Conjunctival ultraviolet autofluorescence as a biomarker of outdoor exposure in myopia: a systematic review and meta-analysis.

Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced synthesis and release of dopamine in the retina. However, until recent years, there was no objective quantifiable method available to measure the association between time spent outdoors and myopia. It is only recently that the conjunctival ultraviolet autofluorescence (CUVAF) area, serving as a biomarker for sun exposure, has begun to be utilized in numerous studies. To provide a comprehensive summary of the relevant evidence pertaining to the association between the CUVAF area and myopia across different geographic regions and age groups, a systematic review and meta-analysis were conducted. The search encompassed multiple databases, including MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, WEB OF SCIENCE, and SCOPUS, and utilized specific search terms such as "conjunctival ultraviolet autofluorescence", "CUVAF", "UVAF", "objective marker of ocular sun exposure", "myopia", "degenerative myopia", and "high myopia". The bibliographic research included papers published between the years 2006 and 2022. A total of 4051 records were initially identified, and after duplicates were removed, 49 articles underwent full-text review. Nine articles were included in the systematic review. These studies covered myopia and outdoor exposure across different regions (Australia, Europe and India) with a total population of 3615 individuals. They found that myopes generally had smaller CUVAF areas compared to non-myopes. The meta-analysis confirmed this, revealing statistically smaller CUVAF areas in myopic patients, with a mean difference of - 3.30 mm2 (95% CI - 5.53; - 1.06). Additionally, some studies showed a positive correlation between more outdoor exposure and larger CUVAF areas. In terms of outdoor exposure time, myopic patients reported less time outdoors than non-myopic individuals, with a mean difference of - 3.38 h/week (95% CI - 4.66; - 2.09). Overall, these findings highlight the connection between outdoor exposure, CUVAF area and myopia, with regional variations playing a significant role. The results of this meta-analysis validate CUVAF as a quantitative method to objectively measure outdoor exposure in relation with myopia development.

Rural Palliative Care Telemedicine for Advanced Cancer Patients: A Systematic Review.

Context: Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced diseases. Objectives: Establish a telemedicine model of rural palliative care for advanced cancer patients with difficulties in accessing standard care. Methods: This review comports with the minimum standards described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and uses the palliative care literature review iterative method (PALETTE) proposed by Zwakman et al in 2018. Results: Three hundred, ninety-two articles were identified in PubMed and EMBASE databases and alternative search engines such as Google Scholar and OpenGrey. A telemedicine delivery model was developed for patients with limited access to standard care, which consists of identifying the candidate population, establishing the most convenient telemedicine modality, agreeing with patients and caregivers on palliative care needs, and evaluating the interventions effectiveness. Conclusion: Telemedicine is a revolutionary tool to provide palliative care to advanced cancer patients whose clinical condition or location prevent them from accessing conventional care.

Identification and characterization of class 1 integrons among multidrug-resistant uropathogenic Escherichia coli strains in Mexico.

This study aimed to identify and characterize integrons among multidrug-resistant (MDR) uropathogenic Escherichia coli (UPEC) from outpatients in Mexico City, Mexico. PCR assays were used to screen for the presence of class 1, 2 and 3 integrons, whose PCR products were sequenced to identify the inserted gene cassettes within the variable regions. Out of 83 tested strains, 53 (63.9%) were positive for the presence of class 1 integrons, whereas no integrons were detected in the remaining strains, regardless of their classes. Most of the strains carrying the intI1 gene belonged to the extraintestinal B2 (41.5%) and commensal A (32.1%) phylogroups, and to a lesser extent, the extraintestinal D (20.8%) and commensal B1 (5.7%) phylogroups. Moreover, 8 different gene cassette arrangements were detected, with dfrA17 and aadA5 being the most common (32.1% of the class 1 integron-positive strains), which confer resistance to trimethoprim/sulfamethoxazole and aminoglycosides, respectively. Our results suggest that class 1 integrons are widely distributed among MDR-UPEC strains in Mexico, which may directly or indirectly contribute to the selection of MDR strains. These findings are important for a better understanding of the factors and mechanisms that promote multidrug resistance among UPEC strains.

Laboratory Findings in Patients with Probable Dengue Diagnosis from an Endemic Area in Colombia in 2018.

As demonstrated with the novel coronavirus pandemic, rapid and accurate diagnosis is key to determine the clinical characteristic of a disease and to improve vaccine development. Once the infected person is identified, hematological findings may be used to predict disease outcome and offer the correct treatment. Rapid and accurate diagnosis and clinical parameters are pivotal to track infections during clinical trials and set protection status. This is also applicable for re-emerging diseases like dengue fever, which causes outbreaks in Asia and Latin America every 4 to 5 years. Some areas in the US are also endemic for the transmission of dengue virus (DENV), the causal agent of dengue fever. However, significant number of DENV infections in rural areas are diagnosed solely by clinical and hematological findings because of the lack of availability of ELISA or PCR-based tests or the infrastructure to implement them in the near future. Rapid diagnostic tests (RDT) are a less sensitive, yet they represent a timely way of detecting DENV infections. The purpose of this study was to determine whether there is an association between hematological findings and the probability for an NS1-based DENV RDT to detect the DENV NS1 antigen. We also aimed to describe the hematological parameters that are associated with the diagnosis through each test.

Recommendations from the Asociación Colombiana de Medicina del Sueño for the practice of sleep medicine in Colombia during the COVID-19 pandemic / Recomendaciones de la Asociación Colombiana de Medicina del Sueño para el ejercicio de la medicina del sueño en Colombia durante la pandemia por COVID-19

Abstract Measures such as frequent handwashing, mandatory use of face masks by the general population in public spaces, social and physical distancing, and mandatory confinement of most people at their homes have contributed to slowing down the spread of the new coronavirus (SARS-CoV-2), which is the source of the current COVID-19 pandemic. However, adopting some of these measures has caused delays in the diagnosis and treatment of various diseases, including sleep disorders. Therefore, it is urgent for sleep specialists and sleep centers to gradually resume activities, as long as strict biosecurity protocols aimed at reducing the risk of contagion are implemented. In this scenario, and in order to help somnologists reopen sleep centers and resume the procedures performed there, the Asociación Colombiana de Medicina del Sueño (Colombian Association of Sleep Medicine) proposes through this reflection paper several recommendations that should be considered during the reactivation process. These recommendations are based on the COVID-19 spread mitigation strategies established by the Colombian health authorities, the guidelines issued by the American Academy of Sleep Medicine, and relevant literature on this subject, which was reviewed after performing a search in the PubMed, SciELO, and Google Scholar databases using the search terms "sleep" "sleep medicine" and "COVID19".

Resumen El lavado de manos frecuente, el uso obligatorio de mascarilla por parte de la población general en sitios públicos, el distanciamiento físico y social, y el confinamiento obligatorio de la mayoría de la población en sus casas son las medidas que hasta el momento han ayudado a frenar la propagación del nuevo coronavirus (SARS-CoV-2), causante de la actual pandemia por COVID-19. Sin embargo, la adopción de algunas de estas medidas ha generado retraso en el diagnóstico y tratamiento de diferentes enfermedades, incluyendo los trastornos del sueño, por lo que es urgente que los especialistas en medicina del sueño y los centros de sueño retomen sus actividades gradualmente, siempre que se implementen estrictos protocolos de bioseguridad que mitiguen el riesgo de contagio. En este contexto, y con el fin de ayudar a los somnólogos a reabrir los centros de sueño y reanudar los procedimientos allí realizados, la Asociación Colombiana de Medicina del Sueño propone en la presente reflexión una serie de recomendaciones para tener en cuenta durante el proceso de reactivación. Estas recomendaciones se basan en las estrategias de mitigación establecidas por las autoridades sanitarias del país, las directrices de la American Academy of Sleep Medicine y la literatura disponible sobre el tema, la cual fue revisada luego de realizar una búsqueda en las bases de datos PubMed, SciELO y Google Scholar usando los términos "sleep" "sleep medicine" y "COVID19".

Recomendaciones en los laboratorios de sueño y para el uso de dispositivos de presión positiva durante la pandemia por COVID-19 / Recommendations in sleep lab and for the use of positive pressure devices during the pandemic of COVID-19

La enfermedad por coronavirus 2019 o COVID-19 se transmite principalmente a través de gotas respiratorias, contacto cercano no protegido y procedimientos generadores de aerosoles (1). Las pruebas realizadas en un laboratorio de sueño y la terapia con presión positiva, como la CPAP o la BPAP, pueden aumentar el riesgo de exposición de transmisión de COVID-19 al personal médico y a los pacientes. Las decisiones basadas en la evidencia son el estándar ideal; sin embargo, esta evidencia va apareciendo poco a poco, a un ritmo más lento que la emergencia de salud pública que estamos viviendo; por tanto, por el momento debemos basar nuestras decisiones en la experiencia, en documentos de consenso, cuando estén disponibles, y en el juicio clínico, cuando no exista evidencia. Nuestro objetivo es proporcionar unas recomendaciones, teniendo como marco de referencia las dictadas por organismos nacionales e internacionales, como la Asociación Colombiana de Medicina del Sueño, la Academia Americana de Medicina del Sueño, la Academia Mexicana de Medicina del Dormir y otras publicaciones en revistas indexadas (2,3).

The coronavirus disease 2019 or COVID-19 is transmitted primarily through respiratory drops, unprotected close contact, and aerosol-generating procedures (1). Tests performed in a sleep laboratory and positive pressure therapy such as CPAP or BPAP, may increase the risk of exposure of transmission of COVID-19 to clinicians and patients. Evidence-based making decisions are the ideal standard, however, this evidence appears little by little, at a slower rate than the public health emergency that we are experiencing; therefore, for the moment, our decisions must be based on our experience, on consensus documents, when they are available, and clinical judgment when there is no evidence. Our objective is to give recommendations, taking as a reference framework those issued by national and international organizations, such as Colombian Asociation of Sleep Medicine, the American Academy of Sleep Medicine, the Mexican Academy of Sleep Medicine, and other publications in indexed journals.

Outcomes of traumatic brain injury: the prognostic accuracy of various scores and models.

INTRODUCTION: Traumatic Brain Injury (TBI) is a worldwide health problem, and is a pathology that causes significant mortality and disability in Latin America. Different scores and prognostic models have been developed in order to predict the neurological outcomes of patients. We aimed to test the prognostic accuracy of the Marshall CT classification system, the Rotterdam CT scoring system, and the IMPACT and CRASH models, in predicting 6-month mortality and 6-month unfavourable outcomes in a cohort of trauma patients with TBI in a university hospital in Colombia. METHODS: We analysed 309 patients with significant TBI who were treated in a regional trauma centre in Colombia over a two year period. Bivariate and multivariate analyses were undertaken. The discriminatory power of each model, as well as its accuracy and precision, were assessed by logistic regression and AUC. Shapiro Wilks, chi2 and Wilcoxon test were used to compare the actual outcomes in the cohort against the predicted outcomes. RESULTS: The median age was 32 years, and 77.67% were male. All four prognostic models showed good accuracy in predicting outcomes. The IMPACT model had the greatest accuracy in predicting an unfavourable outcome (AUC 0.864; 95% CI 0.819 - 0.909) and in predicting mortality (AUC 0.902; 95% CI 0.862 - 0.943) in patients with TBI. CONCLUSION: All four prognostic models are applicable to eligible TBI patients in Colombia. The IMPACT model was shown to be more accurate than the other prognostic models, and had a higher sensitivity in predicting 6-month mortality and 6-month unfavourable outcomes in patients with TBI in a university hospital in Colombia.

Fibronasolaringoscopia en el diagnóstico de síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) / Fibronasolaringoscopy in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS)

Resumen En los pacientes con diagnóstico de trastornos respiratorios del sueño (TRS) no se ha podido asociar ningún hallazgo anatómico a la severidad de la patología que el paciente presenta o a su éxito quirúrgico. Los avances actuales en la tecnología de video han permitido evaluar de manera más fidedigna las medidas de la vía aérea (VA) y trazar un mapa más exacto del sitio específico de obstrucción. La fibronasolaringoscopia es una técnica accesible y económica para la evaluación de la VA en múltiples posiciones en períodos de sueño y vigilia; esta requiere un amplio conocimiento por parte del examinador de la anatomía y fisiología de la vía aérea superior para determinar los sitios exactos de obstrucción y los patrones de colapso que podrían determinar la posibilidad del manejo quirúrgico o no, haciendo de este examen diagnóstico parte fundamental en el estudio de los pacientes con TRS.

Abstract In patients diagnosed with sleep-disordered breathing (SDB), no anatomical findings can be associated with the severity ofthe pathology or the surgical success. Current advances in video technology have allowed a more accurate assessment of airway measurements and a more accurate map of the specific site of obstruction. Fibronasolaryngoscopy is an affordable and economical technique for evaluating the airway in multiple positions during sleep and wakeful periods; this requires a thorough understanding of the anatomy and physiology of the upper airway by the examiner to determine the exact sites of obstruction and patterns of collapse that could lead to a possible surgical management of the condition, making this diagnostic examination a fundamental part of the study of patients with SDB.

Tratamiento quirúrgico por otorrinolaringología en el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) / Surgical treatment by otorhinolaryngology in obstructive sleep apnea-hypopnea syndrome (OSAHS)

Resumen El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) se caracteriza por la obstrucción parcial o el colapso total de la vía aérea superior, de manera intermitente y repetitiva, por lo que, en un principio, se vio el manejo quirúrgico como una alternativa curativa para esta patología. Sin embargo, en la actualidad se reconoce que la cirugía, aun sin lograr tasas de efectividad muy altas de manera consistente, sí mejora la tolerancia y adaptación a la terapia de presión positiva, la cual sigue siendo la primera línea de manejo. Así, el primer paso antes de pensar en cualquier procedimiento quirúrgico es un adecuado diagnóstico topográfico, de modo que siempre se debe realizar una nasofibrolaringoscopia para identificar el o los sitios de obstrucción. Además, se sabe que el 75% de los pacientes presentan obstrucciones en múltiples niveles y que, cuando el abordaje se hace multinivel, se logra corregir el SAHOS hasta en un 95%. Entre los procedimientos vigentes se encuentran cirugías de nariz, paladar blando, amígdalas, base de lengua, estimulación del nervio hipogloso y procedimientos del esqueleto facial, así como procedimientos coadyuvantes, entre los que están radiofrecuencia e implantes de paladar.

Abstract Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by the partial obstruction or total collapse of the upper airway in an intermittent and repetitive manner; in this scenario, surgical management was initially regarded as an alternative for treating this pathology. Nowadays, surgery is highly recognized because it improves tolerance and adaptation to positive pressure therapy; it remains as the first line of treatment, although high rates of effectiveness are not achieved. The first step before considering any surgical procedure is an adequate topographic diagnosis; therefore, a nasofibrolaryngoscopy should always be performed to identify the obstruction site(s). It is known that 75% of patients have obstructions at multiple levels, so correcting OSAHS by up to 95% is possible when the approach considers all the levels. Current procedures include nasal surgery, soft palate, tonsils, tongue base, hypoglossal nerve stimulator and facial skeletal procedures, as well as adjuvant procedures that include radiofrequency and palate implants.

Characterization of Escherichia coli causing community acquired urinary tract infections in Mexico City.

The O25-ST131 clone was identified within 169 uropathogenic Escherichia coli (UPEC) strains. The 44.8% of the 29 O25-ST131 clones detected were positive to least to one extended-spectrum ß-lactamase gene. The phylogroup D was mainly found. The O25-ST131 clone appeared to be associated with community-acquired UTI in Mexico City.

Escherichia coli clonal group A among uropathogenic infections in Mexico City.

Escherichia coli clonal group A (CGA) causes urinary tract and other extra-intestinal infections in humans. CGA is an important cause of trimethoprim/sulfamethoxazole (SXT) resistance in extra-intestinal pathogens. We examined the extent to which resistance in this area is related to CGA dissemination of E. coli from urinary tract infections (UTIs) in Mexico City. The virulence backgrounds of the isolates were also characterized. In this study, the frequency of resistance to SXT used for UTI treatment was high (56-65 %), and CGA isolates accounted for 9 of the 78 SXT-resistant isolates (11.5 %). Although all CGA isolates were found to be multidrug resistant (MDR), none of them were extended-spectrum ß-lactamase-producing organisms. The prevalence of CGA among the 45 MDR isolates that we identified was 20 %, indicating that this clonal group moderately contributes to the antibiotic resistance of uropathogenic E. coli isolates in this region. Most of the nine CGA isolates carried transferable, large-size plasmids of approximately 80 to 100 kb, which were able to transfer antimicrobial resistance to E. coli J53 in mating assays. CGA isolates mainly belonged to phylogenetic groups F and D. We found no association between antimicrobial resistance and virulence-associated genes: the median virulence scores of CGA isolates were slightly higher (4.6) than those of non-CGA isolates, whether they were susceptible (3.7) or resistant (3.5) to SXT. Our results indicate that CGA is not a major contributor to the high level of resistance to SXT in this region but, instead, seems to be an important constituent of MDR isolates from UTIs.

Guía para la certificación de servicios diagnósticos de trastornos del sueño en Colombia (Incluye estándares para Servicios Pediátricos) / Guidelines for the voluntary certification of services studying sleep disorders in Colombia (including standards for paediatric services)

Antecedentes. La Asociación Colombiana de Sociedades Científicas (ACSC) convocó al Grupo de Investigación Transdisciplinario en Trastornos del Sueño (GITTS) -conformado por la Asociación Colombiana de Medicina del Sueño (ACMES), la Asociación Colombiana de Medicina Interna (ACMI®-Médicos para adultos), la Asociación Colombiana de Neumología y Cirugía de Tórax (Asoneumocito), la Asociación Colombiana de Neurología (ACN), la Asociación Colombiana de Otorrinolaringología y Cirugía Plástica Facial (ACORL) y la Asociación Colombiana de Psiquiatría (ACP)- para que elaboraran un documento con el cual se estableciera una normatividad para la certificación voluntaria de los servicios que estudian los trastornos del sueño en Colombia. Se busca que este proceso fomente la excelencia en el diagnóstico de los trastornos del sueño. Objetivos. El proceso busca definir los estándares mínimos para los servicios diagnósticos de medicina del sueño en Colombia. Aunque riguroso, el proceso ha de ser "amigable para el usuario". Se propone a la ACMES como ente evaluador. Materiales y métodos. El proceso evalúa la organización y administración de los servicios, los empleados y la dirección, las políticas y los procedimientos, la educación y el desarrollo del personal, las instalaciones y los equipos, así como el aseguramiento de la calidad. El enfoque general estuvo influenciado por programas establecidos y adoptados en otros países. Se espera que la consistencia con las guías internacionales disminuya la cantidad de trabajo necesaria para preparar la aplicación para los servicios que ya estén involucrados en los procedimientos de certificación -por ejemplo, certificación de hospitales- y que esto ayude a preparar el camino para la certificación en sueño. Resultados. La primera fase del proceso incluye contestar un cuestionario detallado designado para evaluar qué tan preparado está el servicio para ser certificado. La autoevaluación es una característica clave de esta fase. La habilidad para responder satisfactoriamente el cuestionario, guiado por los Estándares de Certificación detallados más adelante, deberá indicar al servicio solicitante su capacidad para cumplir con los requisitos de certificación. Si las respuestas son satisfactorias, el servicio enviará una solicitud completa. Si el Comité Evaluador (ACMES) establece que la solicitud llena los estándares, se realizará una visita a las instalaciones. Los servicios que evalúan niños menores de 12 años, deben cumplir con los requisitos específicos para esta población. Los mayores de 12 años sin condiciones médicas complejas se pueden estudiar en servicios certificados para adultos, siempre y cuando, disponga de los equipos de reanimación y de personal entrenado.

Background. The Colombian Association of Scientific Societies (known as ACSC in Spanish) requested the Transdisciplinary Research Group on Sleep Disorders (GITTS) to prepare a document establishing regulations for the voluntary certification of services studying sleep disorders in Colombia. The GITTS was formed by the Colombian Association of Sleep Medicine (ACMES), the Colombian Association of Internal Medicine (ACMI), the Colombian Association of Pneumology and Thoracic Surgery (Asoneumocito), the Colombian Association of Neurology (ACN), the Colombian Association of Otorhinolaryngology and Facial Plastic Surgery (ACORL) and the Colombian Association of Psychiatry (ACP). It was intended that this exercise would promote excellence in diagnosing sleep disorders. Objectives. Defining minimum standards for assessing/evaluating sleep disorder diagnosis services in Colombia; although rigorous, they had to be user-friendly. ACMES was proposed to play the role of guidelines controller. Materials and methods. The exercise evaluated service organisation and management, employees and management, policy and procedures, education and staff development, facilities and equipment and quality assurance. The overall approach was influenced by programmes already established and adopted by other countries. It was expected that uniformity regarding international guidelines would decrease the amount of work needed for preparing documentation for services which are already involved in certification procedures, for example, hospital certification, and that this would help pave the way for sleep medicine certification. Results. The first step involved a self-questionnaire designed to assess whether a particular service was ready to be certified, self-assessment being a key feature of this phase. Successfully responding to the questionnaire (guided by the certification standards) indicated whether a particular sleep disorder service met certification requirements. If the answers were satisfactory, then such service would send in a complete application. A site visit would then be made if the evaluation committee (ACMES) stated that the full standards had been satisfactorily met. Services assessing children under 12 years-old had to meet specific requirements for such population. Children over 12 years-old who did not have a complex medical condition could be studied by certified adult services, as long as resuscitation equipment and trained personnel were available.

Identification of secretory immunoglobulin A antibody targets from human milk in cultured cells infected with enteropathogenic Escherichia coli (EPEC).

Enteropathogenic Escherichia coli (EPEC) uses a type III secretion system (T3SS) to inject effectors into host cells and alter cellular physiology. The aim of the present study was to identify targets of human secretory immunoglobulin A (sIgA) antibodies from the proteins delivered by EPEC into HEp-2 cells after infection. Bacterial proteins delivered into EPEC-infected cells were obtained in sub-cellular fractions (cytoplasmic, membrane, and cytoskeleton) and probed with sIgA antibodies from human milk and analyzed by Western blotting. These sIgA antibodies reacted with Tir and EspB in the cytoplasmic and membrane fractions, and with intimin in the membrane fraction mainly. The sIgA also identified an EPEC surface-associated Heat-shock protein 70 (Hsp70) in HEp-2 cells infected with EPEC. Purified Hsp70 from EPEC was able to bind to HEp-2 cells, suggesting adhesive properties in this protein. EspC secreted to the medium reacted strongly with the sIgA antibodies. An EPEC 115 kDa protein, unrelated to the EspC protein, was detected in the cytoplasm of infected HEp-2 cells, suggesting that this is a new protein translocated by EPEC. The results suggest that there is a strong host antibody response to Tir and intimin, which are essential proteins for attaching and effacing (A/E) pathogen mediated disease.

Cisticercosis en Colombia. Estudio de seroprevalencia 2008 – 2010 / Cysticercosis in Colombia. Seroprevalence study 2008 – 2010

IntroduccIón: el complejo Taeniasis / Cisticercosis (T/C) es una infección parasitaria que en Colombia como en otros países constituye un gran problema de Salud Pública. La prevalencia de cisticercosis en la población general Colombiana no ha sido determinada a la fecha. objetIvo: determinar la prevalencia de cisticercosis en la población general de Colombia e identificar los principales riesgos ambientales, socioeconómicos, culturales y estilos de vida relacionados con la cisticercosis. MaterIales y Métodos: mediante técnica ELISA investigamos la prevalencia de sero positividad de anticuerpos IgG anti cistiercos en población general de 23 departamentos Colombianos incluyendo la ciudad capital. Se analizaron 23.960 muestras sanguíneas. El proceso se realizó en la sección de parasitología del Instituto Nacional de Salud, Bogotá Colombia. resultados: la seroprevalencia general fue de 8.55%, la más alta se presentó en el departamento de Vaupés (40,19%) y la menor en el departamento de Caldas (0,53%). El análisis multivariado de factores de riesgo mostró riesgo incrementado de seropostividad para Mujeres (OR=1,60 IC 1,40 – 1,90) p <0,05, y para personas quienes consumían alimentos sin cocción (OR = 44,80 IC 5,00 – 401,40) p <0,05. No lavarse las manos después de ir al baño y haber utilizado el sanitario (OR = 1,37 IC 0,70 – 2,70) no mostró significancia estadística. conclusIones: Colombia tiene un rango variable de prevalencia de seropositividad de cisticercosis en población general (0.53% to 40.19%). Los principales factores de riesgo fueron el género femenino y el no lavado de manos después de ir al baño.

Obstrucción intestinal maligna. Revisión de tema / Malignant bowel obstruction. Review

La obstrucción intestinal maligna es una patología compleja que, a pesar de la baja prevalencia, produce un alto grado de incomodidad, debido a síntomas secundarios producidos por alteraciones mecánicas y funcionales en los diferentes mecanismos fisiopatológicos; entre estos mecanismos se encuentran la oclusión del lumen intestinal, las alteraciones en la motilidad y la acumulación de secreciones. En el tratamiento de la obstrucción intestinal maligna se debe individualizar cada paciente para definir la mejor estrategia, ya sea una intervención quirúrgica -gastrostomía o yeyunostomía descompresiva, realización de ostomías y endoprótesis vasculares (stents] o un tratamiento médico -opioides, anticolinérgicos, antieméticos y esteroides-. En general, se recomienda una estrategia que de manera sinérgica combine diferentes opciones para logar un control adecuado de los síntomas.

Malignant intestinal obstruction is a complex disease that, despite the low prevalence, causes a high level of discomfort, due to the secondary symptoms produced by various mechanical and functional alterations in the different pathophysiological mechanisms. These symptoms include occlusion of the intestinal lumen, changes in motility, and accumulation of secretions. The treatment of the malignant intestinal obstruction must be individualized to each patient in order to establish the best strategy, either surgical intervention - decompressive gastrostomy or jejunostomy, performing of ostomies and vascular stents - or a medical treatment - opioids, anticholinergics, antiemetics, and steroids. A strategy that synergically combines the different options is generally recommended, in order to achieve suitable control of the symptoms.

Efecto del suero autólogo en la reparación de la superficie ocular asociada a ojo seco / Effect of autologous serum in the repair of the ocular surface associated with dry eye

l daño de la superficie ocular asociado a la alteración de la película lagrimal causa múltiples síntomas y como tratamiento se usa el suero autólogo. Objetivos: comparar el efecto del suero autólogo sobre la reparación de la superficie ocular, preparado con dos concentraciones diferentes (80 y 20 %). Materiales y métodos: se realizó un estudio prospectivo cuasiexperimental en 25 pacientes diagnosticados con ojo seco, mediante el test de Schirmer, tbut y tinción con rosa de Bengala. Se administró colirio de suero autólogo al 80 % en el ojo derecho y al 20 % en el ojo izquierdo, y después de 30 días de utilización se realizaron nuevamente los tests. Para la preparación del suero autólogo se realizaron los procedimientos éticos y se siguió con el protocolo estandarizado de la Universidad de Lübeck, Alemania, de acuerdo con la guía Bundesãrztekammer y del Instituto Paul Ehrlich. Resultados: la aplicación de suero autólogo al 80 % y al 20 % presenta un aumentoignificativo tanto en el volumen lagrimal (Schirmer) ccomo en la estabilidad y calidad lagrimal (tbut) y se logra, además, reparación sobre la superficie ocular. No se encontraron diferencias significativas con las dos concentraciones, pero con mayores concentraciones se logra un mayor efecto sobre la producción y tiempo de ruptura de la película lagrimal (p<0,080). Conclusiones: la administración de suero autólogo como tratamiento para el ojo seco presenta reparación sobre la superficie ocular en concentraciones tanto del 20 % como del 80 %.

The ocular surface damage associated with the alteration of the tear film causes multiple symptoms, and autologous serum is used as treatment. Objectives: To compare the effect of autologous serum on the ocular surface repair, prepared with two different concentrations (80 y 20 %). Materials and methods: A quasi-experimental prospective study was carried out in 25 patients diagnosed with dry eye through the Schirmer test, tbut and Rose Bengal staining. Autologous serum eye drops were administered to 80% in the right eye and 20% in the left eye, and after 30 days of application, tests were once again performed. For the preparation of autologous serum, ethical procedures were performed and the standardized protocol at the University of Lübeck, Germany, was followed according to the Bundesãrztekammer guide and the Paul Ehrlich Institute. Results: The application of autologous serum to 80% and 20% showed a significant increase in both tear volume (Schirmer) and tear stability and quality (tbut) and, additionally, ocular surface repair is achieved. No significant differences were found with the two concentrations but with higher concentrations a greater effect on production and time of rupture of the tear film is achieved (p<0.080). Conclusions: The administration of autologous serum as a treatment for dry eye presents repair on the ocular surface in both concentrations of 80% and 20%.

Drug resistance, serotypes, and phylogenetic groups among uropathogenic Escherichia coli including O25-ST131 in Mexico City.

INTRODUCTION: The increasing prevalence of uropathogenic Escherichia coli (UPEC) strains resistant to multiple antibiotics complicates the treatment of urinary tract infections (UTIs). This study aimed to analyze the antimicrobial resistance, serotypes, and phylogenetic groups among strains of E. coli isolated from outpatients with UTIs in Mexico City. METHODOLOGY: A total of 119 E. coli isolates were recovered from urine samples from outpatients with clinical diagnosis of uncomplicated UTIs from 2004 to 2007. The serotype was assessed by agglutination in microtiter plates; susceptibility to antimicrobials was determined by the disk diffusion method. Clone O25-ST131 and phylogenetic groups of E. coli strains were tested by methods based on PCR multiplex. RESULTS: The predominant serotype was O25:H4 (21.2%). Resistance to antibiotics was ampicillin (83.7%); piperacillin (53.8%); the fluoroquinolone group (55.5-60.6%), and trimethoprim/sulfamethoxazole (TMP/SMX) (56.4%). Additionally, 36 (30.2%) isolates were multidrug-resistant and 13 of these 36 strains were identified as E. coli O25-ST131 clone by an allele-specific PCR-based assay. Phylogenetic analysis showed that 15 of 17 isolates with serotype O25:H4 belonged to group B2. CONCLUSIONS: This is the first report that establishes the presence in Mexico of the O25-ST131 clonal group of E. coli, which has been associated with multidrug-resistance and with high virulence potential. The spread of this clone in Mexico should be monitored closely. We found a correlation between serotype O25:H4 and multidrug resistance in UPEC strains. Our results indicate that the use of ampicillin, fluoroquinolones, and TMP/SMX should be reviewed when selecting empirical therapy for UTIs.

Renin gene haplotype diversity and linkage disequilibrium in two Mexican and one German population samples.

INTRODUCTION: Renin is the main rate-limiting enzyme in the renin-angiotensin-aldosterone system. Its gene, REN, is a candidate crucial factor in essential hypertension and cardiovascular disease. The aim of this study was to evaluate allele and haplotype distributions of REN polymorphisms, and to estimate normalised linkage disequilibrium (D') in Mexican and German populations. MATERIALS AND METHODS: Four groups were studied for the REN single nucleotide polymorphisms (SNPs) 1205C>T, 1303G>A, and 10607G>A, in population samples of Mexican Mestizo (n = 86), Mexican Huichol (n = 49), German (n = 39), and individuals with hypertension diagnosis (n = 66). Polymorphisms were detected by PCR-RFLP. Genotype, allele and haplotype frequencies were estimated. RESULTS: SNP 1205C>T and 10607G>A allele and genotype distribution showed inter-group differences. The 1205T and 10607A allele showed a significance difference in hypertensive population. Haplotype analysis also showed some inter-group differences, especially in 1205C-1303G-10607G, 1205C-1303G-10607A and 1205T-1303G-10607G haplotypes. The segregation analysis disclosed complete linkage disequilibrium between 1205 and 1303 loci. CONCLUSION: These results provide an example of genetic diversity in related populations and illustrate the convenience of increasing the number of loci in associative studies between diseases and candidate genes.

Una lesión periférica poco común: Reporte de un caso / A rare peripheral lesion: a case report

El Fibroma Odontogénico Periférico, pertenece al grupo de tumores Odontogénicos Mixtos y es considerado la contraparte de tejido blando del Fibroma Odontogénico Central. Es una lesión gingival benigna poco común, con una ligera preferencia por pacientes entre la segunda y tercera década de la vida, que se caracteriza por ser una masa exofítica, no encapsulada, usualmente de base sesil, cubierta por una mucosa de color normal, firme a la palpación, de crecimiento lento y asintomática. Se localiza con preferencia en la encía vestibular mandibular y generalmente no crece más de 1,5 cm. El propósito de este trabajo es reportar, previo consentimiento, un caso de un FOP en la encía maxilar de una paciente de 67 años de edad, con características clínicas similares a otras lesiones periféricas. Previa preparación de la paciente se realizó la biopsia escisional, diagnosticándose esta entidad. Se procedió a caracterizarla clínica e histopatológicamente, recalcando su similitud con otras lesiones y resaltando la importancia de su estudio microscópico para poder identificarla, considerando esta patología como un probable diagnóstico diferencial cuando se trate de lesiones periféricas.

The Peripheral Odontogenic Fibroma (POF), belongs to the mixed odontogenic tumors group. It is considered the soft tissue counterpart of the Central Odontogenic Fibroma. It is a rare benign lesion, slightly common between the second and third decade of life. It is described as an exofitic, no encapsulated, sessile mass, covered by a normal appearance mucosa. It is a slow growing, firm and asymptomatic tumor and it is mainly located at the vestibular mandibular gingival. Its size usually is not more than 1,5 cm. The purpose of this paper is to report a POF at the maxillary gingiva of a 67 years old female, with clinical features similar to other peripheral lesions. After routine exams an excisional biopsy was performed and the POF diagnosis was given. Clinical and microscopic features were studied as well as its similarities with other peripheral lesions and the importance of its histopathologic study in order to identify it. This pathology must be considered in the differential diagnosis when peripheral lesions are studies.

Presentación de trabajos realizados durante diplomado Salud familiar y comunitaria / Presentation of graduate work during Family and Community Health

La Salud familiar y comunitaria, es ahora un gran pilar de la medicina. Si bien por mucho tiempo no se le dio la importancia merecida, en estos tiempos que se la ha implementado como la base de las nuevas políticas de salud, ya que sus características integradoras entre lo que son la comunidad, la familia y los distintos servicios de salud, hace partícipes a los primeros en las decisiones de que se vayan a tomar en lo que respecta a su salud y bienestar.Es así que la importancia de la salud familiar y comunitaria, que el médico y la comunidad interviene ahora no solo en temas relacionados con los servicios sanitarios sino también, en los problemas políticos y sociales de la comunidad, mediante leyes, estrategias y políticas de salud.Si bien aún existe cierto recelo por el personal de salud en la intervención de la comunidad en temas relacionados con la salud, se implementan nuevas técnicas de capacitación en este sentido, esperando la colaboración para el avance en este proceso.Consientes de estas necesidades la Universidad Mayor de San Simón con sus entidades: Escuela Universitaria de Posgrado Facultad de Medicina, Escuela de Graduados y Educación continua y Centro para el desarrollo de la gerencia social CEDEGES, han desarrollado el diplomado de Salud Familiar y Comunitaria, en respuesta a dicha necesidad. El presente documento presenta todos aquellos trabajos presentados de manera interactiva, durante la realización de dicho diplomado, los mismos que se espera sean beneficiosos a los lectores.