Reaching new lands: Updating the distribution of Angiostrongylus cantonensis in South America with the first record in Argentina.

BACKGROUND: Angiostrongylus cantonensis, commonly known as the rat lungworm, is a metastrongyloid nematode found primarily not only in tropical and subtropical regions but also in temperate areas and considered the leading cause of eosinophilic meningitis in humans. Synanthropic rodents such as Rattus norvegicus and Rattus rattus are the most frequent definitive hosts of this parasite. METHODS AND RESULTS: The presence of this parasite was detected in the pulmonary arteries of three specimens of R. norvegicus in the city of Buenos Aires representing the species' southernmost known record in natural hosts. Species confirmation was achieved through partial sequences of 18S and COI genes. By comparing the COI gene sequences with those available in GenBank through the construction of a haplotype network, we obtained that the analysed specimen presents high similarity with those reported in Japan and Southeast Asia. CONCLUSIONS: All infected rats were captured in an area surrounding a port with significant import and export activity, suggesting that A. cantonensis may have been introduced through commercial ships. Specifically, the parasite was detected in a neighbourhood with vulnerable socio-economic conditions and in a nature reserve, which exhibit biotic and abiotic characteristics conducive to sustaining high-density rat populations, scattered waste, areas of spontaneous vegetation, debris accumulation and flooded areas or lagoons offering suitable habitats for intermediate hosts such as snails. Thus, the close proximity of the port to these sites creates a favourable ecological context for the establishment of A. cantonensis. This study shows the need to conduct research to detect A. cantonensis in non-endemic areas but with the characteristics that promote its arrival and development of its life cycle in order to implement control measures to prevent expansion of this parasite and its transmission to humans and other animals.

Point shear-wave elastography for the diagnosis of veno-occlusive disease in children and young adults.

BACKGROUND: Hepatic veno-occlusive disease or sinusoidal obstruction syndrome is a potentially life-threatening complication of hematopoietic stem cell transplantation. OBJECTIVE: To assess the usefulness of point shear-wave elastography (pSWE) for the early diagnosis of sinusoidal obstruction syndrome (SOS) in children. MATERIALS AND METHODS: A retrospective study was carried out in 43 patients with suspected SOS assessed between March 2018 and November 2021. Diagnosis of SOS was confirmed in 28 patients based on the European Society for Blood and Marrow Transplantation diagnostic criteria. Abdominal ultrasound and pSWE of the liver were performed before and after hematopoietic stem cell transplantation on first suspicion of SOS. RESULTS: Liver stiffness on initial suspicion was higher in patients diagnosed with SOS and these values increased compared to the pre-transplantation values. A cutoff value of 1.37 m/s was found for the diagnosis of SOS, with an area under the curve of 0.779 (95% CI 0.61-0.93). CONCLUSION: Point shear wave elastography of the liver is a promising technique for the early diagnosis of pediatric SOS.

Intra- and inter-annual variations in metal concentrations in the superficial water of a highly polluted urban basin of Argentina.

To protect ecosystems impacted by human activities and prevent their degradation, it is imperative to evaluate variations in the concentration of environmental pollutants over time. Here, we evaluated the intra- and inter-annual variations of several metals from 15 sites in the Matanza Riachuelo River basin (one of the most polluted in the world) and determined the physicochemical and meteorological parameters associated with these changes from 2008 to 2015. For this, in each site, we used Asymmetric Eigenvector Maps and Redundancy Analysis. The results highlighted temporal patterns of metal concentrations and several factors associated with them, perhaps related to the actions performed in the area since 2008. Additionally, we found that the effects of physicochemical and meteorological factors on metal concentrations were site-dependent, possibly related to the presence of different local sources of pollution or characteristics of the river in each site, such as its sediments. This approach could be applied to different scenarios (aquatic and terrestrial) and could provide a tool to help decision-makers address the harmful consequences of the continuous advance of human activities on human and ecosystem health.

Enfermedades de origen laboral en docentes escolares: una revisión sistemática / Occupational Diseases in School Teachers: A Systematic review

Introducción. La docencia es una de las principales profesiones vinculadas con el desarrollo de una sociedad; como cualquier labor, se encuentra expuesta a diferentes factores de riesgo que pueden generar una enfermedad de origen laboral. Objetivo. Identificar y caracterizar la literatura actual que presente las principales enfermedades de los docentes escolares como consecuencia de su trabajo y/o las condiciones laborales. Materiales y Métodos. Revisión sistemática con búsqueda en las bases de datos Academic Search Complete (EBSCOHOST), APA - PSYCNET, ERIC (Education Resources Information Center), MEDLINE (PubMed), SCOPUS y Open Grey. Se realiza selección pareada independiente bajo criterios de inclusión y análisis de forma narrativa, incluyendo generalidades, información de la enfermedad y desenlaces en docentes. Resultados. Se incluyeron 47 estudios, de los cuales el 25,5 % fueron publicados en 2015; Brasil fue el país con mayor aporte temático. La mayoría de los estudios agrupó a los docentes escolares sin distinción de su ciclo (primaria, bachillerato y media). Las principales enfermedades identificadas fueron trastornos de la voz 51,1 %, musculoesqueléticos 23,4 % y psicosociales 21,3 %. Adicionalmente, se identificó que al menos el 50 % de los reportes por país estuvieron relacionados con trastornos de la voz; Brasil e India fueron los países de mayor representatividad. Conclusiones. Las principales enfermedades laborales docentes fueron las relacionadas con trastornos de la voz, musculoesqueléticos y psicosociales; a su vez, estas se relacionan con riesgos físicos, condiciones de seguridad, riesgos biomecánicos y psicosociales en el contexto escolar.

Introduction. Teaching is one of the main professions linked to the development of a society, and like any other labor it is exposed to different risk factors that can generate an occupational disease. Objective. To identify and characterize the current literature on the main illnesses suffered by schoolteachers as a result of their work and/or working conditions. Methodology. Systematic review with search in the databases Academic Search Complete (EBSCOHOST), APA - PSYCNET, ERIC (Education Resources Information Center), MEDLINE (PubMed), SCOPUS and Open Grey. We performed independent paired selection under inclusion criteria and narrative analysis including generalities, disease information and outcomes in teachers. Results. Forty-seven studies were included, 25.5% of which were published in 2015, and Brazil was the country with the largest thematic contribution. Most of the studies grouped schoolteachers regardless of their cycle (primary, secondary and high school). The main illnesses identified were voice disorders 51.1%, musculoskeletal disorders 23.4% and psychosocial disorders 21.3%. In addition, it was found that at least 50% of the reports per country were related to voice disorders, with Brazil and India being the most representative. Conclusions. The main occupational illnesses identified were related to voice, musculoskeletal and psychosocial disorders; these in turn are related to physical, safety, biomechanical and psychosocial risks in the school context.

Evolución satisfactoria de un paciente adulto con malaria grave y complicada por Plasmodium falciparum / Satisfactory course of an adult patient with severe complicated Plasmodium falciparum malaria

Introducción: La malaria continúa siendo un importante problema de salud a nivel mundial, su diagnóstico temprano y tratamiento inmediato son fundamentales para prevenir las complicaciones y la muerte. Objetivo: Reportar el caso de un paciente cubano procedente de República de Guinea, que presentó malaria complicada por Plasmodium falciparum, el cual fue hospitalizado en el Instituto de Medicina Tropical Pedro Kourí (IPK). Caso clínico: Paciente masculino, cubano, de piel negra, 63 años de edad, profesión marinero mercante. Sin antecedentes patológicos personales. Llegó al IPK en camilla, con cierto deterioro de la conciencia, debilidad generalizada, dificultad respiratoria y compromiso del ritmo diurético. Ingresó en la Unidad de Cuidados Intensivos donde recibió tratamiento con los antipalúdicos artesunato y primaquina. La parasitemia fue descendiendo en el decursar de los días. El paciente sobrevivió y egresó satisfactoriamente a los 16 días posteriores a su ingreso. Fue debidamente notificado a las autoridades del Ministerio de Salud Pública de Cuba, lo que constituye un procedimiento obligatorio del Sistema Nacional de Vigilancia de Enfermedades Transmisibles en Cuba. Conclusión: La rapidez en el diagnóstico, así como el tratamiento integral, eficaz y oportuno, fue de importancia vital y condujo a un buen desenlace de la enfermedad.

Introduction: Malaria continues to be a major health problem worldwide, its early diagnosis and prompt treatment are critical to prevent complications and death. Objective: To report the case of a Cuban patient from the Republic of Guinea, who presented with complicated Plasmodium falciparum malaria, who was hospitalized at the Institute of Tropical Medicine Pedro Kourí (IPK). Clinical case: Male patient, Cuban, black-skinned, 63 years old, occupation: merchant seaman. No personal pathological history. He arrived at the IPK on a stretcher, with some deterioration of consciousness, generalized weakness, respiratory distress and diuretic rhythm compromise. He was admitted to the Intensive Care Unit where he received treatment with the antimalarial drugs artesunate and primaquine. Parasitemia decreased over the days. The patient survived and was discharged satisfactorily 16 days after admission. This case was duly notified to the authorities of the Ministry of Public Health of Cuba, which is a mandatory procedure of the National Surveillance System of Communicable Diseases in Cuba. Conclusion: Prompt diagnosis, as well as a comprehensive, effective, and timely treatment was vital and led to a good disease outcome.

Paludismo importado no falciparum: aspectos de interés para el tratamiento de los pacientes / Imported non-falciparum malaria: aspects of interest for patient therapeutic management

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos transmitidos por el mosquito Anopheles. El paludismo no falciparum (PNF), producido por otras especies de Plasmodium, está menos documentado en la literatura internacional, a pesar de su prevalencia. Objetivos: Describir aspectos clínicos y epidemiológicos de interés para el tratamiento en pacientes ingresados con diagnóstico de PNF importado, y determinar la relación existente entre la respuesta al tratamiento y otras variables. Métodos: Se realizó un estudio transversal analítico de 89 pacientes adultos con PNF importado, ingresados en el Departamento de Medicina del Instituto de Medicina Tropical Pedro Kourí, entre enero de 1997 a diciembre de 2017. Se determinó la pauta de profilaxis y tratamiento según los criterios de las guías publicadas y los fármacos disponibles en Cuba, y la definición de paludismo complicado según la OMS en 2003. Hubo respuesta demorada al tratamiento, cuando el paciente demoraba más de 7 días en negativizar la gota gruesa. Resultados: Predominaron los pacientes del sexo masculino, y una media de edad de 37,2 años. El 55,1 por ciento de los pacientes provenía de la región de las Américas y en el 85,4 por ciento se aisló Plasmodium vivax. La respuesta al tratamiento fue excelente con los esquemas combinados utilizados a base de cloroquina. Fue significativa la relación existente entre la demorada respuesta al tratamiento con la gravedad del cuadro clínico y el estado no inmune de los pacientes. Conclusiones: El PNF es una importante causa de paludismo importado en pacientes provenientes de áreas endémicas, fundamentalmente de América. Se distingue por parasitemias bajas, un cuadro clínico caracterizado por fiebre, escalofríos, cefaleas y evolución hacia cuadros no complicados. La cloroquina fue el medicamento de elección, aunque la repuesta demorada al tratamiento no justifica su suspensión o variación(AU)

Introduction: Malaria is a potentially fatal acute febrile illness caused by parasites transmitted by the Anopheles mosquito. Non-falciparum malaria (NFM), caused by other Plasmodium species, is less documented in the international literature, despite its prevalence. Objectives: To describe clinical and epidemiological aspects of interest for the treatment of patients hospitalized with a diagnosis of imported NFM, and to determine the relationship between response to treatment and other variables. Methods: It was conducted an analytical cross-sectional study of 89 adult patients with imported NFM, admitted to the Department of Medicine of the Institute of Tropical Medicine Pedro Kourí, between January 1997 to December 2017. The prophylaxis and treatment guideline was determined according to the published guidelines and drugs available in Cuba, and the definition of severe malaria by WHO in 2003. There was delayed response to treatment when the patient took more than 7 days to become negative for thick blood smear. Results: Patients were predominantly male, with a mean age of 37.2 years. Plasmodium vivax was isolated in 85.4 percent of the patients and 55.1 percent were from the Americas region. The response to treatment was excellent with the chloroquine-based combination regimens used. The relationship between the delayed response to treatment and the severity of the clinical picture and the non-immune status of the patients was significant. Conclusions: NFM is an important cause of imported malaria in patients from endemic areas, mainly from the Americas. It is characterized by low parasitemia, clinical manifestations of fever, chills, headache and evolution towards uncomplicated symptoms. Chloroquine was the drug of choice, although the delayed response to treatment does not justify its suspension or variation(AU)

A review of the diversity of Cryptosporidium in Rattus norvegicus, R. rattus and Mus musculus: What we know and challenges for the future.

The aim of this paper is to review the diversity of Cryptosporidium species and genotypes infecting synantropic rodents. A total of 27 papers published between 1990 and 2020 assed the presence of Cryptosporidium in these rodents worldwide and described 17 different species and genotypes of Cryptosporidium. A great variation in the prevalence values were observed (0-63%). The most frequent species/genotypes were Rat genotype I and IV for R. norvegicus and Rat genotype II and III R. rattus, while C. tyzzeri was for M. musculus. Cryptosporidium parvum, the second most common species after C. hominis involved in human cryptosporidiosis cases, was the third most detected Cryptosporidium species in R, norvergicus (9.4% of the positive samples) and the 3 rodent species are common host for C. muris, also recognized as zoonotic. Besides, these synanthopic rodents can harbor Cryptosporidium species whose natural hosts are cattle, bovids, pigs, other rodent species, birds and a broad range of mammals. Considering the diversity described so far, it would have a great epidemiological impact to know how the variation of Cryptosporidium species composition along urban-rural gradients is like, including synanthropic rodents, wild and domestic animals and environmental samples, and to analyze the causal factors of such variation.

Utilidad de la prueba de la lactato deshidrogenasa en fallecidos cubanos con sida y neumonía por Pneumocystis jirovecii

RESUMEN Introducción: La neumonía por Pneumocystis jirovecii es una de las enfermedades de mayor impacto negativo en los pacientes con sida. La imposibilidad de cultivar el agente que la provoca, así como su cuadro clínico inespecífico y el alto costo de los métodos diagnósticos moleculares, señalan la necesidad de otras alternativas para su diagnóstico. La prueba de la lactato deshidrogenasa representa una opción a considerar. Objetivo: Demostrar la utilidad de la prueba de la lactato deshidrogenasa como diagnóstico de la Pneumocystis jirovecii en fallecidos cubanos por sida. Métodos: Se realizó un estudio de casos y controles (25 casos [Pneumocystis jirovecii] y 30 controles [compuestos por tres grupos: tuberculosis, linfoma y neumonía bacteriana, respectivamente]) en fallecidos cubanos a los que se realizó la autopsia desde enero de 1996 a diciembre de 2016. Se utilizaron cinco rangos de corte para buscar el valor óptimo de la prueba. Resultados: En el presente estudio existen diferencias altamente significativas entre los pacientes analizados (casos y controles) y entre los restantes individuos que componen los controles con respecto al del linfoma. El rango de corte óptimo para la prueba de la lactato deshidrogenasa fue (550-<800 U/I) con sensibilidad de 80 % y especificidad de 63 %. La razón de disparidad (OR) demostró que existe 6,91 veces más probabilidades que los pacientes por Pneumocystis jirovecii tengan las cifras de LDH mayor que los pacientes controles. Conclusiones: Este trabajo aporta evidencias científicas del rol de la prueba de la lactato deshidrogenasa como herramienta complementaria para el diagnóstico de la Pneumocystis jirovecii.

ABSTRACT Introduction: Pneumocystis jirovecii pneumonia is one of the diseases causing the greatest negative impact on AIDS patients. The impossibility of culturing its causative agent, its unspecific clinical presentation and the high cost of molecular diagnostic methods, make it necessary to find other diagnostic alternatives. The lactate dehydrogenase test is an option to be considered. Objective: Demonstrate the usefulness of the lactate dehydrogenase test to diagnose Pneumocystis jirovecii in Cuban patients deceased with AIDS. Methods: A case-control study was conducted (25 cases [Pneumocystis jirovecii] and 30 controls [distributed into three groups: tuberculosis, lymphoma and bacterial pneumonia, respectively]) of Cuban deceased patients undergoing post-mortem examination from January 1996 to December 2016. Five cutoff ranges were used to find the optimal value of the test. Results: Highly significant differences were found between the patients analyzed (cases and controls) and between the remaining individuals making up the controls with respect to the one with lymphoma. The optimal cutoff range for the lactate dehydrogenase test was 550-<800 U/I, with 80% sensitivity and 63% specificity. The odds ratio (OR) showed that probabilities are 6.91 times greater that Pneumocystis jirovecii pneumonia patients have higher LDH figures than control patients. Conclusions: Scientific evidence is contributed of the role of the lactate dehydrogenase test as a complementary tool in the diagnosis of Pneumocystis jirovecii.

Symptom variability in outpatients with COPD and validation of the Colombian COPD Symptom Variability Instrument (EPOC-CoVaSy) / Variabilidad de síntomas en pacientes ambulatorios con EPOC y validación del Instrumento Colombiano de Variabilidad de Síntomas en EPOC (EPOC-CoVaSy)

Abstract Introduction: The variability of respiratory symptoms in chronic obstructive pulmonary disease (COPD) is considered to be low or nonexistent. However, some authors state that there may be fluctuations. Objectives: To describe symptom variability in patients with COPD throughout the day and night for four weeks using a patient diary, and to validate a questionnaire created for such purpose (Colombian Self-Ad -ministered Instrument of Symptom Variability in COPD - EPOC-CoVaSy). Materials and methods: Cohort study conducted in 96 patients with COPD treated between June and December 2016 at the Centro de Atención Pulmonar - CAP in Barranquilla, Colombia, who filled out a patient diary for four weeks and, after this period, the self-administered EPOC-CoVaSy instrument. Independence and comparison of frequencies of categorical and continuous variables were established using the chi- square and the Fisher ' s exact tests and the Pearson's correlation coefficient, respectively. A MANO-VA was performed using linear regression models to determine the correlations between the results of the diary and the instrument. Results: Participants' mean age was 73.3±8.3 years and 71.87% were male. According to the analysis of the diaries, the mean scores (visual analog scale) for all symptoms and the performance of activities of daily living ranged between 0.5 and 2.5, being higher in the morning (mean scores between 1.5 and 2.5) than in the afternoon and night (mean scores between 0.5 and 1.5); however, symptom variability was minimal. These results were similar to those obtained in the EPOC-CoVaSy instrument, demonstrating a high correlation between both instruments that allowed to confirm that EPOC-CoVaSy is a useful instrument to measure such variability. Conclusions. Based on the findings of the present study, it can be concluded that there is a slight variability in COPD symptoms throughout the day, which should be considered when establishing treatment regimens for this disease. Likewise, it was determined that the EPOC-CoVaSy instrument is valid to measure such variability in Colombian patients with COPD.

Resumen Introducción. Se considera que la variabilidad de los síntomas respiratorios de la enfermedad pulmonar obstructiva crónica (EPOC) es baja o inexistente. Sin embargo, algunos autores afirman que se pueden presentar fluctuaciones. Objetivos. Describir la variabilidad de síntomas en pacientes con EPOC a lo largo del día y la noche durante cuatro semanas mediante un diario del paciente, y validar un cuestionario desarrollado para tal fin (Instrumento Colombiano Autoadministrado de Variabilidad de Síntomas en EPOC: EPOC-CoVaSy). Materiales y métodos. Estudio de cohorte realizado en 96 pacientes con EPOC atendidos entre junio y diciembre de 2016 en el Centro de Atención Pulmonar - CAP, en Barranquilla, Colombia, quienes diligenciaron un diario del paciente durante cuatro semanas y, luego de este periodo, el instrumento autoadministrado EPOC-CoVaSy. La independencia y comparación de frecuencias de las variables categóricas y continuas se establecieron mediante las pruebas % 2 y exacta de Fisher y el coeficiente de correlación de Pearson, respectivamente. Se realizó un MANOVA, utilizando modelos de regresión lineal, para determinar las correlaciones entre los resultados del diario y el instrumento. Resultados. La edad promedio de los participantes fue 73.3±8.3 años y 71.87% eran hombres. Según el análisis de los diarios, los puntajes promedio (escala visual analógica) para todos los síntomas y el desempeño de actividades diarias oscilaron entre 0.5 y 2.5, siendo más altos en la mañana (puntajes promedio entre 1.5 y 2.5) que en la tarde y noche (puntajes promedio entre 0.5 y 1.5); sin embargo, esta variabilidad fue mínima, lo que coincidió con los resultados obtenidos en el EPOC-CoVaSy, evidenciándose una alta correlación entre ambos instrumentos que permitió confirmar que la herramienta diseñada es útil para medir dicha variabilidad. Conclusiones. Con base en los hallazgos del presente estudio, se puede concluir que existe una leve variabilidad en los síntomas de EPOC a lo largo del día, la cual debe considerarse a la hora de establecer esquemas de tratamiento para esta enfermedad. Asimismo, se estableció que el EPOC-CoVaSy es válido para medir dicha variabilidad en la población colombiana con EPOC.

La rehabilitación profesional desde la perspectiva del trabajador con trastorno mental de origen laboral: un estudio cualitativo / Professional rehabilitation from the perspective of worker with a mental disorder: a qualitative study

Introducción: Los trabajadores que presentan diferentes deficiencias en sus estructuras y funciones corporales deben trascurrir por diferentes procesos con el fin de mantener una actividad productiva. Las personas con trastornos mentales de origen laboral no son la excepción y tienden a tener mayor dificultad para ser incluidos. Objetivo: Describir la experiencia de un trabajador con trastorno mental de origen laboral durante el proceso de rehabilitación profesional en Colombia. Material y Métodos: Estudio cualitativo fenomenológico con enfoque interpretativo. La recopilación de datos fue llevada a cabo en 2020 a través de entrevista semiestructurada y con posterior análisis por categorías, temas y patrones. Resultados: La experiencia está estrechamente ligada o determinada por el acceso a los servicios oportunamente. El proceso de rehabilitación profesional se constituye como un protector del rol laboral, no obstante, las redes de apoyo pueden influir drásticamente. Conclusiones: El proceso de rehabilitación profesional es determinante en los casos de trabajadores con trastorno mentales de origen laboral (AU)

Introduction: Workers who present different deficiencies in their body structures and functions must go through different processes to maintain a productive activity. People with work-related mental disorders are no exception and tend to have more difficulty being included. Objective: To describe the experience of a worker with a work-related mental disorder during the professional rehabilitation process in Colombia. Material and Methods: Qualitative phenomenological study with an interpretive approach. Data collection was carried out in 2020 through a semi-structured interview and subsequent analysis by categories, themes and patterns. Results: The experience of workers with mental disorders is closely linked or determined by access to timely services. The professional rehabilitation process is constituted as a protector of the work role; however, support networks can drastically influence. Conclusions: The professional rehabilitation process is decisive in the cases of workers with work-related mental disorders since it provides the necessary tools to strengthen and provides strategies that allow the worker to maintain their work role (AU)

Signos de alarma en pacientes con paludismo importado por Plasmodium falciparum / Warning signs in patients with imported Plasmodium falciparum malaria

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos que se transmiten al ser humano por la picadura de mosquitos del género Anopheles. De los 214 millones de casos de paludismo registrados en 2016, la mayoría de ellos se producen en niños menores de cinco años en África subsahariana. La mortalidad está dada por la presencia de sus complicaciones que deben ser detectadas y tratadas precozmente. Objetivo: Identificar la presencia de signos de alarma, y determinar su relación con otras variables clínicas y de laboratorio. Métodos: Se realizó un estudio descriptivo de 47 pacientes adultos con paludismo por Plasmodium falciparum importado, ingresados en el Departamento de Medicina del Instituto de Medicina Tropical Pedro Kourí, desde enero de 2016 a diciembre de 2018. Los datos fueron procesados en una base de datos en Microsoft Excel y luego analizados en el programa estadístico SPSS 11,5. Resultados: Predominaron los pacientes del sexo masculino, con una media de edad de 35,9 años. Fue significativa la relación existente entre los signos de alarma y la severidad del cuadro clínico, la hiperparasitemia, el supuesto estado no inmune de los pacientes, trombocitopenia y la demora en el ingreso. La respuesta al tratamiento es excelente con los esquemas combinados utilizados a base de quinina. Conclusiones: Los signos de alarma, dentro de los cuales podemos incluir la trombocitopenia, constituyen elementos importantes para poder prevenir futuras complicaciones(AU)

Introduction: Malaria is an acute potentially fatal febrile disease caused by parasites transmitted to humans through the bite of mosquitoes from the genus Anopheles. Most of the 214 million malaria cases reported in the year 2016 were children aged under five years from Sub-Saharan Africa. Mortality is due to the presence of complications which should be detected and treated timely. Objective: Identify the presence of warning signs and determine their relationship to other clinical and laboratory variables. Methods: A descriptive study was conducted of 47 adult patients with imported Plasmodium falciparum malaria admitted to the Medicine Department of Pedro Kourí Tropical Medicine Institute from January 2016 to December 2018. The data obtained were processed in a Microsoft Excel database and then analyzed with the statistical software SPSS 11.5. Results: Male patients prevailed, with a mean age of 35.9 years. A significant relationship was found between warning signs and severity of the clinical status, hyperparasitemia, the supposed non-immune status of patients, thrombocytopenia and admission delay. An excellent response was obtained to treatment with combined quinine-based schemes. Conclusions: Warning signs, among them thrombocytopenia, are important to prevent future complications(AU)

Valoración del desempeño ocupacional: factor integrador en la calificación de la pérdida de capacidad laboral y ocupacional / Assessment of occupational performance: An integrating factor of the loss of work and occupational capacity

Resumen Introducción: El desempeño ocupacional (DO) como concepto integrador permite la valoración holística de la persona e identifica el potencial para el retorno a la actividad productiva a través del concepto ocupacional, como insumo para la valoración de la pérdida de la capacidad laboral y ocupacional (PCLO), esto permite una calificación objetiva de los aspectos que constituyen el Manual único para la calificación de la pérdida de la capacidad laboral y ocupacional (MUCPCLO). Métodos: Estudio transversal analítico con aplicación de una escala de evaluación del DO a una muestra de trabajadores seleccionados a conveniencia, con alteraciones en funciones o estructuras corporales, participación o restricción a nivel ocupacional. Se realizaron comparaciones analíticas con el estándar de calificación del MUCPCLO y se identificaron factores diferenciales e integradores. Resultados: La muestra estuvo integrada por seis sujetos, cuatro presentaron un accidente de trabajo y dos, enfermedades laborales. En cuanto a la evaluación del desempeño, se evidenció que el 66 % presentó dependencia leve en actividades específicas; producto de ello, se logró realizar un análisis diferencial con énfasis en la calificación del MUCPCLO. Se reconocen factores específicos en el proceso como la objetividad de la valoración del DO, los múltiples aportes del concepto de DO y las posibilidades de articulación con el manual MUCPCLO. Conclusiones: La valoración previa del DO y el concepto integral del terapeuta ocupacional se constituyen como un eje fundamental que aporta al proceso de la valoración PCLO.

Abstract Introduction: Occupational performance (OP) as an integrating concept allows the holistic assessment of the person and identifies the potential for the return to productive activity through the occupational concept as an input for the assessment of the loss of work and occupational capacity (LWOC), allowing an objective qualification of the aspects that constitute the Manual único para la calificación de la pérdida de la capacidad Laboral y Ocupacional (MUCPCLO, Spanish acronym for Manual for the qualification of the loss of labor and occupational capacity). Methods: A cross-sectional study was conducted with application of an OP evaluation scale to a sample of conveniently selected workers with alterations in body functions or structures, participation, or restriction at the occupational level. Analytical comparisons were made with the MUCPCLO scoring standard, and differential and integrating factors were identified. Results: Six subjects made up the sample, four had an occupational accident and two occupational diseases. In performance evaluation, 66% of the sample presented slight dependence on specific activities that lead to a differential analysis with emphasis on the MUCPCLO score. Specific factors were recognized, such as, objectivity of the assessment of occupational performance, multiple contributions of the concept of occupational performance, and possibilities of articulation with the manual. Conclusions: The prior assessment of occupational performance and the integral concept of the occupational therapist are constituted as a fundamental axis that contributes to the process of the assessment of the LWOC.

Co-occurrence of and risk factors for Cryptosporidium and Giardia in brown rats from Buenos Aires, Argentina.

A rodent survey was conducted in different landscape units of the city of Buenos Aires (Argentina) to determine the prevalence of Cryptosporidium and Giardia in Rattus norvegicus and to, ultimately, assess the biotic, environmental and meteorological factors that explain the variations of the likelihood of infection for both parasites in an urban environment. The results of this study revealed a ubiquitous presence of Cryptosporidium and Giardia in R. norvegicus within an urban environment with the likelihood of infection depending on environmental and meteorological conditions for both parasites. The overall prevalence was greater for Cryptosporidium (p = 50.4%) than for Giardia (20.3%). The prevalence for both parasites separately was higher in parks compared to shantytowns and scrap metal yards. Generalized Linear Mixed Models revealed that the occurrence of these parasites separately, at an individual level, was positively related with rainfall variables and that the effect of temperature depended on the landscape unit. The similarities in the transmission modes, which are affected by common extrinsic factors, may facilitate the co-occurrence of Cryptosporidium and Giardia in urban rats. Rattus norvegicus is recognized as a good model for epidemiological studies and the results of this work suggest that, from an epidemiological point of view, the probability of contact with infectious oocysts and cysts of these parasites can be modulated through environmental management and healthy behaviour towards risk factors. The information presented here will be useful to improve the understanding of the dynamics of zoonotic diseases within urban environments and to contribute to the decision-making of new and effective prophylactic measures.

Caracterización clínica del paludismo importado / Clinical characterization of imported malaria

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos que se transmiten al ser humano por la picadura de mosquitos del género Anopheles. Cuba logró eliminar la transmisión de esta enfermedad gracias a grandes esfuerzos encaminados a conseguirlo, por lo que es necesario adoptar una serie de medidas para evitar su reaparición, mediante la vigilancia y el Programa de Control Sanitario Internacional. Objetivo: Caracterizar clínicamente un grupo de pacientes con paludismo importado. Métodos: Se realizó un estudio descriptivo de corte transversal de 46 pacientes adultos con paludismo importado, ingresados en el Instituto de Medicina Tropical Pedro Kourí desde enero 2015 a diciembre 2016. Los datos fueron tomados de las historias clínicas. El análisis de las variables cualitativas fue expresado en tablas de frecuencias absolutas y relativas. Resultados: Predominaron los pacientes del sexo masculino, con una edad media de 37,4 años. Entre los pacientes, 38 (82,6 por ciento) arribaron del continente africano, la mayoría de ellos de Angola (26,1 por ciento del total de casos). Fue significativa la relación existente entre el supuesto estado no inmune de los pacientes con la severidad del cuadro clínico y presencia de comorbilidades; así como la severidad del cuadro clínico con mayor parasitemia y la especie Plasmodium falciparum. La respuesta al tratamiento resultó excelente con los esquemas combinados utilizados a base de quinina y cloroquina según la especie. Conclusiones: La demora desde el arribo al ingreso hospitalario de los pacientes constituye un riesgo extraordinario para la reintroducción del paludismo en Cuba y para la vida de estos(AU)

Introduction: Malaria is an acute potentially fatal febrile disease caused by parasites transmitted to humans through the bite of mosquitoes from the genus Anopheles. Cuba succeeded in eliminating transmission of this disease thanks to great efforts geared to such an end. It is therefore necessary to take a number of measures aimed at preventing its re-emergence via surveillance and the International Health Control Program. Objective: Clinically characterize a group of patients with imported malaria. Methods: A descriptive cross-sectional study was conducted of 46 adult patients with imported malaria admitted to Pedro Kourí Tropical Medicine Institute from January 2015 to December 2016. The data were collected from the patients' medical records. Results of the analysis of qualitative variables were transferred onto absolute and relative frequency tables. Results: Male patients prevailed, with a mean age of 37.4 years. Of the patients studied, 38 (82.6 percent) were from the African continent, most of them from Angola (26.1 percent of the total cases). A significant relationship was found between the supposed non-immune status of patients and the severity of the clinical status and the presence of comorbidities, as well as between the severity of the clinical status and greater parasitemia and the presence of the species Plasmodium falciparum. An excellent response was obtained to treatment with combined schemes based on quinine and chloroquine, depending on the species. Conclusions: Delay between arrival and hospital admittance of patients is an extraordinary risk for the reintroduction of malaria in Cuba and to the patients' lives(AU)

Estrategias de intervención de los factores de riesgo psicosocial de origen laboral: una visión desde terapia ocupacional / Estratégias de intervenção do fator de risco psicossocial relacionadas ao trabalho: uma visão da terapia ocupacional / Work-related psychosocial risk factor intervention strategies: an occupational therapy view

Resumen Introducción Los factores psicosociales son interacciones dinámicas entre diferentes dimensiones del ser humano, quehacer, ocupación, ambiente, entre otros. La alteración de esta dinámica produce riesgos que impactan en la salud y bienestar de los trabajadores. Objetivo Identificar y proponer estrategias de intervención enfocadas en los factores psicosociales a nivel laboral desde terapia ocupacional. Método Estudio de enfoque cualitativo, transversal y bajo paradigma histórico hermenéutico. Se realizaron dos fases enfocadas en intervenciones psicosociales de origen laboral desde terapia ocupacional. La primera fase de búsqueda documental y la segunda, una encuesta a terapeutas ocupacionales colombianos sobre su experiencia específica en intervención del riesgo psicosocial. Se realiza análisis por triangulación. Resultados Se identifican siete documentos con influencia teórica, práctica e histórica relevantes para la investigación y análisis. De la segunda fase, se validan 11 respuestas de terapeutas ocupacionales colombianos los cuales describen dos preguntas de interés para esta investigación relacionadas a factores protectivos o preventivos en cuanto a riesgos psicosociales de origen laboral. Acerca de la segunda pregunta describen acciones, intervenciones o actividades que desde su experticia profesional han considerado efectivos para la formulación de una estrategia de intervención de factores psicosociales. Se realiza una triangulación analítica donde se proponen estrategias derivadas de la búsqueda documental, las respuestas de la encuesta y la información compilada. Se identifican adicionalmente categorías de promoción, prevención, teoría y sustentación. Conclusión Se proponen trece estrategias de intervención enmarcadas en el objetivo y su especificidad en promoción de la salud, prevención de accidentes y enfermedades laborales, rehabilitación laboral y favorecimiento de la población trabajadora.

Resumo Introdução Os fatores psicossociais são interações dinâmicas entre diferentes dimensões do ser humano, tarefa, ocupação, meio ambiente, entre outros. A alteração dessa dinâmica produz riscos que impactam a saúde e o bem-estar dos trabalhadores. Objetivo Identificar e propor estratégias de intervenção voltadas para fatores psicossociais no nível ocupacional a partir da terapia ocupacional. Método Estudo do paradigma histórico qualitativo, transversal e de baixa hermenêutica. Duas fases focalizaram intervenções psicossociais de origem ocupacional a partir da terapia ocupacional. A primeira fase foi busca documental e a segunda um levantamento dos terapeutas ocupacionais colombianos sobre sua experiência específica na intervenção de risco psicossocial. A análise foi realizada por triangulação dos dados. Resultados Foram identificados sete documentos com influência teórica, prática e histórica para a investigação e análise. A partir da segunda fase, foram validadas 11 respostas de terapeutas ocupacionais colombianos, que descreveram duas questões de interesse relacionadas a fatores protetores ou preventivos em relação aos riscos psicossociais de origem laboral. Descrevem ações, intervenções ou atividades em que em sua perícia profissional consideraram eficazes para a formulação de uma estratégia de intervenção psicossocial. Uma triangulação analítica foi realizada entre as estratégias derivadas da pesquisa documental, as respostas da pesquisa e as informações compiladas. As categorias de promoção, prevenção, teoria e apoio também foram identificadas. Conclusão Treze estratégias de intervenção são propostas enquadradas no objetivo e sua especificidade na promoção da saúde, prevenção de acidentes e doenças ocupacionais, reabilitação laboral e favorecimento da população trabalhadora.

Abstract Introduction Psychosocial factors are dynamic interactions between different dimensions of the human being, task, occupation, environment, among others. The alteration of this dynamic produces risks that impact the health and well-being of workers. Objective To identify and propose intervention strategies focused on psychosocial factors at the occupational level from occupational therapy Method Study of qualitative, transversal and hermeneutical historical paradigm. Two phases focused on psychosocial interventions of occupational origin from occupational therapy. The first phase of documental search and the second, a survey of Colombian occupational therapists about their specific experience in psychosocial risk intervention. Analysis are carried out by triangulation. Results Seven documents with theoretical, practical and historical influence relevant to the investigation and subsequent analysis are identified. From the second phase, 11 responses from Colombian occupational therapists are validated, which describe two questions of interest for this investigation related to protective or preventive factors regarding psychosocial risks of work origin. About the second question describe actions, interventions or activities that your professional expertise has considered effective for the formulation of a psychosocial intervention strategy. An analytical triangulation is carried out where strategies derived from the documentary search, the answers of the survey and the compiled information are proposed. Categories of promotion, prevention, theory and support are also identified. Conclusion Thirteen intervention strategies are proposed framed in the objective and its specificity in health promotion, prevention of accidents and occupational diseases, labor rehabilitation and favoring the working population.

Genotoxicity evaluation using micronucleus test in Rattus norvegicus captured in urban ecosystems of Buenos Aires, Argentina.

The overall goal of the present study was to evaluate and compare the existence of genotoxic damage in Rattus norvegicus captured in sites with different levels of chemical mixtures along the Matanza-Riachuelo river basin (MRRB). For this, thirty-six wild rats (R. norvegicus) were captured from six different sites in the MRRB. Capture sites were characterized with concentrations of 20 parameters in surface water, including concentrations of metals and its soluble state and physicochemical parameters. To evaluate genotoxic damage in the rats, the bone marrow micronucleus test was performed. For this, the frequency of micronucleated polychromatic erythrocytes (MNPCE) was calculated based on the observation of 2000 polychromatic erythrocytes (PCE) per animal. Also, to detect possible cytotoxic effects, the PCE/TE (total erythrocytes) ratio in 1000 erythrocytes/animal was calculated. The frequency of MNPCE was positively associated with the highest concentration of chrome, lead, copper, biological oxygen demand, and chemical oxygen demand. Also, the decrease on PCE/TE ratio in bone marrow was related with increase of practically all metals and physicochemical parameters in surface water. The results of this study reveal that rats that live in the MRRB were exposed to concentrations of pollutants that can cause genotoxic damage, even though the concentrations of these pollutants are mostly below the safety standards. Therefore, this work highlights the importance of using methods that allow to integrate all environmental parameters in risk assessment, such as sentinel species.

Are soft tissues of urban rats good indicators of exposure to heavy metal pollution? A study conducted in one of the most polluted basins of Buenos Aires, Argentina.

The overall goal of this work was to analyze the relationship between the concentration of lead in the kidney, liver, and stomach contents of rats captured in a polluted urban basin and the concentration of this metal in the environment, meteorological factors, and different intrinsic characteristics of the individuals. To this end, we determined the concentration of lead in the kidney, liver, and stomach contents of 133 Norway rats (Rattus norvegicus) captured in the Matanza-Riachuelo River Basin (Buenos Aires, Argentina). This basin is one of the most severe cases of water pollution in Latin America and metals like lead represent the most common chemical pollutants. Rats were trapped in nine sites with different soil and water lead concentrations, between 2014 and 2015. A positive relationship was found between lead concentration in the liver and kidney of R. norvegicus and the environmental concentration of this metal in water and soil. Although the remaining variables analyzed were also related to the lead concentration in soft tissues, they did not affect the association between the lead concentration in soft tissues and that in the environment. The lead concentration in the stomach contents was not related to any of the variables analyzed. Our results constitute the first study in an urban basin with a gradient of environmental lead concentration and suggest that the quantification of lead in the kidney and liver of rats can be used as an indicator of exposure to this metal within a large city.

Lineamientos del Colegio Colombiano de Terapia Ocupacional para la rehabilitación hospitalaria de usuarios con COVID-19 / Guidelines of the Colombian College of Occupational Therapy for the hospital-based rehabilitation of users with COVID-19 / Diretrizes do Colégio Colombiano de Terapia Ocupacional para a reabilitação hospitalar de usuários com COVID-19

Hasta el momento, la enfermedad COVID-19 ha demostrado tener implicaciones funcionales a corto, y en ocasiones, a largo plazo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colombiano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales que se involucren en la rehabilitación intrahospitalaria y ambulatoria de usuarios con COVID-19 en Colombia. Se realizó una revisión de la literatura sobre el rol y la efectividad de la Terapia Ocupacional en la rehabilitación hospitalaria, las complicaciones reportadas en usuarios con COVID-19, y su manejo terapéutico en la rehabilitación intrahospitalaria y ambulatoria. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. La Terapia Ocupacional, como parte del equipo de rehabilitación, incide de manera directa en el nivel de independencia, la autonomía y la futura reincorporación a las actividades dentro de la sociedad; adicionalmente, facilitando y promoviendo actividades cognitivas, psicosociales y de ocio, aporta al mantenimiento del equilibrio ocupacional para prevenir la aparición de disfunciones de índole sensoriomotor, perceptivo y psicosocial a corto, mediano y largo plazo. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupacional hospitalaria.

Up to this date, COVID-19 disease has shown to have short-term, and sometimes long-term, functional implications. Faced with the health emergency triggered by this disease, the Colombian College of Occupational Therapy convened a group of professional experts in the area to provide guidelines for occupational therapists involved in inpatient and outpatient rehabilitation of users with COVID-19 in Colombia. A literature review was conducted on the role and effectiveness of Occupational Therapy in subacute rehabilitation, the complications reported in users with COVID-19, and its therapeutic management in inpatient and outpatient rehabilitation. A consensus of experts determined the applicability of the guidelines to the Colombian context. Occupational Therapy, as part of the rehabilitation team, directly affects the level of independence, autonomy and future reincorporation to the activities within society. It also contributes to maintaining occupational balance to prevent short, medium, and long term sensorimotor, perceptual, and psychosocial dysfunctions, by facilitating and promoting cognitive, psychosocial, and leisure activities. These guidelines constitute a relevant technical and educational resource for subacute care in Occupational Therapy.

Até agora, foi demonstrado que a doença COVID-19 tem implicações funcionais de curto e, às vezes, de longo prazo. Diante da emergência sanitária desencadeada por esta doença, o Colégio Colombiano de Terapia Ocupacional reuniu um grupo de profissionais, especializados na área, para fornecer orientações aos terapeutas ocupacionais, envolvidos na reabilitação hospitalar e ambulatorial de usuários com COVID-19, na Colômbia. Foi realizada uma revisão da literatura sobre o papel e a eficácia da Terapia Ocupacional na reabilitação hospitalar, as complicações relatadas em usuários com COVID-19 e seu manejo terapêutico na reabilitação hospitalar e ambulatorial. Um consenso de especialistas determinou a aplicabilidade das diretrizes ao contexto colombiano. A Terapia Ocupacional, como parte da equipe de reabilitação, afeta diretamente o nível de independência, autonomia e futura reincorporação às atividades na sociedade; além disso, facilitando e promovendo atividades cognitivas, psicossociais e de lazer, contribui para a manutenção do equilíbrio ocupacional, para prevenir o aparecimento de disfunções sensório-motoras, perceptivas e psicossociais em curto, médio e longo prazo. Tais orientações constituem um recurso técnico e educacional importante para a Terapia Ocupacional hospitalar.

Participación de la terapia ocupacional en políticas públicas de salud laboral: un desafío profesional / Occupational therapy involvement in occupational health public policies: A professional challenge

Resumen En Colombia, el planteamiento de políticas públicas y el desarrollo de un marco normativo en salud laboral han permitido que diferentes profesiones visibilicen sus competencias y posibilidades de participación en esta área. Lo anterior constituye un desafío para la terapia ocupacional (TO), ya que esta también actúa en el sector trabajo. El objetivo del presente artículo es contextualizar a los lectores sobre el ejercicio profesional de la TO en Colombia, su relación con el sector trabajo y el desafío profesional que su participación representa en el desarrollo de normas y políticas públicas en salud laboral. Para la elaboración del presente documento se realizó una búsqueda de toda la normatividad en salud laboral publicada en Colombia. Luego, se plantearon algunas reflexiones a partir de la experiencia en diferentes ámbitos laborales y del análisis de la literatura encontrada, lo que permitió concluir que la inclusión de la TO en la planeación e implementación de las políticas públicas en salud laboral ha hecho que esta profesión tenga un buen posicionamiento en el país.

Abstract In Colombia, the public policies approach and the development of an occupational health regulatory framework have allowed different professions to make visible their competences and ]participation ]possibilities in this branch of medicine. This represents a challenge for occupational therapy (OT), since its scope of work also includes the labor market. The objective of this article is to provide readers with information regarding professional practice of occupational therapists in Colombia, its relationship with the labor market and the challenge OT faces due to its participation in the planning and development process of standards and public health policies on occupational health. This paper is the result of a documentary review of the regulations on occupational health adopted in Colombia. It also proposes several reflections based on the occupational therapists' experiences in different areas of work and on the analysis of the documents and papers found in the review, which allowed concluding that the inclusion of OT in the planning and implementation of occupational health public policies has helped it to achieve a good professional positioning in the country.