Groin pain of neurological origin as a differential diagnosis of femoroacetabular impingement.

BACKGROUND: To describe the experience in the diagnostic process and treatment of patients with groin pain (GP) of neurological origin due to entrapment of the iliohypogastric (IH), ilioinguinal (IL) and genitofemoral (GF) nerves in a hip preservation clinic. METHODS: Retrospective study of patients with GP of neurological origin confirmed with ultrasound-guided nerve block. Clinical outcomes were reported in 21 cases (age, 53.3 ± 15.9 years) treated with conservative treatment from January to December 2019, and in 9 patients (age 43.7 ± 14.6 years) who underwent neurectomy from January 2015 to December 2019. Pain intensity was assessed with a numerical rating scale (NRS) before starting the diagnostic process (Day 0) and at the end of follow-up. RESULTS: All cases reported pain on groin palpation. Half of these cases also reported a positive FADIR test (flexion, adduction, internal rotation) (15/30). On day 0, the intensity of pain in cases treated with conservative treatment was severe in 19 patients (NRS 7-10) and moderate in 2 (NRS 4-6), with a median improvement of 7 points (interquartile range [IQR] 5.5-8.0) at the end of follow-up (p < 0.001). In neurectomy group, a similar improvement in pain severity was (Day 0: 9 points [IQR 8.0-9.0]; end of follow-up: 0 points [IQR: 0-2.0]; p = 0.002). At the end of the study, 17/21 patients with conservative treatment and 7/9 with neurectomy were pain free or with mild pain (NRS < 3). CONCLUSIONS: In cases with PG of neurological origin, there is a high frequency of false positives in the FADIR test. Our findings suggest that neurectomy is a treatment option for patients in whom conservative treatment fails, providing significant pain relief.

Disgeusia como principal manifestación oral en pacientes con COVID-19 leve en el Instituto Nacional de Enfermedades Respiratorias / Dysgeusia as the main oral manifestation in patients with mild COVID-19 at the National Institute of Respiratory Diseases

Objetivo. Reportar las manifestaciones orales más comunes asociadas a COVID-19 así como si estas persisten en un período de 3 meses. Métodos. Se realizó un estudio longitudinal, descriptivo, evaluando a 149 individuos positivos por reacción en cadena de la polimerasa (PCR) para SARS-CoV-2 a los cuales se les realizó un estudio inicial y un control 3 meses después. Resultados. El 65% de los participantes reportó alguna manifestación en cavidad bucal y el 24% alguna secuela. Dentro de estos síntomas y secuelas bucales observados, la de mayor frecuencia fue la disgeusia la cual se encontró en 51% de los pacientes seguida por xerostomía 27%, ganglios o glándulas inflamadas (17%). Dichas manifestaciones disminuyeron de forma importante en el seguimiento, sin embargo, prevalecieron en algunos pacientes. Conclusiones. La disgeusia es la manifestación oral de mayor frecuencia en este estudio y se presentó entre las cinco manifestaciones generales más comunes.

Objective. To report the oral manifestations associated with COVID-19 as well as whether these persist over a period of 3 months. Methods. A longitudinal, descriptive study was carried out evaluating 149 individuals positive for SARS-CoV-2 by polymerase chain reaction (PCR), who underwent an initial examination and a control 3 months later. Results. A total of 65% of the participants reported some manifestation in the oral cavity and 24% some sequelae. Within these observed symptoms and oral sequelae, the one with the highest incidence was dysgeusia, which was found in 51% of patients followed by xerostomia (27%), lymph nodes or swollen glands (17%). These manifestations decreased significantly during the follow-up, however they prevailed in some patients. Conclusions. Dysgeusia is the oral manifestation with the highest incidence in this study and was among the 5 most common general manifestations.

Readiness to provide pharmaceutical care to transgender patients: Perspectives from pharmacists and transgender individuals.

OBJECTIVES: The objectives of this study were (1) to assess pharmacist readiness to provide pharmaceutical care for transgender patients through measuring both pharmacists' knowledge and attitudes towards transgender patients, (2) to assess transgender patients' perception of pharmacist readiness to provide them pharmaceutical care through measuring both pharmacists' knowledge and attitudes toward them, and (3) to compare pharmacist readiness to provide pharmaceutical care for transgender patients and patient perception of this readiness. DESIGN: The study used a descriptive, cross-sectional design. The pharmacist's readiness and the transgender patient's perception of their readiness, defined as a combination of knowledge and attitude, were evaluated. Two separate, validated questionnaires with dichotomous, multiple choice, and open-ended questions were used to measure both constructs among both populations. SETTING: Community-based research. PARTICIPANTS: Pharmacists practicing in Puerto Rico were provided the questionnaire by e-mail or in person. Transgender participants in Puerto Rico were recruited through health clinics and community partners and were surveyed in person. The analysis included responses from 96 pharmacists and 31 transgender participants. RESULTS: The majority of the pharmacists' knowledge scores (90%) were found in the low (0-5) and moderate (6-10) ranges, with a mean score of 7.23 out of a total possible score of 16 (SD ±2.36). For the attitude construct, most of the scores (81%) were found in the high (18-26) range, with a mean score of 19.63 out of a total possible score of 26 (SD ±3.65). For both constructs, transgender patient perceptions echoed the results of the pharmacists, indicating several perceived knowledge deficits in combination with mostly positive attitudes. CONCLUSION: The majority of pharmacists demonstrated positive attitudes toward caring for transgender patients, and transgender patients also perceived these positive attitudes from pharmacists. However, the measured and perceived knowledge deficits observed in this study suggest the need for educational interventions to improve pharmacist readiness to provide care for transgender patients.

Encuentros con la diferencia: la pluralidad en las experiencias de jóvenes universitarios / Encounters with the difference: the plurality in the experiences of university students

Resumen Este artículo se desprende de la tesis "Relaciones sociales en la universidad: poder, conflicto y pluralidad entre jóvenes", presentada por la autora, Ana María Arias Cardona, como requisito para optar al título de Doctora en Ciencias Sociales: Niñez y Juventud, en el Centro de Estudios Avanzados en Niñez y Juventud de la Universidad De Manizales-CINDE, la cual se centra en universitarios y analiza formas simbólicas de exclusión. Se enfoca en la categoría "pluralidad", cuyo objetivo es comprender cómo configuran los jóvenes su encuentro con la diferencia, cómo afrontan la diversidad en sus relaciones. El diseño es cualitativo, el método hermenéutico y las técnicas empleadas talleres y entrevistas. Participaron 119 jóvenes de dos universidades públicas y dos privadas de Antioquia (Colombia). Los resultados se agrupan en tres subcategorías: "Todos somos 'el otro' del otro: la diferencia como déficit"; "Preferir no es excluir: ¿optar por unos sin vulnerar a otros?"; y "Procesos de inclusión que evidencian movilizaciones solidarias". Esto permite concluir que la diversidad se lee como algo negativo, y que es difuso el límite respecto a la discriminación, pues dichos actos se han "naturalizado".

Abstract This article summarizes the highlights of a thesis that analyses the symbolic ways of exclusion among university students. It focuses on the "plurality" category which objective was to understand how young frame their encounter with difference, how they confront diversity in their relationships. The design was qualitative, the hermeneutical method was used along with workshops and interviews techniques. 119 young people participated, from two public university and two private university in Antioquia (Colombia). The results are grouped into three subcategories: "We are all 'the other of the other: difference as deficit"; "To prefer is not to exclude: How to opt for certain ones without harming others?" and inclusion processes that show solidary mobilizations: which allows to conclude that diversity is read as something negative, that the limit regarding discrimination is diffuse and such, since those acts have been "naturalized".

Non-destructive DNA extraction methods for entomophagous insects with emphasis on biological control.

One of the major challenges in molecular analysis of arthropods, especially for natural enemies of insect pests, is the intact preservation of the specimens to be integrated into entomological collections. However, most of the DNA extraction protocols involve maceration of the tissue, avoiding the preservation of the original specimen. Two general methods were adapted into non-destructive DNA extraction protocols, DNeasy® Blood & Tissue Kit (A) and the CaCl2 lysis buffer method (B), while the potential of the method with the alkaline lysis buffer (HotSHOT; C) was evaluated for the first time on insect specimens. These protocols were assessed for the recovery of DNA from Ceraeochrysa valida, Tamarixia radiata, and Hippodamia convergens. Photographical records showed that morphological features of the specimens were preserved after the DNA extraction process. COI fragments were successfully amplified with method A (100%), B (77%), and C (88%), respectively. We conclude that these non-destructive DNA extraction methods avoid the destruction of tissue and preserve the original insects and their morphological characteristics for future reference.

A Preliminary Assessment of Selected Social Determinants of Health in a Sample of Transgender and Gender Nonconforming Individuals in Puerto Rico.

Purpose: Transgender and gender nonconforming (GNC) people continue to experience suboptimal health care, social exclusion, and lower quality of life. Globally, lack of access to services, institutional violence, and public harassment have been reported. However, there is limited data on transgender health in Puerto Rico and the Caribbean. The purpose of this study is to assess the social determinants of health and wellbeing of transgender and GNC people living in Puerto Rico. Methods: Utilizing a community-based participatory research approach, 52 self-identified transgender and GNC individuals living in Puerto Rico completed a survey, which included questions on access to health care services, social support, and violence, among others. Data were collected from March to Ma y of 2015 and descriptive statistical analysis was conducted. Results: Most of the participants reported experiences of discrimination across multiple social settings, most commonly at school (70.6%) and work (67.4%). Regarding experiences of violence, more than half (65.4%) had been verbally attacked in a public space. Many reported that access to gender-affirming health care services is difficult in Puerto Rico (88.5%) due to lack of knowledgeable providers (59.6%) and discomfort during the encounter (55.8%). The main perceived priority for their wellbeing was a transgender health care center. Conclusion: Although the LGBT equality movement has reached great milestones, access to gender-affirming health services and safe educational and work spaces are still needed. Findings from the study provide guidance for actions to reduce health disparities by addressing the needs for health and wellbeing among transgender and GNC individuals.

Treatment of Hypertensive Cardiogenic Edema with Intravenous High-Dose Nitroglycerin in a Patient Presenting with Signs of Respiratory Failure: A Case Report and Review of the Literature.

BACKGROUND Pulmonary edema is the accumulation of fluid in the lung secondary to increased hydrostatic pressure. Hypertensive cardiogenic pulmonary edema presents with a sudden onset of severe dyspnea, tachycardia, and tachypnea, and can occur when the systolic blood pressure exceeds 160 mmHg in association with acute decompensated congestive cardiac failure (CCF). A case is presented of hypertensive cardiogenic pulmonary edema treated with high-dose nitroglycerin and includes a review of the literature. CASE REPORT A 63-year-old Hispanic male with a medical history of hypertension, coronary artery disease, heart failure with a reduced ejection fraction of 35%, chronic kidney disease (CKD) and diabetes mellitus, presented as an emergency with acute, severe dyspnea. The patient was initially managed with 100% oxygen supplementation and intravenous (IV) high-dose nitroglycerin (30 mcg/min), which was titrated every 3 minutes, increasing by 15 mcg/min until a dose of 120 mcg/min was reached. After 18 minutes of aggressive therapy, the patient's condition improved and he no longer required mechanical ventilation. CONCLUSIONS Hypertensive cardiogenic pulmonary edema is a challenging clinical condition that should be diagnosed and managed as early as possible, and distinguished from respiratory failure due to other causes. Although hypertensive cardiogenic pulmonary edema is usually managed acutely with high-dose diuretics, this case has highlighted the benefit of high-dose IV nitroglycerin, and review of the literature supports this treatment approach.

Dilatación no neumática de anastomosis después de derivación o bypass gástrico, revisión de 23 casos / Non pneumatic dilatation of anastomosis following gastric bypass, review of 23 cases

Antecedentes. La derivación gástrica por laparoscopia en Y de Roux es uno de los procedimientos más comúnmente practicados para el manejo de la obesidad mórbida. Este procedimiento requiere de una pequeña anastomosis gastro-yeyuno que, en ocasiones, puede causar estenosis. Este estudio pretende evaluar la seguridad y eficacia del manejo de la estenosis de la anastomosis gastro-yeyuno utilizando dilatadores de Savary-Gilliard guiados por endoscopia. Métodos. Setecientos ocho pacientes se sometieron a derivación gástrica por laparoscopia en Y de Roux. La edad promedio fue de 41 años, y la media de su índice de masa corporal fue 43 kg/m². A los pacientes con sospecha de estenosis de la anastomosis gastro-yeyuno, se les practicó endoscopia de vías digestivas altas. Aquellos que presentaron estenosis se manejaron endoscópicamente con dilatadores de Savary-Gilliard. Resultados. La estenosis de la anastomosis gastro-yeyuno fue confirmada en 23 pacientes (3,24 %). Se practicaron 36 dilataciones en estos pacientes, resultando en una media de 1,5 dilataciones por paciente. Fue necesario hacer una dilatación para 20 pacientes (87 %), tres dilataciones para uno (4 %), y cuatro dilataciones o más para dos (9 %). La media de tiempo entre la cirugía de derivación gástrica por laparoscopia en Y de Roux y la dilatación de la estenosis de la anastomosis gastro-yeyuno, fue de 10 semanas. Todas las dilataciones se hicieron de manera ambulatoria. Conclusión. El manejo y tratamiento de la estenosis de la anastomosis gastro-yeyuno luego de la derivación gástrica por laparoscopia en Y de Roux puede hacerse de manera ambulatoria, utilizando dilatadores de Savary-Gilliard, con resultados efectivos y seguros.

Background: Laparoscopic Roux en -Y Gastric Bypass (LRYGB) is one of the most commonly performed procedures for the management of morbid obesity. The success of this procedure requires the creation of a small gastrojejunostomy, which sometimes can become stenotic. The treatment of choice for this complication is endoscopic balloon dilatation. This study aims to evaluate the safety and effectiveness of the management of gastrojejunal anastomotic stricture (GJAS) using Savary-Gilliard dilators guided by endoscopy. Methods: 708 patients underwent LRYGB. The average age was 41 years, and mean bodymass index was 43 kg/m². Patients with symptoms suggesting stenosis of the anastomosis underwent upper gastrointestinal endoscopy. When confirmed, those stenosis were managed endoscopically with Savary-Gilliard dilators. Results: GJAS was confirmed in 23 patients (3.24%). A total of 36 dilatations were performed in these patients, which resulted in an average of 1.5 sessions per patient. It was necessary to perform one dilatation to 20 patients (87%), three dilatations in one patient (4%), and four or more in 2 patients (9%). The average time between surgery and GJAS dilation was 10 weeks. All dilations were performed on an outpatient basis. Conclusion: The management and treatment of GJAS after LRYGB can be done as an outpatient procedure using Savary-Gilliard dilators, which are effective and safe.

Reintervenciones en cirugía bariátrica, conversión a otro procedimiento / Reoperations in bariatric surgery, conversion to a different type of procedure

Antecedentes. Este estudio pretende evaluar la seguridad y la eficacia del abordaje laparoscópico al practicar una nueva intervención por cirugía bariátrica fallida y evaluar los resultados de la conversión de una cirugía a otra. Métodos. Se estudiaron 27 pacientes entre agosto de 2002 y febrero de 2008 en la Fundación Valle de Lili. El tipo de reintervención elegido fue determinado por el grupo de cirujanos de obesidad, según el procedimiento previo y los hábitos alimentarios, los síntomas y las características de cada paciente. Se evaluó el tiempo operatorio, las complicaciones, la mortalidad y la morbilidad del procedimiento quirúrgico; además, la mejoría de las enfermedades concomitantes del paciente y su reducción de peso al hacerle el respectivo seguimiento. Resultados. Se reintervinieron 27 pacientes, 19 mujeres (70%) y 8 hombres (30%). La edad media fue de 44 años (rango, 26 a 71 años). La media de seguimiento fue de 19 meses (rango, 2 a 60 meses). La media del índice de masa corporal antes de la cirugía fue de 41 kg/m² y al seguimiento, de 32 kg/m². Los procedimientos quirúrgicos practicados inicialmente fueron: 1 minibypass, 9 bandas gástricas ajustables (33%), 1 gastroplastia vertical con bandas (4%), 14 bandas gástricas no ajustables (52%) y 2 bypass gástricos en 7% de los pacientes. Los procedimientos de reintervención realizados fueron: manga gástrica en 3 pacientes (11%), bypass gástrico en 14 pacientes (52%), derivación biliopancreática en 9 pacientes (33%) y alargamiento de asa en un paciente (4%). El promedio de tiempo operatorio fue de 237 minutos (rango, 110 a 580 minutos). Conclusión. Las reintervenciones por cirugía bariátrica deben ser practicadas por un grupo de cirujanos expertos en ella y en cirugía mínimamente invasiva por ser procedimientos técnicamente más complejos.

Background: This study evaluated the safety and efficacy of the laparoscopic approach in performing reoperations for failed bariatric surgery, and the assessment of the results of conversion to the another type of procedure. Methods: We studied 27 patients in the period August 2002 to February 2008 at Fundación Valle del Lili in Cali, Colombia. The type of revisional surgery was determined by the group of bariatric surgeons, according to the previous procedure, alimentary habits, symptoms, and characteristics of each patient. We evaluated operative time, complications, mortality and morbidity, improvement of the patients´ comorbidities, and post reoperation weight loss. Results: 27 patients had revisional bariatric surgery. The mean age was 44 years (range 26 to 71), 19 were women (70%) and 8 men (30%). Mean follow up was 19 months (range 2 to 60 months). The mean body mass index (BMI) before reoperation was 41 kg/m² and after revisional surgery reached 32 kg/m². Bariatric operations before revisional surgery were: mini gastric bypass (1), adjustable gastric band (n=9. 33%), vertical banded gastroplasty (n=1. 4%), non-adjustable gastric band (n=14.52%), and gastric bypass (n=2.7%). The revisonal procedures performed were: sleeve gastrectomy in 3 patients (11%), gastric bypass in 14 patients (52%), biliopancreatic diversion in 9 patients (33%) and elongation of loop in one patient (4%). The average operating time was 237 minutes (range 110 to 580). Conclusion: reoperations for bariatric surgery should be performed by a group of surgeons with wide experience in bariatric surgery and minimally invasive surgery. They are technically more demanding procedures.

A male poecillid's sexually dimorphic body plan, behavior, and nervous system.

Here we review the literature of a male poecillid's sexually dimorphic body plan, behavior, and nervous system, including work dating from the mid 1800s to the mid 1990s as well as work in press or in preparation for publication. Rosa-Molinar described the remodeling of the sexually dimorphic anal fin appendicular support, confirmed earlier claims about the development of the male and female secondary sex characteristics in the Western Mosquitofish, Gambusia affinis and provided for the first time direct embryonic evidence suggesting that remodeling of the sexually dimorphic anal fin appendicular support is biphasic. The first process begins in embryos and proceeds similarly in immature males and females; the second process occurs only in males and results in the anterior transposition of the anal fin and its appendicular support to the level of vertebra 11 [Rosa-Molinar E, Hendricks SE, Rodriguez-Sierra JF, Fritzsch B. 1994. Development of the anal fin appendicular support in the western mosquitofish, Gambusia affinis (Baird and Girard, 1854): a reinvestigation and reinterpretation. Acta Anat 151:20-35.] and the formation of a gonopodium used for internal fertilization. Studies using high-speed video cameras confirmed and extended Peden's and others' observations of copulatory behavior. The cameras showed that circumduction is a complex movement combining in a very fast sequence abduction, extension and pronation, S-start-type fast-start (defined as torque-thrust), and adduction movements. Recent work on the nervous system demonstrated dye-coupling between motor neurons and interneurons via gap junctions, suggesting an attractive substrate for the rapid motions involved in poecillid copulatory reflexes.

Kidney transplantation and gastric bypass: a better control of comorbidities.

The database of patients who underwent laparoscopic gastric bypass at our institution from 2002 to 2008 was reviewed. Five patients with kidney transplants were found. The impact of the laparoscopic gastric bypass on their comorbidities and the grafts and patients' survival were studied. The five patients of the group are between 36 and 66 years old, three men and two women. Preoperative body mass index ranged between 35 and 42 kg/m(2). The first patient was operated on 4 years ago and presented an anastomotic leak at the gastrojejunal anastomosis that healed with medical treatment. The remaining four patients did not present postoperative complications. At the moment of analysis, the five patients were healthy and enjoying a good quality of life. All the patients had dyslipidemia which reached normal levels after surgery. Three of the patients had diabetes and achieved good control after the surgery. Most importantly, the absorption of immune suppressors was not altered; while some of the patients were even able to reduce their doses. Patients with renal terminal renal diseases and those with renal transplants with severe or morbid obesity are a group that can particularly benefit from a gastric bypass. The laparoscopic gastric bypass is feasible in severely or morbidly obese patients with kidney transplantation. The absorption of the immune-suppressive medication is not altered after a gastric bypass.

Diagnóstico y seguimiento del feto con restricción del crecimiento intrauterino (RCIU) y del feto pequeño para la edad gestacional (PEG). Consenso Colombiano / Diagnosing and managing foetuses suffering from intrauterine growth restriction (IUGR) and foetuses which are small for their gestational age (SGA). Colombian consensus

Objetivo: dar a conocer a los participantes en el cuidado de la salud de la mujer embarazada, los más recientes avances y recomendaciones clínicas de un tema controversial que es causa importante de morbimortalidad perinatal en Colombia. Metodología: se revisaron las bases de datos Cochrane, Medline y Embase, además de la base latinoamericana SciELO, libros de la especialidad y consensos de otras sociedades científicas en búsqueda de estudios diagnósticos, revisiones sistemáticas, estudios aleatorizados y metaanálisis relativos a los términos: “restricción de crecimiento intrauterino” y “pequeño para la edad gestacional” en el período comprendido entre 1995-2009. A partir de esto, se realizó un manuscrito inicial, el cual fue sometido a discusión por medio de Internet. Posteriormente, el manuscrito final fue discutido y modificado en la ciudad de Medellín (Colombia), en el marco del congreso de Medicina Fetal S.A. en septiembre de 2008. Resultados: teniendo en cuenta la evidencia disponible, se presentó una guía para el manejo del feto PEG y con RCIU, la cual puede ser aplicada a Colombia. Conclusiones: este tema genera controversia debido a la falta de evidencia científica para la aplicación de algunas definiciones y pruebas diagnósticas en su manejo.

Objective: making those participating in pregnant women’s health care aware of the latest clinical recommendations regarding a controversial topic which is an important cause of perinatal morbidity in Colombia. Methodology: the Cochrane Library, Medline and Embase databases were searched as well as SciELO Latin-American database, specialised books and consensus from other scientific societies for diagnostic studies, systematic reviews, randomised trials and meta-analysis carried out between 19952009 regarding the terms “intrauterine growth restriction”and “small for gestational age”. An initial manuscript was written and submitted for on-line discussion. The final manuscript was discussed and amended in Medellín, Colombia, during the Foetal Medicine Congress held in September 2008. Results: a guide to managing SGA and IUGR foetuses was written and is presented here; it has been based on the best available evidence and could be applied in Colombia. Conclusions: this issue produces controversy due to a lack of scientific evidence for applying some definitions and diagnostic tests when managing IUGR and SGA foetuses.

Factores asociados con el resultado virológico de la terapia antirretroviral altamente activa (HAART) en 340 pacientes Naive, Medellín - Colombia, 1997 - 2000 / Associated factors to virologic result on highly active antiretroviral theraphy (HAART) in 340 Naive patients: Medellín - Colombia, 1997 – 2000

Contexto: La mayoría de los estudios que soportan las guías actuales de manejo de la enfermedad VIH-SIDA han sido realizados en países desarrollados. Sin embargo, su aplicabilidad y efectividad de las terapias en países en vía de desarrollo puede variar, dado que al tener diferentes características socioeconómicas pueden modificarel resultado de la terapia. Objetivo: Medir la efectividad de la terapia HAART y los factores asociados con eléxito virológico al sexto mes de tratamiento. Diseño: Cohorte histórica.Sitio: Clínica pública ambulatoria para pacientes con VIH-SIDA en un paíssubdesarrollado (Medellín-Colombia). Mayo 1997 a mayo 2000. Pacientes: 340 pacientes naive, mayores de 13 años, todos iniciaron TerapiaAntirretroviral Altamente Activa (HAART). Medición: La variable dependiente fue la carga viral al sexto mes, categorizada mayor o menor de 500 copias/ml. El análisis univariado se realizó con la medición de la razón de disparidades (OR) para las variables categóricas y la t de student para las variables cuantitativas. La regresión logística se utilizó para identificar losfactores asociados ajustando por variables de confusión...

Context: Most studies supporting guidelines on HIV/AIDS have been conducted in developed countries. Nevertheless, their applicability on effectiveness of therapies may vary in developing countries, because of different socioeconomic characteristicswhich can affect therapy responses.Objective: To measure HAART effectiveness and factors associated with favorable virologic responses after six months of treatment. Study design: Historical Cohort. Place: Public Hospital with ambulatory service for HIV/AIDS patients in a developing country (Medellín, Colombia). May 1997 trough May 2000. Patients: 340 naive patients, over 13 years of age, which began HAART theraphy. Measurements: The dependent variable was the viral load after six months of therapy, classified as a result either over or below 500 copies/ml. Univariate analysiswas conducted using odds ratios for categorical variables and student – t test for quantitative ones. Logistic regression was used in order to identify adjusted risk factors of confounding factors...

Long-lasting effects of a Bacillus thuringiensis serovar israelensis experimental tablet formulation for Aedes aegypti (Diptera: Culicidae) control.

Dengue is a growing public health problem in many tropical and subtropical countries worldwide. At present, the only method of controlling or preventing the disease is to eliminate its vector, Aedes aegypti (L.) (Diptera: Culicidae). In the current study, an experimental larvicide tablet formulation XL-47 based on Bacillus thuringiensis serovar israelensis (Bti) and containing 4.8% of technical powder was developed. This formulation was evaluated against Ae. aegypti in three different sets of experiments, under field-simulated conditions: two experiments were indoors and under partial sunlight exposure and one experiment was outdoors with sunlight exposure. Larvae were added throughout the experiment two times per week, and the residual larvicidal activity was recorded daily. Pupal formation was reduced in the containers with Bti by > 80% in relation to the containers without treatment for 12 wk; to our knowledge, this is the longest period of control reported for a Bti tablet formulation outdoors under sunlight exposure. Moreover, samples from the top, middle, and bottom of the water column were collected to perform bacterial plate counts and toxicity assays. The Bti population and the active ingredient of the tablet formulation remained mainly at the bottom of the containers and mosquito larvae reached the formulation by diving and shredding the tablet's material. In conclusion, the experimental tablet formulation XL-47 showed an inhibition of pupal formation that lasted for long periods under sunlight exposure.

Análisis de severidad y criterios de hospitalización en pacientes con neumonía adquirida en la comunidad / Severity of illness analysis and hospitalization criteria in patients with community-acquired pneumonia

La neumonía adquirida en la comunidad es una enfermedad que causa alta morbilidad, mortalidad y costos. Este artículo tiene como finalidad discutir los diferentes métodos de evaluación de severidad de la enfermedad, para determinar el mejor sitio para el tratamiento de los pacientes. Utilizamos un caso clínico ficticio a manera de ejercicio para aplicar las diferentes herramientas: PSI, CURB y CURB-65. Sugerimos el uso tanto del CURB como de CURB-65, por su fácil aplicación y buena efectividad en la práctica clínica. La presencia de dos o más de los criterios clínicos: (Confusión, BUN>19,6 mg/dL 7mmol/L), frecuencia respiratoria >=30/min, e hipotensión arterial (presión arterial sistólica o diastólica <90/60 mmHgl) sugieren que el paciente debe ser manejado en el hospital. Estos métodos no tienen la función de reemplazar sino de reforzar objetivamente el criterio clínico en la toma de decisión del lugar apropiado de tratamiento del paciente con neumonía adquirida en la comunidad...

Gastronomia endoscopica percutanea: Evaluacion de un nuevo sistema de bajo costo / Endoscopic percutaneus gastronomy: Evaluation of a new low cost system

Introducción: La Gastrostomía Endoscópica Percutánea (GEP) es la técnica de elección para la realización de gastrostomías en pacientes que requieren una vía de alimentación permanente. Objetivo: Desarrollo y evaluación clínica de un nuevo sistema para GEP. Métodos: Se desarrolló y fabricó un sistema de gastrostomía endoscópica percutánea (JPV), 20 Fr, combinando las técnicas de "halar" y "empujar". Se realizó la GEP con este sistema en un grupo de pacientes y se evaluó la presencia de complicaciones y problemas técnicos. Resultados: Se realizaron 37 GEP en 34 pacientes. El tiempo operatorio fue de 8.6 minutos. La mayoría de los pacientes presentaba trastornos neurológicos con disfagia importante (n=23) y cáncer de cabeza y cuello (n=8). Una paciente con obesidad severa presentó complicaciones del estoma. En tres casos se presentó falla técnica del equipo. En esos casos se realizó la GEP con un nuevo sistema sin complicaciones. No se presentaron complicaciones mayores relacionadas con el uso del nuevo sistema. El costo del sistema JPV es de aproximadamente el 50 por ciento del sistema disponible comercialmente. Este sistema de gastrostomía puede ser una alternativa útil, segura y económica para la realización de GEP, con un costo equivalente al 50 por ciento de los sistemas disponibles comercialmente