Linfagitis superficial reactiva a insecto: un camino por la vía linfática / Insect-reactive superficial lymphangitis: a walk through the lymphatic pathwa

La linfangitis superficial aguda reactiva a picadura de insecto es una entidad poco descrita en la literatura. Se caracteriza por una inflamación de los conductos linfáticos debido a las toxinas inoculadas por el insecto. Se presenta como una lesión eritematosa ovalada en la zona de la picadura, que se extiende de manera lineal siguiendo el trayecto de un vaso linfático. El diagnóstico es clínico y el tratamiento sintomático. Es importante descartar la etiología infecciosa que puede confundirse con esta patología y cursar con elevada gravedad. Presentamos el caso de una paciente de 69 años, sin antecedentes personales de interés ni alergias conocidas, que acude a consulta por una lesión eritematosa, lineal y pruriginosa que por la anamnesis y la exploración podría ser una linfangitis aguda reactiva a insecto.(AU)

Acute superficial lymphangitis after insect bite is an entity little reported in the literature. This is characterized by an inflammation of the lymphatic ducts due to toxins inoculated by the insect. It presents as an oval erythematous lesion in the bite area, which extends in a linear manner along the path of a lymphatic vessel. Diagnosis is clinical and treatment is symptomatic. It is important to rule out the infectious etiology that can be confused with this pathology and be very serious. We report the case of a 69-year-old patient with no relevant personal history of interest or known allergies, who came to the clinic with an erythematous, linear and pruritic lesion that, based on the history and examination, could correspond to acute insect-reactive lymphangitis.(AU)

Transcriptome-guided annotation and functional classification of long non-coding RNAs in Arabidopsis thaliana.

Long non-coding RNAs (lncRNAs) are a prominent class of eukaryotic regulatory genes. Despite the numerous available transcriptomic datasets, the annotation of plant lncRNAs remains based on dated annotations that have been historically carried over. We present a substantially improved annotation of Arabidopsis thaliana lncRNAs, generated by integrating 224 transcriptomes in multiple tissues, conditions, and developmental stages. We annotate 6764 lncRNA genes, including 3772 that are novel. We characterize their tissue expression patterns and find 1425 lncRNAs are co-expressed with coding genes, with enriched functional categories such as chloroplast organization, photosynthesis, RNA regulation, transcription, and root development. This improved transcription-guided annotation constitutes a valuable resource for studying lncRNAs and the biological processes they may regulate.

Agricultores Tradicionales Produciendo para el Mercado Agroexportador: Causas y Consecuencias de Dicho Cambio Productivo / Traditional Farmers Producing for the Agro-Export Market: Causes and Consequences of Such Productive Change / Agricultores Tradicionais Produzindo para o Mercado Agroexportador: Causas e Consequências De Dita Mudança Produtiva

Resumen Introducción. En el municipio de El Peñol, Antioquia, la incursión de pequeños y medianos productores al mercado agroexportador de la gulupa (Passifflora edulis Sims) es hoy una realidad reconocida, que, asumida como caso de estudio, permite aportar a la comprensión de un fenómeno particular: el tránsito de agricultores tradicionales-locales hacia la producción para el mercado internacional, asunto sobre del que versa el presente estudio. Objetivo. Identificar y analizar las causas y consecuencias de la incursión de pequeños y medianos productores de El Peñol, Antioquia, al mercado agroexportador de la gulupa. Materiales y métodos. La investigación, de índole cualitativa, se centró en analizar las múltiples narrativas expuestas por los propios actores localmente asociados al cultivo de gulupa sobre las causas y consecuencias del fenómeno estudiado. La información se recolectó mediante entrevistas a profundidad, posteriormente analizadas en su contenido. Resultados. Entre las causas de la incursión al mercado global destacan las ventajas ofrecidas por el cultivo ante la inestabilidad de los precios de los productos tradicionales, el conocimiento previo de la especie y la oportunidad de tránsito hacia una agricultura más limpia. Entre las consecuencias, el mejoramiento de las condiciones socioeconómicas familiares, la reafirmación de la vocación agrícola de pequeños y medianos productores y la alta dependencia de la intermediación realizada por las empresas agroexportadoras. Conclusiones. Las causas y consecuencias del cambio productivo presentan un carácter multidimensional y ambivalente, situación que induce a explorar el fenómeno más allá de su dimensión económica, dando cuenta, simultáneamente, de sus bondades y riesgos.

Abstract Introduction. In the municipality of El Peñol, Antioquia, the incursion of small and medium producers to the agricultural export market of gulupa (Passifflora edulis Sims) is currently a recognized reality. Subject which, assumed as a case study, contributes to the understanding of a particular phenomenon: the movement of traditional-local farmers towards production for the international market, an issue addressed by this research. Objective. Identify and analyze the causes and consequences of the incursion of small and medium producers from El Peñol, Antioquia, to the agricultural export market of the gulupa. Materials and methods. The research was qualitative and focused on analyzing the multiple narratives presented by the local actors, associated with the gulupa crops about the causes and consequences of the phenomenon studied. The information was collected through in-depth interviews, subsequently analyzing its content. Results. Among the causes of the global market incursion, the advantages offered by the crop are highlighted due to the instability of the prices of traditional products, the prior knowledge of the gulupa and the opportunity to move towards a cleaner agriculture. Among the consequences are the improvement of family socioeconomic conditions, the reaffirmation of the agricultural vocation of small and medium producers and the high dependence on intermediation carried out by agro-exporting companies. Conclusions. The causes and consequences of productive change have a multidimensional and ambivalent character, a situation that leads to explore the phenomenon beyond its economic dimension, while simultaneously presenting simultaneously its benefits and risks.

Resumo Introdução. No município de El Peñol, Antioquia, a incursão de pequenos e médios produtores no mercado agrícola de exportação da gulupa (Passifflora edulis Sims) é uma realidade hoje reconhecida, que, assumida como estudo de caso, permite contribuir para a compreensão de um fenômeno particular: o trânsito de agricultores tradicionais locais para a produção para o mercado internacional, assunto sobre o qual o estudo trata. Objetivo. Identificar e analisar as causas e consequências da incursão de pequenos e médios produtores de El Peñol, Antioquia, no mercado de exportação agrícola da gulupa. Materiais e métodos. A pesquisa, de ordem qualitativa, teve como objetivo analisar as múltiplas narrativas apresentadas pelos próprios atores associados ao cultivo da gulupa sobre as causas e consequências do fenômeno estudado. As informações foram coletadas por meio de entrevistas em profundidade, posteriormente analisadas em seu conteúdo. Resultados. Entre as causas da incursão no mercado global, destacam-se as vantagens oferecidas pela gulupa, dada a instabilidade dos preços dos produtos tradicionais, o conhecimento prévio da espécie e a oportunidade de avançar para uma agricultura mais limpa. Entre as consequências, estão a melhoria das condições socioeconômicas da família, a reafirmação da vocação agrícola dos pequenos e médios produtores e a alta dependência de intermediação realizada pelas empresas agroexportadoras. Conclusões. As causas e consequências da mudança produtiva têm um caráter multidimensional e ambivalente, situação que leva a explorar o fenômeno além de sua dimensão econômica, percebido, ao mesmo tempo, seus benefícios e riscos.

Pharmacist's Role and Pharmaceutical Care During the COVID-19 Pandemic.

Pharmacists play a vital role in public health during the COVID-19 pandemic. In this chapter, we present the most significant contributions that pharmacists could make to communitarian and hospital settings. It includes the provision of essential services, such as continuous access to medication and supplies, support to medical services, education and information to the population and the health team to reduce the misuse of medications, patient monitoring and follow-up, and the detection and referral of suspected cases of COVID-19. The chapter ends with a discussion over certain elements related to innovation needs, such as telepharmacy services.

How to link patients with suspicious COVID-19 to health system from the community pharmacies? A route proposal.

Colombia confirmed its first case of the COVID-19 on March 6th, 2020. On March 16th, 2020, 54 cases have been confirmed (36 imported and 18 associated), therefore, Colombia is at highest alert, and it is now trying to avoid or minimize the last stage of "community transmission". We present a route proposal that shows how the community pharmacist may develop his responsibility to contribute to the early detection and appropriate referral of possible cases of the COVID-19. In the route have been considered three possible entrances depending on the needs of the users: anti-flu drugs, symptoms related to COVID-19 infection or the request for items for hygiene and prevention of transmission such as alcohol and face masks. Later, self-care education should be given, and the possible cases should be reported to the telephone lines designated by the mayor or the governor, continuing the healthcare process. Community pharmacies and pharmacy staff play a crucial role in minimizing the stage of "community transmission" of COVID-19, through properly detection and management of possible cases and customer education.

Rol del farmacéutico en la atención integral de pacientes con hepatitis C: revisión sistemática / The role of pharmacists in the comprehensive care of patients with hepatitis C: a systematic review

Resumen Objetivo: identificar y caracterizar las acciones/intervenciones realizadas desde los servicios farmacéuticos en el abordaje de pacientes con hepatitis C y proponer una vía clínica para la gestión de la enfermedad que incluya la participación del farmacéutico. Método: revisión sistemática en PubMed y EMBASE empleando los términos "Hepatitis C", "Pharmaceutical Services", "Community Pharmacy Services", y "Pharmacies"; artículos publicados hasta el 31 de marzo de 2019, cuyo tema central fueran las actividades realizadas por los servicios farmacéuticos en la atención a pacientes con hepatitis C. Se recopiló información sobre la actividad realizada, responsable, si la intervención era individual o colectiva y el entorno de aplicación. Las actividades se agruparon en promoción y prevención, gestión administrativa, atención farmacéutica, investigación y otros servicios de apoyo. De acuerdo con esto, se propuso una vía clínica para el manejo de la hepatitis C con participación del farmacéutico. Resultados: se incluyeron 60 artículos, principalmente de estudios descriptivos. La mayoría de las publicaciones reportó intervenciones realizadas en Estados Unidos y España. Se identificó la participación del personal farmacéutico en cada una de las etapas del proceso de atención, que incluye la provisión de servicios de reducción del daño, tamizaje del virus de la hepatitis C, vinculación de los pacientes al tratamiento, prescripción de medicamentos y órdenes de laboratorio. Conclusiones: se identifican y caracterizan las acciones/intervenciones realizadas desde el servicio farmacéutico para el manejo de la hepatitis C y se propone una vía clínica en la que se integran los servicios profesionales farmacéuticos a las demás actividades de la atención del paciente.

Abstract Objective: To identify and characterize the actions/interventions carried out by pharmaceutical services to approach patients with Hepatitis C and propose a clinical pathway for managing the disease that involves pharmacists. Methodology: A systematic review was conducted in PubMed and EMBASE using the terms "Hepatitis C," "Pharmaceutical Services," "Community Pharmacy Services," and "Pharmacies." Articles published until March 31, 2019, whose central topic was the activities carried out by the pharmaceutical services in the care of patients with Hepatitis C, were included. Information on the activity performed, the person in charge, whether the intervention was individual or collective, and the implementation environment was collected. The activities were grouped into promotion and prevention, administrative management, pharmaceutical care, research, and other support services. Based on the above, a clinical pathway for the management of Hepatitis C involving pharmacists was proposed. Results: Sixty articles were included, mainly descriptive studies. Most publications reported interventions in the United States and Spain. Pharmaceutical staff involvement was identified at each stage of the care process, including the provision of harm reduction services, Hepatitis C virus screening, enrolling patients to treatment, medication prescription, and laboratory orders. Conclusions: The actions/interventions carried out by the pharmaceutical service for Hepatitis C management were identified and characterized. A clinical pathway has been proposed to integrate professional pharmaceutical services with other patient care activities.

Conformación de póntico E en sector anterior / Pontic E conformation at anterior sector

El póntico E es una alternativa de tratamiento para la pérdida prematura dental, este tipo de póntico fue publicado por primera vez en 2014 por Robert P. Korman. El diseño del póntico permite ofrecer predictibilidad en cuanto a soporte y mantenimiento de la arquitectura gingival, también promueve que el tejido vestibular migre coronalmente sobre el póntico, creando un surco gingival. Se recibió a una paciente que presentaba fragmento radicular del diente 21 y ausencia del diente 12, reborde residual atrófico (clase I según Seibert). Como plan de tratamiento, se realizó la extracción atraumática del fragmento radicular del diente 21 para retardar el colapso del reborde alveolar y se colocó injerto de tejido conectivo en la zona del diente 12 para corregir el defecto clase I de Seibert, se realizó la conformación de los nichos gingivales con electrobisturí en conjunto con la prótesis provisional y la preparación de los dientes pilares para la recepción y rehabilitación con pónticos E. Se colocó una prótesis fija de cinco unidades (dientes 13 al 23) en material núcleo de Zr y estratificada con cerámica (AU)

Pontic E is an alternative treatment for premature dental loss, this type of pontic was published for the first time in 2014 by Robert P. Korman. The design of the pontic allows to offer predictability in terms of support and maintenance of the gingival architecture, it also promotes that the vestibular tissue migrates coronally over the pontic, creating a gingival groove. A patient was received who presented a radicular fragment of tooth 21 and absence of tooth 12, atrophic residual ridge (class I according to Seibert). As a treatment plan, atraumatic extraction of the root fragment of tooth 21 was performed to delay the collapse of the alveolar ridge and connective tissue graft was placed in the area of tooth 12 to correct Seibert's class I defect, conformation was performed of the gingival niches with electrocautery in conjunction with the provisional prosthesis and the preparation of the abutment teeth for the reception and rehabilitation with pontics E. A fixed prosthesis of five units was placed (teeth from 13 to 23) of Zr core material and stratified with ceramic (AU)

Patrones de prescripción de medicamentos para la diabetes mellitus tipo 2 en cinco departamentos de Colombia, en 2014 / Patterns of Medicine Prescriptions for Diabetes Mellitus Type 2 in five Departments of Colombia in 2014 / Padrões de prescrição de medicamento para a Diabetes Mellitus tipo 2 em cinco departamentos da Colômbia em 2014

Resumen Objetivos: Describir los patrones de prescripción de los medicamentos para la diabetes mellitus tipo 2 (DM2) y comorbilidades de pacientes atendidos en cinco instituciones prestadoras de servicios de salud de Colombia. Metodología: Estudio descriptivo transversal, en el cual se revisaron las historias clínicas de 5098 pacientes con DM2, atendidos en centros de atención ambulatoria ubicados en cinco ciudades colombianas entre el 1.º de enero y el 31 de diciembre de 2014. Cada uno de los pacientes con DM2 tenía al menos dos consultas ambulatorias registradas durante el periodo de estudio. La recolección de la información se hizo mediante una encuesta electrónica. Para la categorización de los medicamentos se usaron las guías nacionales e internacionales para el tratamiento de la diabetes. El análisis de los datos fue realizado utilizando el programa IBM SPSS® Statistics versión 21. Resultados: El medicamento de más frecuente prescripción fueron las biguanidas (59 %) y las sulfonilureas (28 %). La prescripción de inhibidores de la dipeptidil peptidasa-4 fue 7 % y la frecuencia de prescripción de agonista del receptor del péptido similar al glucagón tipo 1 (AR GLP-1) fue de 2 %. El medicamento con mayor frecuencia de prescripción como monoterapia fueron las biguanidas (22 %). La combinación más frecuente fue biguanida y las sulfonilureas (21 %), seguida de biguanida e insulina (10 %), y otras combinaciones. El 27 % pacientes con DM2 no recibió ningún tratamiento farmacológico para la diabetes. Con respecto a los medicamentos para comorbilidades, el 52 % de los pacientes utiliza al menos un tipo de antihipertensivo, el 39 % usa al menos un tipo de hipolipemiante y el 35 % utiliza ácido acetilsalicílico. Conclusiones: Las biguanidas fueron el medicamento con mayor frecuencia de prescripción, seguido de las sulfonilureas. Uno de cada cuatro pacientes no tenía registro de prescripción de medicamentos. El uso de ácido acetilsalicílico como prevención del riesgo cardiovascular fue menor al esperado.

Abstract Objetive: to describe the patterns of medicine prescriptions for diabetes mellitus type 2 (dm2) and the comorbidity of patients in five health care institutions in Colombia. Methodology: descriptive cross-sectional study carried out checking the medical records of 5098 patients with dm2 treated at the outpatient service centers in five Colombian cities between January 1 and December 31 of 2014. Each patient with dm2 had a record of at least two outpatient appointments registered during the time of this study. The information was collected through electronic surveys. National and international guides on diabetes treatment were used to categorize the medications. The spss® 21 software was used to analyze the data. Results: the most frequently prescribed medications were biguanides (59%) and sulfonylureas (28%). The prescription of inhibitors for Dipeptidyl peptidase-4 was 7% and the frequency of prescription of glucagon-like peptide-1 receptor agonists (ar glp-1) was 2%. The medication with the highest frequency of prescription as monotherapy were biguanides (22%). The most frequent combination was biguanide and sulfonylureas (21%). The second most frequent combination was biguanide with insulin (10%), and other combinations. 27% of patients with dm2 did not receive any pharmacological treatment for diabetes. Regarding the medicines for comorbidity, 52% of patients use at least one type of antihypertensive drug, 39% use at least one type of hypolipidemic drug and 35% uses acetylsalicylic acid. Conclusions: biguanides were the most frequently prescribed medication, sulfonylureas came after. One in four patients did not have a record of medicine prescription. The prescription of acetylsalicylic acid to prevent cardiovascular risk was lower than expected.

Resumo Objetivo: descrever os padrões de prescrição dos medicamen tos para a Diabetes Mellitus tipo 2 (dm2) e de comorbilidades de pacientes atendidos em cinco instituições de serviço de saú de da Colômbia. Metodologia: estudo descritivo transversal, no qual revisaram-se as histórias clínicas de 5098 pacientes com dm2, atendidos em centros de atendimento ambulatorial localizados em cinco cidades colombianas, entre 1 de janeiro e 31 de dezembro de 2014. Cada paciente com dm2 tinha pelo menos duas consultas ambulatoriais registradas durante o pe ríodo do estudo. A informação coletou-se através de inquérito eletrônico. Para a categorização dos medicamentos, utiliza ram-se os guias nacionais e internacionais para o tratamento da diabete. A análise dos dados realizou-se utilizando o progra ma spss® 21. Resultados: os medicamentos de prescrição mais frequente foram biguanidas (59%) e as sulfoniluréias (28%). A prescrição de inibidores da dipeptidil peptidase IV foi 7% e a frequência de prescrição de agonista do receptor do péptido si milar ao glucagão tipo 1 (ar glp-1) foi de 2%. O medicamento com mais frequência de prescrição como monoterapia foi as biguanidas (22%). A combinação mais frequente foi biguanida e sulfoniluréias (21%). A segunda combinação mais frequente foi biguanida com insulina (10%), e outras combinações. 27% dos pacientes com dm2 não recebeu tratamento farmacológi co nenhum para a diabetes. Respeito dos medicamentos para comorbilidades, 52% dos pacientes utiliza pelo menos um tipo de anti-hipertensivo, 39% utiliza pelo menos um tipo de hi polipemiante e 35% utiliza ácido acetilsalicílico. Conclusões: as biguanidas foram o medicamento com mais frequência de prescrição, e depois as sulfoniluréias. Um de quatro pacientes não rinha registro de prescrição de medicamentos. O uso de ácido acetilsalicílico como prevenção do risco cardiovascular foi menor do que se esperava.

Propiedades de la sericina de seda colombiana / Properties of colombian silk sericine / Propriedades da sericina de seda

Resumen Introducción: Colombia produce actualmente seda natural. Durante la transformación de esta a hilos, se retira y descarta la sericina, una proteína que recubre las fibras y que presenta diferentes propiedades que pueden ser aprovechadas industrialmente. Objetivo: Caracterizar la sericina obtenida a partir de hilos de seda colombiana y secada por aspersión. Materiales y métodos: La sericina fue extraída usando agua caliente en autoclave y posteriormente secada por aspersión. La muestra en polvo obtenida se caracterizó mediante pruebas morfológicas (SEM), determinación del punto isoeléctrico, contenido de proteína, actividad antimicrobiana, solubilidad, actividad acuosa (aw) y color. Resultados: Los resultados obtenidos por SEM mostraron que se logró remover la mayor parte de sericina presente en los hilos, y que cuando esta se seca adquiere una forma esférica, con superficie rugosa, cóncava y colapsada. Se encontró que la muestra tiene un contenido de proteína y un punto isoeléctrico de 99,50% y 4,07 respectivamente, y no presenta propiedades antimicrobianas frente a los microorganismos estudiados. La solubilidad aumenta con la temperatura, alcanzando un 44,11% ± 5,75 a 90 °C. El aw fue de 0,287 y su color muestra una tendencia al blanco (coordenadas CIELAB: L: 89,55 ± 0,20, a*: +0,44 ± 0,04 y b*: +5,16 ± 0,30). Conclusiones: Los resultados muestran que es posible extraer sericina desde hilos de seda usando autoclave, con altos porcentajes de rendimiento. Se observa que la muestra es susceptible de ser secada por aspersión, mostrando características que pueden ser estudiadas con mayor profundidad para evaluar la viabilidad de utilizarla en el desarrollo de diferentes productos.

Abstract Introduction: During Colombian silk transformation to obtain threads, a protein called sericin is removed and discarded. Nevertheless, due to its properties, it should be industrially recovered and used. Objective: Characterize the sericin obtained, through spray drying, from Colombian silk threads. Materials and methods: The sericin was extracted using hot water in autoclave and later spray-dried. Obtained solution was dehydrated in dry spray equipment. The obtained powdered sample was characterized by morphological tests (SEM), isoelectric point and protein content, antimicrobial activity, solubility, aqueous activity (aw) and color. Results: The results obtained by SEM showed that the degumming process extracted the most of sericin from the threads. In addition, it was seen that dehydrated samples have a spherical shape, with a rough, concave and collapsed surface. The protein content and the isoelectric point of sericin were 99.5 % and 4.07, respectively. No antimicrobial properties were observed against the microorganisms studied. The solubility of the protein increased with temperature (44.11 % ± 5.75 at 90 °C), its aw was 0.287, and its color showed a white trend whose CIELAB coordinates are L: 89.55 ± 0.20, a*: +0.44 ± 0.04 and b*: +5.16 ± 0.30. Conclusions: The results show that it is possible to extract sericin from silk threads using autoclave, with high percentages of yield. Additionally, it was observed that the sample is susceptible to be dehydrated by spray drying, showing characteristics that can be studied in greater depth to evaluate the viability of using this protein in the development of different products.

Resumo Introdução: Colômbia produz atualmente seda natural. Durante a transformação desta aos fios, retira-se e descarta-se a sericina, uma proteína que recobre as fibras e que apresenta diferentes propriedades que podem ser aproveitadas industrialmente. Objetivo: Caracterizar a sericina obtida a partir de fios de seda colombianos e secagem por aspersão. Materiais e métodos: A sericina foi extraída usando água quente no autoclave e posteriormente desidratada com secagem por aspersão. A amostra em pó obtida caracterizou-se mediante provas morfológicas (SEM), determinação do ponto isoelétrico, contido de proteína, atividade antimicrobiana, solubilidade, atividade aquosa (aw) e cor. Resultados: Os resultados obtidos pelo SEM amostram que conseguiu-se remover a maior parte da sericina presente nos fios, e quando esta se seca adquire uma forma esférica, com superfície rugosa, côncava e colapsada. Encontrou-se que a amostra tem um contido de proteína e um ponto isoeléctrico de 99,50% e 4,07 respetivamente, e não apresenta propriedades antimicrobianas frente aos microrganismos estudados. A solubilidade aumenta com a temperatura, atingindo um 44,11% ± 5,75 a 90 °C. O aw foi de 0,287 e sua cor mostra uma tendência ao branco (coordenadas CIELAB: L: 89,55 ± 0,20, a*: +0,44 ± 0,04 y b*: +5,16 ± 0,30). Conclusões: Os resultados mostram que é possível extrair sericina desde fios de seda usando autoclave, com altos percentagens de rendimento. Observa-se que a amostra é suscetível de ser desidratada com secagem por aspersão, mostrando características que podem ser estudadas com maior profundidade para avaliar a viabilidade de utilizarla no desenvolvimento de diferentes produtos.

Perspectiva de las parteras en Jalisco, México, frente al embarazo de alto riesgo: estudio cualitativo / Perspectives of midwives in Jalisco, México, regarding high risk pregnancy: A qualitative study

RESUMEN Objetivo: Comprender la perspectiva de las parteras frente a los factores de riesgo, la detección y el manejo del embarazo de alto riesgo en Jalisco, México, 2013. Materiales y métodos: Estudio cualitativo fenomenológico desarrollado durante 2013; a partir del Censo Estatal de Parteras se aplicó muestreo teórico, definiendo tamaño de muestra por saturación teórica del eje: factores de riesgo, detección y manejo del embarazo de alto riesgo. El trabajo de campo inició con la identificación de informantes clave, quienes invitaron a parteras a un "Encuentro estatal"; se trabajó con las técnicas lluvia de ideas y entrevista grupal; posteriormente se llevaron a cabo 11 entrevistas a profundidad a parteras, realizando análisis semiótico de los datos. Resultados: Fueron 82 parteras informantes, mediana de edad 53 años, parteras tradicionales empíricas 21,95 %, parteras tradicionales capacitadas 42,69 % y parteras enfermeras 35,36 %; 59,75 % tienen 20 años o más como parteras, 63,42 % con estudios de primaria o menos y 78,05 % con más de 10 años sin recibir capacitación institucional. Cualitativamente, el embarazo de alto riesgo para parteras enfermeras implica complicaciones obstétricas o neonatales y el control prenatal debe ser en hospitales. En parteras tradicionales, empíricas y capacitadas, su perspectiva tiene elementos de la medicina institucional y tradicional, por lo que señalan que envían al médico a estas mujeres, asumiendo no poder atender estos embarazos; en parteras tradicionales de población indígena representa un embarazo "de peligro", configurado en el modelo mágico-religioso de la salud. Conclusiones: La perspectiva de las parteras frente al embarazo de alto riesgo está determinada por la medicina tradicional y algunos elementos de la medicina institucional, diferenciada según tipo de partera y zona geográfica de desempeño, señalando la disposición de formarse para alcanzar embarazos saludables y sin riesgos.

ABSTRACT Objective: To understand midwife perspective regarding risk factors, detection and management of high risk pregnancy in Jalisco, Mexico, 2013. Materials and methods: Qualitative phenomenological study conducted during the year 2013. A theoretical sampling was applied on the basis of the State Midwives Census and the sample size was defined by theoretical saturation of each axis: risk factors, detection and management of high risk pregnancy. The field work began by identifying key informants who then invited midwives to a "State Meeting", working with brainstorming techniques and group interviews. This was followed by 11 in-depth interviews with the midwives and a semiotic data analysis. Results: Overall, 82 informant midwives were included, with a median age of 53. Of them, 21.95 % were empirical, 42.69 % were traditional trained midwives, and 35.36 % were midwife nurses. In terms of practice, 59.75 % had been practicing for 20 years or more, 63.42 % had primary schooling or less, and 78.05 % had been working for more than 10 years without receiving institutional training. Qualitatively, high risk pregnancy for nurse midwives entails obstetric or neonatal complications, and antenatal control must take place in the hospital. As for traditional empirical and trained midwives, their perspectives include elements of institutional medicine whereby they refer these women to the physician because they assume that they cannot care for those pregnancies. For traditional midwives of indigenous origin, high risk pregnancy represents the "dangerous pregnancy" under the magical-religious model of health. Conclusions: Midwife perspective regarding high risk pregnancy is determine by traditional medicine and some elements of institutional medicine, differentiated according to the type of midwife and the geographic area where they perform their work. Midwives reported willingness to train in order to contribute to healthy, risk-free pregnancies.

Desarrollo de un refresco a partir de la mezcla de fresa ( Fragaria ananassa ), mora ( Rubus glaucus ), gulupa ( Passiflora edulis Sims ) y uchuva ( Physalis peruviana L. ) fortificado con hierro dirigido a niños en edad preescolar / Development of an iron-fortified drink from strawberry ( Fragaria ananassa ), blackberry ( Rubus glaucus ), purple passion fruit ( Passiflora edulis sims ) and gooseberry ( Physalis peruviana l. ) for preschoolers

RESUMEN Antecedentes la deficiencia de hierro, es reconocida a nivel mundial como uno de los principales problemas de salud pública asociados a la nutrición. En Colombia es necesario mejorar las estrategias nutricionales encaminadas a la población infantil, con el fin de incrementar su calidad de vida. Objetivo: desarrollar un refresco a partir de la mezcla de fresa, mora, gulupa y uchuva fortificado con hierro para niños en edad preescolar. Materiales y métodos para el desarrollo del producto, se seleccionaron cuatro frutas y se caracterizaron fisicoquímicamente. Para establecer la formulación del refresco, se realizó un diseño experimental ortogonal L82 , evaluando la aceptación sensorial como variable respuesta. Finalmente, se caracterizó el producto desarrollado, determinando el contenido de hierro y vitamina C. Resultados los ocho prototipos evaluados durante el desarrollo de la formulación, cumplieron con los requisitos establecidos en la normativa colombiana para los refrescos de fruta. El prototipo final presentó un contenido de 36,7% de fruta y el 40% del valor diario recomendado de hierro, en una porción de 250 ml. Conclusiones las cuatro frutas estudiadas pueden ser utilizadas en el desarrollo de refrescos con un importante aporte de vitamina C y fortificados con hierro, como estrategia nutricional para prevenir la deficiencia de este mineral en niños.

ABSTRACT Background Iron deficiency is recognized worldwide as a major public health concern, related to nutrition. In Colombia, the improvement of the nutritional strategies for children are required to increase their life quality. Objective To develop a mixed fruit beverage from strawberry, blackberry, gooseberry and purple passion fruit, fortified with iron for preschoolers. Materials and methods For the product development, four fruits were selected and characterized. To establish the beverage formulation, an orthogonal experimental design L825 was performed, evaluating the sensory acceptance as the response variable. Finally, the selected product was characterized by determining the content of iron and vitamin C. Results The eight prototypes obtained during the development of the beverage formulation accomplished the requirements of the Colombian law. The final prototype had a fruit content of 36.7 wt% and an iron intake value of 40 wt%, in a portion of 250 ml. Conclusions the four fruits studied can be used for the development of iron-fortified beverages, with an important contribution of vitamin C, as a nutritional strategy to prevent the deficiencies of this mineral in children.

Sitagliptina versus insulina en pacientes hospitalizados con diabetes tipo 2. Estudio comparativo de costos / Sitagliptin vs insulin in hospitalized patients with type 2 diabetes: a comparative cost analysis

Introducción: tradicionalmente, el paciente hospitalizado con diabetes tipo 2 (DT2) se trata con insulina en un esquema basal/bolo, pero han surgido investigaciones en las que se muestra similar control metabólico con agentes orales, como sitagliptina. Basado en un ensayo clínico aleatorizado en el que se pudo comprobar esta hipótesis se plantea en este estudio las consecuencias en el costo para instituciones en Colombia de esta alternativa. Objetivo:determinar, a partir de un ensayo clínico aleatorizado publicado, los costos derivados de la utilización de sitagliptina o sitagliptina más insulina basal o insulina basal/bolo, en pacientes hospitalizados con diagnóstico de diabetes tipo 2. Métodos: partiendo de un ensayo clínico aleatorizado de referencia se evaluaron tres brazos: 1) sitagliptina + correcciones, 2) sitagliptina + basal + correcciones y, 3) insulina basal/bolo. Se diseñó una matriz de costos con casos tipo para cada brazo. Se tuvo en cuenta la posibilidad de fallo terapéutico y la necesidad de correcciones con insulina de acción rápida. Se realizó un análisis de sensibilidad de una vía, evaluando la influencia de los cambios en el costo de sitagliptina. Resultados: en el caso base, se observó una diferencia de COL $2 cuando se comparó sitagliptina + correcciones contra insulina basal/bolo. El modelo fue sensible al cambio de precio de la sitagliptina. La estrategia sitagliptina + basal siempre se comportó como la más costosa. Conclusión: en los escenarios evaluados no existen diferencias entre el uso de sitagliptina + correcciones o el esquema basal/bolo en pacientes con diabetes hospitalizados y que ingresan sin medicación, usando un agente oral o usando dosis de insulina inferiores a 0,4 UI/kg. El modelo es sensible al cambio en el costo de sitagliptina.

Patients with type 2 diabetes admitted to the hospital have traditionally been treated with basal/bolus insulin. A study published by Umpierrez et al., has shown that the same glucose control can be achieved with Sitagliptin (DPP IV inhibitor) compared to insulin glargine and glulisine. Based on this data a cost analysis was made to assess if this strategy would change inpatient diabetic care in Colombia. Objectives: To determine, from a published randomized clinical trial, the cost of utilizing Sitagliptin or Sitagliptin and basal insulin or basal / bolus insulin in patients hospitalized with a diagnosis of T2DM. Methods: The study evaluated three arms: 1) Sitagliptin + supplemental insulin, 2) Sitagliptin + basal insulin + supplemental insulin and 3) Insulin basal / bolus + supplemental insulin. A Cost matrix was designed with type cases for each arm. It took into account the possibility of therapeutic failure and the need for corrections with a fast-acting insulin. A sensitivity analysis was performed in a platform, evaluating the influence of changes in the cost of Sitagliptin. Results: In the base case, a difference of $2 COP (Colombian pesos) was observed between the use of Sitagliptin + supplemental insulin compared with the basal/bolus + supplemental insulin strategy. The model is sensitive to the change in price of Sitagliptin. The Sitagliptin + Basal insulin strategy was the most expensive. Conclusion: In the 3 scenarios analyzed there was no difference between using Sitagliptin + supplemental insulin or basal / bolus + supplemental insulin in diabetic patients admitted to the hospital who were being treated with diet and exercise, oral agents or insulin at doses less than 0.4 IU / kg. The model is sensitive to changes in the cost of Sitagliptin.

Incidencia, mortalidad y supervivencia al cáncer de próstata en Cali, Colombia, 1962-2011 / Prostate cancer in Cali, Colombia, 1962-2011: incidence, mortality and survival

Objetivo. Analizar la tendencia de las tasas de incidencia, mortalidad y supervivencia al cáncer de próstata (CP) en el periodo 1962-2011. Material y métodos. Con base en el Registro Poblacional de Cáncer en Cali (Colombia) y los registros de mortalidad de la Secretaría de Salud Pública Municipal se analizaron las tendencias de las tasas de incidencia, mortalidad y supervivencia por CP en Cali durante el periodo 1962-2011. Resultados. La incidencia de cáncer de próstata aumentó vertiginosamente entre 1986 y 2002 (Annual Percent Change APC 6.2%) y se estabilizó posteriormente. La mortalidad disminuyó desde 1997 en los mayores de 70 años, mientras que en el grupo de 50-69 años fue a partir de 1981. La supervivencia relativa a cinco años fue 69.8% (IC95% 67.5-72.0) y se asoció de manera significativa con la edad, periodo de diagnóstico y estrato socioeconómico. Conclusión. El incremento en la incidencia del CP coincide temporalmente con la implementación del antígeno específico de próstata (PSA por sus siglas en inglés) en Cali; hay evidencia de mejoría en la supervivencia en el CP y disminución en su mortalidad.

Objective. To analyze the trend in prostate cancer survival, incidence and mortality rates in Cali, Colombia from 1962 to 2011. Materials and methods. Based on the Cancer Registry of Cali, Colombia and the mortality registry of the City's Public Health Secretary, incidence, mortality age-standardized rates and relative survival were calculated during 1962-2011. Results. Prostate cancer incidence rates increased sharply between 1986 and 2002 (APC: 6.21%) and then leveled off. Mortality diminished in 1997 in men older than 70 years-old while in men aged 50-69 years declined since 1981. The 5-year-relative-survival was 69.8% (CI95% 67.5-72.0) and it was significantly associated with age, quinquennial period of diagnosis and socioeconomic strata. Conclusion. The increase in incidence rates of prostate cancer in time coincides with the implementation of the PSA in Cali. There is evidence of improvement in prostate cancer survival, and decreased prostate cancer mortality.

Diagnostic accuracy of preoperative urinary smear test in patients with bladder urothelial carcinoma in a high-volume center.

OBJECTIVES: To determine diagnostic accuracy of urinary cytology (smear test) in patients with preoperative diagnosis of urothelial bladder carcinoma. METHODS: Clinical records of the patients with urotelial bladder carcinoma at the Instituto Nacional de Cancerología (Bogotá D.C.,Colombia) from January 2006 to November 2010 were reviewed. Demographic data, pathological reports of preoperative cytology and definitive surgery, tumor classification and time between sample taking for cytology and final pathology were extracted. Descriptive statistics and graphs for continuous and categorical variables were performed. RESULTS: We included 52 patients, 20 underwent cystectomy and 32 transurethral resection of the bladder tumor (TURB). 41 were male. Mean age was 66.6 ± 10.7 years. 151 smears were obtained before surgery, with a median of 3 smears performed per patient at 2.5 ± 1.8 months before definitive surgery. 107 were negative, 14 low grade positive and 30 high grade positive. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 30.7%, 90.9%, 97.7%, 9.34%, 3.37 and 0.76 respectively. When the high-grade cytology was compared with the high-grade definitive report some characteristics increased (Sensitivity 47.4%, Specificity: 97.8%, Positive Likelihood Ratio: 21.8) and also when compared with muscle invasion (Sensitivity: 73.9, Positive Likelihood Ratio: 7.27 ). CONCLUSION: Preoperative cytology has sensitivity and specificity similar to those described in other clinical settings. Also noteworthy is that one high-grade preoperative cytology has a high positive likelihood ratio for high-grade tumor and invasive tumor (≥T2).

Validez diagnóstica de la citología urinaria preoperatoria en pacientes con carcinoma urotelial de vejiga en el Instituto Nacional de Cancerología, Colombia / Diagnostic validity of preoperative urine cytology in patients with bladder urothelial carcinoma in the "Instituto Nacional de Cancerologia" Colombia

OBJETIVO: Determinar la validez diagnóstica de la citología urinaria preoperatoria en los pacientes con diagnóstico de carcinoma urotelial de vejiga. MÉTODOS: Se revisaron los registros de los pacientes con diagnóstico de carcinoma urotelial de vejiga en la base de datos del Instituto Nacional de Cancerología (Bogotá D.C., Colombia) desde enero de 2006 hasta noviembre de 2010. Se extrajeron datos demográficos, reportes histopatológicos de las citologías preoperatorias y de la pieza quirúrgica definitiva, clasificación del tumor y tiempo transcurrido entre la toma de la muestra para la citología y la patología definitiva. Se utilizó estadística descriptiva y gráficos acordes para las variables continuas y categóricas. RESULTADOS: Se incluyeron 52 pacientes, 20 llevados a cistectomía y 32 a resección transuretral (RTU). 41 fueron masculinos. El promedio de edad fue 66,6 ± 10,7 años. Se obtuvieron 151 citologías preoperatorias, con una mediana de 3 citologías por paciente realizadas 2,5 ± 1,8 meses antes de la cirugía definitiva. 107 fueron negativas, 14 positivas de bajo grado y 30 positivas de alto grado. La sensibilidad, especificidad, valor predictivo positivo y negativo, razón de probabilidad positiva y negativa (LR + y LR -, de su descripción en inglés) generales fueron respectivamente: 30,7%, 90,9%, 97,7%, 9,34%, 3,37 y 0,76. Cuando se comparó la citología de alto grado con el reporte definitivo de alto grado algunas características aumentaron (sensibilidad: 47,4%; especificidad: 97,8%; LR+: 21,8) así como cuando se comparó la citología de alto grado con el reporte definitivo con invasión muscular (sensibilidad: 73,9; LR+: 7,27). CONCLUSIÓN: La citología urinaria preoperatoria presenta sensibilidad y especificidad similares a las descritas en otros contextos clínicos. Además se destaca que una citología urinaria preoperatoria positiva de alto grado tiene una razón de probabilidad muy elevada para diagnóstico de tumor invasivo (>=T2) o de alto grado

OBJECTIVES: To determine diagnostic accuracy of urinary cytology (smear test) in patients with preoperative diagnosis of urothelial bladder carcinoma. METHODS: Clinical records of the patients with urotelial bladder carcinoma at the Instituto Nacional de Cancerología (Bogotá D.C., Colombia) from January 2006 to November 2010 were reviewed. Demographic data, pathological reports of preoperative cytology and definitive surgery, tumor classification and time between sample taking for cytology and final pathology were extracted. Descriptive statistics and graphs for continuous and categorical variables were performed. RESULTS: We included 52 patients, 20 underwent cystectomy and 32 transurethral resection of the bladder tumor (TURB). 41 were male. Mean age was 66.6 ± 10.7 years. 151 smears were obtained before surgery, with a median of 3 smears performed per patient at 2.5 ± 1.8 months before definitive surgery. 107 were negative, 14 low grade positive and 30 high grade positive. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 30.7%, 90.9%, 97.7%, 9.34%, 3.37 and 0.76 respectively. When the high-grade cytology was compared with the high-grade definitive report some characteristics increased (Sensitivity 47.4%, Specificity: 97.8%, Positive Likelihood Ratio: 21.8) and also when compared with muscle invasion (Sensitivity: 73.9, Positive Likelihood Ratio: 7.27). CONCLUSION: Preoperative cytology has sensitivity and specificity similar to those described in other clinical settings. Also noteworthy is that one high-grade preoperative cytology has a high positive likelihood ratio for high-grade tumor and invasive tumor (≥T2)

[Prostate cancer in Cali, Colombia, 1962-2011: incidence, mortality and survival]. / Incidencia, mortalidad y supervivencia al cáncer de próstata en Cali, Colombia, 1962-2011.

OBJECTIVE: To analyze the trend in prostate cancer survival, incidence and mortality rates in Cali, Colombia from 1962 to 2011. MATERIALS AND METHODS: Based on the Cancer Registry of Cali, Colombia and the mortality registry of the City's Public Health Secretary, incidence, mortality age-standardized rates and relative survival were calculated during 1962-2011. RESULTS: Prostate cancer incidence rates increased sharply between 1986 and 2002 (APC: 6.21%) and then leveled off. Mortality diminished in 1997 in men older than 70 years-old while in men aged 50-69 years declined since 1981. The 5-year-relative-survival was 69.8% (CI95% 67.5-72.0) and it was significantly associated with age, quinquennial period of diagnosis and socioeconomic strata. CONCLUSION: The increase in incidence rates of prostate cancer in time coincides with the implementation of the PSA in Cali. There is evidence of improvement in prostate cancer survival, and decreased prostate cancer mortality.

Causas de abandono, cambio o fallo terapéutico de la anticoncepción hormonal en mujeres universitarias / Causes of dropout, change or therapeutic failure to hormonal contraception in university women

Introducción: los anticonceptivos hormonales son determinantes para el control de la natalidad. Pese a su uso, pueden aparecer embarazos no deseados, asociados al cambio o abandono terapéutico. Las causas de estos eventos deben ser identificadas para su intervención. Objetivo: medir la frecuencia de posibles causas asociadas al cambio y abandono terapéutico, que puedan desencadenar embarazos no deseados en mujeres universitarias entre los 17 y 30 años de edad, que usan o han usado anticonceptivos hormonales como método de planificación familiar. Materiales y métodos: Estudio de corte en mujeres matriculadas en alguno de los programas de la Universidad de Antioquia, que usan o usaron anticonceptivos hormonales como método de planificación familiar. Muestreo no aleatorio estratificado. Se diseñó e implementó una encuesta para recolectar los datos. Se analizó la estadística descriptiva de las variables. Resultados: se incluyeron 353 mujeres (edad promedio de 21,3 años). El 22,5% de las usuarias actuales y el 24,7% de las usuarias en el pasado del método anticonceptivo hormonal lo toman o tomaron por autoprescripción. Aunque la mayoría de ellas recibieron información sobre uso adecuado de la medicación, entre el 26,2 % y el 41,4 %, consideraron que la capacitación fue insuficiente. La causa más importante de abandono de la terapia fue los eventos adversos (48,6 %); de los cuales el dolor de cabeza y aumento de peso fueron los más relevantes. Las condiciones de acceso fueron la segunda causa de abandono terapéutico (23,6 %). Por su parte, el cambio de terapia se atribuyó a los eventos adversos y la incomodidad del uso. En total se reportaron siete fallos terapéuticos (2 %), sin causas destacables. Conclusiones: la alta incidencia de eventos adversos asociados a los anticonceptivos hormonales, puede ser una de las causas más importantes de cambio y abandono de la terapia. Otras causas, en orden de importancia, son la falta de acceso a los medicamentos ...

Hormonal contraceptives are decisive for birth control. Despite the use of these, undesired pregnancies could appear, associated with therapeutic change or dropout. The causes of these events must be measured to plan further interventions. Objectives: To measure the prevalence of possible causes associated with hormonal contraceptive change or dropout that can trigger therapeutic failure in university women between 17 and 30 years old. Women who use or have used some hormonal contraceptive for birth prevent. Materials and methods: A cross-sectional study was made. The target population was women enrolled in any of the programs of the University of Antioquia. Women included in this study use or have used hormonal contraceptives as a method of birth control. A non-randomized and stratified sampling was made. A poll to collect data was designed and implemented. The descriptive statistics of the variables was evaluated. Results: 353 women (average age of 21,3 years) were included. A 22,5 % of current users and 24,7 % of past users, take or took hormonal method for self-prescription. Although most of the women had received information of proper use of medication, between 26.2 % and 41.4 % believed that training was insufficient. The most important cause of dropout of therapy was adverse events (48,6% of total cases). Headache and weight gain were the most relevant. Access and economic issues were the second cause of dropout (23.6 % of total cases). Meanwhile, therapy change was attributed to adverse events and discomfort in use. In total there were 7 pregnancies (2 %) without any remarkable cause. Conclusions: The high incidence of adverse events associated to hormonal contraceptives, may be one of the most important causes of change and dropout therapy. Access problems and economic issues are other causes, in order of importance. With these findings, we can highlight the need for vigilance and education in hormonal contraceptive use.

Mechanized instrumentation of root canals oscillating systems.

Cleaning and shaping are important steps in the root canal treatment. Despite the technological advances in endodontics, K and Hedstroen files are still widely used. In an attempt to be more effective in preparing the root canals, faster and more cutting efficient kinematic, alloys and design alternatives utilizing mechanically oscillating or rotary files are proposed. Even with all these technological innovating alternatives, the preparation of root canals remains a challenge.