Effect of Agavins and Agave Syrup Use in the Formulation of a Synbiotic Gelatin Gummy with Microcapsules of Saccharomyces Boulardii.

Agavins are reserve carbohydrates found in agave plants; they present texture-modifying properties and prebiotic capacity by increasing the viability of the intestinal microbiota. Through its hydrolysis, agave syrup (AS) can be obtained and can be used as a sweetener in food matrices. The objective of this work was to evaluate the effect of the variation in the content of agavins and AS on the physical, structural, and viability properties of Saccharomyces boulardii encapsulates incorporated into gelatin gummies. An RSM was used to obtain an optimized formulation of gelatin gummies. The properties of the gel in the gummy were characterized by a texture profile analysis and Aw. The humidity and sugar content were determined. A sucrose gummy was used as a control for the variable ranges. Alginate microcapsules containing S. boulardii were added to the optimized gummy formulation to obtain a synbiotic gummy. The viability of S. boulardii and changes in the structure of the alginate gel of the microcapsules in the synbiotic gummy were evaluated for 24 days by image digital analysis (IDA). The agavins and agave syrup significantly affected the texture properties (<1 N) and the Aw (>0.85). The IDA showed a change in the gel network and an increase in viability by confocal microscopy from day 18. The number of pores in the gel increased, but their size decreased with an increase in the number of S. boulardii cells. Agavins and cells alter the structure of capsules in gummies without affecting their viability.

Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain.

Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer's instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.

Myeloid cells in vascular dementia and Alzheimer's disease: Possible therapeutic targets?

Growing evidence supports the suggestion that the peripheral immune system plays a role in different pathologies associated with cognitive impairment, such as vascular dementia (VD) or Alzheimer's disease (AD). The aim of this review is to summarize, within the peripheral immune system, the implications of different types of myeloid cells in AD and VD, with a special focus on post-stroke cognitive impairment and dementia (PSCID). We will review the contributions of the myeloid lineage, from peripheral cells (neutrophils, platelets, monocytes and monocyte-derived macrophages) to central nervous system (CNS)-associated cells (perivascular macrophages and microglia). Finally, we will evaluate different potential strategies for pharmacological modulation of pathological processes mediated by myeloid cell subsets, with an emphasis on neutrophils, their interaction with platelets and the process of immunothrombosis that triggers neutrophil-dependent capillary stall and hypoperfusion, as possible effector mechanisms that may pave the way to novel therapeutic avenues to stop dementia, the epidemic of our time. LINKED ARTICLES: This article is part of a themed issue From Alzheimer's Disease to Vascular Dementia: Different Roads Leading to Cognitive Decline. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v181.6/issuetoc.

Conocimiento del Equipo de Enfermería sobre Prevención de Lesiones por Presión en un hospital de Barranquilla, Colombia / Knowledge by the Nursing Team about Prevention of Pressure Ulcers at a hospital in Barranquilla, Colombia

Objetivo: determinar el nivel de conocimiento sobre prevención de lesiones por presión (LPP) en el equipo de Enfermería (enfermeros/as y auxiliares de Enfermería) en un hospital de cuarto nivel en Barranquilla, Colombia.Material y método: estudio descriptivo transversal realizado en los servicios de Medicina Interna y Cuidados Intensivos (N= 77). Se midieron la edad, el tiempo de formación, el tiempo de experiencia y el nivel de conocimientos sobre LPP mediante el porcentaje de aciertos en el Cuestionario Pieper y Mott Pressure Ulcer Knowledge de 41 ítems, traducido ad hoc, para los apartados de evaluación y clasificación y prevención. Se efectuó estadística descriptiva y bivariante.Resultados: participaron 77 personas. El porcentaje promedio de aciertos en la prueba de conocimiento fue de un 62% (DE= 27) en el apartado de evaluación y clasificación de las LPP (auxiliares de Enfermería [x–= 61%; DE= 26]; enfermeros/as [x–= 64%; DE= 30]; valor p= 0,663) y de un 72% (DE= 17) en el apartado de prevención (auxiliares de Enfermería [x–= 72%; DE= 16]; enfermeros/as [x–= 71%; DE= 22]; valor p= 0,663). En total, diez de los ítems superaron un 90% de aciertos en el caso de las/os enfermeras/os y uno en el caso de las/os auxiliares.Conclusiones: las/os enfermeras/os y auxiliares de Enfermería presentaron un conocimiento aceptable en prevención de LPP. Es necesario implementar estrategias exitosas para mejorar la prevención e incentivar la actualización de conocimientos. (AU)

Objective: to determine the level of knowledge about prevention of pressure ulcers (PU) by the Nursing Team (nurses and nursing assistants) at a fourth level hospital in Barranquilla, Colombia.Material and method: a descriptive, cross-sectional study conducted at the Internal Medicine and Intensive Care Units (N= 77). Their age, time of training, time of experience, and level of knowledge about PU prevention were measured through the percentage of right answers at the 41-item Pressure Ulcer Knowledge Questionnaire by Pieper and Mott, translated ad hoc, for the sections of evaluation and classification and prevention. Descriptive and bivariate statistics were conducted.Results: the study included 77 persons. The average proportion of right answers at the knowledge test was of 62% (SD= 27) in the section of evaluation and classification of PU prevention (nursing assistants [x–= 61%; SD= 26]; nurses [x–= 64%; SD= 30]; p value= 0.663) and 72% (SD= 17) in the prevention section (nursing assistants [x–= 72; SD= 16]; nurses [x–= 71%; SD= 22]; p value= 0.663). In total, ten of the items exceeded 90% of right answers in the case of nurses, and one in the case of assistants.Conclusions: nurses and Nursing assistants presented an acceptable knowledge regarding PU prevention. It is necessary to implement successful strategies in order to improve prevention and encourage the updating of knowledge. (AU)

Ipsilesional Hippocampal GABA Is Elevated and Correlates With Cognitive Impairment and Maladaptive Neurogenesis After Cortical Stroke in Mice.

BACKGROUND: Cognitive dysfunction is a frequent stroke sequela, but its pathogenesis and treatment remain unresolved. Involvement of aberrant hippocampal neurogenesis and maladaptive circuitry remodeling has been proposed, but their mechanisms are unknown. Our aim was to evaluate potential underlying molecular/cellular events implicated. METHODS: Stroke was induced by permanent occlusion of the middle cerebral artery occlusion in 2-month-old C57BL/6 male mice. Hippocampal metabolites/neurotransmitters were analyzed longitudinally by in vivo magnetic resonance spectroscopy. Cognitive function was evaluated with the contextual fear conditioning test. Microglia, astrocytes, neuroblasts, interneurons, γ-aminobutyric acid (GABA), and c-fos were analyzed by immunofluorescence. RESULTS: Approximately 50% of mice exhibited progressive post-middle cerebral artery occlusion cognitive impairment. Notably, immature hippocampal neurons in the impaired group displayed more severe aberrant phenotypes than those from the nonimpaired group. Using magnetic resonance spectroscopy, significant bilateral changes in hippocampal metabolites, such as myo-inositol or N-acetylaspartic acid, were found that correlated, respectively, with numbers of glia and immature neuroblasts in the ischemic group. Importantly, some metabolites were specifically altered in the ipsilateral hippocampus suggesting its involvement in aberrant hippocampal neurogenesis and remodeling processes. Specifically, middle cerebral artery occlusion animals with higher hippocampal GABA levels displayed worse cognitive outcome. Implication of GABA in this setting was supported by the amelioration of ischemia-induced memory deficits and aberrant hippocampal neurogenesis after blocking pharmacologically GABAergic neurotransmission, an intervention which was ineffective when neurogenesis was inhibited. These data suggest that GABA exerts its detrimental effect, at least partly, by affecting morphology and integration of newborn neurons into the hippocampal circuits. CONCLUSIONS: Hippocampal GABAergic neurotransmission could be considered a novel diagnostic and therapeutic target for poststroke cognitive impairment.

Online Training for Primary Care Staff: Skills development on the Mental Health Gap Action Programme (mhGAP) Intervention Guide / Entrenamiento en línea para personal de atención primaria: Desarrollo de habilidades sobre la Guía de Intervención para Superar las Brechas en Salud Mental (mhGAP)

Abstract Developing effective learning strategies to strengthen mental health professionals' capacities and deliver evidence-based interventions in their communities is urgent. We developed and evaluated an online training program for the Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings. Nine hundred and seventy-five health professionals in Mexico were enrolled in the training program, during the period of social distancing brought about by the COVID-19 pandemic. Participants completed a pre-post online evaluation strategy including Knowledge screening, assessment of Learning Activities, and performance in Programmed-Simulated cases to evaluate knowledge and skills for the assessment, management, and follow-up of Mental, Neurological and Substance Use Disorders. We found that participants improved their knowledge and skills from training on the mhGAP online course. Notably we observed these positive results regardless of sex, profession, institution, or social vulnerability rating of participants, suggesting that this is a relevant training program for primary care staff. These results contribute to the Mental Health Gap Action Programme and advance the use of online teaching and evaluation technologies in this field.

Resumen El desarrollo de estrategias efectivas de aprendizaje para fortalecer las competencias de los profesionales de la salud mental y brindar intervenciones basadas en evidencia en sus comunidades es necesario. El objetivo del presente trabajo fue desarrollar y evaluar un programa de entrenamiento en línea para la Guía de Intervención en Trastornos Mentales, Neurológicos y por Uso de Sustancias en nivel de atención de salud no especializada. Participaron 975 profesionales de la salud mexicanos durante el período de distanciamiento social provocado por la pandemia de COVID-19. Los participantes completaron una evaluación previa y posterior que incluyó un cuestionario de conocimientos, actividades de aprendizaje y la ejecución en casos simulados programados para evaluar el conocimiento y las habilidades para la evaluación, el manejo y el seguimiento de los trastornos mentales, neurológicos y por uso de sustancias. Los resultados indicaron que los participantes mejoraron sus conocimientos y habilidades en función de su participación en el curso en línea, independientemente del sexo, la profesión, la institución o la vulnerabilidad social de los participantes, sugiriendo que se trata de un programa de formación relevante para el personal de atención primaria. Los resultados contribuyen al Programa de Acción para la Brecha de Salud Mental y promueven el uso de tecnologías de evaluación y enseñanza en línea en este campo.

Effect of Agave Fructans on Changes in Chemistry, Morphology and Composition in the Biomass Growth of Milk Kefir Grains.

Prebiotic effects have been attributed to agave fructans through bacterial and yeast fermentations, but there are few reports on their use as raw materials of a carbon source. Kefir milk is a fermented drink with lactic acid bacteria and yeast that coexist in a symbiotic association. During fermentation, these microorganisms mainly consume lactose and produce a polymeric matrix called kefiran, which is an exopolysaccharide composed mainly of water-soluble glucogalactan, suitable for the development of bio-degradable films. Using the biomass of microorganisms and proteins together can be a sustainable and innovative source of biopolymers. In this investigation, the effects of lactose-free milk as a culture medium and the addition of other carbon sources (dextrose, fructose, galactose, lactose, inulin and fructans) in concentrations of 2, 4 and 6% w/w, coupled with initial parameters such as temperature (20, 25 and 30 °C), % of starter inoculum (2, 5 and 10% w/w) was evaluated. The method of response surface analysis was performed to determine the optimum biomass production conditions at the start of the experiment. The response surface method showed that a 2% inoculum and a temperature of 25 °C were the best parameters for fermentation. The addition of 6% w/w agave fructans in the culture medium favored the growth of biomass (75.94%) with respect to the lactose-free culture medium. An increase in fat (3.76%), ash (5.57%) and protein (7.12%) content was observed when adding agave fructans. There was an important change in the diversity of microorganisms with an absence of lactose. These compounds have the potential to be used as a carbon source in a medium culture to increase kefir granule biomass. There was an important change in the diversity of microorganisms with an absence of lactose, where the applied image digital analysis led to the identification of the morphological changes in the kefir granules through modification of the profile of such microorganisms.

Microglial Caspase-3 is essential for modulating hippocampal neurogenesis.

Adult hippocampal neurogenesis (AHN) is a process involved in numerous neurodegenerative diseases. Many researchers have described microglia as a key component in regulating the formation and migration of new neurons along the rostral migratory stream. Caspase-3 is a cysteine-aspartate-protease classically considered as one of the main effector caspases in the cell death program process. In addition to this classical function, we have identified the role of this protein as a modulator of microglial function; however, its action on neurogenic processes is unknown. The aim of the present study is to identify the role of Caspase-3 in neurogenesis-related microglial functions. To address this study, Caspase-3 conditional knockout mice in the microglia cell line were used. Using this tool, we wanted to elucidate the role of this protein in microglial function in the hippocampus, the main region in which adult neurogenesis takes place. After the reduction of Caspase-3 in microglia, mutant mice showed a reduction of microglia in the hippocampus, especially in the dentate gyrus region, a region inherently associated to neurogenesis. In addition, we found a reduction in doublecortin-positive neurons in conditional Caspase-3 knockout mice, which corresponds to a reduction in neurogenic neurons. Furthermore, using high-resolution image analysis, we also observed a reduction in the phagocytic capacity of microglia lacking Caspase-3. Behavioral analysis using object recognition and Y-maze tests showed altered memory and learning in the absence of Caspase-3. Finally, we identified specific microglia located specifically in neurogenic niche positive for Galectin 3 which colocalized with Cleaved-Caspase-3 in control mice. Taken together, these results showed the essential role of Caspase-3 in microglial function and highlight the relevant role of this specific microglial phenotype in the maintenance of AHN in the hippocampus.

Kinetics and Mechanisms of Saccharomyces boulardii Release from Optimized Whey Protein-Agavin-Alginate Beads under Simulated Gastrointestinal Conditions.

Encapsulation is a process in which a base material is encapsulated in a wall material that can protect it against external factors and/or improve its bioavailability. Among the different encapsulation techniques, ionic gelation stands out as being useful for thermolabile compounds. The aim of this work was to encapsulate Saccharomyces boulardii by ionic gelation using agavins (A) and whey protein (WP) as wall materials and to evaluate the morphostructural changes that occur during in vitro gastrointestinal digestion. Encapsulations at different levels of A and WP were analyzed using microscopic, spectroscopic and thermal techniques. Encapsulation efficiency and cell viability were evaluated. S. boulardii encapsulated at 5% A: 3.75% WP (AWB6) showed 88.5% cell survival after the simulated gastrointestinal digestion; the bead showed a significantly different microstructure from the controls. The mixture of A and WP increased in the survival of S. boulardii respect to those encapsulated with alginate, A or WP alone. The binary material mixture simultaneously allowed a controlled release of S. boulardii by mostly diffusive Fickian mechanisms and swelling. The cell-release time was found to control the increment of the Damköhler number when A and WP were substrates for S. boulardii, in this way allowing greater protection against gastrointestinal conditions.

Production and Characterization of Gelatin Biomaterials Based on Agave Microfibers and Bentonite as Reinforcements.

The objective of this work was to obtain biomaterials as gelatin films or biofilms produced by casting, reinforced with a microfiber (MF) from Agave angustifolia Haw bagasse and bentonite (BN) nanoparticles and evaluate the effect of such reinforcements at different concentrations. Agave microfibers were obtained by a non-abrasive chemical method. Three formulations based on gelatin with glycerol were reinforced with microfiber, bentonite and both materials with 1.5, 3.5 and 5.5% w/w solids content. Physicochemical properties were determined using SEM and FTIR, thickness, soluble matter and moisture. The XRD, barrier, mechanical and thermal properties were measured. The films' micrographs showed agglomerations on the surface. Interactions between its functional groups were found. The solubility increased when the MF concentration increased. The thickness of the films was between 60 and 110 µm. The crystallinity ranged from 23 to 86%. The films with both MF and BN and 3.5% w/w solids had the lowest barrier properties, while the film with 5.5% w/w solids showed the highest mechanical properties, being thermally resistant. Overall, Agave microfibers together with bentonite were able to improve some of the films' properties, but optimized mixing conditions had to be used to achieve good particle dispersion within the gelatin matrix to improve its final properties. Such materials might have the potential to be used as food packaging.

A Case of Hemothorax as Manifestation of Thoracic Endometrial Syndrome.

Thoracic endometriosis is a rare progression of a mostly benign disease of ectopic endometrial activity involving the pleura and lung. This is a case of a young female who presented with progressive shortness of breath and was found to have significant anemia. Further investigations showed a massive right-sided pleural effusion and ascites. Subsequent thoracentesis and pelvic diagnostic laparoscopy showed a hemorrhagic pleural effusion and ascites, along with dense pelvic adhesions. Pathology was consistent with endometriosis. Patient improved on leuprolide acetate and norethindrone. This case illustrates an important consideration in the differential of a reproductive-age female with new onset shortness of breath and anemia.

Corneal Healing and Recovery of Ocular Crystallinity with a Dichloromethane Extract of Sedum dendroideum D.C. in a Novel Murine Model of Ocular Pterygium.

Pterygium is a corneal alteration that can cause visual impairment, which has been traditionally treated with the sap of Sedum dendroideum D.C. The pharmacological effect of a dichloromethane extract of S. dendroideum was demonstrated and implemented in a pterygium model on the healing process of corneal damage caused by phorbol esters. In mice of the ICR strain, a corneal lesion was caused by intravitreal injection of tetradecanoylphorbol acetate (TPA). The evolution of the corneal scarring process was monitored with vehicle, dexamethasone, and dichloromethane extract of S. dendroideum treatments by daily ophthalmic administration for fifteen days. The lesions were evaluated in situ with highlighted images of fluorescence of the lesions. Following treatment levels in eyeballs of IL-1α, TNF-α, and IL-10 cytokines were measured. The effective dose of TPA to produce a pterygium-like lesion was determined. The follow-up of the evolution of the scarring process allowed us to define that the treatment with S. dendroideum improved the experimental pterygium and had an immunomodulatory effect by decreasing TNF-α, IL-1α, and maintaining the level of IL-10 expression, without difference with respect to the healthy control. Traditional medical use of S. dendroideum sap to treat pterygium is fully justified by its compound composition.

In Vitro Bile Salt Hydrolase (BSH) Activity Screening of Different Probiotic Microorganisms.

Bile salt hydrolase (BSH) activity in probiotic strains is usually correlated with the ability to lower serum cholesterol levels in hypercholesterolemic patients. The objective of this study was the evaluation of BSH in five probiotic strains of lactic acid bacteria (LAB) and a probiotic yeast. The activity was assessed using a qualitative direct plate test and a quantitative high-performance thin- layer chromatography assay. The six strains differed in their BSH substrate preference and activity. Lactobacillus plantarum DGIA1, a potentially probiotic strain isolated from a double cream cheese from Chiapas, Mexico, showed excellent deconjugation activities in the four tested bile acids (69, 100, 81, and 92% for sodium glycocholate, glycodeoxycholate, taurocholate, and taurodeoxycholate, respectively). In the case of the commercial probiotic yeast Saccharomyces boulardii, the deconjugation activities were good against sodium glycodeoxycholate, taurocholate, and taurodeoxycholate (100, 57, and 63%, respectively). These last two results are part of the novelty of the work. A weak deconjugative activity (5%) was observed in the case of sodium glycocholate. This is the first time that the BSH activity has been detected in this yeast.

Post-stroke Neurogenesis: Friend or Foe?

The substantial clinical burden and disability after stroke injury urges the need to explore therapeutic solutions. Recent compelling evidence supports that neurogenesis persists in the adult mammalian brain and is amenable to regulation in both physiological and pathological situations. Its ability to generate new neurons implies a potential to contribute to recovery after brain injury. However, post-stroke neurogenic response may have different functional consequences. On the one hand, the capacity of newborn neurons to replenish the damaged tissue may be limited. In addition, aberrant forms of neurogenesis have been identified in several insult settings. All these data suggest that adult neurogenesis is at a crossroads between the physiological and the pathological regulation of the neurological function in the injured central nervous system (CNS). Given the complexity of the CNS together with its interaction with the periphery, we ultimately lack in-depth understanding of the key cell types, cell-cell interactions, and molecular pathways involved in the neurogenic response after brain damage and their positive or otherwise deleterious impact. Here we will review the evidence on the stroke-induced neurogenic response and on its potential repercussions on functional outcome. First, we will briefly describe subventricular zone (SVZ) neurogenesis after stroke beside the main evidence supporting its positive role on functional restoration after stroke. Then, we will focus on hippocampal subgranular zone (SGZ) neurogenesis due to the relevance of hippocampus in cognitive functions; we will outline compelling evidence that supports that, after stroke, SGZ neurogenesis may adopt a maladaptive plasticity response further contributing to the development of post-stroke cognitive impairment and dementia. Finally, we will discuss the therapeutic potential of specific steps in the neurogenic cascade that might ameliorate brain malfunctioning and the development of post-stroke cognitive impairment in the chronic phase.

Hematologic disorders associated with COVID-19: a review.

Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2. Primarily an infection of the lower respiratory tract, it is now well known to cause multisystem abnormalities. Hematologic manifestations constitute a significant area of concern. Severe acute respiratory syndrome coronavirus 2 infects monocytes and endothelial cells leading to a complex downstream cascade, cytokine storm, and eventual intravascular thrombosis. Coronavirus disease 2019 causes lymphopenia, neutrophilia, and thrombocytopenia. Prophylactic anticoagulation is vital in patients with coronavirus disease 2019, as its effect on the coagulation system is associated with significant morbidity and mortality. The disease can cause both arterial and venous thromboses, especially pulmonary embolism and pulmonary microthrombi. A high index of suspicion is indispensable in recognizing these complications, and timely institution of therapeutic anticoagulation is vital in treating them. Virus-induced disseminated intravascular coagulation is uncommon but shares some similarities to sepsis-induced disseminated intravascular coagulation. Marked elevations in hematologic biomarkers such as lactate dehydrogenase, D-dimer, ferritin, and C-reactive protein are associated with worse outcomes. Understanding the pathophysiology and recognizing factors associated with poor prognosis are crucial in improving patient outcomes with coronavirus disease 2019.

Disseminated Mycobacterium abscessus infection and native valve endocarditis.

Mycobacterium abscessus is a rapidly growing mycobacterium. It rarely causes disseminated infection or endocarditis. A 55-year-old male with a history of hepatitis C, liver cirrhosis, intravenous drug use (last use was four years ago), and chronic back pain presented with a three-week history of a right calf nodular lesion. He did not have a fever, chills, rash, dyspnea, or cough. Laboratory data showed mild leukocytosis. Computed tomography of the chest revealed bilateral cavitating nodules. Skin biopsy, sputum, and blood cultures grew Mycobacterium abscessus. Therapy with meropenem, tigecycline, and amikacin was initiated. He was re-admitted with worsening lower back pain. A lumbar magnetic resonance imaging showed destructive changes of L4 and L5 vertebral bodies concerning for osteomyelitis. Blood culture and bone biopsy grew Mycobacterium abscessus again. An echocardiogram was performed due to persistent bacteremia, which revealed large vegetation on the tricuspid valve and small vegetation on the mitral valve. Therapy was changed to eight weeks of amikacin, with cefoxitin and imipenem for twelve months based on drug susceptibility. Treatment of disseminated Mycobacterium abscessus is challenging due to antibiotic resistance. Typically, multidrug therapy is warranted with at least three active drugs. In severe valvular endocarditis, valve replacement may be required.

[School absenteeism in asthmatic students of an academic institution in Cali]. / Ausentismo escolar en estudiantes asmáticos de una institución educativa de la ciudad de Cali.

Introduction: Asthma as a chronic inflammatory disease of the airways that is characterized by wheezing, respiratory distress, chest tightness and cough, which occurs mainly at night or in the early hours of the morning. In spite of the diagnostic and therapeutic advances, the prevalence of this pathology worldwide continues to increase, affecting mainly the child and adolescent population, in which it generates limitations in daily physical activity, interference in sleep, absence from school days and low academic performance. The objective of this study was to determine the frequency of school absenteeism in asthmatic students of an educational institution in the city of Cali. Methodology: A total of 385 students from 5 to 14 years were included in the study, to which they were supplied with the ISAAC questionnaire, which were completed by the caregivers. From the data obtained, the statistical analysis was performed in the SPSS package version 20 Results: The prevalence of asthma found was 27%, in relation to the absenteeism in this group of students it was evidenced that in total 776 days of classes had been lost during the year, with an average of 7.5 days (DE +/- 7) per student. 45% missed 1-5 times and 6% more than 20 times Conclusions: Based on the findings, it is concluded that asthma is a disease that can have clear repercussions at school level.

Introducción: El asma como una enfermedad crónica inflamatoria de las vías aéreas que se caracteriza por sibilancias, dificultad respiratoria, opresión torácica y tos, la cual se da principalmente en la noche o en las primeras horas de la mañana. A pesar de los avances diagnósticos y terapéuticos, la prevalencia de esta patología a nivel mundial sigue en aumento, afectando principalmente la población infantil y adolescente, en las que genera limitaciones en la actividad física diaria, interferencias en el sueño, ausencias a las jornadas escolares y bajo rendimiento académico. El objetivo del presente estudio fue determinar la frecuencia de ausentismo escolar en estudiantes asmáticos de una institución educativa de la ciudad de Cali. Metodología: Un total de 385 estudiantes de 5 a 14 años fueron incluidos en el estudio, a los cuales se les suministro el cuestionario ISAAC, los cuales fueron diligenciados por los cuidadores. A partir de los datos obtenidos se realizó el análisis estadístico en el paquete SPSS versión 20. Resultados: La prevalencia de asma encontrada fue del 27%, con relación el ausentismo en este grupo de estudiantes se evidenció que en total 776 días de clases se habían perdido durante el año, con un promedio de 7.5 días (DE +/- 7) por estudiante. El 45% faltó de 1-5 veces y un 6% más de 20 veces. Conclusiones: A partir de los hallazgos se concluye que el asma una enfermedad que puede traer claras repercusiones a nivel escolar.

Prevalence and Potential Factors Associated with Tobacco Consumption in Schooled Adolescents / Prevalencia y posibles factores asociados al consumo tabáquico en adolescentes escolarizados / Prevalência e possíveis fatores associados ao consumo de tabaco em adolescentes escolarizados

ABSTRACT Objective: This study estimates the prevalence in tobacco consumption and the associated factors in adolescents at official educational institutions in the municipality of Palmira. Methods: This was a cross-sectional analysis with an analytical component, including 205 high school students from six official schools. The analysis was performed through the SPSS statistics software version 24. Qualitative variables were expressed as ratios with their corresponding 95 % confidence intervals (CI). Quantitative variables were expressed as central tendency and dispersion measures, depending on the distribution of the variable. Finally, an odds ratio was calculated for the associated factors with a 95 % CI and the binary logistic regression model statistical model was used to adjust the variables. Results: The tobacco consumption's overall prevalence was 38.5%, CI 95 % (31.6-45.4 %); e-cigarette, 20 %, 95 % CI (14.2-25.7 %); cigarette, 18.5 %, 95 % CI (12.9-24.1 %) and hookah, 17.9 %, 95 % CI (12.1-23 %), with a greater incidence in women than men. The resulting associated factors were age (OR 3.17, CI 95 % [1.48-6.79]), a partner who smokes (OR 2.51, 95 % CI (1.36-4.63 %), friends who smoke (OR 7.0, 95 % CI [3.4-14.5]), and the possibility of buying individual cigarettes instead of a pack (OR 2.60, 95 % CI (1.26-5.3). Conclusions: Smoking habit's overall prevalence is higher than the one reported in adolescents. Female subjects reported greater and more frequent consumption of e-cigarettes.

RESUMEN Objetivo: estimar la prevalencia del consumo de tabaco y los factores asociados a esta práctica en adolecentes de instituciones educativas oficiales del municipio de Palmira. Métodos: estudio transversal con un componente analítico, que incluyó 205 estudiantes de bachillerato de seis colegios oficiales. El análisis se realizó con el programa estadístico SPSS versión 24. Las variables cualitativas se expresaron como proporciones, con sus respectivos intervalos de confianza (IC) al 95 %; y las variables cuantitativas como medidas de tendencia central y dispersión, según la distribución de la variable. Para los factores asociados, se calcularon Odds ratio con su IC al 95 %, y el ajuste de variables se realizó a través de regresión logística binaria. Resultados: la prevalencia global del consumo tabáquico fue del 38.5 %, IC 95 % (31.6-45.4 %); cigarrillo electrónico, del 20 %, IC 95 % (14.2-25.7 %); cigarrillo, del 18.5 %, IC 95 % (12.9-24.1 %); y narguile, del 17.9 %, IC 95 % (12.1-23 %), con más frecuencia en mujeres que en hombres. Los factores asociados fueron la edad (OR 3.17, IC 95 % [1.48-6.79]), tener novio que consuma tabaco (OR 2.51, IC 95 % (1.36-4.63 %), estar rodeado de amigos que fumen (OR 7.0, IC 95 % [3.4 -14.5]) y comprar cigarrillos sueltos (OR 2.60, IC 95 % (1.26-5.3). Conclusión: la prevalencia global del hábito tabáquico es superior a la reportada en adolescentes, mayor en el sexo femenino, con mayor frecuencia de consumo de cigarrillos electrónicos. Los factores asociados fueron la edad, tener novio o amigos que consuman tabaco y la posibilidad de comprar cigarrillos sueltos.

RESUMO Objetivo: estimar a prevalência do consumo de tabaco e os fatores associados a esse hábito em adolescentes de instituições educativas oficiais do município de Palmira, Colômbia. Métodos: estudo transversal com um componente analítico, que incluiu 205 estudantes do ensino médio de seis colégios oficiais. A análise foi realizada com o programa estadístico SPSS versão 24. As variáveis qualitativas foram expressas como proporções, com seus respectivos intervalos de confiança (IC) a 95 %; as variáveis quantitativas como medidas de tendência central e dispersão, segundo a distribuição da variável. Para os fatores associados, foram calculados Odds ratio com seu IC a 95 %, e o ajuste de variáveis foi realizado por meio de regressão logística binária. Resultados: a prevalência global do consumo de tabaco foi de 38,5 %, IC 95 % (31,6-45,4 %); cigarro eletrônico, de 20 %, IC 95 % (14,2-25,7 %); cigarro, de 18,5 %, IC 95 % (12,9-24,1 %); narguilé, de 17,9 %, IC 95 % (12,1-23 %), com mais frequência em mulheres do que em homens. Os fatores associados foram a idade (OR 3,17, IC 95 % [1,48-6,79]), ter parceiro(a) que consuma tabaco (OR 2,51, IC 95 % (1,36-4,63 %), estar rodeado(a) de amigos que fumam (OR 7,0, IC 95 % [3,4 -14,5]) e comprar cigarro solto (OR 2,60, IC 95 % (1.26-5.3). Conclusões: a prevalência global do hábito tabágico é superior à relatada em adolescentes, maior no sexo feminino, com mais frequência de consumo de cigarros eletrônicos. Os fatores associados foram a idade, ter parceiro(a) ou amigos que consumam tabaco e a possibilidade de comprar cigarros soltos.