Review: Reproductive physiology of bison and application of assisted reproductive technologies to their conservation.

Bison are an ecologically and culturally important species on the European and North American continents. Their near extirpation was met with conservation efforts that prevented their extinction but left few animals or highly fragmented populations. Contemporary conservation efforts are focused on building ecologically and genetically sustainable bison herds for long-term conservation of the species. Assisted reproductive technologies (ARTs) can play a key role in building these herds by facilitating the movement of genetics in the form of gametes and embryos, while protecting animal well-being and ensuring biosecurity of existing bison herds. In addition, ARTs such as gamete and embryo cryopreservation can be used to protect against future losses of genetic diversity through biobanking. In this review, a brief summary of basic bison reproductive physiology is presented followed by an overview of the current state of ART in Bison bison (American bison) and Bison bonasus (European bison or wisent). Research on ART ranging from artificial insemination to in vitro embryo transfer and cloning is discussed with particular regard to the application of ART for conservation purposes. While significant progress has been made in ART for bison, there are still many opportunities to improve these technologies and expand their impact for bison conservation.

Host associations of biting midges (Diptera: Ceratopogonidae: Culicoides) at deer farms in Florida, USA.

Documenting the host use of vector species is important for understanding the transmission dynamics of vector-borne pathogens. Biting midges (Diptera: Ceratopogonidae: Culicoides) are vectors of epizootic hemorrhagic disease virus (EHDV) and bluetongue virus (BTV) worldwide. However, relative to mosquitoes and many other vector groups, host associations of this group are poorly documented. In this study, we used PCR-based bloodmeal analysis to determine species-level host associations of 3,603 blood-engorged specimens belonging to 18 Culicoides species at 8 deer farms in Florida, USA. We used a binomial mixed model with a Bayesian framework to compare the effect of host composition on the feeding patterns of Culicoides spp. and employed the Morisita-Horn Index to investigate the similarity of host use between farms for Culicoides stellifer and Culicoides insignis. Results show that the estimated probability of Culicoides spp. feeding upon white-tailed deer depends on the availability of cattle or exotic game and demonstrates differences in host-feeding selection among species. Culicoides insignis had high host similarity across farms suggesting that its host-use patterns are somewhat conserved. Culicoides stellifer had lower host similarity across farms suggesting that it is a more opportunistic feeder. White-tailed deer are fed upon by many Culicoides species on deer farms in Florida, and while most Culicoides species feed on white-tailed deer, the ratio of white-tailed deer bloodmeals to other bloodmeals is likely influenced by host availability. Culicoides spp. taking a majority of their bloodmeals from farmed white-tailed deer should be assessed for their vector competence for EHDV and BTV.

Peritoneal lymphomatosis. A case report

ABSTRACT Introduction: Involvement of the peritoneum occurs very rarely and is exceptional as an exclusive extranodal presentation of lymphomas. In most cases lymphomas associated with this rare entity are high-grade ones. PL secondary to high-grade nodal lymphoma is more frequent than primary peritoneal lymphoma, and there are only a few cases of the latter described in the literature. Description of the case: We present the case of a patient with constitutional syndrome and imaging findings suggestive of peritoneal carcinomatosis who was finally diagnosed with a Diffuse Large B-cell Lymphoma (DLBCL) by an ultrasound-guided core needle biopsy (CNB) of peritoneum. The patient received one polychemotherapy cycle; however tumor lysis syndrome occurred with death of the patient in the following days. This case tries to show the existence of a PL without other radiological findings of lymphoma, a fact that is very exceptionally described in the literature. Discussion: The differential diagnosis between PL and others peritoneum diseases such as peritoneal carcinomatosis, malignant primary peritoneal mesotheliomas, tuberculous peritonitis, sarcomatosis, diffuse peritoneal leiomyomatosis or benign splenosis, constitutes a major problem in imaging techniques. An exhaustive analysis of the radiological characteristics as well as a clinical-analytical context allows the differential diagnosis against peritoneal carcinomatosis and the rest of the entities previously referred although the final diagnosis will always be a biopsy. Conclusion: PL usually manifests as an aggressive histological subtype of high-grade lymphomas leading to a rapid progression and deterioration of the patient. It is crucial for the radiologist and the clinician to be aware of this rare entity providing the earliest possible diagnosis and optimal treatment to prolong the patient's life.

Peritoneal lymphomatosis. A case report.

INTRODUCTION: Involvement of the peritoneum occurs very rarely and is exceptional as an exclusive extranodal presentation of lymphomas. In most cases lymphomas associated with this rare entity are high-grade ones. PL secondary to high-grade nodal lymphoma is more frequent than primary peritoneal lymphoma, and there are only a few cases of the latter described in the literature. DESCRIPTION OF THE CASE: We present the case of a patient with constitutional syndrome and imaging findings suggestive of peritoneal carcinomatosis who was finally diagnosed with a Diffuse Large B-cell Lymphoma (DLBCL) by an ultrasound-guided core needle biopsy (CNB) of peritoneum. The patient received one polychemotherapy cycle; however tumor lysis syndrome occurred with death of the patient in the following days. This case tries to show the existence of a PL without other radiological findings of lymphoma, a fact that is very exceptionally described in the literature. DISCUSSION: The differential diagnosis between PL and others peritoneum diseases such as peritoneal carcinomatosis, malignant primary peritoneal mesotheliomas, tuberculous peritonitis, sarcomatosis, diffuse peritoneal leiomyomatosis or benign splenosis, constitutes a major problem in imaging techniques. An exhaustive analysis of the radiological characteristics as well as a clinical-analytical context allows the differential diagnosis against peritoneal carcinomatosis and the rest of the entities previously referred although the final diagnosis will always be a biopsy. CONCLUSION: PL usually manifests as an aggressive histological subtype of high-grade lymphomas leading to a rapid progression and deterioration of the patient. It is crucial for the radiologist and the clinician to be aware of this rare entity providing the earliest possible diagnosis and optimal treatment to prolong the patient's life.

Clinical, laboratory, microbiological and echocardiographic characteristics of infective endocarditis in a tertiary care hospital

Abstract Objectives: infective endocarditis (IE) is a potentially fatal disease. This study analyzed the clinical, laboratory, microbiological and echocardiographic characteristics of IE in a population of patients at a tertiary care hospital in Medellín, Colombia, over a three-year period. Methods: a retrospective observational study. The patients were classified according to the modified Duke criteria. Clinical and echocardiographic data, laboratory results and cultures were gathered from the clinical charts. Factors associated with the prognosis were determined. Results: a total of 48 cases were included, 29 (60.4%) of which involved males. The mean age was 53.8±19.2 years. Fever and fatigue were the most common clinical signs. No heart murmur was reported on admission in 52.1% of the patients. Most of the patients (62.5%) had no underlying predisposing heart condition. The IE occurred in a native valve in 36 patients (75%), with the mitral valve being the most frequently affected site. Transthoracic and/or transesophageal echocardiography showed vegetations in 45 cases (93.7%); these were mostly mobile, with an average size of 17.6±11.3 mm. Staphylococcus aureus was the main causal organism (33%). The prevalence of IE with negative blood cultures was 37.5%. The most frequent complication was embolism in 21 patients (43.7%), followed by heart failure (41.7%). On multivariate analysis, septic shock, kidney failure, Staphylococcus infection and the use of immunosuppressants were predictors of higher inpatient mortality. Conclusions: most cases occur in elderly patients with no underlying predisposing heart condi tion, in a native valve, with a predilection for the mitral valve. Staphylococcus aureus is the most frequent causal organism. Several factors predict greater inpatient mortality, including the presence of septic shock, kidney failure, Staphylococcus infection and the use of immunosuppressants. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1930)

Human Blood Feeding by Aedes aegypti (Diptera: Culicidae) in the Florida Keys and a Review of the Literature.

Aedes aegypti L. is considered to have a proclivity for feeding on human blood even when other hosts are available. However, few studies have demonstrated host use by this mosquito in the continental United States, where local transmission of dengue, Zika, and chikungunya viruses has been recently documented. This study investigated the bloodmeal sources of female Ae. aegypti in the subtropical city of Key West and the surrounding county in Florida with the goal of identifying preferred hosts. Blood-engorged Ae. aegypti mosquitoes were collected from BG Sentinel traps used as part of a routine surveillance program in the Florida Keys (Monroe County, Florida). Bloodmeal samples were analyzed using PCR assays, sequencing, and comparison with reference sequences in GenBank. Aedes aegypti females from Key West fed predominantly on humans (79.6%) and did not differ statistically from females collected from the rest of the Florida Keys (69.5%). Culex quinquefasciatus Say (Diptera: Culicidae), considered a host generalist, was collected and analyzed from the same sites for comparative purposes. Females of Cx. quinquefasciatus fed predominantly (70.7%) on birds and nonhuman mammals in the Florida Keys, corroborating the validity of molecular assay breadth and demonstrating that given the same group of available hosts Ae. aegypti selects humans. Our results indicated that Ae. aegypti has a high rate of human-biting in a subtropical area within the United States, supporting its role in recent local transmission of dengue and other viruses.

Seasonal Changes of Host Use by Culiseta melanura (Diptera: Culicidae) in Central Florida.

The mosquito Culiseta melanura (Coquillett) is the primary enzootic vector of eastern equine encephalitis virus (EEEV), a zoonotic Alphavirus endemic to eastern North America. In its northern range, Cs. melanura is considered a strict avian biter, transmitting EEEV among susceptible birds in a cycle of enzootic amplification. In its southern range, however, Cs. melanura is more general in host use, feeding heavily upon birds but also reptiles and mammals. The goal of this study was to better understand how host use of Cs. melanura changes throughout the year in Florida, where year-round EEEV transmission is observed. Mosquitoes were sampled in 2018 from nine sites across three central Florida counties. In total, 213 Cs. melanura bloodmeals were identified by PCR consisting of 39 species of birds, reptiles, and mammals. Avian bloodmeals were prominent throughout the year (range = 30-85%), and songbirds were a large portion of identified bloodmeals (37.1%). Reptiles surpassed birds only in spring (April-June), and brown anole (Anolis sagrei Duméril and Bibron, 1837 [Reptilia: Dactyloidae]) was the most commonly detected single host species (22.1% overall). Mammalian bloodmeals were mainly observed in summer, with humans being the most fed on mammal (12.7% overall). This study reveals that in southern foci of EEEV transmission, Cs. melanura host use varies throughout the year with reptiles providing the majority of blood meals in spring (51.3%), and birds are fed on more than other host groups during all other seasons (50.6-70.1%). In addition, feeding on mammals increases during summer months, which may implicate Cs. melanura in epizootic transmission in Florida.

Host Associations Of Biting Midges (Diptera: Ceratopogonidae: Culicoides) Near Sentinel Chicken Surveillance Locations In Florida, USA.

Quantifying host use is important for understanding transmission of vector-borne pathogens. Despite the importance of biting midges (Diptera: Ceratopogonidae) in pathogen transmission, the vector-host relationships of most Culicoides species are poorly documented, even in locations where active arbovirus surveillance is conducted. Polymerase chain reaction-based blood-meal analysis was performed on 663 blood-engorged Culicoides females collected by 7 Florida mosquito control districts at 24 sentinel chicken arbovirus surveillance sites in 2017. A total of 638 blood meals were successfully analyzed to determine host species source, representing 11 Culicoides species. The most commonly bitten host was domestic chicken (Gallus gallus) (presumably sentinel chickens), constituting 565 of 638 (88.6%) the total blood meals. Other common hosts included humans (5.8%), white-tailed deer (Odoocoileus virginianus) (2.5%), and brown basilisk (Basiliscus vittatus) (1.6%). Significant differences in distribution of mammal and avian blood meals were found for a number of Culicoides species, and these patterns did not vary across locations. These results indicate that sentinel chickens are exposed to bites by Culicoides, potentially exposing them to Culicoides-borne pathogens. The findings that vertebrate host use was consistent across locations suggests that each Culicoides species has affinity for one or more specific animal groups, and does not feed randomly upon available animals.

Host Associations of Culex (Melanoconion) atratus (Diptera: Culicidae) and Culex (Melanoconion) pilosus from Florida, USA.

Characterizing the host-use patterns of mosquitoes is an essential component of understanding the transmission dynamics of mosquito-vectored pathogens. The host associations of two species of the medically important Culex subgenus Melanoconion, Culex atratus, and Culex pilosus are unknown or unclear, respectively. Both species have wide neotropical distributions. In the United States of America (USA), Culex pilosus occurs throughout the southeastern coastal plain, while Culex atratus is restricted to the southern Florida Peninsula. Using PCR-based blood meal analysis, we investigated the host associations of Culex atratus and Culex pilosus that were collected from Everglades National Park, Florida, USA We identified the host species of 208 Culex atratus and 168 Culex pilosus. Both species were narrowly associated with reptilian host species, particularly native and non-native lizards of the genus Anolis. Sampled Culex atratus exclusively fed on reptilian hosts, with >99% of blood meals derived from Anolis lizards. Culex pilosus fed predominantly from reptiles, but avian and mammalian blood meals were also detected. Of these, 92% of blood meals were derived from Anolis species. For both species, Anolis sagrei, an invasive exotic lizard in Florida, was the most frequently detected host species. These data indicate that Culex atratus and Culex pilosus are specialists of reptilian hosts, particularly Anolis lizards.

Field data implicating Culicoides stellifer and Culicoides venustus (Diptera: Ceratopogonidae) as vectors of epizootic hemorrhagic disease virus.

BACKGROUND: Epizootic hemorrhagic disease virus (EHDV) is an Orbivirus of veterinary importance which is transmitted by biting midges of the genus Culicoides (Diptera: Ceratopogonidae) to ruminants. Culicoides sonorensis Wirth & Jones, the only confirmed vector of EHDV in the USA, is rare in the southeastern states where transmission persists, suggesting that other Culicoides species transmit EHDV in this region. The present study aimed to determine which Culicoides species transmitted EHDV in Florida and Alabama, two states in the southeastern USA. Viral RNA was detected in field-collected midges using molecular methods. These data are presented alongside data on Culicoides blood meal analysis, white-tailed deer (Odocoileus virginianus) aspiration, and seasonality to demonstrate an interaction between potential vector species and EHDV hosts. RESULTS: Out of 661 pools tested, 20 pools were positive for EHDV viral RNA, including six pools from Culicoides stellifer (Coquillett) and 14 pools from Culicoides venustus Hoffman. The overall infection rate was 0.06% for C. stellifer and 2.18% for C. venustus. No positive pools were identified for a further 17 species. Serotypes identified in Culicoides included EHDV-2, EHDV-6, and coinfections of EHDV-2 and EHDV-6 and were identified in similar proportions to serotypes in deer at 3 of 4 deer farms. Viral detections conducted in Alabama also identified one positive pool of C. venustus. Blood meal analysis revealed that both Culicoides species fed on white-tailed deer (verified through aspiration), fallow deer, and elk, species for which EHDV viremia has been documented. Seasonality data indicated that both species were present throughout the period in which viral transmission occurred to EHDV hosts in 2016 in addition to the 2017 epizootic. CONCLUSIONS: Our finding of EHDV positive pools of field-collected C. stellifer and C. venustus and an interaction between these species and EHDV hosts satisfy two of the four criteria for vector incrimination as set by the World Health Organization. Determining the vectors of EHDV is an important step towards developing sound strategies for the control of vector Culicoides and management of EHDV in the southeastern USA.

Patterns of Abundance, Host Use, and Everglades Virus Infection in Culex (Melanoconion) cedecei Mosquitoes, Florida, USA.

Everglades virus (EVEV), subtype II within the Venezuelan equine encephalitis (VEE) virus complex, is a mosquitoborne zoonotic pathogen endemic to south Florida, USA. EVEV infection in humans is considered rare, probably because of the sylvatic nature of the vector, the Culex (Melanoconion) cedecei mosquito. The introduction of Cx. panocossa, a tropical vector mosquito of VEE virus subtypes that inhabits urban areas, may increase human EVEV exposure. Field studies investigating spatial and temporal patterns of abundance, host use, and EVEV infection of Cx. cedecei mosquitoes in Everglades National Park found that vector abundance was dynamic across season and region. Rodents, particularly Sigmodon hispidus rats, were primary vertebrate hosts, constituting 77%-100% of Cx. cedecei blood meals. Humans were fed upon at several locations. We detected EVEV infection in Cx. cedecei mosquitoes in lower and upper regions of Everglades National Park only during the wet season, despite an abundance of Cx. cedecei mosquitoes at other sampling times.

Vector Competence of Culicoides sonorensis (Diptera: Ceratopogonidae) for Epizootic Hemorrhagic Disease Virus Serotype 2 Strains from Canada and Florida.

Epizootic hemorrhagic disease virus (EHDV), an Orbivirus transmitted by Culicoides spp. vectors, is represented by seven serotypes and numerous strains worldwide. While studies comparing vector competence between serotypes exist, studies between viral strains are lacking. In this study, we examined the rates of infection, dissemination, and transmission of two strains of EHDV-2 orally fed to the known vector, Culicoides sonorensis Wirth & Jones. Culicoides sonorensis cohorts were fed an infectious blood meal containing EHDV-2 strains from either Alberta, Canada (Can-Alberta) or Florida (5.5 log10 PFUe/mL) and tested for the vector's susceptibility to infection and dissemination. In addition, transmission rates of the virus were assessed and compared using capillary tube and honey card methods. Our results show that the Florida strain had higher infection and dissemination rates than the Can-Alberta strain in spite of the Florida strain having significantly lower viral titers in C. sonorensis bodies, legs, and saliva than the Can-Alberta strain. Overall transmission rates were not significantly different between the two strains but varied significantly between the methods used. These findings suggest that the consequences of EHDV infection in C. sonorensis vary between virus strains and have huge implications in future vector competence studies involving Culicoides species and Orbiviruses.

Social and Clinical Impact of Congenital Urological Malformations in a Developing Country: The Need for a Transdisciplinary Way of Treatment / Impacto social y clínico de las malformaciones urológicas congénitas en un país en desarrollo: La necesidad de un tratamiento transdisciplinario

Zoom Image Abstract Introduction The prognosis of congenital anomalies (CAs) can be improved if detected and treated accurately. Given the complexity of some anomalies, it is almost always necessary to approach them with an interdisciplinary team. Our objective was to contact patients with congenital urological anomalies (CUAs) and follow them up during their first years of life and evaluate their clinical status, as well as their social and health care limitations. Method Based on the Bogota Congenital Malformations Surveillance Program (BCMSP), we have contacted by phone all the patients with CUAs and evaluated their follow-up. We have included all the registered patients from 2006 until 2015. A standardized questionnaire was applied by a trained staff. The questions assessed on each call included: evaluation of the clinical status of the patient, the clinical treatments and evaluations performed by clinical and surgical subspecialties, health care limitations, and social barriers. The first call was made at the 2nd month, then every 3 months during the 1st year and every 6 months thereafter. Results A total of 277 patients were contacted, 97.3% of whom have an increased risk of mortality or significant disability. The malformation related mortality was of 38.1%. Only 38.7% of the patients were evaluated by a specialist, while 57.4% where still waiting to be seen by a specialist. Ninety eight percent of the limitations related to the health care system were the long waiting lists to be seen by a specialist. Conclusion Many of the pathologies that we have found belong to the group that has a significant reduction in mortality when treated accurately and promptly. However, we have a profound problem in our health care system, in that many of the patients have not been seen by a specialist, which results in a worse prognosis and recovery rate.

Introducción El pronóstico de las anomalías congénitas puede mejorarse si se detectan y tratan adecuadamente. Dada la complejidad de algunas anomalías, casi siempre es necesario abordarlas con un equipo interdisciplinario. Nuestro objetivo fue contactar a los pacientes con anomalías urológicas congénitas (CUA) con posterior seguimiento durante los primeros años de vida, se evaluó su estado clínico así como las limitaciones sociales y de atención médica. Método Basado en el Programa de Vigilancia de Malformaciones congénitas de Bogotá, contactamos por teléfono a todos los pacientes con CUA y evaluamos su seguimiento. Fueron incluidos todos los pacientes desde 2006 hasta 2015. Un cuestionario estandarizado fue aplicado por personal capacitado. Las preguntas evaluadas durante la llamada incluyeron: evaluación del estado clínico, tratamientos clínicos realizados y evaluaciones por subespecialidades clínicas y quirúrgicas, limitaciones de atención médica y barreras sociales. La primera llamada se realizó en el segundo mes y luego cada tres meses durante el primer año y luego cada 6 meses a partir de entonces. Resultados Se contactó a un total de 277 pacientes en los que el 97,3% tenía un riesgo de mortalidad o de discapacidad significativa. La mortalidad relacionada con la malformación fue del 38.1%. Solo el 38,7% de los pacientes fueron evaluados por un especialista, mientras que el 57,4% aún esperaban ser atendidos por un especialista. El noventa y ocho por ciento de las limitaciones relacionadas con el sistema de atención fueron las largas listas de espera para ser visto por un especialista. Conclusión Muchas de las patologías pertenecen al grupo que cuando son tratadas adecuadamente y prontamente tienen una reducción significativa en la mortalidad. Sin embargo, tenemos un problema profundo en nuestro sistema de atención médica donde muchos de los pacientes no han sido atendidos por un especialista, lo que resulta en un peor pronóstico y tasa de recuperación.

Mammal decline, linked to invasive Burmese python, shifts host use of vector mosquito towards reservoir hosts of a zoonotic disease.

Invasive apex predators have profound impacts on natural communities, yet the consequences of these impacts on the transmission of zoonotic pathogens are unexplored. Collapse of large- and medium-sized mammal populations in the Florida Everglades has been linked to the invasive Burmese python, Python bivittatus Kuhl. We used historic and current data to investigate potential impacts of these community effects on contact between the reservoir hosts (certain rodents) and vectors of Everglades virus, a zoonotic mosquito-borne pathogen that circulates in southern Florida. The percentage of blood meals taken from the primary reservoir host, the hispid cotton rat, Sigmodon hispidus Say and Ord, increased dramatically (422.2%) from 1979 (14.7%) to 2016 (76.8%), while blood meals from deer, raccoons and opossums decreased by 98.2%, reflecting precipitous declines in relative abundance of these larger mammals, attributed to python predation. Overall species diversity of hosts detected in Culex cedecei blood meals from the Everglades declined by 40.2% over the same period (H(1979) = 1.68, H(2016) = 1.01). Predictions based upon the dilution effect theory suggest that increased relative feedings upon reservoir hosts translate into increased abundance of infectious vectors, and a corresponding upsurge of Everglades virus occurrence and risk of human exposure, although this was not tested in the current study. This work constitutes the first indication that an invasive predator can increase contact between vectors and reservoirs of a human pathogen and highlights unrecognized indirect impacts of invasive predators.

Environmental Drivers of Seasonal Patterns of Host Utilization by Culiseta melanura (Diptera: Culicidae) in Florida.

Field studies were carried out in four Florida counties to investigate winter and spring ecology of host use by Culiseta melanura (Coquillet), the primary vector of eastern equine encephalomyelitis virus (EEEV) in North America. Bloodmeal analysis by PCR was used to identify 233 host bloodmeals, which mainly originated from birds (78.5%) and reptiles (17.2%), primarily Anolis spp. lizards. Across counties, the percentage of bloodmeals from reptiles (7-37% depending upon county) increased with increasing day length and temperature in the spring. Multiple logistic regression revealed that differences in reptile host use across collection sites were largely explained by differences in average day length and temperature on the day of collection, and is probably owing to environment-driven behavioral patterns of ectothermic animals. Although past studies have demonstrated reptile biting by epizootic vectors of EEEV, including Culex (Melanoconion) spp., this is the first study to demonstrate widespread and common feeding upon ectothermic hosts by Cs. melanura. This work suggests that reptiles, particularly anole lizards, play a role in the ecology of EEEV in Florida either as amplifying hosts or as noncompetent hosts which dilute vector feedings thereby suppressing transmission. Detailed laboratory studies investigating impacts of environmental variables (temperature and photoperiod) on EEEV competence of anoles are needed to assess whether these animals support virus amplification.

Dolor en personas ancianas con dependencia: programa de visita domiciliaria adaptado culturalmente a población rural / Pain in dependent elderly people: home visit program culturally adapted to a rural population

RESUMEN Objetivo Evaluar los efectos de un programa de visita domiciliaria culturalmente adaptado sobre la intensidad del dolor de personas ancianas en situación de discapacidad y pobreza en la población rural de Cáqueza-Cundinamarca. Método Estudio cuasi-experimental con pre-prueba y post-prueba. Participaron 34 mayores de 60 años con deficiencia física o visual y dependencia total o parcial. El programa de visita domiciliaria constó de siete visitas con un promedio de dos horas de duración y un intervalo de 13 a 15 días. Para el manejo del dolor se propuso un sincretismo entre medicamentos, plantas medicinales y remedios caseros. El dolor se evaluó con la escala verbal del dolor y en diario de campo fueron registrados los datos cualitativos. Se aplicó la prueba de rangos asignados de Wilcoxon. Resultados En la pre-prueba el 100 % tenían un tipo de dolor y en la post-prueba hubo efectos favorables y significativos (p.valor <0.001) en la disminución del dolor. Cualitativamente son atribuidos los cambios en parte al desarrollo del programa y otras explicaciones corresponden a los valores y creencias del grupo. Conclusiones El programa de visita domiciliaria adaptado culturalmente deja evidencia cómo ofrecer una respuesta donde se dialoga entre el saber popular y profesional logrando una práctica segura y adaptada al universo cultural de las personas. Latinoamerica requiere de profesionales culturalmente sensibles a las expresiones y percepciones de dolor con curiosidad para explorar en la evidencia las posibilidades terapéuticas de las propuestas provenientes del saber popular.(AU)

ABSTRACT Objective To assess the effects of a culturally adapted home visit program on pain intensity in elderly people with disability and poverty conditions in the rural population of Cáqueza-Cundinamarca, Colombia. Method Quasi-experimental study with pre-test and post-test. The study included 34 people over 60 years of age with physical or visual impairment and total or partial dependence. The home visit program consisted of seven visits paid for an average of two hours and an interval of 13 to 15 days. A syncretism of drugs, medicinal plants and home remedies was proposed for pain management. Pain was assessed using the verbal pain scale and qualitative data were recorded in the field diary. Wilcoxon signed-rank test was applied. Results During the pre-test, 100 % of the participants presented with a type of pain, while favorable and significant effects were observed in the post-test (p value <0.001) in relation to pain reduction. Changes are qualitatively attributed, partly, to the development of the program and other explanations include values and beliefs of the group. Conclusions The culturally adapted home visits program shows that it is possible to act in contexts where dialogues occur between popular and professional knowledge, achieving a safe practice adapted to the cultural universe of people. Latin America requires professionals culturally sensitive to expressions and perceptions of pain, who are curious to explore, based on evidence, the therapeutic possibilities proposed by popular knowledge.(AU)

[Pain in dependent elderly people: home visit program culturally adapted to a rural population]. / Dolor en personas ancianas con dependencia: programa de visita domiciliaria adaptado culturalmente a población rural.

OBJECTIVE: To assess the effects of a culturally adapted home visit program on pain intensity in elderly people with disability and poverty conditions in the rural population of Cáqueza-Cundinamarca, Colombia. METHOD: Quasi-experimental study with pre-test and post-test. The study included 34 people over 60 years of age with physical or visual impairment and total or partial dependence. The home visit program consisted of seven visits paid for an average of two hours and an interval of 13 to 15 days. A syncretism of drugs, medicinal plants and home remedies was proposed for pain management. Pain was assessed using the verbal pain scale and qualitative data were recorded in the field diary. Wilcoxon signed-rank test was applied. RESULTS: During the pre-test, 100 % of the participants presented with a type of pain, while favorable and significant effects were observed in the post-test (p value <0.001) in relation to pain reduction. Changes are qualitatively attributed, partly, to the development of the program and other explanations include values and beliefs of the group. CONCLUSIONS: The culturally adapted home visits program shows that it is possible to act in contexts where dialogues occur between popular and professional knowledge, achieving a safe practice adapted to the cultural universe of people. Latin America requires professionals culturally sensitive to expressions and perceptions of pain, who are curious to explore, based on evidence, the therapeutic possibilities proposed by popular knowledge.

OBJETIVO: Evaluar los efectos de un programa de visita domiciliaria culturalmente adaptado sobre la intensidad del dolor de personas ancianas en situación de discapacidad y pobreza en la población rural de Cáqueza-Cundinamarca. MÉTODO: Estudio cuasi-experimental con pre-prueba y post-prueba. Participaron 34 mayores de 60 años con deficiencia física o visual y dependencia total o parcial. El programa de visita domiciliaria constó de siete visitas con un promedio de dos horas de duración y un intervalo de 13 a 15 días. Para el manejo del dolor se propuso un sincretismo entre medicamentos, plantas medicinales y remedios caseros. El dolor se evaluó con la escala verbal del dolor y en diario de campo fueron registrados los datos cualitativos. Se aplicó la prueba de rangos asignados de Wilcoxon. RESULTADOS: En la pre-prueba el 100 % tenían un tipo de dolor y en la post-prueba hubo efectos favorables y significativos (p.valor <0.001) en la disminución del dolor. Cualitativamente son atribuidos los cambios en parte al desarrollo del programa y otras explicaciones corresponden a los valores y creencias del grupo. CONCLUSIONES: El programa de visita domiciliaria adaptado culturalmente deja evidencia cómo ofrecer una respuesta donde se dialoga entre el saber popular y profesional logrando una práctica segura y adaptada al universo cultural de las personas. Latinoamerica requiere de profesionales culturalmente sensibles a las expresiones y percepciones de dolor con curiosidad para explorar en la evidencia las posibilidades terapéuticas de las propuestas provenientes del saber popular.

Enfermedad por crioaglutinina del subtipo IgA como manifestación temprana de mieloma múltiple y resolución tras tratamiento con nuevos fármacos anti-mieloma / Cold agglutinin disease of IgA class as early manifestation of multiple myeloma and resolution after treatment with new anti-myeloma drugs

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