GPR124 regulates murine brain embryonic angiogenesis and BBB formation by an intracellular domain-independent mechanism.

The GPR124/RECK/WNT7 pathway is an essential regulator of CNS angiogenesis and blood-brain barrier (BBB) function. GPR124, a brain endothelial adhesion seven-pass transmembrane protein, associates with RECK, which binds and stabilizes newly synthesized WNT7 that is transferred to frizzled (FZD) to initiate canonical ß-catenin signaling. GPR124 remains enigmatic: although its extracellular domain (ECD) is essential, the poorly conserved intracellular domain (ICD) appears to be variably required in mammals versus zebrafish, potentially via adaptor protein bridging of GPR124 and FZD ICDs. GPR124 ICD deletion impairs zebrafish angiogenesis, but paradoxically retains WNT7 signaling upon mammalian transfection. We thus investigated GPR124 ICD function using the mouse deletion mutant Gpr124ΔC. Despite inefficiently expressed GPR124ΔC protein, Gpr124ΔC/ΔC mice could be born with normal cerebral cortex angiogenesis, in comparison with Gpr124-/- embryonic lethality, forebrain avascularity and hemorrhage. Gpr124ΔC/ΔC vascular phenotypes were restricted to sporadic ganglionic eminence angiogenic defects, attributable to impaired GPR124ΔC protein expression. Furthermore, Gpr124ΔC and the recombinant GPR124 ECD rescued WNT7 signaling in culture upon brain endothelial Gpr124 knockdown. Thus, in mice, GPR124-regulated CNS forebrain angiogenesis and BBB function are exerted by ICD-independent functionality, extending the signaling mechanisms used by adhesion seven-pass transmembrane receptors.

Promoción de la salud mental por medio de la siembra de huertas en Cali / Promotion of mental health through planting orchards in Cali

Investigaciones previas sobre la promoción de la salud por medio de la siembra consideran co-mo resultados el fortalecimiento de los lazos sociales, la práctica de hábitos de vida saludables y la atención a dificultades psicológicas. Así, se hace importante para este proyecto partir des-de una perspectiva sistémica y multidisciplinar de la salud que busca fortalecer aspectos de la salud mental (el apoyo social, el bienestar psicológico y calidad de vida) y de conocimientos en agroecología urbana (seguridad alimentaria, siembra y sostenimiento de cultivos), con personas habitantes de Cali, vinculados a la estrategia de la siembra de huertas caseras. Se basa en un enfoque cualitativo-transformativo, con un diseño de investigación-acción participativa. Con los resultados se espera promover aspectos de la salud y el bienestar de las relaciones consigo mismo, con los demás y con el entorno inmediato, así como el conocimiento básico para el cui-dado de la huerta. (AU)

Previous research on health promotion through planting considers the strengthening of social ties, the practice of healthy lifestyle habits, and attention to psychological difficulties as re-sults. Thus, it is important for this project to start from a systemic and multidisciplinary per-spective of health that seeks to strengthen aspects of mental health (social support, psycho-logical well-being and quality of life) and knowledge in urban agroecology (food security, planting and crop maintenance), with people from Cali, linked to the strategy of planting home gardens. It is based on a qualitative-transformative approach, with a participatory ac-tion research design. The results are expected to promote aspects of health and well-being in relationships with oneself, with others and with the immediate environment, as well as basic knowledge for caring for the garden. (AU)

Multi-omics characterization of the microbial populations and chemical space composition of a water kefir fermentation.

In recent years, the popularity of fermented foods has strongly increased based on their proven health benefits and the adoption of new trends among consumers. One of these health-promoting products is water kefir, which is a fermented sugary beverage based on kefir grains (symbiotic colonies of yeast, lactic acid and acetic acid bacteria). According to previous knowledge and the uniqueness of each water kefir fermentation, the following project aimed to explore the microbial and chemical composition of a water kefir fermentation and its microbial consortium, through the integration of culture-dependent methods, compositional metagenomics, and untargeted metabolomics. These methods were applied in two types of samples: fermentation grains (inoculum) and fermentation samples collected at different time points. A strains culture collection of ∼90 strains was established by means of culture-dependent methods, mainly consisting of individuals of Pichia membranifaciens, Acetobacter orientalis, Lentilactobacillus hilgardii, Lacticaseibacillus paracasei, Acetobacter pomorum, Lentilactobacillus buchneri, Pichia kudriavzevii, Acetobacter pasteurianus, Schleiferilactobacillus harbinensis, and Kazachstania exigua, which can be further studied for their use in synthetic consortia formulation. In addition, metabarcoding of each fermentation time was done by 16S and ITS sequencing for bacteria and yeast, respectively. The results show strong population shifts of the microbial community during the fermentation time course, with an enrichment of microbial groups after 72 h of fermentation. Metataxonomics results revealed Lactobacillus and Acetobacter as the dominant genera for lactic acid and acetic acid bacteria, whereas, for yeast, P. membranifaciens was the dominant species. In addition, correlation and systematic analyses of microbial growth patterns and metabolite richness allowed the recognition of metabolic enrichment points between 72 and 96 h and correlation between microbial groups and metabolite abundance (e.g., Bile acid conjugates and Acetobacter tropicalis). Metabolomic analysis also evidenced the production of bioactive compounds in this fermented matrix, which have been associated with biological activities, including antimicrobial and antioxidant. Interestingly, the chemical family of Isoschaftosides (C-glycosyl flavonoids) was also found, representing an important finding since this compound, with hepatoprotective and anti-inflammatory activity, had not been previously reported in this matrix. We conclude that the integration of microbial biodiversity, cultured species, and chemical data enables the identification of relevant microbial population patterns and the detection of specific points of enrichment during the fermentation process of a food matrix, which enables the future design of synthetic microbial consortia, which can be used as targeted probiotics for digestive and metabolic health.

Acompañamiento creativo para el duelo por muerte en contexto hospitalario: Laexperiencia en un Hospital en Bogotá / Apoio criativo ao luto pela morte no contexto hospitalar: a experiência em umhospital de Bogotá / Creative support for death grief in a hospital context: the experience in a Bogotá hospital

The article presents the results of a participatory research process based on the arts, whichsought to incorporate art and creativity in seven units of a high-complexity university hospital, forsupport at the end of life and bereavement. This was done through the provision of kits with materials with creative potential and the development of awareness and creation workshops with healthand administrative staff, patients, and family members. The process was produced through participant observation and field diaries. Informal, semi-structured interviews and a discussion groupwere also conducted to identify the main barriers and facilitators of the proposal. We conclude that,in order to integrate this type of resources and for care centered on the person and families, healthservices require deep transformations that include death as a significant experience, giving space totheir own mourning and emotions, which would reduce Fatigue due to inflammation is very frequent in health personnel confronted with death in a systematic way. The project was approved bythe respective ethics committee.(AU)

El artículo presenta los resultados de un proceso de investigación participativa basadaen las artes, en el que se buscó incorporar el arte y la creatividad en siete unidades de un hospitaluniversitario de alta complejidad, para el acompañamiento en final de vida y duelo. Esto se hizo através de la disposición de kits con materiales con potencial creativo y el desarrollo de talleres desensibilización y creación con personal sanitario, administrativo, pacientes y familiares. El procesose registró a través de observación participante y diarios de campo. También se realizaron reunionesperiódicas, entrevistas informales, semiestructuradas de seguimiento y un grupo de discusión paraidentificar las principales barreras y facilitadores de la propuesta. Concluimos que, para poderintegrar este tipo de recursos y para una atención centrada en la persona y las familias, los serviciosde salud requieren transformaciones de fondo que incluyan la muerte como experiencia significante, dando espacio a sus propios duelos y emociones, lo que reduciría la fatiga por compasiónmuy frecuente en personal de salud enfrentado a la muerte de manera sistemática. El proyecto contócon la aprobación del comité de ética respectivo.(AU)

O artigo apresenta os resultados de um processo de pesquisa participativa baseado nasartes, que buscou incorporar arte e criatividade em sete unidades de um hospital universitário dealta complexidade, para apoio no final da vida e luto. Isso foi feito por meio da disponibilização dekits com materiais com potencial criativo e do desenvolvimento de oficinas de sensibilização e criação com equipe de saúde e administrativa, pacientes e familiares. O processo foi produzido pormeio de observação participante e diários de campo. Também foram realizadas entrevistas informais semiestruturadas e um grupo de discussão para identificar as principais barreiras e facilitadores da proposta. Concluímos que, para integrar este tipo de recursos e para um cuidado centradona pessoa e na família, os serviços de saúde necessitam de profundas transformações que incluama morte como uma experiência significativa, dando espaço ao seu próprio luto e emoções, o quereduziria a Fadiga por a inflamação é muito frequente em profissionais de saúde confrontados coma morte de forma sistemática. O projeto foi aprovado pelo respectivo comitê de ética.(AU)

Sistematización de experiencia de pulpos para neonatos Instituto Roosevelt Bogotá Colombia / Sistematização da experiência do polvo para neonatos Instituto Roosevelt BogotáColômbia / Systematization octopus experience for neonates Instituto Roosevelt Bogotá Colombia

The initiative octopuses for newborns began with the Noupops NGO "thread for life"which emerged in 2012 in Denmark and in 2017 in Spain, which the Roosevelt Institute in Colombiahas been implementing since 2018. This qualitative research was based on the systematization ofexperiences, finding that the weavers and its possibility to heal through weaving is related to theancestral knowledge of how to do it and the mastery that is combined when they make the octopus.The project leaders refer to the importance of volunteering and donations for weaving the octopus,the therapeutic role in the mother-child relationship that these elements provides and refines, andits potential in the humanization of health services. The mother-child binomial in the voices of themothers capitalizes the experience of being present with the baby, which implies reducing the feeling of anxiety and abandonment. Health personnel highlight the difficulty of the initiative within amedicalized scheme by assuming the octopus as an object of risk, which is controlled with sterilization. The evidenced value in the bond of the mother-child binomial, however, make the health personnel to reevaluate the lack of objective evidence that allows them to "guarantee" sterilization overthe benefit.(AU)

La iniciativa pulpos para neonatos comienza en 2012 en Dinamarca y en 2017 en Españasurge la Noupops ONG "hilo para la vida", a partir de la cual el Instituto Roosevelt en Colombia laimplementa desde 2018. Esta investigación cualitativa se basó en la sistematización de experiencias,encontrando que, en las tejedoras, es una posibilidad para sanar y sanarse a través del tejido y serelaciona con el conocimiento ancestral de cómo hacerlo y la maestría que se conjuga al realizar elpulpo. Las lideresas del proyecto, refieren la importancia del voluntariado y donaciones, el papelterapéutico en el binomio madre hijo y su potencial en la humanización de los servicios de salud. Elbinomio madre hijo en las voces de las madres, capitaliza la experiencia de estar presente con elbebé, lo que implica disminuir la sensación de zozobra y abandono. El personal de salud resalta ladificultad de la iniciativa dentro de un esquema medicalizado al asumirse como un objeto deriesgo, lo cual se controla con esterilización. Valoran el poder en el vínculo del binomio madre hijo,sin embargo, manifiestan que carecen de pruebas objetivas que les permitan “avalar” su beneficio.(AU)

A iniciativa polvos para recém-nascidos, a qual vem se implementando no Instituto Roosvelt na Colombia desde 2018, começou em 2012 na Dinamarca e em 2017 na Espanha surgiu a ONGNoupops "thread for life". A pesquisa qualitativa, que foi baseada na sistematização de experiências,constatou que nas mulheres tecelãs existe uma possibilidade de curar e se curar através da tecelagemque está relacionada ao saber ancestral conjugado com a destreza na confecção do polvo. As líderesdo projeto referem a importância do voluntariado e as doações, o papel terapêutico na relação mãefilho e seu potencial na humanização dos serviços de saúde. O binômio mãe-filho nas vozes dasmães capitaliza a experiência de estar presente com o bebê, o que implica diminuir o sentimento deansiedade e abandono. Os profissionais da saúde destacam a dificuldade da iniciativa dentro de umesquema medicalizado ao se assumirem como objeto de risco, que é controlado com esterilização.Valorizam o poder no vínculo do binômio mãe-filho, porém, afirmam que carecem de evidênciasobjetivas que permitam "garantir" seu benefício.(AU)

Social determination of alcohol consumption among Indigenous peoples in Colombia: a qualitative meta-synthesis.

BACKGROUND: Alcohol consumption is a social phenomenon that involves society, groups, and individuals from different cultures around the world. Among some Indigenous groups located in Colombia, South America, alcohol consumption has been present in their lives, where contradictory processes occur and generate public health attention. We aimed to analyze qualitative research findings on alcohol consumption among Indigenous peoples in Colombia. METHODS: This article used the qualitative meta-synthesis methodology, which included: (a) comprehensive search strategy, (b) appraisal of qualitative research reports, (c) findings classification, and (d) synthesis. Databases were searched for papers published from 2004 to 2019 in SCOPUS, LILACS, PROQUEST, and JSTOR, among other sources of information. A total of 2,159 papers were reviewed and finally, 13 studies were included in this meta-synthesis. The synthesis of findings included a constant comparative analysis and also aimed for the articulation of its findings to alternative perspectives in a predefined matrix. RESULTS: Nine Indigenous ethnic groups of Colombia were represented in the 13 articles analyzed. From the analysis emerged the symbolic approach "Alcohol: a chameleon that unpredictable society colors" as the meta-theme of this research. This reflects four social processes that influence interaction with alcohol: Dynamic Systems Mergers (Indigenous system, influence of non-Indigenous system); Diverse Authority Spheres (parenting, Indigenous authority, school, university, religious and spiritual, traditional medicine); Between Transculturation and Interculturality (cultural crises effects and dynamism); and the Paradoxes of the Normalization of Alcohol (reasons, functions, and types of alcohol consumption). Likewise, these results support the social determination of health and sociocultural epidemiology perspectives, as being an adequate way of explaining a complex phenomenon. CONCLUSION: Alcohol consumption among Indigenous peoples in Colombia is a social construction. Alcohol acts as an instrument, which is present in the changing relationships and tensions of social processes. This is reflected in harmonies, or disharmonies, in the life of Indigenous Colombians, which take place in a historical, sociocultural, economic, and political context. The results provide a reference point to guide practice and research but also reiterate the need to include the social determination of health perspective in public policies, as a path to the understanding of alcohol consumption.

Evaluación de adherencia a la guía de práctica clínica para el manejo de faringoamigdalitis aguda en la atención de urgencias del Hospital Universitario San Ignacio, Bogotá, Colombia / Evaluation of adherence to the clinical practice guideline for the management of acute pharyngotonsillitis in the emergency care of the University Hospital San Ignacio, Bogota, Colombia

Introducción: la faringoamigdalitis aguda, independientemente de su origen, es de los diagnósticos más frecuentes en los servicios de urgencias. Aunque se ha establecido que en la mayoría de casos su origen es viral, ante la dificultad de identificar su agente etiológico con hallazgos clínicos se ha aumentado la formulación indiscriminada de antibióticos, principalmente en los servicios de urgencias, lo que contribuye con la emergencia de resistencias bacterianas y la aparición de efectos secundarios. Se propone evaluar la adherencia a la guía de práctica clínica para el manejo de faringoamigdalitis aguda en urgencias en el Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: se realizó un estudio de tipo descriptivo retrospectivo. Se revisaron 7762 historias clínicas de pacientes que consultaron por urgencias entre 2016 y 2019 por dolor de garganta. Se analizaron los datos de formulación de analgésicos, antibióticos, solicitud de la prueba rápida de detección de Estreptococo betahemolítico del grupo A (SBHGA) y el registro de la presencia de exudados al examen físico. Resultados: se incluyeron 7762 pacientes. Del total, 74,2 % recibieron antibiótico y 98 % analgesia. Se solicitó la prueba rápida de detección de SBHGA al 11,53 % de los pacientes. La presencia de exudados es el principal factor asociado a la formulación de antibióticos, y la solicitud de una prueba rápida de detección disminuye significativamente su formulación, dado que 21 % de dichos estudios fueron positivos

Objective: Sore throat is one of the most frequent complaints in the ER, both in children and adults. Although it has been established that most cases of acute tonsillitis are caused by viruses, given the difficulty in identifying its etiology based exclusively upon clinical signs, the indiscriminate prescription of antibiotics in the emergency setting has become very frequent. This practice may lead to the emergence of antibiotic resistance and secondary effects. We evaluated the adherence of ER physicians to clinical practice guidelines for the management of acute tonsillitis at Hospital Universitario San Ignacio in Bogotá, Colombia. Methods: A retrospective descriptive study was carried out. Clinical records for emergency visits between the years of 2016 and 2019 were reviewed. Data regarding rapid antigen detection test for GABHS (RAD), antibiotic and analgesic prescription and tonsillar exudates on physical exam, were recorded. Results: 7.762 patients with acute tonsillitis were included in the study. 74,2% were prescribed antibiotics and 98% received pain medication. For 11,53% of cases the rapid antigen test for GABHS was requested. Although tonsillar exudates are the main factor associated with the formulation of antibiotics, only 21% of rapid antigen detection tests were positive. As such, the systemic use of rapid diagnostic tests may help reduce unnecessary antibiotic prescription, bacterial resistance and drug side effects

Association Between Hyponatremia and Maintenance Intravenous Solutions in Critically Ill Children: A Retrospective Observational Study.

Objetive: We sought to determine the association between maintenance intravenous solutions and the presence of hyponatremia in children in pediatric intensive care (PICU). Materials and Methods: An analytical observational study in children hospitalized in the PICU between January 2015 and December 2018. Patients who received maintenance fluids within the first 48 h after admission and who had at least two serum sodium levels drawn during this time were included. Measurements and Main Results: A total of 1,668 patients were admitted to the PICU during the study period, 503 of whom met the inclusion criteria. The median age was 24 months (IQR 8-96) and 50.9% were female. Altogether, 24.1% of the children developed hyponatremia; it was more frequent in those who received hypotonic solutions (63 vs. 37%; OR 1.41 95% CI 0.92, 2.15 p = 0.106), who also had a longer hospital stay (20 vs. 14 days, difference in means 8 days, 95% CI 2.67, 13.3, p = 0.001). Children who received loop diuretics and those who were post-operative had a greater risk of developing hyponatremia if they received hypotonic solutions (aOR 2.1 95% CI 1.41, 3.0, p = 0.000). Those with balanced isotonic solutions had a lower risk of developing hyponatremia (aOR 0.59 95% CI 0.35, 0.99, p = 0.004) and hyperchloremia (aOR 0.51 95% CI 0.34, 0.77, p = 0.000), adjusted for disease severity. A greater risk of death was found in the group with severe hyponatremia <130 mEq/L (aOR 9.75 95% CI 1.64-58.15; p = 0.01). Conclusions: Hyponatremia associated with the use of hypotonic maintenance solutions occurs in one out of four children in intensive care. The use of these solutions is associated with a longer hospital stay, and the main risk groups are post-operative patients and those who receive loop diuretics. Clinical studies are needed to determine which maintenance solutions have the greatest efficacy and safety in critically ill children.

Fatiga por compasión y agotamiento profesional en personal de salud ante el duelo y muerte en contextos hospitalarios / Compassion fatigue and burnout in healthcare facing of grief and death in hospital

Resumen Este artículo pretende identificar y analizar en la literatura la producción relacionada con la fatiga por compasión y el agotamiento psicológico presente en el personal sanitario que brinda atención y cuidado a personas durante los procesos de muerte y duelo de pacientes y sus familiares, respectivamente. Esta es una revisión integradora en las bases de datos JSTOR, ProQuest, Medline (vía PubMed), LILACS y Google Scholar en el periodo 2005-2018. La revisión permitió la identificación de tres cuerpos importantes de producción académica: trabajos de corte cualitativo que describen el fenómeno; los que desarrollan escalas y herramientas de medición del problema; y los que describen estrategias desarrolladas frente al mismo. En los contextos hospitalarios al personal de salud que acompaña a persona durante el proceso de muerte se le impide demostrar sentimientos y vivir el duelo por la pérdida de sus pacientes. Los trámites administrativos, la despersonalización sanitaria, el número de pacientes a cargo y la baja conciencia en relación con la muerte regulan de cierta forma lo acontecido, impidiendo que exista por parte del personal de salud descarga de sentimientos, llevándolos a presentar agotamiento psicológico y fatiga por compasión.

Abstract To identify and analyze in the literature the production related to comparison fatigue and psychological exhaustion present in healthcare personnel who provide care and attention to people during the death and grief processes of patients and their families, respectively. Integrative review in the JSTOR, ProQuest, Medline (vía PubMed), LILACS y Google Scholar databases in the period 2005-2018. The review identified the identification of three important bodies of academic production: on the one hand, qualitative studies that describe the phenomenon, secondly, those that scale and measurement tools of the problem and finally those that analyze strategies developed against the same. In hospital settings, health personnel accompanying a person during the death process are prevented from showing feelings and mourning the loss of their patients. The administrative procedures, the depersonalization of health, the number of patients in charge and the low conscience in relation to death regulated in a certain way, what happened, preventing health personnel from unloading feelings, leading them to present psychological exhaustion and fatigue. out of compassion.

Weaning rápido vs. weaning gradual de ventriculostomía externa en hidrocefalia secundaria a hemorragia subaracnoidea: Revisión sistemática de la literatura y metaanálisis / Weaning fast vs. Gradual Weaning of External Ventriculostomy in Hydrocephalus Secondary to Subarachnoid Hemorrhage: A Systematic Review of the Literature and Meta-analysis

Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.

Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning ́s groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.

Long-term users of benzodiazepines in Colombia: Patterns of use and cessation of treatment.

BACKGROUND: Benzodiazepines have low abuse potential, but patients often develop physical dependence and neurological impairments. The objective of this study was to investigate treatment cessation and use of high doses in long-term benzodiazepine users in Colombia. METHODS: Retrospective study. Patients who used benzodiazepines for at least six months (long-term) were selected from a prescription database and followed from initiation of benzodiazepine treatment for up to 30 months. We investigated treatment duration and compared patients who received normal and high (≥2 mean prescribed daily dose) doses. RESULTS: Only 1255 (6.1 %) out of 20,567 patientsprescribed benzodiazepines became long-term users; their mean age was 60.6 years (SD=20.0) and 61.7 % were women. Mean high doses were used by 42.5 % (n=534) of the sample. Age under 20 years was a protector, whereas the long half-life benzodiazepines and use of other neurological medications were predictors of high dosage. Overall, 44.8 % (n=563) of the sample was still using benzodiazepines at the end of the study period. The use of antidepressants, antipsychotics, and anticonvulsants were negatively associated with cessation of benzodiazepine treatment. CONCLUSIONS: A low proportion of patients starting benzodiazepines became long-term users. Nearly half of them used high doses and continued the medication for up to 30 months. Use of concomitant neurological drugs was associated with higher doses and less cessation.

Recomendaciones ante el COVID-19 para la práctica de otología y audiología / Recomendations for the practice of otology and audiology during COVID-19

Hasta el momento, no se conoce con certeza si el virus SARS-CoV-2 se encuentra en la mucosa que recubre la trompa de Eustaquio, el oído medio o la mastoides, aunque es bastante probable que sí lo esté, dada la relación de vecindad anatómica y fisiológica que existe con la mucosa de la naso y orofaringe, ubicaciones en las que claramente se ha documentado alta carga viral. Actualmente, se encuentra en construcción científica la definición de los aspectos relacionados con la seguridad en la práctica integral otológica en el contexto de la pandemia de la enfermedad por coronavirus 2019 (COVID-19). Este documento pretende recopilar el conocimiento y las experiencias nacionales e internacionales relacionados con la pandemia, para ser aplicados en el día a día en la práctica médica como especialistas. Es pertinente aclarar que el contenido de estos lineamientos deberá ser actualizado a medida que se conozca nueva información o evidencia, puesto que esta se encuentra en constante y rápida evolución.

Until now, it is not known with certainty if the SARS-CoV-2 virus is found in the mucosa that covers the Eustachian tube, the middle ear and the mastoid, but it is quite probable that it is, given the relationship that exists with the mucosa of the nasopharynx and oropharynx, anatomical sites where a high viral load has clearly been documented. The definition of safety-related aspects for the otological practice is currently under construction in the context of the 2019 coronavirus disease pandemic (COVID-19). This document aims to gather the national and international knowledge and experiences related in order to be applied in the day to day of our medical practice as specialists. It is important to mention that the content of these guidelines should be updated as new information or evidence becomes known since it is constantly changing.

Mística, yerbas santas y solidaridad: memoria del cuidado no médico de la lepra en Agua de Dios / Mystique, Holy Herbs and Solidarity: Memory of Non-Medical Care of Leprosy in Agua de Dios / Mística, ervas santas e solidariedade: memória do cuidado no médico da lepra em Agua de Dios

Resumen Introducción: La representación social de la lepra como una enfermedad del pasado, el carácter local que la circunscribe a los sanatorios y el escaso contacto de trabajadores de la salud foráneos con la enfermedad hace pensar que el conocimiento sobre su cuidado ha circulado entre generaciones de una manera más o menos confinada. Ese saber que incorpora no solo conocimiento biomédico, sino expresiones en saberes, creencias, prácticas, relatos, los actores que las construyen y recrean y su relación compleja con las dinámicas de inserción en el territorio, se constituye hoy, en sí mismo, en un patrimonio vivo, que merece ser narrado. Desarrollo: Se parte de comprender la memoria de los cuidados no médicos de la lepra en Agua de Dios, por medio de un estudio etnográfico, cuyos resultados permiten proponer dos expresiones. La primera involucra a agentes de salud no médicos y su relación con los sujetos de cuidado; que muestra que el cuidado demanda no solo conocimiento científico, sino también disposiciones particulares de los sujetos, como capacidad de escucha, observación, paciencia y trascendencia, acompañadas de un posicionamiento y negociación cotidianos en el territorio. La segunda está compuesta por las alternativas de cuidado intermediadas por otros agentes con saberes autorizados, que agrupan una amplia farmacopea relacionada con el uso de plantas medicinales, referencias a curanderos y prácticas solidarias de tutoría entre pacientes y relaciones de su bienestar con el medio ambiente. Conclusiones: Todas estas expresiones de cuidado desafían los discursos y prácticas canónicas de la biomedicina alrededor de esta enfermedad.

Abstract Introduction: The social representation of leprosy as a disease from the past, its local character that circumscribes it to the sanatoria, and the scarce contact of health workers with it suggest that the knowledge about its care has circulated between generations more or less confined. This confined knowledge, which incorporates not only biomedical knowledge but also expressions in knowledge, beliefs, practices, stories, the actors that construct and recreate them and their complex relationship with the dynamics of insertion in the territory in a living heritage, deserves to be narrated. Development: We begin by understanding the memory of the non-medical care of leprosy in Agua de Dios, through an ethnographic study, whose results allow us to propose two expressions of these. The first one, involving the non-medical health agents (especially nurses) and its relationship with care subjects, showed that this demands particular dispositions from the subjects as listening ability, observation, patience, and transcendence, accompanied by daily positioning and negotiation in the territory. The second is the care alternatives mediated by other agents with authorized knowledge that group a wide pharmacopeia related to the use of medicinal plants; references to healers and solidarity practices of mentoring between patients and relationships of their well-being with the environment. Conclusions: All these expressions of care challenge the discourses and canonical practices of biomedicine around this disease.

Resumo Introdução: A representação social da lepra como uma doença do passado, seu carácter local que a circunscreve aos sanatórios, e o escasso contato de trabalhadores da saúde estrangeiros com a doença, faz pensar que o conhecimento sobre seu cuidado, tem circulado entre gerações de uma maneira mais ou menos confinada. Esse saber "confinado", que incorpora não só conhecimento biomédico, senão expressões em saberes, crenças, práticas, relatos, os atores que as constroem e recriam e sua relação complexa com as dinâmicas de inserção no território, constitui-se hoje em si mesmo, em um patrimônio vivo, que merece ser narrado. Desenvolvimento: Partimos de compreender a memória dos cuidados não médicos da lepra em Agua de Dios, através de um estudo etnográfico, cujos resultados nos permitem propor duas expressões destes. A primeira que envolve agentes de saúde não médicos e sua relação com os sujeitos de cuidado, mostrou que esta demanda não só conhecimento "científico", mas também disposições particulares dos sujeitos como capacidade de escuta, observação, paciência e transcendência, acompanhadas de um posicionamento e negociação cotidianos no território. A segunda a constituem as alternativas de cuidado intermediadas por outros agentes com saberes "autorizados" que agrupam uma ampla farmacopeia relacionada com o uso de plantas medicinais; referências a curandeiros e práticas solidárias de tutoria entre pacientes e relações de seu bem-estar com o meio ambiente. Conclusões: Todas estas expressões de cuidado, desafiam os discursos e práticas canónicas da biomedicina ao redor desta doença.

Diagnóstico e intervención temprana de insuficiencia velofaringea posterior a palatoplastia primaria en pacientes atendidos interdisciplinariamente en fisulab (Bogotá, Colombia) / Diagnosis and early intervention of velofaringeal insufficiency posterior to primary palatoplasty in patients attended interdisciplinarily in fisulab (Bogotá, Colombia)

Introducción y Objetivo: El tratamiento integral e interdisciplinario de los pacientes con paladar hendido es fundamental para garantizar resultados a largo plazo. El habla es una de las metas principales en el tratamiento ya que permitirá un adecuado aprendizaje escolar y socialización. La insuficiencia velofaríngea (IVF) se debe a alteraciones anatómicas del esfínter velofaringeo y el manejo temprano y adecuado de los pacientes con paladar hendido es clave para evitarla. El objetivo de este estudio es determinar el porcentaje de IVF detectado y manejado antes de los primeros 5 años de vida en pacientes con paladar hendido tratados interdisciplinariamente en el Centro de Rehabilitación para Niños con Labio y Paladar Fisurado (FISULAB) en Bogotá, Colombia, evidenciando la efectividad del abordaje temprano. Material y Método: Estudio descriptivo tipo serie de casos en el que presentamos los resultados funcionales del tratamiento continuo en pacientes con paladar hendido, diagnosticados y tratados de forma exclusiva en FISULAB de acuerdo a su guía integral. Del total de 972 pacientes atendidos en la institución, 118 cumplían con los criterios de inclusión. Resultados: Estudiamos 118 pacientes con paladar hendido con o sin labio hendido atendidos bajo la guía integral desde el nacimiento hasta los 5 años de edad: 67 varones y 51 mujeres. Del total, 17 (14.4%) presentaron IVF (8 varones y 9 mujeres). De los que presentaron IVF, 4 (23.5%) tenían diagnóstico sindrómico asociado. La incidencia de IVF en nuestra población de pacientes, excluyendo los pacientes sindromáticos, fue del 11%, con una resolución del 100% de la IVF en los pacientes que fueron llevados a uno o múltiples procedimientos quirúrgicos. Conclusiones: El diagnóstico temprano y el manejo interdisciplinario de la IVF son esenciales para asegurar el éxito en la rehabilitación del lenguaje de los pacientes con paladar hendido. Un tratamiento conservador y por etapas de la IVF puede asegurar buenos resultados minimizando complicaciones

Background and Objective: A comprehensive and interdisciplinary treatment of patients with cleft palate is essential to ensure satisfactory long-term results. Adequate speech is one of the main goals because it allows each patient a proper adjustment to their educational and social environment. Velo- pharyngeal insufficiency (VPI) occurs due to anatomic changes of the velo- pharyngeal sphincter. Early and appropriate management of patients with cleft palate is crucial to prevent velopharyngeal insufficiency. The aim of this study is to determine the incidence of patients with VPI that were detected and received treatment during their first 5 years of age at FISULAB (Rehabilitation Center for Children with Cleft lip and Palate), Bogota, Colombia, and to evaluate the effectiveness early treatment. Methods: Descriptive study of case series. Patients included were diagnosed with cleft palate and treated exclusively in FISULAB, following the treatment protocol of this institution. A total of 972 patients were treated and 118 patients met the inclusion criteria. Results: A total of 118 patients with cleft palate, with or without associated cleft lip, were treated following the institutional protocol: 17 (14.4%) had VPI (8 male and 9 female). Of the patients who had VPI, 4 (23.5%) had a syndromic diagnosis. The incidence of VPI in our patient population was 11% with a resolution of 100% of VPI after surgical treatment. Conclusions: Early diagnosis and interdisciplinary management of VPI are essential to ensure the success in speech rehabilitation in patients with cleft palate. A conservative and stepwise treatment of VPI has shown good results, minimizing complications

Pielonefritis xantogranulomatosa en pediatría / Pediatric Xanthogranulomatous Pyelonephritis

Resumen La pielonefritis xantogranulomatosa es una variante atípica, severa y poco frecuente de una forma crónica de pielonefritis, que puede ocurrir a cualquier edad. En niños está generalmente asociada a malformaciones urológicas congénitas como obstrucción de las vías urinarias. Se describe el caso de un paciente de un año con episodios febriles recurrentes en quien, tras el tratamiento fallido de una pionefrosis y después de descartar múltiples diagnósticos diferenciales, se decide realizar nefreureterectomía izquierda, considerando clínicamente una pielonefritis xantogranulomatosa, la cual fue confirmada por estudio histopatológico.

Abstract Xanthogranulomatous pyelonephritis is an atypical, severe and infrequent variant of a chronic form of pyelonephritis, which can occur at any age. In children it is generally associated with congenital urological malformations as obstruction of the urinary tract. Next, we describe the case of a 1-year-old patient, with recurrent febrile episodes, where after the failed treatment of pionefrosis and after ruling out multiple differential diagnoses, it was decided to perform a left nephrectomy clinically considering a xanthogranulomatous pyelonephritis, a diagnosis confirmed by study histopathological.

Mapping the residual incidence of taeniasis and cysticercosis in Colombia, 2009-2013, using geographical information systems: Implications for public health and travel medicine.

BACKGROUND: In Colombia, taeniasis and cysticercosis have been significantly reduced over the past decades, however still reported with implications for public health and travel medicine. METHODS: An observational, retrospective study, in which the incidence of taeniasis and cysticercosis (ICD-10 codes B68s/B69s) in Colombia, 2009-2013, was estimated based on data extracted from the Individual Health Records System (Registro Individual de Prestación de Servicios, RIPS) was performed. The Geographic Information System (GIS) generated national maps showing the distribution of taeniasis and cysticercosis by department by year. RESULTS: During the period, 3626 cases were reported (median 796/year), for a cumulative crude national rate of 7.7 cases/100,000pop; 58.2% corresponded to male; 57% were <40 year-old (10.2% < 9.9 year-old). Cases were 57.6% neurocysticercosis, the rest were taeniasis due to T. solium, T. saginata, ocular cysticercosis and cysticerci in other organs. Bolivar, a touristic department, had the highest cumulated incidence rate (16.17 cases/100,000pop), as also evident across the map series developed in this study. CONCLUSION: Despite the limitations of this study, data presented provide recent estimates of national taeniasis and cysticercosis incidence in the country useful in public health and for travel medicine practitioners, as some highly touristic areas presented higher disease incidence. Improved control, particularly of taeniasis, should be an attainable goal, which among other strategies would require improved sanitation and health education to prevent transmission, but also enhanced surveillance.

In silico search of inhibitors of Streptococcus mutans for the control of dental plaque.

Biofilm is an extremely complex microbial community arranged in a matrix of polysaccharides and attached to a substrate. Its development is crucial in the pathophysiology of oral infections like dental caries, as well as in periodontal, pulp, and periapical diseases. Streptococcus mutans is one of the most effective microorganisms in lactic acid production of the dental biofilm. Identifying essential Streptococcus mutans proteins using bioinformatics methods helps to search for alternative therapies. To this end, the bacterial genomes of several Streptococcus mutans strains and representative strains of other cariogenic and non-cariogenic bacteria were analysed by identifying pathogenicity islands and alignments with other bacteria, and by detecting the exclusive genes of cariogenic species in comparison to the non-pathogenic ones. This study used tools for orthology prediction such as BLAST and OrthoMCL, as well as the server IslandViewer for the detection of pathogenicity islands. In addition, the potential interactome of Streptococcus mutans was rebuilt by comparing it to interologues of other species phylogenetically close to or associated with cariogenicity. This protocol yielded a final list of 20 proteins related to potentially virulent factors that can be used as therapeutic targets in future analyses. The EIIA and EIIC enzymatic subunits of the phosphotransferase system (PTS) were prioritized, as well as the pyruvate kinase enzyme, which are directly involved in the metabolism of carbohydrates and in obtaining the necessary energy for the microorganism's survival. These results will guide a subsequent experimental trial to develop new, safe, and effective molecules in the treatment of dental caries.

Work-related illness, work-related accidents, and lack of social security in Colombia.

The impacts of neoliberal or market-based social security reforms in health have been extensively studied. How such reforms transformed employment-related insurance and entitlements, however, has received significantly less attention. This study aims to understand how the employment insurance system operates in Colombia and to assess how the experience of workers seeking social security entitlements relates to the system's structure. We conducted an ethnographic study of the Colombian Occupational Risk System between May 2014 and March 2016, with two main components: 1) analysis of the system itself through in-depth interviews with 32 people working in leadership positions and a systematic review of the system's most important legislation, and 2) a study of people who experienced problems receiving entitlements and were challenging the assessment of their work-related illness or accident. We conducted in-depth interviews with 22 people, followed up with half of them, and reviewed their case files. We found that difficulties accessing health care services, payments for medical leave, job reassignments, severance packages, and filing for pension benefits were common to all cases and resulted from overwhelming bureaucratic and administrative demands. Regional and national evaluation bodies dictate whether a given illness or accident is work-related, and establish a percentage of Loss of Wage Earning Capacity (LWEC). People's disabled bodies rarely reached the threshold of 50% LWEC to qualify for disability pensions. The lengthy process that workers were forced to endure to obtain work-related entitlements always involved the judiciary. The three competing for-profit financial sectors (health insurance, pension funds, and Occupational Risk Administrators) actively challenged workers' demands in order to increase their profits. We conclude that these for-profit sectors work contrary to the principles that sustain social security. Indeed, they push sick and disabled workers to unemployment, informality, economic dependence, and ultimately dire poverty.