de toxina botulínica en el músculo de Horner para el tratamiento de ojo seco.

OBJECTIVE/METHODS: The aim of this study is to describe the use of botulinum toxin to increase tear retention in patients with dry eye, using the description of 2 cases. RESULTS: Patients with moderate to severe dry eye that were given an injection of type A botulinum toxin in the Horner's muscle. The results at one month and 3 months are reported. An assessment was made of the subjective perception of the patient as regards any improvement, as well as taking into account, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus. A significant improvement was observed in the subjective perception of the patient, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus at one month after treatment, and the good results still being maintained at the third month. There were no adverse events. DISCUSSION: The use of type A botulinum toxin can be considered as an alternative to increase tear retention in moderate to severe dry eye, with a good response during the first month, with an acceptable response still being maintained at the third month. Given the temporary effect of the drug, further treatments would be required.

[Case report: total hip replacement in osteogenesis imperfecta]. / Artroplastía total de cadera en osteogénesis imperfecta. A propósito de un caso.

We study, apropos of a case, a total hip arthroplasty in a patient with osteogenesis imperfecta. The characteristics of this disease, such as high risk of fracture and the presence of deformities, make this surgery a challenge for the orthopedic surgeon. In this manuscript, we review for the first time in this indication the preoperative planning and the selection of implants, with special emphasis on measures for the prevention of complications.

En este trabajo se ha estudiado, a propósito de un caso, la cirugía de artroplastía total de cadera en un paciente con osteogénesis imperfecta. Las características propias de esta enfermedad, como son el elevado riesgo de fractura y la presencia de deformidades, convierten esta cirugía en un reto para el cirujano ortopédico. En este manuscrito se revisa, de forma inédita para esta indicación, la planificación preoperatoria y la elección del tipo de implantes, con especial interés en las medidas para la prevención de complicaciones.

Novel Acanthamoeba 18S rRNA gene sequence type from an environmental isolate.

The free-living amoebae, Acanthamoeba, can act as opportunistic parasites on a wide range of vertebrates and are becoming a serious threat to human health due to the resistance of their cysts to harsh environmental conditions, disinfectants, some water treatment practices, and their ubiquitous distribution. Subgenus classification based on morphology is being replaced by a classification based on the sequences of the 18S rRNA gene with a total of 18 different genotypes (T1-T18). A new environmental strain of Acanthamoeba isolated from a waste water treatment plant is presented in this study as a candidate for the description of the novel genotype T19 after phylogenetic analysis.

Mother-child HIV disease: a model for collaborative care.

Women Connected and the Maternal Child Clinic are two unique dyad-centered programs for providing quality care to HIV-infected women and their children. Each is a collaborative effort to maintain standard of care for these patients within a large county facility. Women Connected facilitates their inpatient treatment and care, while the Maternal Child HIV Clinic provides follow-up outpatient health and social services.