Hiperinfección por Strongyloides stercoralis en un paciente joven con infección por HTLV-1 y colitis ulcerativa / Strongyloides stercolaris hyperinfection in a young patient with HTLV-1 infection and ulcerative colitis

Resumen La estrongiloidiasis es una infección causada por el parásito Strongyloides stercoralis (SS) y se asocia con una alta mortalidad en pacientes inmunosuprimidos debido a una diseminación larvaria y síndrome de hiperinfección. El compromiso de la mucosa gástrica es raro, pero cuando se presenta se caracteriza por sangrado digestivo y emesis persistente. A continuación, se presenta el caso de un paciente de 27 años con síntomas gastrointestinales, antecedente de infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) y colitis ulcerativa, quien desarrolló síndrome de hiperinfección por SS. Se describe la presentación clínica, diagnóstico, tratamiento y complicaciones derivadas del cuadro infeccioso.

Abstract Strongyloidiasis is an infection caused by the parasite Strongyloides stercolaris (SS) and is associated with high mortality in immunosuppressed patients due to larval spread and hyperinfection syndrome. Gastric mucosal involvement is rare, but when it occurs, it is characterized by digestive bleeding and persistent emesis. The following is the case of a 27-year-old patient with gastrointestinal symptoms, a history of HTLV-1 infection and ulcerative colitis, who developed hyperinfection syndrome with SS. The clinical presentation, diagnosis, treatment and complications arising from the infectious disease are described.

Gender and Polysomnographic Profiles Findings in Obstructive Sleep Apnea Syndrome Patients Living in High Altitude.

PURPOSE: Obstructive sleep apnea (OSA) is a common sleep disorder which prevalence is 22% in men and 17% in women. It is well described that females presented different clinical and polysomnographic characteristics compared with men. Those studies were performed in plain areas. We described the analysis by gender and clinical profiles of a sample of patients with diagnostic of OSA and living at high altitude. PATIENTS AND METHODS: It is an observational study that describes differences between clinical and polysomnographic characteristics by gender in patients with OSA. Additionally, an unsupervised cluster algorithm was used to find groups of patients with similar clinical and polysomnographic characteristics. RESULTS: We included 709 patients, 51.6% were females and 48.3% were males with mean age of 64 and 62 years old, respectively, in which 90.97% presented OSA. Men presented a higher apnea and hypopnea index than women (p=0.002), besides presented more sleep polysomnographic alterations. Meanwhile, women evidenced better sleep quality based on parameters. Additionally, in the sample of patients, we found four separated clinical profiles characterized mainly by differences in the severity of polysomnographic parameters. CONCLUSION: The patients were more obese, older, and had lower SpO2 values than most of those previously reported. Men had greater severity in most of the parameters measured by polysomnography. Polysomnographic variables were different both in the OSA patient profiles and in the gender comparison. However, the REM sleep apnea hypopnea index did not differ between sexes, indicating the importance of this variable in the evaluation of OSA severity in women. In contrast to previous reports, clinical and demographic characteristics showed few differences in both analyses. This result suggests that the behavior of OSA at high altitudes may have particularities with respect to low altitudes.

Factors determining adoption of water conservation practices in cattle farming systems of the upper basin of the river Guarinó (Caldas, Colombia) / Factores que determinan la adopción de prácticas de conservación del agua en sistemas ganaderos de la cuenca alta del río Guarinó (Caldas, Colombia) / Factores que determinam a adopçäo de prácticas de conservaçäo do água em sistemas pecuários de bacia alta do rio Guarinó (Caldas, Colombia)

Factors determining the adoption of water conservation practices are specific to the study sites and need to be identified to develop local policies. Objective: identify factors that determine the adoption of water conservation practices in cattle farms in a high Andean watershed, given that this area is considered a conservation priority in Caldas province, Colombia. Methods: in this study, five factor categories related to the adoption of conservation practices were used as a reference. The study quantified variables obtained by survey from February to April 2009. A total of 69 farmers were surveyed. A Logit regression model was used to explain adoption of conservation practices. Significant variables were plotted to measure their effect on the probability of practice adoption. Results: model results show that although factors related to biophysical properties (NAC and LIM) along with risk and uncertainty factors (TEN and CAP) were significant, other factors are also significant in the study area, such as those related with decision makers (EDU) and farm resources (TAM). Conclusions: regarding the effect of significant variables on the probability of adoption, it is not necessary to reach a conclusion about which ones are most important; however, the model results and the determination of the effects offer keys to direct the conservation actions in the area, allowing to generate recommendations in this regard that can be used as reference in cattle areas around high Andean aquatic ecosystems.

Los factores que determinan la adopción de prácticas de conservación a nivel agropecuario son específicos de los sitios de estudio e identificarlos es necesario para tomar decisiones a nivel local. Objetivo: en el presente trabajo, tomando como referencia cinco categorías de factores relacionados con la adopción de prácticas de conservación, se buscó identificar aquellos factores que determinan la adopción de prácticas de conservación del agua en sistemas ganaderos de una cuenca alto andina con prioridad de conservación en el departamento de Caldas (Colombia). Métodos: en el estudio se cuantificaron algunas variables, obtenidas a través de una encuesta realizada entre Febrero-Abril del 2009 a 69 tomadores de decisión de predios ganaderos del sector, las cuáles fueron incluidas en un modelo de regresión Logit para explicar la adopción. Las variables significativas fueron graficadas para medir el efecto que ejercen sobre la probabilidad de adopción. Resultados: los resultados del modelo muestran que aunque los factores relacionados con aspectos biofísicos de los predios (NAC y LIM) y los factores de riesgo e incertidumbre (TEN y CAP) son significativos, en la zona de estudio existen otros factores que también son significativos, como los relacionados con los tomadores de decisión (EDU) y los recursos de dotación de los predios (TAM). Conclusiones: con relación al efecto de las variables significativas sobre la probabilidad de adopción, no es preciso llegar a una conclusión sobre cuál o cuáles son las más importantes, sin embargo, los resultados del modelo y la determinación de los efectos, ofrecen elementos para dirigir las acciones de conservación en la zona, permiten generar algunas recomendaciones en tal sentido y pueden servir de referente en zonas ganaderas relacionadas con ecosistemas acuáticos alto andinos.

Os fatores que determinam a adoção de práticas de conservação agrícola são específicos dos locais de estudo. Objetivo: usando como referência 5 categorias de fatores relacionados com a adoção de práticas de conservação ao nível pecuário, neste estudo tentou se identificar os fatores que determinam a adoção de práticas de conservação da água nos sistemas pecuários da bacia alta do rio Guarinó em Caldas. Métodos: no estudo quantificaram-se algumas variáveis obtidas através de enquetes realizados desde Fevereiro até Abril do 2009, para 69 tomadores de decisão, as quais foram incluídas em um modelo de regressão logística para explicar a adoção. As variáveis significativas foram plotadas para medir o efeito que exercem sobre a probabilidade de adoção. Resultados: os resultados do modelo demonstram que embora os fatores relacionados com aspectos biofísicos dos prédios (NAC e LIM) e os fatores de risco e incerteza (TEN e CAP) foram significativos, na zona de estudo existem outros fatores que também foram significativos: os que tem relação com os tomadores de decisão (EDU) e os recursos de dotação dos prédios (TAM). Conclusões: em relação ao efeito das variáveis significativas sobre a probabilidade de adoção, não é preciso chegar a uma conclusão sobre qual ou quais são as de maior importância, entretanto, os resultados do modelo e a determinação dos efeitos, oferecem elementos para dirigir as ações de conservação da região que permitem gerar algumas recomendações. Nesse sentido, podem servir como referência em regiões pecuárias que tenham relação com ecossistemas aquáticos andinos.